Youth & Suicide Series Part 1- You Have To Ask: The Importance of Screening for Suicide Prevention

Youth suicide is a public health crisis, and we all have a role in prevention! Join Cassie, Ellen, & Chris as they bust some myths about youth suicide, dig into the importance of screening, and walk through an accessible approach to screening that almost anyone can use.

Guest Info: 

Ellen Arrowsmith, LICSW (she/her) is a Liaison Coordinator with the Vermont Child Psychiatry Access program which provides free, immediate consultation and support to pediatric primary care providers in Vermont. Ellen is a graduate of the University of Vermont’s MSW program, and she brings over a decade of experience in serving children, youth, and families in Vermont. Ellen has worked within a Designated Agency as a school social worker and in private practice; she has worked with children from kindergarten through high school, in mainstream and “alternative” settings, with youth in foster care, and with families impacted by domestic violence. Ellen is a “systems thinker” and is passionate about working to improve access to high quality mental health care for families in Vermont.

Chris Allen (he, him) is a survivor of suicide loss and is the Director of Suicide Prevention for the State of Vermont. Since losing Jordan Porco, a friend and classmate at Saint Michael’s College (SMC) in 2011, he has embarked on a journey to explore, uncover, and better understand ways to assist people in times of vulnerability and while experiencing of suicidality. Along the journey, he has established an Active Minds Chapter at SMC and served in various leaderships roles for the Vermont Chapter of the American Foundation for Suicide Prevention (AFSP). Prior to becoming the Director of Suicide Prevention, he was employed as a Psychiatric Social Worker at the Vermont Psychiatric Care Hospital working with adults involuntarily hospitalized. While in this setting, he immersed himself in humanistic, dialogical, and person-centered approaches. As a licensed independent clinical social worker, he has a small private practice in Burlington, VT, where he believes everyone is on a journey of discovery to create meaning within their life.

Host Info: 

Cassie Gillespie, LICSW is a full-time faculty member in the University of Vermont’s Social Work Department, and the host of the SOCIAL WORK LENS podcast. Cassie is a former child welfare worker, and training team lead at the Vermont Child Welfare Training Partnership (VT-CWTP) with over 15 year’s experience serving children, youth, families, and helping professionals.

Show Notes and Resources:

If you or someone you know is in crisis or having thoughts of suicide call or text 988 or chat online at 988lifeline.org, for confidential support available 24 hours a day, seven days a week, 365 days a year.

Transcript:

Ellen Arrowsmith (00:00):

I would say that just generally we need to get more comfortable with talking about suicide and suicidal ideation, and to ask ourselves some tough questions about if we are really uncomfortable, why and what we can do to get more comfortable. Because it’s in that relationship and our willingness to ask that we can really help people and we can, we can save lives, and that’s really important. So that would be my number one takeaway from today, is just get comfortable asking even though it can feel scary.

Cassie Gillespie (00:33):

Hi, I am Cassie Gillespie and you’re listening to the Social Work Lens. The Social Work Lens is brought to you by a collaboration between the University of Vermont’s Child Welfare Training Partnership, and the State of Vermont’s Family Services Division. Today we’re bringing you the first part of a three part mini-series on youth and suicide. We’ll be talking about this topic in three parts. In the first part, we’ll talk about screening that you have to ask in order to know. In the second part, we’ll dig into what to do when someone screens positive. And in the third part we’ll zoom out and have a more global conversation about prevention and hope, and the fact that suicide prevention starts long before screening. In the studio today, we have Ellen Arrowsmith and Chris Allen, and they’ll be with us for all parts of the series. We’re gonna dig in specifically today to the topic of screening.

Cassie Gillespie (01:29):

We’re calling this one, you have to ask. The importance of screening for suicide prevention. But before we jump in, I’d like to make a note. This is a difficult topic. Many of us have our own personal connections, and we wanna make sure that you’re taking care of yourself. Feel free to step away and come back. It’s also okay to step away and not come back. If you or someone you know is worried about suicide, please also be aware that we have a number of notes and resources linked in this show notes for this episode. Okay, here we go. Welcome Ellen. Welcome Chris.

Ellen Arrowsmith (02:05):

Hi, Cassie. Thank you.

Chris Allen (02:06):

Hello. Thank you Cassie.

Cassie Gillespie (02:07):

Thanks for being here today. I think it probably makes the most sense for you two to introduce yourself. So Ellen, would you mind starting off?

Ellen Arrowsmith (02:14):

Sure. My name is Ellen Arrowsmith, and I am a graduate of the MSW program at UVM. So I have lots of connections probably to lots of folks in your listenership. I’m a liaison coordinator at the Vermont Child Psychiatry Access Program, and before that I worked at a designated agency in a school services program and have work experience with youth aging out of the foster care system and folks who have lived experience with domestic violence. So that’s the experience that I bring with me today. And I just wanna start out from a place of humility to say that this is not an area of expertise of mine. I’ve had a lot of experience over my decade in the social work field close to this issue and working with this issue, and it really is an area of focus for the Vermont Child Psychiatry Access Program.

Ellen Arrowsmith (03:01):

So I bring a lot of care and interest to this topic, but I wanna also acknowledge the many folks around the state who work in our designated agencies and crisis services who really do this work all day every day. And so we’re really fortunate, I think, in Vermont to have some really amazing folks across the state who really delve into this work with a lot of care and nuance that we can rely on in some of those resources that Cassie mentioned at the top. So I will give them all the credit that they are due, and thank you for the opportunity to be here today.

Cassie Gillespie (03:32):

Oh, no problem. We’re so happy to have you. Chris, tell us a little bit about yourself and your journey here.

Chris Allen (03:37):

Hello, everybody. My name is Chris Allen and I am the director of suicide prevention for the State of Vermont. First and foremost, I am a survivor of suicide loss. Having lost a friend Jordan Porco to suicide in 2011 here in Vermont at St. Michael’s College. So I, I come to this conversation first as a loss survivor and then also as, as the director of suicide prevention for the State. I am also a fellow graduate of the UVM MSW program. So great connection there with Ellen. Yeah, so prior prior to this role with the state, I was working as a psychiatric social worker at the Vermont Psychiatric Care Hospital, working with involuntarily held adults in the highest level of care in the state. And through that experience, I learned a lot about suicide and how we can help people feel more connected to both themselves, but also to their communities when they are outside of that community.

Chris Allen (04:48):

Through my journey since 2011 of healing and recovery, I have held various positions with Active Minds, which is a, a peer-to-peer organization for college campuses to start their own chapters on supporting student mental health and educating them on warning signs, protective factors, and other topics that we’ll discuss today. And then after Active Minds, I spent a period of time volunteering for the Vermont Chapter of the American Foundation for Suicide Prevention. The American Foundation for Suicide Prevention is a national organization with state chapters, and it’s a great way to find local connections to individuals that are also lost survivors and finding a role to help others as well. So I believe that each of us does have a role and preventing suicide. And, and so that’s a primary message that I live by and share.

Cassie Gillespie (05:51):

Thank you so much. We’re so honored to have you here, and thanks for sharing some about your personal story and your personal connection to this topic right off the bat. So I know there’s a lot of things we wanna talk about, but I understand that maybe a place to start is a little bit about why the language matters when we’re talking about suicide. So are one of you willing to tell us a little bit about why that’s relevant?

Ellen Arrowsmith (06:13):

Sure, yeah. I think that as all things related to suicide, how we approach it has a really significant impact on sort of how we’re able to serve people and the implications of our process and the outcome for folks. And that’s true even of the language we choose to use. And I think for a lot of us, just culturally, we don’t talk about death or dying or suicide very well or very often.

Cassie Gillespie (06:36):

Yeah.

Ellen Arrowsmith (06:36):

And it can feel slippery and confusing and we, we wanna say the right thing and we don’t wanna say the wrong thing. And a lot of times that stops us before we even start with these conversations is like, I just don’t know what to say or how to say it. And I think that there are also implications in the language we use in terms of reducing or increasing stigma and increasing the likelihood of a person trying to reach out for help and support or not.

Ellen Arrowsmith (07:00):

So some of the recommended language we try to use death by suicide, took his or her or their own life, died of suicide, killed him, her or themselves, suicide death, or survived a suicide attempt. And we try to avoid language, you know, like committed, completed, successful or failed in relation to suicide because those have some undercurrents of morality or legality that can just kind of muddy the waters and add to the stigma. And also like, what does it mean for a suicide to be successful, right? Like, some of that language is just really problematic. So we try to be really careful in the language that we use to talk about this and to always center the people themselves when we’re talking about it, that it’s not that they are a complex whole human with a whole life, and this is one aspect of their experience.

Ellen Arrowsmith (07:53):

And in the language we use, we want it to convey openness. And that’s a theme that I hope we come back to today, is like we want it to open the door to conversation and connection and even in our language, not to start by narrowing spaces. So we wanna create openness for conversation and connection when we’re talking about this. So I will probably make mistakes, I think for all of us. It’s like a, I don’t know, Chris, maybe you have more experience, but I still sometimes make mistakes in the language I use.

Cassie Gillespie (08:20):

Yeah.

Ellen Arrowsmith (08:20):

And I might today, but we wanna be mindful of the language we’re using. And I was thinking too about the importance of input of folks with lived experience too, and taking the cue of the person in front of you. So we might, as you said, these words and language are always evolving and will change and it’s hard to stay on top of, but I think taking cues from the person in front of you and the language that they use that’s meaningful to them is probably your best bet of the way to talk about it.

Cassie Gillespie (08:47):

Yeah. And you know, if I’m a listener and I’m thinking, oh, I’ve been saying this thing and now I shouldn’t be saying it and I wanna be saying this thing I imagine that there’s probably a resource that you might send people to where they could even just get a little refresher of what you said or see some information about what’s current. And, you know, don’t worry, listeners we’ll actually link in the show notes, but if you’re driving in a car and you’re just listening right now Chris and Ellen, what do you wanna send them?

Chris Allen (09:12):

Yeah, so there is a great resource from our neighbors up north in Canada that really outlines what words that we’re encouraged to use and what words we’re encouraged not to use. And it’s really a, a very simple, easily digestible diagram with a phrase on one hand and a phrase to avoid on the other hand. So it’s a great way to look at the language that you’re using and try and replace that with the language that’s recommended.

Cassie Gillespie (09:44):

Awesome. Okay, great. So I understand that. So as, and please constantly jump in and let me know if I’m, I’m miscategorizing, but the, one of the important concepts we wanna get into today is how suicide exists along a spectrum, or suicidality exists along a spectrum. Would you be willing to talk a little bit about that?

Ellen Arrowsmith (10:01):

Yeah, I think that it’s just important. I think for a lot of us we think about suicidality or suicidal thoughts as being like one discreet thing that maybe we’ve seen on the media or that we have some sort of touch point to. But it’s important to understand that lots of people, probably most of us, have thoughts about death or suicide or dying in different ways across our life, right? Depending on our experience and what’s going on. And I think that what we hope to talk about is that we need to have a lot of nuance in how we understand that. So you know, when we talk about a spectrum, I think we can think about like non-suicidal self-injury, and then going all the way up to maybe having a specific plan or action around suicide. So, you know, we have thoughts of suicide, maybe some planning around suicide up to a suicide suicidal act.

Ellen Arrowsmith (10:53):

And I think sometimes folks maybe misunderstand like non-suicidal self-injury. So for example, I worked in a middle school and we would often see youth who may be engaged in some behavior like cutting or some, something like that, right? Which the, the purpose of those behaviors generally as around the relief of distressing feelings or emotions. So there’s not an intent, generally speaking, with those behaviors to die, right? It’s an, it’s an intent to relieve some suffering or some really intense feelings. But I think folks might maybe misinterpret or misunderstand some of those behaviors and think that they’re a suicidal gesture. So I think it’s really important that we, we understand what is this person trying to convey, or what is their intent or what are they feeling right now? And to understand that there is a lot of variation, that we don’t have enough nuance and understanding with how folks might talk about death or dying or suicidal thoughts. And we need to think about that in a more complex way. So I’ll hand over to Chris.

Chris Allen (11:59):

Yeah. Thank you for sharing that anecdote, Ellen. I think it, it really speaks to how suicidality or reasons for living and dying are really like dynamic, right? How we feel today is not how we felt yesterday and how we feel in an hour is likely not how we’re feeling right now. And so, just going off of Ellen’s point about the nuance of it, we really need to look at the underlying reasons of why someone might be sharing a thought or their experience and not being afraid to ask why. And really try and better understand where they’re coming from, put yourself in their shoes and really assist them in finding ways that they can find more meaning or reasons that they can stay alive. And, you know, there’s, there’s no wrong way or right way to do this ’cause each reason for someone staying alive is gonna be personal to them. It’s unique to them and we have to be responsive to that.

Cassie Gillespie (13:09):

So this is, this is great. And I’m wondering if we can kind of pivot to, to talk more specifically about youth and kiddos. What are some of the things we wanna be thinking about when we’re trying to talk to kids or, or just have this openness as you talked about Ellen? When we start to move into a place where we wanna understand a little bit about why someone’s making that statement or maybe how significant this risk is what should we be thinking about with kids?

Chris Allen (13:35):

So when a kid has expressed some thoughts of wanting to harm themselves or wanting to die, we really need to slow down in that instance and really take a deep breath, pause for a moment, and then we can address because we need to regulate ourselves. ’cause That’s a, yeah, that’s an intense emotion that, that someone is sharing. And we want to show that we care for that individual and wanna help them. And I think the most important thing to think about here is that when someone shares that statement of wanting to die, is that not all individuals that share that they wanna die need to go to the emergency department. That is not the most therapeutic place.

Cassie Gillespie (14:18):

Yeah.

Chris Allen (14:18):

And only a few kids would be appropriate for that setting. And that would be the highest risk population that has intent, a plan and maybe even has the means or the method figured out and has access to that method.

Cassie Gillespie (14:36):

And in a little bit, we’ll talk about some actual screening tools you can do to sort of parse that out a little bit. Is that correct?

Chris Allen (14:42):

Yeah, absolutely. Okay. Yeah. We’ll get into a few evidence-based tools that people can use in order to really figure out where someone’s, where they lie on the, the risk scale. So.

Cassie Gillespie (14:55):

But before we get there, it sounds like there’s a whole group of kiddos we’re going to, the emergency department isn’t necessarily appropriate. Are there recommendations or just things you want our listeners to know about, about that group?

Ellen Arrowsmith (15:06):

Yeah, I think that in determining next steps what to do the best thing you can do you know, as we’ve mentioned, is to use these evidence-based tools. I mean, you wanna have a real human conversation with the real human in front of you. And these tools are your friend because they help you to understand the level of risk in a really clear way so that you have a sense of what to do next. And so when we’re talking about these screening tools, it’s those kids, as Chris mentioned, who have indicated that they have a clear and imminent plan who do need to go to the emergency room. But that is a really small percentage of the kids who identify some suicidal ideation. And the vast majority of kids need to know that someone loves them and cares about them to make a safety plan, to think about how are we gonna keep this kid safe?

Ellen Arrowsmith (15:55):

And then maybe some supports in the community, you know, therapy, folks at school, checking in on them you know, like having that regular contact to check in and say, how are you doing? How are you feeling Like that we’re not, it’s not a one and done conversation, it’s an ongoing relationship. And so that will be the vast majority of the intervention is to have that moment of connection to say, I see you, I wanna hear about this. I care about you. Let’s talk about how to keep you safe. And then let’s think about what else might you need to help keep you safe. And that’s gonna be the vast majority of the kids who we see should have that intervention.

Cassie Gillespie (16:32):

I can imagine it must be so stressful. You know, I’ve been in this position, I’m sure many of us have as clinicians or in various roles. And this may sound like a terrible frame to put on it, but the word that’s coming to mind is liability. When you’re talking to someone about their potential plan or their thoughts about harming themselves it can just feel like such a really heavy burden that you wanna get. Right. So what are your thoughts about almost like context for that conversation? Does, does it make sense to spend some time there? Like what should someone be thinking about or how should they be approaching this conversation? Because you’ve mentioned before, it’s we’re a little bit averse to even having this conversation and I bet there’s some kind of groundwork, baseline information that could be helpful for folks

Chris Allen (17:15):

When when we think about liability, we often can get tense not really sure how to handle it. And it comes up with a lot of fear and discomfort. And, and so I think when we think about liability, we really need to pause and assess how we’re reacting to what’s coming up.

Cassie Gillespie (17:39):

Oh, yeah.

Chris Allen (17:40):

And for us internally, like are we really uncertain of how to approach this situation? Do we know who to go to? Do we know where the kid is? Or do we know if there’s a protocol that we have in place to address the situation? And so I think it’s really important to slow down. Our heart rate might be really elevated at this point, and that’s okay to notice and acknowledge. And we also need to really go beyond that and really lean into that discomfort of a difficult conversation might be coming up.

Cassie Gillespie (18:16):

Yeah.

Chris Allen (18:16):

But that we can share that amongst other people. And once we’ve started having conversations, I really enjoy the phrase, if something is mentionable, it’s manageable. If we can’t mention it, then we cannot manage it. And so when we slow down and we share something with someone else, like if we’re in a school situation or in a meeting with a kid that has just come from Starbucks and they’ve shared a really deeply personal thought about wanting to die, we need to really pause there and think about what our next steps might be in order to manage that level of statement.

Ellen Arrowsmith (19:02):

Absolutely. And I, one thing that I heard a long time ago in a training was just this idea that I think we are so fearful, as you mentioned, we live in a really liability focused world, especially in this line of work that we’re always fearful of like, what if something bad happens on my watch? Like that’s kind of the worst nightmare. But I think it was, you know, a a lawyer in this field who said, you are way more protected from liability if you ask. And if you use an evidence-based tool and your best clinical judgment, and you do your best, even if something bad happens, you are much more protected, even from a liability perspective than if you don’t ask. The worst thing you can do is to ignore it or not ask when there’s a clear reason to ask in front of you.

Ellen Arrowsmith (19:44):

So I think it can feel scary, and that could be for a number of reasons. You know, we mentioned at the top of the episode we might have our own personal experiences with it.

Cassie Gillespie (19:54):

Yeah.

Ellen Arrowsmith (19:54):

Or just be fearful about getting in trouble or not knowing what to do or what the outcome might be. And I think it’s really important early on before that is presented to us that we’ve kind of grappled with those things for ourselves or with a supervisor or with some support, so that when it does happen, which is inevitable, right?

Cassie Gillespie (20:11):

Yeah.

Ellen Arrowsmith (20:12):

That we feel a sense of groundedness in our ability to have those conversations because, you know, there, there is always gonna be some risk with this even when we do our best. You know? ’cause The reality is even folks who maybe are in a, a locked, completely monitored psychiatric treatment in the facility have died by suicide.

Ellen Arrowsmith (20:34):

So there’s never gonna be a hundred percent guarantee of anything. But we need to be able to grapple with our own discomfort and feelings so that we can respond appropriately to the needs in front of us and know that there’s always gonna be parts that we can’t control, which is why we do things like access training and supervision and peer supervision and engage in self-care so that we’re in the strongest possible position to respond like compassionately and appropriately to the person in front of us. And the reality is, we’re all like busy people who have case notes and caseloads. I don’t in my current life, but <laugh> I can imagine a situation where, you know, it’s like 2:45 and school’s getting out at three o’clock and a kid makes a disclosure to you and your office and we’d, it just, it also like nuts and bolts has like a domino effect on your day, right?

Ellen Arrowsmith (21:28):

And sometimes like that is really cynical, but that does have an impact on how, and if people ask or are willing to open that proverbial can of worms because it’s like, you know, is the crisis service gonna come or is the parent gonna pick up the phone? Do I let this kid get on the bus? Like it does, you need to be prepared for what you’re gonna do with a yes, but not be fearful of the yes. That the yes is just as Chris said, if it’s mentionable, it’s manageable, even if it can be really inconvenient to the flow of your day. Right? And that, that’s not a reason to hold yourself back from asking.

Cassie Gillespie (22:05):

One of the things that I know comes up, it, it’s come up for me personally, I’ll share, but also other professionals that I talk to and not just social workers, people outside of social work. So teachers, school nurses, you know, folks who are working with kids or, or just have kids in their life but maybe don’t have a ton of clinical training. Sometimes I think there’s a fear that, that you need something extra, some specific clinical knowledge to engage in this conversation. And that if you don’t have it, you might make it worse. Right? That there’s like some specialist somewhere who should be doing this assessment, not you. So, I don’t know, should we do a little myth busting about that? What do you think about that?

Chris Allen (22:42):

Yes, I think that’s a, a great idea and there are a lot of myths out there. And so we only have a few mentioned here, but certainly there’s others out there. So we’ll start with who can administer a screening tool and the myth that you need specialized clinical knowledge to administer that. And that is not true. It is administering a screening tool is really quick and simple. It only takes a few minutes and anyone can do that using an evidence-based tool is the most important thing about administering a screening tool. And it’s really just to give a snapshot of the level of risk. It’s not a full comprehensive assessment. It really just gives a baseline. And then the really important thing about asking these questions is how you’re asking them.

Cassie Gillespie (23:39):

Mm-Hmm.

Chris Allen (23:39):

So if you, you have to feel comfortable and competent asking them, if you are not facing the individual that shared that statement with you, it makes them feel like they can’t trust you.

Cassie Gillespie (23:52):

Right.

Chris Allen (23:52):

And really you’re trying to build that personal connection with them while you’re asking. And that is really important. And you don’t wanna lead with anything. Like you’re not depressed, are you?

Cassie Gillespie (24:06):

Right. <laugh>.

Chris Allen (24:07):

You wanna keep it open-ended and allow them to, to answer the question as they see fit and tone and delivery matters as well. So you don’t wanna like close your eyes or be nervous about it. Have your like voice trembling about it. Really, even just naming like that is a really challenging thing that you shared with me. And because of that, I’m gonna ask you a couple of questions and it’s really out of concern for you and wanting you to feel safe.

Ellen Arrowsmith (24:43):

Yeah. I think about all of us have probably had that experience at a doctor’s office where we’ve been administered some of those standard screenings.

Cassie Gillespie (24:51):

Yeah.

Ellen Arrowsmith (24:51):

That are just part of it. And, and I can think of even in my like postpartum you know healthcare journey, getting asked those questions in that way of like, you’re not depressed, are you?

Cassie Gillespie (25:01):

Yeah.

Ellen Arrowsmith (25:02):

And when it’s asked that way, the only response is no,?

Cassie Gillespie (25:05):

No? <Laugh>.

Ellen Arrowsmith (25:05):

With a question mark at the end. Right? And so like, like Chris was saying, you don’t need to be a clinician. You don’t need a graduate degree in psychology or social work or any of those fields in order to administer these tools. But you do need to have practiced and to feel comfortable and to know how you would use them. And yeah. I, so I think it’s, for a lot of us, it might feel kind of part of the daily routine or whatever, but I think we need to approach it as if each person in front of us is a totally new situation and to be prepared for that.

Ellen Arrowsmith (25:37):

Yes. ’cause if we are in our head, I’ll think a lot of us kind of are thinking, say no, say no, say no.

Cassie Gillespie (25:44):

Right, right.

Ellen Arrowsmith (25:44):

Just because of our own stuff. But people are so pre especially kids are so perceptive.

Cassie Gillespie (25:50):

Yeah.

Ellen Arrowsmith (25:50):

And especially kids maybe who have a trauma history. They’re reading your body language and your face and a lot of ’em have maybe learned how to make adults happy.

Cassie Gillespie (25:59):

Yeah.

Ellen Arrowsmith (25:59):

In their life and through their trauma. And so if your face is saying, say no, and your body is saying say no, they will say no. And so I think again it’s, it’s just preparing your, your body and your face and your whole stance towards openness.

Cassie Gillespie (26:16):

Mm-Hmm. <Affirmative>.

Ellen Arrowsmith (26:16):

And curiosity and a genuine connection. Even though you’re using a tool that can feel a little rote or standardized, but it’s important that it’s standardized because it will give you that accurate information about level of risk that you can use so that you don’t, you’re not guessing what to do next.

Ellen Arrowsmith (26:33):

You have a clear pathway. But you’re using it in a way that is genuine and human. And I think, you know, you wanna have fidelity to the questions of the screening tool, but if you’re talking to like a 6-year-old, you might need to adjust your language a little bit. So they get it. But it’s important also I think, not to do that with care and carefully. I think a lot of us with really good intentions kind of speak in metaphor about death.

Cassie Gillespie (27:01):

Oh yeah.

Ellen Arrowsmith (27:01):

And dying and suicide to kids like, you know, your dog went to a better place or you know, and kids developmentally tend to be quite black and white thinkers.

Cassie Gillespie (27:10):

Yeah. <laugh>.

Ellen Arrowsmith (27:10):

And it leads to a lot of confusion and they’re like, what, what are you talking about? Even though, so you’re trying to be kind and gentle, but you end up very much confusing them.

Cassie Gillespie (27:18):

Yeah.

Ellen Arrowsmith (27:18):

And then you will not get accurate or helpful information about what you’re trying to get. And so even if it can feel quite uncomfortable, you wanna use very specific and concrete language. Like, have you thought about dying or wanting to be dead? Like that language can feel uncomfortable, but you, you need to use specific language even with little ones. ’cause They get it, you know, I think the metaphor is really more for the adult than the kid.

Cassie Gillespie (27:44):

Yeah.

Ellen Arrowsmith (27:44):

Kids get it and generally speaking they can handle it. And you know, so I think we need to think about our own intentions, which is gentleness is a good intention, but the outcome which is maybe less accurate information.

Cassie Gillespie (27:59):

Yeah. And I know we’ll get into specifically which, which tools are evidence-based in, in just a few minutes. But I wanna pause here and summarize just ’cause I think it’s so important and I’m inviting you both to correct me if I mess this up. So what I hear you saying is anybody, like anybody can use an evidence-based screening tool, at least initially if you’ve been talking to a young person and they’ve said something that makes you worried that they may be thinking about suicide or self-harm. And that as long as you’re using one of those tools that are pretty straightforward and pretty brief and pretty easy to use, that that’s really what’s advised. And that you would want to use those tools in a way that’s kind of like authentic and genuine and not be too leading. You’re not thinking about harming yourself, are you? And you don’t want to use too many metaphors, but generally the idea that anyone from the bus driver to the school nurse to the clinician to the parent can kind of grab this tool and talk about it with a kiddo that that’s okay.

Ellen Arrowsmith (28:55):

Yes. Because then tools in the next sequence of events exist for that higher level of assessment and evaluation that there, if they screen positive, you know, your crisis services or your clinician or your other folks who do have more robust training, we’ll be asking those follow-up questions and getting a really much bigger picture of what’s going on. But that’s not necessarily the burden of the person just doing the initial screener. That’s just to say, Hey, I’m worried about this person right here.

Cassie Gillespie (29:24):

Yeah.

Ellen Arrowsmith (29:24):

We need to ask some more questions. That’s what the screening tool is intended to do. And yeah, I, I mean, you know, maybe not every organization would have that same stance or policy, but I think given the level of rates of suicide and we’re contending with right now for children and youth, I think that we do need folks, you know, across the spectrum of, of different kinds of professions who are able to ask these questions from it. I think even like the front desk person at the pediatric office or like where kids are, we need grownups who feel comfortable asking these questions and whatever role they might be in.

Cassie Gillespie (29:59):

And what about that idea that I think this is another myth I’m gonna tow right into, but the idea that asking can plant the seed? Because I think at times people are nervous to ask ’cause they don’t want to lead kids, they don’t want to plant any ideas in their head. What does your expertise tell us about that?

Chris Allen (30:17):

Yeah, so that is another myth that is completely false as well. You know, there’s a lot of well-documented studies that asking if someone is feeling suicidal or experiencing suicidal ideation they, or having any thoughts of wanting to die, that does not plant the seed. In fact, it is protective for them. So knowing it’s really all about information and knowing if someone is thinking about dying or have thoughts of dying, that that is then opening up a conversation to really look at that and why they wanna die. And also look at how we can enhance protective factors for them, which we’ll talk about in future episodes.

Cassie Gillespie (31:05):

Yeah. Yeah.

Chris Allen (31:05):

So there’s certainly, when someone shares that they wanna die, we just really wanna demonstrate that we care about them and that there’s a lifeline for them. That there’s support and resources out there and that there’s individuals and people around them. Natural supports that care and want them to, to stay alive.

Cassie Gillespie (31:27):

Yeah.

Ellen Arrowsmith (31:28):

Mm-Hmm. <Affirmative>

Ellen Arrowsmith (31:29):

And I, I’ve seen especially working with kids and youth, like sometimes you have a conversation and you might not get much of a response or an engagement from kids and you’re like, well, like I don’t know how well that conversation went. You know, and but then a year later or two years later or something, they have remembered that you were a safe grownup to talk to and it comes back kind of full circle in a way where suddenly they feel comfortable being vulnerable or talking to you about something. So sometimes I think, you know, it might might seem like kind of a small interaction or not that momentous of a conversation, but when we convey openness and willingness to have hard conversations with kids, they remember that. And that really makes a big impact. And it might be a year or two or whatever later that they then feel like they could go to a grownup for help or support when they’re really struggling. So I think even those small conversations are important.

Chris Allen (32:23):

And just going off of that, Ellen too, I, that modeling happens too when someone, when an adult asks really hard questions, then that kid is, sees that it’s possible to ask hard questions.

Cassie Gillespie (32:37):

Oh yeah.

Chris Allen (32:37):

And so that can have a domino effect for that. That’s so powerful, that kid. And maybe then they approach situations that have been really hard with more openness and confidence and hope that there’s a, a better solution or a better outcome. And that that just has a ripple effect.

Cassie Gillespie (32:57):

That’s amazing.

Ellen Arrowsmith (32:58):

Mm-Hmm. <Affirmative>.

Cassie Gillespie (32:59):

Or even checks in on their peers.

Chris Allen (33:00):

Mm-Hmm. <affirmative>.

Ellen Arrowsmith (33:00):

Yeah. Yeah. So, cool.

Cassie Gillespie (33:01):

Are there other myths that we should debunk before we get into the tools?

Ellen Arrowsmith (33:08):

One that I have encountered especially in working with kids maybe who have a complex trauma history or other just difficult life circumstances, is this idea of youth who maybe more frequently than their peers express suicidal ideation or attention seeking.

Cassie Gillespie (33:25):

Oh yes.

Ellen Arrowsmith (33:26):

Right. I heard that a lot at schools. Like, oh, this kid is just attention seeking. We should ignore them so that, you know, ’cause otherwise we’re giving them attention.

Cassie Gillespie (33:33):

Yeah.

Ellen Arrowsmith (33:34):

And I think it’s really important to take a step back and pause with that. And anytime someone expresses suicidal ideation or just deep suffering of any kind, like we, we have to respond. Right. Like we have to. And I heard a really useful reframe and I apologize, I can’t give credit where credit is due to, I don’t remember where this came from other than it really stuck with me of reframing attention, seeking to connection seeking.

Cassie Gillespie (34:03):

Oh, amazing.

Ellen Arrowsmith (34:04):

And it’s just like, that gets to the heart of it is a valid human need that they are expressing sometimes through bad or obnoxious or whatever behavior, you can say whatever you want about the behavior, but the need and the feelings underneath are valid and need to be attended to always. And so I think you should never ignore people who are expressing deep suffering or thoughts of suicide. And I think thinking about it as you know, someone who’s seeking connection is a more productive way to move forward with how to help. That also makes me think of for kids who I’m thinking of who I worked in the school system, sometimes they just don’t have a super robust emotional vocabulary.

Cassie Gillespie (34:48):

Yeah.

Ellen Arrowsmith (34:48):

Right? And that’s part of the work with trusted adults is teaching how to talk about big feelings. So you know, sometimes I would work with a kid who would say something like, oh, I wanna, you know, I wanna kill myself or I wanna die. And I would say, you know, take a deep breath and say like, tell me more what’s going on? And they would get to, I’m just really mad. Like,

Cassie Gillespie (35:07):

I mean as an adult, I do that.

Ellen Arrowsmith (35:09):

Right? <Laugh>. And, and so I think, but if we just had the same exact protocol and response every single time someone uttered those words, that’s like Voldemort or something.

Cassie Gillespie (35:19):

Yeah.

Ellen Arrowsmith (35:19):

Right? We’re not getting to the like, tell me more. What happened, like you just had this like humiliating experience in the classroom and your friend didn’t play with you at recess and mom and dad were fighting last night. And you have this like, volcano of feelings that are erupting and like, let me help model for you different ways to talk about and validate those feelings. ’cause Those feelings are super valid, right?

Cassie Gillespie (35:41):

Yeah.

Ellen Arrowsmith (35:42):

And also like in that moment, that kid was not actually saying they wanted to die. They were just saying those feelings were so overwhelming that they couldn’t bear them in that moment and needed someone to help sit with them and, and be with those feelings and name those feelings.

Cassie Gillespie (35:57):

Okay. Well I think that is so helpful. And you know, I feel like we’ve maybe in this episode we’ve buried the lead a little bit. We’ve talked a lot about the tools, the tools, the tools, without saying what they are. So let’s demystify that a little bit is, you know, are one of you willing to talk us through what these evidence-based tools are. And then listeners, just in terms of of time. And so you can prepare, you know, we’re doing trauma-informed episodes here in our next episode. We’ll get into, you know, warning signs and risk factors and what to do if you screen a positive. But for now, you know, what are these tools and where should people go to, to check ’em out?

Ellen Arrowsmith (36:33):

Sure. I can hop in and Chris can as well. I think that we bring different perspectives and that’s really good and useful. So there are a number of evidence-based tools, and honestly, Chris mentioned before, it doesn’t really matter. Like different folks in different organizations will use different tools and that’s totally fine as long as you’re using an evidence-based tool that you feel comfortable and competent with. So in my current line of work, we typically use the Ask suicide screening questions, which is out of the na, national Institute of Mental Health. But I know that folks around this area also use the Columbia often. And that’s great, both our great tools. So I think that folks often ask me like, where do I start? What do I do? Like you’re talking about like basketball or Pokemon, and then suddenly you’re like trying to ask about suicide? And so.

Cassie Gillespie (37:19):

Yeah!

Ellen Arrowsmith (37:19):

Before you even get to the screening tool, you need some sort of entry point. Like a segway.

Cassie Gillespie (37:25):

Like a bridge question?

Ellen Arrowsmith (37:25):

And with kids that can feel clunky especially. But mine, and maybe Chris can chime in with his mine would usually be, I really care about you and wanna help keep you safe. Is it okay if I ask you some questions? Was my usual entry point, did you have a go-to entry <laugh>?

Chris Allen (37:41):

That that is a, a tried and true entry point and I I use something very similar to that,

Ellen Arrowsmith (37:48):

So, okay. Yep. Yeah. And usually they’re like, oh, okay. And then as we mentioned, these tools are really quick and easy. I have it in front of me here. The ask is intended to take only about two minutes, and it’s five questions, and I’ll read them in a second here. But you’ll notice that the questions go kind of an order from passive, more passive to more active ideation. So number one says, in the past few weeks, have you wished you were dead? In the past few weeks, have you felt that you or your family would be better off if you were dead? In the past week, have you been having thoughts about killing yourself? Have you ever tried to kill yourself? If yes, how? When? And then number five says, are you having thoughts of killing yourself right now? So in this tool, number five is the one that you really wanna pay attention to.

Ellen Arrowsmith (38:40):

If someone says yes to five, they, they shouldn’t go home. They need to go for that higher level of assessment and evaluation immediately. They shouldn’t be left alone, they need to go to the ED or have a crisis evaluation. But I think if there are yeses on the other questions, that’s an opportunity to ask some more questions, some clarifying information. A yes on some of the doesn’t necessarily mean a crisis. So for example, in the first question, in the past few weeks, have you wished you were dead? They say yes. And we’re like, oh my God, go to the ed. But we ask a clarifying question and it’s just like they had one really bad day where they were broken up with and failed a test and lost a soccer game, but then the next day felt in a really different place.

Cassie Gillespie (39:18):

Yeah.

Ellen Arrowsmith (39:19):

So there can be some nuance even in the screening tool to understand what someone is trying to convey to you. But you just go through those five questions and it five is your hot button question on this tool. There are other ones, I think it’s four to six on the Columbia that really indicate that highest level of risk where you need to bump it up to the next level of care. But I’ll hand over to Chris now to weigh in on those tools from your perspective.

Chris Allen (39:42):

Yeah. So thank you Ellen, for talking about the ASQ which stands for Ask the Question. There’s also the Columbia Suicide Severity Risk Scale, otherwise known as the CSSRS long acronym. Sorry about that folks.

Ellen Arrowsmith (39:58):

That’s okay.

Chris Allen (39:59):

And then there’s, there’s also the PHQ nine which stands for patient health questionnaire. And you might actually already be asked these questions from the PHQ in any routine primary care setting. You might not even notice that they’re being asked actually on your annual checkup. But one tool or the tool that we used at the Vermont Psychiatric Care Hospital, which I was a social worker at, was the Columbia. And I’ll run through those questions really, really briefly here. So you always ask the first two questions and they read, have you wished you were dead or wished you could go to sleep and not wake up? Have you actually had any thoughts about killing yourself? And then if they answer yes to the second question, you would ask questions three through five. And those are, have you been thinking about how you might do this? The fourth question, which gets us into the higher risk stratification. That’s a long word. It’s

Cassie Gillespie (41:12):

Perfect. Keep going.

Chris Allen (41:13):

<laugh>. So question number four is, have you had these thoughts and had some intention of acting on them? So we’re getting to have you started planning?

Cassie Gillespie (41:25):

Yeah.

Chris Allen (41:26):

Do you, are you acting with intent? Have you

Cassie Gillespie (41:30):

Sort of moving up the spectrum

Chris Allen (41:31):

Yeah. And, and getting more concerned.

Cassie Gillespie (41:34):

Yeah.

Chris Allen (41:35):

And the fifth question is, have you started to work out or worked out the details of how to kill yourself? Did you intend to carry out this plan? And so those questions are really helpful for figuring out that level of risk.

Cassie Gillespie (41:50):

Mm-Hmm. <affirmative>.

Chris Allen (41:51):

And then we would always ask the last question, question six of have you done anything, started to do anything or prepared to do anything to end your life? So questions one and two and six would always be asked, and you only ask three through five if they answer yes to two.

Cassie Gillespie (42:10):

Okay.

Ellen Arrowsmith (42:11):

One note on working with kids and teenagers is that refusal to answer should be considered a yes, which is really tricky. ’cause I definitely worked with kids or teens who just went cross the arms frown. It would be like a big no <laugh>. And that’s hard. That’s really tricky. And I think leveraging those relationships and really trying to have a sincere conversation. But clinically, if we’re, again, using this tool with fidelity, a a refusal to answer should be considered yes. Because we would rather be wrong on that side than on the other side.

Cassie Gillespie (42:42):

Sure.

Ellen Arrowsmith (42:42):

But that, that is more complicated when you’re talking about kids or teens or, or kids maybe who have like limited verbal skills or developmental it, it can be tricky. But we wanna do our best to use these tools to, you know, as they were designed.

Cassie Gillespie (42:57):

Yeah. Okay. Well, I, I don’t want to do a total cliffhanger here, but I’m gonna do a total cliffhanger and say come back next time, listeners, to talk through what some of the warning signs are, what some of the risk factors are, and what to do when you get different answers to those questions. But before we wrap up here you know, if there was one takeaway you wanted our listeners to have from today, Chris and Ellen, what do you wanna make sure that they take away from this conversation?

Ellen Arrowsmith (43:27):

I would say that just generally we need to get more comfortable with talking about suicide and suicidal ideation, and to ask ourselves some tough questions about if we are really uncomfortable, why, and what we can do to get more comfortable. Because it’s in that relationship and our willingness to ask that we can really help people and we can, we can save lives. And that’s really important. So that would be my number one takeaway from today, is just get comfortable asking even though it can feel scary.

Chris Allen (43:58):

Yeah, absolutely. I, I would just going off of what Ellen said, I, I think what’s really lost in the conversation about suicide too is just how important connection is between individuals. So Ellen talked about relationship and we really want to approach conversations of suicide or thoughts of wanting to die with a lot of compassion care, and really just keeping them safe. It’s really me showing that I care about you and I’m here for you. You’re not alone. And we can get through this together.

Ellen Arrowsmith (44:37):

I one note to end on here, and it’ll be a little tease for our final episode.

Cassie Gillespie (44:42):

Ooh, <laugh>.

Ellen Arrowsmith (44:43):

But just, I think the other thing that gets lost in talking about suicide, I think it feels like this, like terrifying doom and gloom, really scary topic. But there are interventions for folks who have suicidal ideation that work, that really work and that can work quickly to make people feel better. And that there’s good evidence. And I think that should give us a lot of hope. Right? And that when we have these conversations instead of telegraphing, like, no, no, no, don’t ask me that. We wanna be, again, like Chris said, I am here. I’m here with you. We can get through this. And there’s hope. There is hope for this situation.

Cassie Gillespie (45:19):

Thank you both so much for coming today.

Chris Allen (45:21):

Thank you.

Ellen Arrowsmith (45:22):

Thank you so much.

Chris Allen (45:23):

It was a pleasure.

Ellen Arrowsmith (45:23):

Yeah.

Cassie Gillespie (45:27):

The Social Work Lens is produced by the University of Vermont’s Child Welfare Training Partnership and the State of Vermont. Our theme music is composed and performed by local band Brick Drop, and our sound production and engineering has been brought to you by Egan Media Productions. We’d also like to give a special thank you to our in-house administrative production assistant Emma Baird. For the social Work Lens, I’m Cassie Gillespie, and we’ll see you next time.

 

Leave a Comment

Your email address will not be published. Required fields are marked *