Youth & Suicide Series Part 2- Someone screened positive – Now what?

Youth suicide is a public health crisis, and we all have a role in prevention! Join Cassie, Ellen, & Chris as they discuss how to respond to youth in crisis, and what to do after you’ve administered a screening tool. 

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:

Cassie Gillespie (00:00):

Yeah. So would it, would it be accurate to say at this point that youth suicide is a public health crisis, do you think?

Chris Allen (00:05):

100%.

Ellen Arrowsmith (00:06):

Absolutely. Yeah, I would say so.

Cassie Gillespie (00:10):

Hi, this is Cassie Gillespie, and you’re listening to the Social Work Lens. The Social Work Lens is made possible 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 here with part two of our three part series about youth and suicide. We’re calling this one, “someone screened positive- Now what?”. I do wanna pause though, before we jump in and say, if you didn’t listen to part one, it would really be worthwhile to go back and give it a listen. It’ll give you important context about suicide and suicidality, screening in general, and specifically what tools we’re talking about. We do have our returning guest today, Ellen Arrowsmith and Chris Allen. But one more note before we jump in. We’re aware that this is a really difficult topic, and many of us have our own personal connections. So be sure to take care of yourself as you listen. Stepping away and coming back is okay. It’s also okay to not come back if you need. And if you’re looking for more resources or have concerns at the end, please be sure to check out the show notes link to this episode. Okay, here we go. Welcome back, Ellen. Welcome back Chris.

Ellen Arrowsmith (01:19):

Thanks, Cassie.

Chris Allen (01:20):

Thank you.

Cassie Gillespie (01:20):

Thanks for coming again. So today we’re gonna get into what happens when someone screens positive on the tool. But before we do that, I think it might be helpful to just share some statistics about youth and suicide in general. Is, is one of you willing to tell us, give us a little context about kind of how is this problem looking? Are numbers going up, going down? What’s the state of the state?

Chris Allen (01:43):

Yeah. Thank you for that. And we’ll, we’ll talk about some data and I just want to be cognizant about the data. So there are lives lost behind this data, and we don’t want to lose that when we talk about data. So just recognize that numbers can be really high and those are individual lives that are lost or experiencing something that is really, really challenging and hard, difficult, maybe they don’t have the support. And so I just wanted to set the scene there. So people recognize that there’s people behind this. So suicide is the second most common cause of death for youth 10 years old and older after accidents. So more youth die by suicide than the top 17 leading medical causes of death combined. So these are big, big numbers. It’s very, very prevalent amongst youth.

Ellen Arrowsmith (02:57):

Yeah. And I think, you know there’s the numbers and then all of our lived experience, I think it’s probably no surprise to any of us, especially who work in mental health and mental health adjacent fields to know that folks are struggling and really have been. And, and a lot of us noticed in our day-to-Day work, the real increase in folks who are struggling with mental health issues like higher levels, both of numbers of people struggling. And, you know, in my own work, I would say higher acuity too, just the stuff we’re seeing. You know, kids and youth and adults are, are having a hard time right now at higher numbers, I think, than we had seen previously. And I, and I think one statistic that will be useful to some of your listenership who are connected specifically to DCF would be that according to the Suicide Prevention Resource Center, children and youth in foster care are about two and a half times more likely to have seriously considered suicide, and almost four times more likely to have attempted suicide than other youth.

Cassie Gillespie (03:57):

Wow.

Ellen Arrowsmith (03:58):

And that data is a little bit dated at this point, but I think that we can pretty confidently say that because of a lot of risk factors that we’re gonna get to momentarily.

Cassie Gillespie (04:07):

Yeah.

Ellen Arrowsmith (04:07):

This is a higher risk population that we need to be thinking about and taking care when thinking about who’s at risk and who might need some additional screening or help.

Chris Allen (04:18):

Yeah. And one other data point to consider is that from the years 2007 to 2017, there was a 20 or 56% increase in the rate of adolescent suicide. And yes, this data point is a little outdated. And just wanting to also provide a little bit more context about it is that this was pre pandemic and we’ve only seen numbers increase more and more kids struggling with their mental health and having a harder time in, in school and other settings. And it’s really, really stark to see that level of increase. And we’ve also seen the national annual suicide death rate increase as well. So that’s really just underpinning the conversation of what type of increase we’re looking at.

Ellen Arrowsmith (05:19):

And to note too that certain populations are, are more at risk you know, that we need to be, again, paying particular focus to you know, suicide rates are rising you know, at at faster or higher rates, pardon? Sorry. for racial, sexual and gender minority youth. So I think that folks in certain populations are just, are at higher risk and need additional care and, and screening potentially.

Cassie Gillespie (05:48):

Yeah, so would it, would it be accurate to say at this point that youth suicide is a public health crisis, do you think?

Chris Allen (05:53):

100%.

Ellen Arrowsmith (05:54):

Absolutely. Yep. Yeah, I would say so.

Cassie Gillespie (05:57):

Okay.

Chris Allen (05:57):

And it is important to remind ourselves that suicide is preventable as well. So we do have strategies and interventions

Cassie Gillespie (06:07):

That’s address the best kind of public health crisis. <Laugh>,

Ellen Arrowsmith (06:09):

Yes. Yeah. Something we can do something about. Yeah.

Cassie Gillespie (06:12):

So let’s talk about risk factors. What are they?

Ellen Arrowsmith (06:16):

You know, I, I think that as we’ve grappled with numerous times, there’s sort of like population level things and then the individual person in front, in front of you. So we always give that caveat that these are sort of general trends or things to notice. Yeah. So risk factors that we’ve observed are things like loneliness or hopelessness, shame, feeling like other people would be better off without you, or like a burden are really important to notice when people are talking if they’re making mention of that a history of abuse, previous history of suicide attempts is, is really important to pay attention to that really increases your level of risk if it’s been something that has happened previously. Loss or breakdown in relationships, family history of suicide, access to means. Are there any others, Chris, that I neglected on the list here too?

Chris Allen (07:07):

No I, I do think that this is a pretty exhaustive list. I do also want to make mention that risk factors are very personal to people and they can shift and change throughout someone’s life. And so they are dynamic and they, they won’t always be the same. But there are some that, that will stay the same, like family history of suicide. And I think one thing to keep in mind too is that for kids in foster care, the kid might not know the family history of suicide. So just keep that in mind. And, you know, there’s some other risk factors too that a kid might not have that information and it may be pertinent to the conversation or it might not be pertinent to the conversation.

Ellen Arrowsmith (07:58):

And I think you can have these risk factors, probably all of us could look at that list and, and pick off several that we have in our own lives or own family history. And that doesn’t mean in and of itself that you are someone who’s going to die by suicide or have suicidal ideation. These are just things to pay attention to that maybe put you at higher risk. And I think it’s important too, developmentally to note that kids and teens tend to be impulsive, right? Like their prefrontal cortex is not all the way developed.

Cassie Gillespie (08:26):

Yeah!

Ellen Arrowsmith (08:26):

And that often suicidal thoughts are kind of, I like the metaphor of like a wave, right? They come and they crest and then they subside. It’s generally not this chronic constant level. And so the best thing that we can do for kids is to keep them safe during that really pivotal peak of the wave.

Cassie Gillespie (08:46):

Yeah.

Ellen Arrowsmith (08:47):

And the best way we can do that, which we’ll get into is through means restriction and close supervision. So making sure that our environment is as safe as it can be and that we’re keeping eyes on these kids to keep them as safe as we can to get over that wave. ’cause Generally we come down off the wave, even, you know, in our own lives, maybe we have a really bad day, and then we just go to bed and we go to sleep and eight hours later we wake up and it’s not all gone, but maybe we feel slightly differently about it in the morning when we wake up than we did before. And sometimes even getting through that, like long hard night is enough to be in a slightly different and maybe slightly better place in the morning. And then you still need probably supports or resources or help, but we’re really thinking about how to get through that crest moment with kids and keep them safe during that key time.

Cassie Gillespie (09:37):

Yeah and you mentioned that one of the factors specific to kiddos in the child welfare system who are in custody is that they may not know their family history. I’m wondering if the actual act of, of kind of like family disruption of needing to be living somewhere else is a factor in of itself for those kids too?

Chris Allen (09:54):

Yeah. So disruptions any type of transition from one setting to the next, or from one foster home to the next, or a change in the family composition that’s or caregiver composition that’s around them and supporting them, these can come with a lot of different feelings for that kid. And, and those feelings can range from hurt to shame to confusion and hopelessness. They don’t know what’s going on. They may never know what exactly happened, and they may blame themselves because that might be learned behavior from previous situations that, that they’ve been in. And when kids are going through these transitions, it’s a really important time to think about screening kids using an evidence-based tool that we talked about in, in episode one.

Cassie Gillespie (10:51):

Yeah. I imagine there are some particular warning signs that might go beyond risk factors that let you know this is a kid you really need to be paying attention to. Is it, should we talk about some of those?

Ellen Arrowsmith (11:02):

Yeah, absolutely. I think, again, it’s really important to note that these are really specific to the individual person. And the best way that you can know is by relying on your relationship with a person.

Cassie Gillespie (11:13):

Oh, of course.

Ellen Arrowsmith (11:13):

Like, like you’ll know kind of their baseline and how they present and how they go through the world. And if suddenly it’s very different, noticeably different than how they typically present, that is kind of your warning sign. And that can look different for different people. So your best tool is relationship and contact and checking in because some people, you know, kind of counterintuitively maybe once they’ve made a decision around suicide, will actually present as kind of euphoric. Like it feels like a relief and they’re really happy and relieved. And that can be a confusing signal. So I will list off some general warning signs, but wanna give again the caveat that your best tool is knowing and being in relationship with a human and noticing when things feel off.

Ellen Arrowsmith (11:54):

And that’s your cue to ask. But generally speaking, pe kids especially will tell you, they will say they will make explicit comments, right? <Laugh> they’re not beating around the bush generally. I mean, some of them are, again, it’s specific, but you know, those overt comments, feelings of hopelessness, withdrawing or isolating, maybe they quit a team or they drop out of something, or they sort of disengage from things that they were really interested in before giving away their belongings, you know, moodiness or irritability or like researching. I mean, I think that’s why it’s important that we really pay attention to our kids’ online lives as well. You know, if, if we notice what they’re Googling or what they’re searching or what they’re talking to other kids about, that might be another indication that something’s going on. And then, you know, if you’re worried, ask, right? Like that’s what you need to do. Like don’t sit in wondering or guessing. The best thing you can do is, is just to ask them and then to use some of these tools if they say yes, that they’re having some of those thoughts.

Chris Allen (12:55):

Yeah. I think one of the really troubling things is when you’re making these observations in, in someone withdrawing or isolating that you draw the, the conclusion or the assumption they can’t be thinking about suicide, right? Like they’re seven years old, they would never think about killing themselves, or, and I would advise not jumping to that assumption until you ask, like you need to ask in order to better understand and assess the situation about where that, where that kid is. And one thing that, that I noticed a lot is changes in behavior are really good signals of wanting to die or want or thinking about dying. Yeah. Or not being future oriented to, in five years I would like to be, you know, entering high school or things like that. So one example that I’ll share is that while I was working at the psychiatric hospital, there was an individual that, that I was working with that every Friday we wanted to walk the hallway and it was a way for us to just check in with each other.

Chris Allen (14:12):

It was the end of the week, and it really helped that individual regulate themself. And there was no talk about discharge planning or who do you wanna talk to next week? Or what meetings could we set up or what would help you. It was really just a, a time for them to share, share what was going on for them, what was going on in the hospital who were they talking to, was, was anything different about this week that they wanted to share? And when that individual no longer wanted to walk with me.

Cassie Gillespie (14:46):

Yeah.

Chris Allen (14:47):

That was that.

Cassie Gillespie (14:48):

Like a red flag.

Chris Allen (14:49):

Yeah, it was a red flag. And it made me notice a little bit more like, something’s going on. I don’t know what, but then I communicate that to the individual. To the adult in this situation. And also I share that amongst the treatment team. So I’m sharing that, my observation, so that they’re aware as well.

Ellen Arrowsmith (15:11):

And in the last episode, we did some myth busting again about the idea of like planting the idea and worry. And I, I’ll just share a a story of a kid when I worked at the school, you know, kids are weird <laugh> and it can be hard to interpret their behavior. Like sometimes, you know, like we, we just wonder. And so I did, I, I asked this, this kiddo about suicide, and their response was like, what a weird question to ask me. Let’s play Legos. And, and I think that was a good reminder to me of like, it wasn’t troubling to them. It was, it didn’t phase them, it didn’t hurt our relationship. They, they were just like, you know, they just answered the question and then we moved along. But I would not have known that unless I asked.

Cassie Gillespie (15:53):

Yeah.

Ellen Arrowsmith (15:53):

And it helped me the next time I did need to ask, and it was a yes to feel like most kids can, can handle this kind of conversation. And, and can have that, you know, like that, that it was more about me than about them in terms of fear and hesitancy around asking. So I liked that. Like, what a weird question to ask me. You know, so, and just moving Right on.

Cassie Gillespie (16:15):

Moving on.

Ellen Arrowsmith (16:15):

Yeah. And most kids are kind of like that, you know?

Cassie Gillespie (16:18):

Okay. So let’s imagine that, you know, a kiddo in some capacity either in work or in your personal life, and there’s some warning signs. And so you’ve asked the question, right? Something has, has prompted you to ask this kiddo if you can ask them some more questions. And so you’ve done a screening tool, you’ve done the Columbia, or you’ve done the ASQ and they’ve endorsed some level of response that lets, you know, there should be a next step. I’m just gonna pause here and say, so if at the beginning when we said you should listen to the first episode, if you really didn’t, but now you’re like, what are you talking about? It’s all there, right? So you can go right back and check out what those tools are and what the questions are. But, so if you’re working with a kiddo and you’ve done a screen and they’re saying, yes, I have a plan, what do you want us to know about where to go from there?

Ellen Arrowsmith (17:06):

First as we said in episode one, it’s good to just take a deep breath to take a pause. Like to notice what your own body you know, like I always have to say to myself like, watch your face, right? Like, because I have a very expressive face.

Cassie Gillespie (17:18):

Yeah.

Ellen Arrowsmith (17:19):

But to just make sure again, that what we wanna be conveying is connection, groundedness you know, trust that it’s okay for us to be having this conversation. So just to manage yourself momentarily before you even respond at all. And then I think this is gonna, for your folks who have anxiety <laugh> be a little scary, but not to over or underreact, right? Which means like, don’t be dismissive, but also don’t have a big reaction. Because we wanna convey we can handle this. I’m so thankful you told me we can make a plan that you’re, you’re portraying sort of confidence and groundedness that you together can, can make a plan and to keep kids safe.

Ellen Arrowsmith (18:02):

So for me, a go-to response would be something like, thank you for trusting me and telling me how you’re feeling. Let’s make a plan to help you feel better, right? Because we don’t wanna be conveying like, oh my God, what are we gonna do? Or like, no, you’re fine. Right? Because I think kids often get the under or over response from many caregivers in their life and it is kind of an, an art form to respond kind of at the, the right modulation.

Cassie Gillespie (18:28):

Yeah.

Ellen Arrowsmith (18:29):

Right. The right way that conveys care and that we together can, can manage and handle this. And again, that’s not clinical expertise that you have, but you have to practice.

Cassie Gillespie (18:40):

Yeah.

Ellen Arrowsmith (18:40):

And get comfortable. And a lot of that is the stuff that we talked about in the first episode, which is managing kind of your own baggage around suicide to be okay to feel okay yourself talking about it and managing it.

Ellen Arrowsmith (18:53):

So finding that not over or under reaction stance is, is I think something that requires some practice. And I think too, especially for kids who maybe have a trauma history or a complex family situation, it’s important that they don’t feel responsible for managing the feelings of the adult in front of them. Yeah. I think a lot of them kind of instinctively do that. So, you know, we get this in our social work training, like, don’t make it about you <laugh>.

Cassie Gillespie (19:20):

Yeah.

Ellen Arrowsmith (19:20):

I think some of us would wanna be like, don’t hurt yourself. That would make me sad. Or like something like that. I think that can come from like a caring place, but it’s not the right message because then that gives them kind of the burden of not only managing their own feelings, but your feelings as well. So again, that’s that finding that not over or under responding and thinking about, I’m not gonna give any of the, the, any of my own feelings or discomfort to this child to manage as well.

Ellen Arrowsmith (19:47):

So that’s another really important reason to keep yourself regulated. And as you know, we talked about the screening tools in episode one. And, and so we’re talking about there’s a yes. And if, if it was that number five question for the A SQ or on the Columbia whichever tool you’re using, there will be a clear question that indicates the highest level of acuity. And that’s kind of clear, like the buck stops there. Like that kid needs that higher level evaluation right away. And depending on your role, that may or may not be you. For a lot of folks who are listening, it might not be. But then, you know, like, I really can’t leave this kiddo alone or send them home. They need to have that higher level of evaluation before we can go home. But what we’re saying for the other questions is really that we’re digging in and getting a little more information and maybe we find out something that makes us think, oh, like this level of risk is actually quite low.

Ellen Arrowsmith (20:46):

I think that I can call mom or whatever and kind of talk through what happened in the day and, and this kid is probably okay going home and I’m gonna check in on them tomorrow. Right? Like there can be a whole range of responses again that’s really tailored to that specific child and their circumstance and what they’re communicating to you. So these tools are like an entry point to that conversation. And that when we do identify those kids who have the really highest level of acuity that then there’s a next step to that process, which is a more formal assessment or evaluation that’s done that then again has some clinic clear pathways of what to do next, whether they need to be hospitalized or things like that. But again, those will be a, a relatively small portion of the kids who screen positive need that highest level of care that most of the kids who we encounter in our work need a to know that a grownup really cares about them.

Cassie Gillespie (21:44):

Yeah.

Ellen Arrowsmith (21:44):

And wants to help keep them safe and to make a safety plan about how we’re gonna keep them, try to keep them safe, and that we’re communicating and teaming with the other caregivers in their life so that there is some consistency around that.

Cassie Gillespie (21:58):

So I just wanna kind of grab it here and summarize and make sure I’m understanding, you know, clearly as I’m listening to you both. So for the two most common evidence-based tools, the ASQ and the Columbia, which again we’ll link to in the show notes. If you get a positive screen on number five for the Columbia or on numbers four to six No, I did it backwards.

Ellen Arrowsmith (22:19):

<Laugh>. Yeah. Five on the ASQ. Yeah.

Cassie Gillespie (22:21):

Five on the ASQ and four to six on the Columbia, that’s where, you know you shouldn’t be leaving this kiddo alone. There’s a next step and it’s probably someone with more, or it may be someone with more training than you depending on what hat you’re wearing as you move through the world.

Ellen Arrowsmith (22:35):

And the nice thing is those tools are like make it very clear, like, so in the Columbia, it’s bright red, it,

Chris Allen (22:41):

Yeah.

Ellen Arrowsmith (22:41):

It goes, it’s like color coded and it is red on those questions. Or on ASQ, it’s in a standalone box kind of for number five to indicate to you like, this is the question you really need to pay attention to. Where if this is yes, then that kind of triggers that protocol that you hopefully have already in place that you feel comfortable with and you know, ahead of time ’cause you’ve had training or talked to your supervisor, you should not go into that blind of no. Like, you should know what happens if there’s a yes on those questions before you start talking. Otherwise, you probably will end up in a sticky situation.

Cassie Gillespie (23:16):

And so what do you recommend for someone who might be listening who maybe I don’t know, works in an afterschool program or just has a lot of teens in their house and, you know, is is sort of doing their due diligence to be part of this conversation and they heard this episode and they went and they got the show notes and they clicked on the tool and they’ve got it. You know, how do you want people to approach this if they’re not in a sort of formalized social work setting?

Ellen Arrowsmith (23:42):

I’ll let Chris say, but I was just gonna say that we’re spoiled in Vermont and that we have really good resources available to us through our crisis. So if you are not in a mental health setting, you know, I think we have numbers that you can call in every county in Vermont. We have national lines, we have resources and I’ll let Chris speak to those. But I think that, that that’s your next step. If you’re a caregiver or an afterschool provider, you lean on those crisis resources that we have available to us here in Vermont.

Chris Allen (24:08):

Yeah, thank you Ellen for, for highlighting those. And so each county has a community mental health agency that has a 24/7 365 crisis line that can be accessed and that caregiver or parent can talk through the situation and give as much information as they’re able to and willing to to the other, to the call responder. And that person can walk you through what you can do, what level of risk it is, give you some additional resources or ask you to follow up with someone in the morning or the next day. And additionally there is a 988 suicide and crisis lifeline.

Ellen Arrowsmith (24:55):

Mm-Hmm. <Affirmative>.

Chris Allen (24:56):

Which is a, a national suicide and crisis lifeline. And here in Vermont we answer those calls as well. And that’s available 24/7 365 too.

Cassie Gillespie (25:08):

Oh, that’s great.

Chris Allen (25:09):

And it’s confidential. It’s free as is the crisis line through the community mental health agency.

Chris Allen (25:15):

And both of those supports are available online, ready to go. And if you reach out to 988 and there’s an additional layer of support that’s needed in that situation, it might reach a level of needing a follow-up call the next day based on the level of risk. And that can be scheduled right then and there on, on the phone line or maybe there’s a a mobile crisis need as well, which just went live statewide.

Cassie Gillespie (25:54):

Oh that’ right.

Chris Allen (25:54):

And so if that’s needed, then there’s gonna be a two person team that responds to wherever you are in order to better assess what’s going on, get eyes on and figure out what, what makes sense for this this situation and, and really continue to provide support additional resources as needed. And it’s really in the hopes of having a person-centered approach that is led by the individual in crisis or going through it a challenging time. And that is, we wanna be responsive to that need.

Cassie Gillespie (26:34):

Yeah.

Chris Allen (26:34):

Not perceived need. That’s super important.

Ellen Arrowsmith (26:37):

And they’re a helpful resource. I used used them when I was working in schools just as like a resource myself. So say I administer this tool and I just don’t really know what to make of it or how to interpret it. And then I’ve called those resources before to say, Hey, here’s what’s happening and here’s what I’m thinking. Does that make sense?

Cassie Gillespie (26:53):

Yeah.

Ellen Arrowsmith (26:54):

Again, you know, we talked in episode one about liability and just not feeling alone in this work.

Cassie Gillespie (26:59):

Yeah.

Ellen Arrowsmith (26:59):

So even if you’re not ready to have them come evaluate someone necessarily, they can be a helpful resource just to check your own judgment and assumptions.

Cassie Gillespie (27:08):

Yeah.

Ellen Arrowsmith (27:08):

And interpretation of a tool.

Cassie Gillespie (27:09):

Back you up.

Ellen Arrowsmith (27:09):

Exactly. Yeah.

Chris Allen (27:11):

And document, document, document.

Ellen Arrowsmith (27:13):

Yeah. Yeah.

Chris Allen (27:13):

Right?

Ellen Arrowsmith (27:14):

Yeah.

Chris Allen (27:14):

This is liability is best shared, like we talked about.

Cassie Gillespie (27:17):

Don’t worry alone.

Chris Allen (27:18):

Yeah, exactly. And what’s really important is that you’re consulting those resources and using those resources and then making sure that you are writing down in the documentation, whether that’s a case note or therapy note that you have consulted them and what they recommended and then whatever next steps that you took.

Ellen Arrowsmith (27:43):

And we know too that in various roles you might have with kids and youth confidentiality definitely is something to consider and wanna kind of just highlight that when there are concerns around suicidality or, you know, my spiel to kids would always be like, if I’m worried about you or the safety of you or somebody else, then I need to bring other people into the conversation. And that’s definitely true with concerns around suicidality too, that, that supersedes risks of, or considerations around confidentiality and with kids in terms of safety planning, which we’ll talk about next. You really need caregivers, whoever that might be in a kid’s life on board because of pieces around like supervision and means restrictions, really. Kids can’t do that by themselves. Yeah. They need folks around them who can help to implement this plan. So you really need to communicate often and well with caregivers when you’re concerned about a kiddo as part of that safety planning process. And just to have them feel on board and part of the process. And so that they’re weighing in, they, they often have a lot of, I mean, obviously knowledge and backstory and context for their own kid as well. That’s really important and useful information.

Cassie Gillespie (28:57):

So if I go back to this example where maybe I work in an afterschool program, I don’t know why I landed there, but I did, and I’ve done a screening. I’ve done the ASQ and if the child has endorsed yes for five, I’m, I’m clear on what I’m doing next, right? I’m tapping into these resources. I’m calling, I’m not letting this kiddo be alone. I’m contacting caregivers. What if we’ve had a yes to some of the other questions? But not the, not sort of like the big red question.

Ellen Arrowsmith (29:26):

Yeah again, I think the best tool we have is our relationship and having a more nuanced conversation to get to listening to those why’s of like, what happened. Tell me more about that day or when you were feeling that way. So we understand what it is that we need to address, but I, I think the best things we can do are still communicate with the caregiver.

Cassie Gillespie (29:45):

Yeah.

Ellen Arrowsmith (29:45):

Even if it’s not the big red five or the, you know, whatever the number is in the Columbia, we still should be looping in caregivers if really, if we’ve done this screening, that’s a good indication you should be connecting with folks. ’cause They will want to know, probably.

Cassie Gillespie (29:57):

Sure.

Ellen Arrowsmith (29:57):

That we’re worried, but then we wanna think about making a safety plan. And maybe, Chris, you wanna talk us through the nuts and bolts of typical safety planning?

Chris Allen (30:05):

Yeah, absolutely. And so one one commonly used safety plan out there is the Stanley Brown. And really when we’re thinking about safety planning, we’re thinking about what are the ways that this person can stay alive? What is that’s completely individual. It’s unique to them. And ideally the safety plan, if it ever is developed for an individual, would follow them through various settings. So from the school to the pediatric practice to the afterschool program so that everyone knows that they have a role in how to best support this person or this kid. And that they, that they know how to do that. And so there’s a few things that are on the Stanley Brown such as protective factors and coping strategies. So asking the kid how do you work through something that’s really hard? Is it a song that you listen to?

Chris Allen (31:12):

Do you wanna draw? Do you wanna go run around outside? What are the ways that you work through this? And then it also has a section on warning signs. So what are the warning signs that are specific to that individual? Is it when they’re sitting in the back row in the classroom, when they’re usually in the front row? Is it when they, after a soccer game, they don’t run up to their caregiver and give them a big hug? Like what is it that is concerning behavior?

Cassie Gillespie (31:43):

Yeah. Missing the Friday walks.

Chris Allen (31:44):

Yeah, exactly. And also what’s really important too is identify the natural support. And that may be the caregiver or may not be the caregiver.

Cassie Gillespie (31:53):

Yeah.

Chris Allen (31:54):

It could be the afterschool coordinator or someone that lets them out for recess and posts.

Ellen Arrowsmith (32:02):

Pets too.

Chris Allen (32:03):

Oh yeah. <Laugh>.

Ellen Arrowsmith (32:04):

<Laugh> for kids. You’d be amazed how many pets they’re on list.

Cassie Gillespie (32:06):

I believe it.

Ellen Arrowsmith (32:06):

Natural choice.

Chris Allen (32:08):

<Laugh>. And so what are the ways that kids feel supported?

Cassie Gillespie (32:14):

Mm-Hmm. <affirmative>,

Chris Allen (32:14):

They’re all around them, but identifying them and writing them down. That’s easy to find is really, really critical.

Ellen Arrowsmith (32:23):

Yeah. And then I think the other piece too that we’ve mentioned is just thinking big picture again about if you listen to episode one, how are we getting through that wave of.

Cassie Gillespie (32:34):

Yeah.

Ellen Arrowsmith (32:34):

Of suicidal ideation, this crest, this crisis moment. And to do that, we need to think about what are all the ways we can keep this environment as safe as possible? And again, it’s not a hundred percent like we live in an inherently dangerous world, like we live next to roads or other things that we can’t really mitigate, but what are the other things in our house, in our home that we can do to keep this environment as safe as possible? So we’re thinking about keeping all of our medications, both prescription and over the counter medications locked or stored in a safe way. We’re thinking about sharps or other dangerous things like sometimes chemicals or other things in the home.

Ellen Arrowsmith (33:12):

And we do have to have hard conversations about firearms.

Cassie Gillespie (33:16):

Yeah.

Ellen Arrowsmith (33:16):

In Vermont. And, and that can be really tricky. We live in a state where there’s really strong community and culture around hunting. And I, and I think we can still have really good respectful, open conversations about how firearms are stored in homes so that they are, you know, we recommend that firearms be stored and locked separately than, you know, the ammunition and that it’s only grownups who have keys or combinations. And I think kids are smarter than we think they are. <Laugh> they. We might think they don’t know where that key is, but they do. So I think, you know, really digging into that to make sure that we’re making our home environment really as safe as we can and then keeping eyes on kids.

Chris Allen (33:57):

Absolutely. And one thing that I, that’s really important with safety planning too, is that this safety plan is not a static document.

Cassie Gillespie (34:05):

Yeah.

Chris Allen (34:05):

It can change, right? Because someone’s coping strategies from one year might be different the next year and they’re one year older, they’ve been exposed to other experiences or met different people and maybe that favorite song is no longer their favorite song anymore. And maybe it’s a, it’s a clip from a movie. So really tuning into that and checking in with the with the kid because this is their safety plan. It’s not my safety plan.

Cassie Gillespie (34:36):

Yeah.

Chris Allen (34:37):

As the provider or as the person concerned about them. It’s the safety plan for that kid.

Ellen Arrowsmith (34:43):

Yeah. I just heard a thing of that said that if it takes you only five minutes, you’ve done it wrong. Right?

Chris Allen (34:47):

Yeah.

Ellen Arrowsmith (34:47):

That this is a thing that should take you a long time and that’s hard. And to budget for that, like you were saying, Chris, it is such a personal dynamic document that if you’re doing it well, it should be a really thoughtful and kind of long process actually. Maybe 45, you know, like a long in-depth conversation to make a careful plan.

Chris Allen (35:05):

Yeah. And when, when revisiting that plan too, you don’t have to bring out the plan like the document in front of the kid.

Ellen Arrowsmith (35:12):

Yeah.

Chris Allen (35:12):

You can just check back in with them about who are your supports. Yeah, yeah,

Cassie Gillespie (35:18):

Yeah.

Chris Allen (35:18):

How, how have things changed for you or what are you noticing in conversation that’s coming up naturally with that, with that kid? Because you can learn a lot from that without having to have this larger, more official conversation that can feel intimidating for that kid. Should we move on to the limited resources in Vermont and how to maybe work with that and

Ellen Arrowsmith (35:43):

Sure. Yeah. I think, you know, all of us who have worked adjacent to mental health in Vermont know it’s no great mystery that we don’t have as many resources as we would want and as we really need for kids and youth. And that’s a real area of, of need. We have to grapple with that. And that can feel really hard when we’re using these screening tools or asking kids about hard stuff and we don’t really know if the resource that we would want for them really exists or is gonna be available on the other side. So say, you know, we get through this tool and we think, oh, they really need a therapist. You know, like they don’t need to go to the hospital, but they need someone who’s trained in DBT or a IOP program or those kinds of things. But, but we don’t know if we can find that person or there is a really big wait list or so it’s something I think that we grapple with and and worry about when we ask these questions.

Ellen Arrowsmith (36:37):

But I think that we need to ask anyway, even though we’re scared about resources. And to just to do our best and to, to continue to get training and to continue to advocate you know, for these kids for what they need so that the services that they need on the other side will be readily available to them and to families so that we don’t have to have that be an additional consideration when we’re just trying to think about how to keep them safe and what they need to you know, to want to live and to live happy connected lives. On the other side, we don’t want to think about, well how long is it gonna take for the crisis person to get here? Or how long is that wait list for that program? Or are they gonna go have to go out of state for an inpatient program? Like those are considerations we grapple with, but I think we need to learn how to sit in the discomfort of that and still move forward with these the best frameworks that we have available to us while simultaneously like advocating for things to get better.

Cassie Gillespie (37:34):

Yeah.

Ellen Arrowsmith (37:34):

For kids and families in our state.

Chris Allen (37:36):

I’ve got nothing else to add. That was a perfect wrap up.

Cassie Gillespie (37:39):

That is a powerful point. Okay, well thank you both so much for being here again. And listeners, please come back and join us next time ’cause we wanna make sure we also have the conversation about moving beyond prevention into creating lives of hope and connection lives worth living. So thank you Ellen. Thank you Chris. Yeah,

Chris Allen (38:01):

Yeah thank you.

Ellen Arrowsmith (38:02):

Thank you so much, Cassie.

Cassie Gillespie (38:06):

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.

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