CARE is a research-backed, web-based course to provide educators and other school staff guidance to help students who may be going through difficult times. The program is designed to give educators the tools and confidence to identify students who may be at risk for emotional or behavioral distress, including suicide, substance use, violence, and sexual abuse. CARE will help all school staff understand when and how to intervene and make referrals to counselors and mental health professionals, based on their district’s policy and procedure.

Everyone Should Take CARE

CARE is available to everyone who works with students in Washington State, from administrators to support staff.

Counselors, psychologists, social workers, and nurses can take the course, but it does not meet the course requirement for certification or recertification. Those courses can be found on the Professional Educator Standards Board website.

Joining the Course

The course is a free, one-hour, online module that meets the criteria set forth by RCW 28A.320.127 which requires educators receive training on how to recognize and respond to students experiencing emotional or behavioral distress.

CARE may be taken individually or in a group, and a Facilitator Guide is provided to guide staff through the specific examples, discussion questions, additional resources, and role play exercises.

Know the warnings and take action if you see:

• Talking or writing about suicide or death
• Giving direct verbal cues, such as "I wish I were dead" and "I'm going to end it all"
• Giving less direct verbal cues, such as "You will be better off without me," "What's the point of living?", "Soon you won't have to worry about me," and "Who cares if I'm dead, anyway?"
• Isolating themselves from friends and family
• Expressing the belief that life is meaningless
• Giving away prized possessions
• Exhibiting a sudden and unexplained improvement in mood after being depressed or withdrawn
• Neglecting his or her appearance and hygiene
• Dropping out of school or social, athletic, and/or community activities
• Obtaining a weapon (such as a firearm) or another means of hurting themselves (such as prescription medications)

Bullying Prevention SSHB 1163 (2011)

Adds mental health and suicide prevention to the essential academic learning standards in health and fitness RCW 28A.230.095

Troubled Youth ESHB 1336 (2013)

School counselor, psychologist, social worker, and nurse to receive suicide prevention training.

RCW 28A.410.226

Issues of Abuse course content include recognition, screening, and response to emotional or behavioral distress in students, substance abuse, violence, and youth suicide.

RCW 28A.410.035

School districts must adopt a plan for recognition, screening, and response to emotional or behavioral distress in students: substance abuse, violence, and youth suicide.
RCW 28A.320.127

OSPI to develop and maintain a Model School District Plan for Recognition, initial screening, and response to emotional or behavioral distress.
RCW 28A.320.1271

Requires that each Educational Service District develop and maintain the capacity to train on youth suicide screening and referral, and student emotional and behavioral distress.
RCW 28A.310.500

K-12 Schools Suicide Prevention SSB 6431 (2014)

OSPI to assist schools in implementing youth suicide prevention activities.
RCW 28A.300.288

Sexual Abuse Response Plans HB 2597 (2016)

School districts plan must also include training for recognition of sexual abuse, notification requirements, and staff response procedures.
RCW 28A.320.127,
RCW 28A.320.160,
RCW 28A.400.317

The purpose of a prevention plan is to protect the health and well-being of all students by having procedures in place to prevent, assess the risk of, intervene in, and respond to students in crisis. Prevention of youth suicide, violence, substance use/misuse, and the early identification and treatment of behavioral health disorders are most effective when students, staff, parents, and community members have access to prevention information and resources.

OSPI Resources for Comprehensive Suicide Prevention
Model Plan Template
Health Education K - 12 Learning Standards

Guides and Examples of Comprehensive Suicide Prevention
SAMHSA Issue Brief: Suicide Prevention in Schools
Preventing Suicide: A Toolkit for High Schools from the Substance Abuse and Mental Health Services Administration (SAMHSA)
The Trevor Project Model School Policy, developed in partnership with American Foundation for Suicide Prevention, the American School Counselor Association, and the National Association of School Psychologists
HEARD Alliance K-12 Toolkit for Mental Health Promotion and Suicide Prevention a Toolkit based on evidence based youth suicide prevention guidelines.
National Association of School Psychologists Preventing Youth Suicide
To Live to See the Great Day That Dawns Preventing Suicide by American Indian and Alaska Native Youth and Young Adults
Healthy Mind and Body: A Mental Health and Suicide Prevention Guide, resources from True Recovery
Effective Suicide Prevention Instructional video from the Suicide Prevention Resource Center

Training for School Professionals
The Professional Educator Standards Board (PESB) maintains the list of approved trainings required for school nurses, counselors, psychologists, and social workers. Contact an ESD Prevention Director to find out about their training schedule or see the PESB Website for other training options.
OSPI's Suicide Awareness and Resources for Educators
2017-18 National Version - Making Educators Partners in Youth Suicide Prevention: ACT On FACTS; created by The Society for the Prevention of Teen Suicide is a free online training that is appropriate for anyone working in the school setting who would like more training on how to recognize warning signs and next steps for intervention. (Note: this training does not meet the training requirement for ESA certification/recertification.)
What is Complex Trauma? A Resource Guide for Youth and Those Who Care About Them, National Child Traumatic Stress Network
Conversations Matter a practical online resource to support safe and effective community discussions about suicide.
Safety Planning Intervention for Suicidal Individuals, free online training from New York State Center of Mental Health
"Saving Holden Caulfield: Long and Short-term Strategies for Preventing Youth Suicide" recorded webinar from the National Association of State Mental Health Program Directors
UW Medicine Center for Sexual Assault & Traumatic Stress
Injury Control Research Center for Suicide Prevention: Suicide & Bullying: Preventing Suicide through Collaborative Upstream Interventions

School-based Programming
The Suicide Prevention Resource Center Page for Resources and Programs has a searchable database of evidence-based programs and practices for education, screening, treatment, environmental change that can be filtered based on intended population.

School staff have day-to-day contact with many young people, some of whom experience mental distress or illness that could result in feelings of hopelessness that could lead to suicidal behavior. Those who work in schools are well-positioned to observe students' behavior and act when they suspect that a student may be at risk of self- harm and/or suicide.

Specific steps should be followed in order to identify and help young people at risk, including a referral to someone in the school who has been trained to assess suicide risk. School systems should include efforts to recognize the warning signs, refer students to appropriate resources, and create reentry plans for students coming back to school after a crisis that coordinate with mental health treatment plans.

Warning Signs that require immediate action:

• Talking or writing about suicide or death
• Giving direct verbal cues, such as "I wish I were dead" and "I'm going to end it all"
• Giving less direct verbal cues, such as "You will be better off without me," "What's the point of living?", "Soon you won't have to worry about me," and "Who cares if I'm dead, anyway?"
• Isolating themselves from friends and family
• Expressing the belief that life is meaningless
• Giving away prized possessions
• Exhibiting a sudden and unexplained improvement in mood after being depressed or withdrawn
• Neglecting his or her appearance and hygiene
• Dropping out of school or social, athletic, and/or community activities
• Obtaining means such as a firearm or prescription medications

Warning Signs that may indicate a youth is at risk and needs to be referred for screening:

Responding to the Warning Signs:
It takes time and courage to reach out to students on a personal level, but your interest can be a lifeline to a child in crisis.

Intervention Resources

Risk Factors and Warning Signs from the American Foundation of Suicide Prevention
Now Matters Now offers research based ways for managing the most painful moments of life, teaches Mindfulness, Mindfulness of Current Emotion, Opposite Action and Paced-breathing.
Beyond Blue: Guiding their Way Back Information for people who are supporting someone after a crisis.
Suicide Safety Plan and Safety Planning Guide from Stanley and Brown recommendations
Gizmo's Pawesome Guide to Mental Health, safety planning appropriate for children

• A sudden deteriorating academic performance. Teens who were typically conscientious about their school work and who are now neglecting assignments, cutting classes, or missing school altogether.
• Self-mutilation. Some young people resort to cutting their arms or legs with razor blades and other sharp objects to cope with emotional pain. Self- mutilation is an unmistakable sign that something is wrong.
• A fixation with death or violence. Teens may express this fixation through poetry, essays, doodling, or other artwork. They may be preoccupied with violent movies, video games, and music, or fascinated with weapons.
• Unhealthy peer relationships. Teens whose circle of friends dramatically changes, who don't have friends, or who begin associating with other young people known for substance abuse or other risky behaviors may signal a change in their emotional lives.
• Volatile mood swings or a sudden change in personality. Teens who become sullen, silent, and withdrawn, or angry and acting out. Conversely, and teen sullen by nature may start to behave uncharacteristically cheerful. Both internalizing and externalizing behaviors warrant a conversation to determine if the student is at risk.
• Indications that the student is in an unhealthy, destructive, or abusive relationship. This can include abusive relationships with peers or family members. Signs of an abusive relationship include unexplained bruises, a swollen face, or other injuries, particularly if the student refuses to discuss them.
• Risk-taking behaviors. Risk-taking behaviors often co-occur and are symptomatic of underlying emotional or social problems. Such behaviors as unprotected sex, alcohol or other drug use, driving recklessly or without a license, petty theft, or vandalism can be an indication that something is wrong.
• Signs of an eating disorder. An eating disorder is an unmistakable sign that a student needs help. A dramatic change in weight that is not associated with a medically supervised diet may also indicate that something is wrong.
• Difficulty in adjusting to gender identity. Gay, lesbian, bisexual, transgender, queer, and intersex teens are a vulnerable population and have higher suicide attempt rates than their heterosexual peers. While coming to terms with gender identity can be challenging for many young people, LGBTQI youth face social pressures that can make this adjustment especially difficult, particularly if they are not in a supportive environment.
• Bullying. Children and adolescents who are bullied, as well as those who bully, are at increased risk of depression and suicidal ideation. (Bullying and Suicidal Ideation and Behaviors: A Meta-Analysis Melissa K. Holt, Alana M. Vivolo-Kantor, Joshua R. Polanin, Kristin M. Holland, Sarah DeGue, Jennifer L. Matjasko, Misty Wolfe, Gerald Reid
  Pediatrics Feb 2015, 135 (2) e496-e509; DOI: 10.1542/peds.2014-1864)
  • Ask the Tough Questions: Do not be afraid to ask a student if they have considered suicide or other self-destructive acts. Research has shown that asking someone if they have contemplated self-harm or suicide will not increase that person's risk. Rather, studies have shown that a person in mental distress is often relieved that someone cares enough to inquire about the person's well- being. Your concern can counter the person's sense of hopelessness and helplessness. However, you need to be prepared to ask some very specific and difficult questions in a manner that doesn't judge or threaten the young person you are attempting to help. For example:
    1. Sometimes when people feel sad, they have thoughts of harming or killing themselves. Have you had such thoughts?
    2. I've noticed you are going through some rough times. Have you ever felt your life is a burden on others? Do you ever wish you could go to sleep and not wake up?
    3. Are you thinking about killing yourself?
  • Be Persistent: The person you are contacting may feel threatened by your concern. They may become upset or deny that they are having problems. Trust your instinct and be consistent and firm, and make sure that they get the help they need.
  • Be Prepared to Act: You need to know what to do if you believe a student is in danger of harming themselves. Know the school's procedures from the crisis response plan for this situation and explain to the student the steps you will be taking.
  • Do Not Leave a Student at Imminent Risk of Suicide Alone: If you have any reason to suspect that a student may attempt suicide or otherwise engage in self-harm, you need to remain with the student (or see that the student is in a secure environment, supervised by caring adults) until professional help can be obtained.
  • Get Help When Needed: If you believe that the student is in imminent danger, you, or another member of the school staff, should call 911 or (800) 273-TALK (8255). Tell the dispatcher that you are concerned that the person with you "is a danger to themselves" or "cannot take care of themselves." These key phrases will alert the dispatcher to locate immediate care for this person with the help of police. Do not hesitate to make this call if you suspect that someone may be a danger to him- or herself. It could save that person's life.
  • Use Your School's Support System: School districts have crisis plans for working with students who are experiencing emotional or behavioral distress Familiarize yourself with these plans and use them when appropriate.
  • Connect with Parents or Guardians: Do not promise confidentiality to anyone when it comes to issues regarding their safety. If a student opens up to you about their feelings, talk privately with them about putting the steps of the school's crisis plan in place, and include them in the conversation. Follow the school's communication plan for contacting parents or guardians when a student is at risk. If you believe that contacting the parents or guardian may further endanger the child (if, for example, you suspect physical or sexual abuse), contact the proper authorities. School staff are mandated reporters and are required to report suspected child abuse.

After a Suicide: A Toolkit for Schools American Foundation for Suicide Prevention and the Suicide Prevention Resource Center
Suicide Postvention: The Role of the School Community After a Suicide Kognito recorded webinar using the After a Suicide Toolkit
After a Suicide Resource Directory offers links to resources for coping with grief, trauma, and distress - The downloadable Handbook guides people through the first steps toward recovery and a hopeful future after a suicide attempt.
Suicide Prevention Resource Center: Help and Hope Survivors of Suicide Loss
Suicide Prevention Resource Center: Survivors of Suicide Loss

For Parents

Suicide Prevention Information for Parents, Society for the Prevention of Teen Suicide
Children, Teens, and Suicide Loss
How to Talk to a Child about a Suicide Attempt in Your Family

Suicide is a public health issue. Media and online coverage of suicide should be informed by using best practices. The way media cover suicide can influence behavior negatively by contributing to contagion or positively by encouraging help-seeking. See the following resources for best practices when reporting on a death by suicide: Reportingonsuicide.org
Talking About Suicide and LGBTQI Populations-Media Guide
Action Alliance Framework for Successful Messaging
How Facebook is Building a Safer Community with New Suicide Prevention Tools
Forefront 13 Reasons Why Media Statement & Talking Points

Social Media Campaigns that Promote Help-seeking
#BeThe1To
Take 5 to Save Lives
King County Public Health Effects of Adverse Childhood Experiences
Logic's 1-800-273-8255 music video
One Conversation Saved My Life YouTube video
We R Native For Native Youth, By Native Youth
Bring Change to Mind a high school program for students to develop Public Service Announcements promoting mental health.

Crisis Lines
National Suicide Prevention Lifeline provides immediate assistance to individuals in suicidal crisis by connecting them to the nearest available suicide prevention and mental health service provider through a toll-free telephone number: (800) 273-TALK (8255).
Ayuda en Español
Lifeline Crisis Chat provides online emotional support, crisis intervention, and suicide prevention services. The chat specialists listen and support you through whatever difficult times you may be facing.
Crisis Text Line: Text HEAL to 741741 from anywhere in the USA, anytime, about any type of crisis. A live, trained Crisis Counselor receives the text and responds quickly.
Trans Lifeline 877-565-8860 This line is primarily for transgender people experiencing a crisis.

Apps
A Friend Asks Don't be afraid to ask for help for a friend or yourself.
MY3 Lets you stay connected when you are having thoughts of suicide.
Suicide Safe from the Substance Abuse and Mental Health Administration, this suicide prevention app will help providers integrate suicide prevention strategies into practice and address suicide risk.

Websites:
Department of Health Youth Online Services and Resources
Department of Health Suicide Prevention Resource Map a new statewide tool: select the green submit button, and go to the map tab. Select boxes to filter map resources.
Forefront Suicide Prevention, University of Washington

Articles & Research:
Teen Suicide: "The Time for Secrecy is Over", Web MD
Preventing Suicide Breaking the Silence
8 Myths About Suicide That Every Educator and Parent Should Know
Evidence Shows Efficacy of Mental Health Programs in Schools
Caring Letters Prevent Suicide
Advancing Research to Prevent Youth Suicide

National Resources on Suicide and Suicide Prevention:
The American Foundation for Suicide Prevention
Suicide Prevention Resource Center
American Association of Suicidology
Suicide Awareness Voices of Education (SAVE)
Society for the Prevention of Teen Suicide