Board Policy on Suicide Prevention

This Board Policy applies to the San Francisco Unified School District and the County Office of Education.

The Governing Board of San Francisco Unified School District recognizes that suicide is a leading cause of death among youth.  In 2019, 15 percent of California seventh graders and 16 percent of ninth and eleventh graders reported that they seriously considered attempting suicide.  (California Healthy Kids Survey 2019). School leaders and staff must ensure their campuses are safe and nurturing environments that mitigate suicidal ideation and behaviors, and that appropriate procedures, protocols and supports are well promulgated and easily accessible to all. 

Recognizing that it is the duty of the district and schools to protect the health, safety, and welfare of its students, this policy aims to safeguard students and staff against suicide attempts, deaths and other trauma associated with suicide, including ensuring adequate support for students, staff, and families affected by suicide attempts and loss.  As it is known that the emotional wellness of students greatly impacts school attendance and educational success, this policy shall be paired with other policies that support students emotional and behavioral wellness.

This policy is based on research and best practices in suicide prevention and has been adopted with the understanding that suicide prevention activities decrease suicide risk, increase help-seeking behavior, identify those at risk of suicide, and decrease suicidal behaviors. Empirical evidence refutes a common belief that talking about suicide can increase risk or “place the idea in someone’s mind.”

In an attempt to reduce suicidal behavior and its impact on students and families, the Superintendent or designee shall develop strategies for suicide prevention, intervention, and postvention, and the identification of the mental health challenges frequently associated with suicidal thinking and behavior. These strategies shall include professional development for school personnel who regularly interact with students or are in a position to recognize the risk factors and warning signs of suicide.

The Superintendent or designee shall develop and implement preventive strategies and intervention procedures that include the following:

Overall Strategic Plan for Suicide Prevention

The Superintendent or designee has consulted with school and community stakeholders, school-employed mental health professionals (e.g., school counselors, school psychologists, school social workers, mental health therapists, and nurses), administrators, other school staff members, the county mental health plan, and suicide prevention experts in planning, implementing, and evaluating the district’s strategies for suicide prevention and intervention. The District can also work in conjunction with local government agencies, community-based organizations, and other community supports to identify additional resources. These stakeholders shall convene at a minimum every 5 years to update this policy as necessary.

To ensure the policies regarding suicide prevention are properly adopted, implemented, and updated, the district shall appoint the Student & Family Services Division as the suicide prevention point of contact for the district. As a best practice, it is encouraged that each school identify a liaison to the district’s suicide prevention point of contact, and coordinate and implement suicide prevention activities on their specific campus.

Prevention

A. Messaging about Suicide Prevention

Messaging about suicide has an effect on suicidal thinking and behaviors. Consequently, SFUSD designated staff will continue to review all materials and resources used in awareness efforts to ensure they align with best practices for safe messaging about suicide.

B. Suicide Prevention Training and Education

SFUSD will provide suicide prevention and awareness training to all district staff who regularly interact with students or are in a position to recognize the risk factors and warning signs of suicide.

Training:

• All suicide prevention trainings shall be offered under the guidance of school-employed mental health professionals (e.g., school counselors, school psychologists, school social workers, mental health therapist, and school nurse). Staff training can be adjusted year-to-year based on previous professional development activities and emerging best practices.
• At least annually, staff receive training on the risk factors and warning signs of suicide, suicide prevention, intervention, referral, and postvention including:
  • Suicide risk factors, warning signs, and protective factors
  • How to talk with a student about thoughts of suicide           
  • How to respond appropriately to the youth who has suicidal thoughts. Such responses shall include constant supervision of any student judged to be at risk for suicide and an immediate referral for a suicide risk assessment
  • Immediately referring (same day) any student who is identified to be at risk of suicide for assessment while staying under constant monitoring by staff member
  • Reducing stigma associated with mental illness and that early prevention and intervention can drastically reduce the risk of suicide

In addition to the training above, ongoing annual staff professional development for all staff should include the following components:

• The impact of traumatic stress on emotional and mental health
• Common misconceptions about suicide
• School, district, and community suicide prevention resources
• Appropriate messaging about suicide (correct terminology, safe messaging, stigma reduction)
• How to identify youth who may be at risk of suicide (risk factors, warning signs, protective factors)
• How to talk to with a student demonstrating emotional distress or is suicidal (based on district guidelines)
• How to respond and link the student to supports based on district guidelines
• District-approved procedures for supporting students returning to school after exhibiting suicidal behavior.
• Responding after a suicide occurs (suicide postvention)
• The professional development includes additional information regarding groups of students who may be at elevated risk for suicide. These groups include, but are not limited to, the following:
  • Youth bereaved by suicide
  • Youth with a history of suicide ideation or attempts
  • Youth with disabilities, mental illness, or substance abuse disorders
  • Youth experiencing housing instability or in out-of home placements (ie, foster youth)
  • Lesbian, gay, bisexual, transgender, or questioning youth

The Superintendent or designee is encouraged to use the YRBSS (Youth Risk Behavior Surveillance System) or other available survey data to determine the prevalence of suicidal ideation and behaviors, including patterns or trends, among all students, and particularly among identified high-risk student populations.

C. Employee Qualifications and Scope of Services

Employees of SFUSD must act only within the authorization and scope of their credential or license. It is expected that staff be able to identify suicide risk factors and warning signs and connect students to district employed mental health professionals for further assessment and intervention.

D. Specialized Staff Training

Additional professional development in suicide risk assessment and crisis intervention is encouraged for district mental health professionals (school counselors, school psychologists, school social workers, mental health therapists, and nurses).

E. Parents, Guardians, and Caregivers Participation and Education

To the extent possible, parents/guardians/caregivers should be included in all suicide prevention efforts. At a minimum, schools shall share with parents/guardians/caregivers the SFUSD suicide prevention policy and procedures.

• This suicide prevention policy shall be prominently displayed on the SFUSD Web page and included in the parent handbook.
• Parents/guardians/caregivers should be invited to provide input on the development and implementation of this policy.
• All parents/guardians/caregivers should have access to suicide prevention training that addresses the following:
  • Suicide warning signs, risk factors, and protective factors;
  • How to approach and talk with their children about thoughts of suicide;
  • How to respond appropriately to the student who has suicidal thoughts; constant supervision of any student judged to be at risk for suicide and referral for an immediate suicide risk assessment.

F. Student Participation and Education

Under the supervision of school-employed mental health professionals, curriculum for students shall be developmentally appropriate, student-centered and include:

• Individual or group instruction as appropriate to students in problem-solving, coping, and resiliency skills to promote students' mental, emotional, and social health and well-being, as well as instruction in recognizing and appropriately responding to warning signs of suicidal intent in others.
• The content of the education shall include:
  • Coping strategies for dealing with stress and trauma;
  • How to recognize behaviors (warning signs) and life issues (risk factors) associated with suicide and mental health issues in oneself and others;
  • Help-seeking strategies for oneself and others, including how to engage school-based and community resources and refer peers for help;
  • Emphasis on reducing the stigma associated with mental illness and the fact that early prevention and intervention can drastically reduce the risk of suicide.
  • Guidance on district suicide prevention, intervention and referral procedures.

SFUSD encourages the development and implementation of programs and/or activities on campus that raise awareness about mental wellness and suicide prevention (e.g. Mental Health Awareness Month, Suicide Awareness Month, Peer Counseling Programs and National Alliance on Mental Illness campus clubs)

Intervention, Assessment, Referral

A. Staff

Every statement regarding suicidal intent shall be taken seriously. Whenever a staff member suspects or has knowledge of a student's suicidal intentions based on the student's verbalizations or act of self-harm, the staff member shall promptly notify the appropriate staff including the principal and the school counselor, mental health therapist, social worker or nurse.  When suicidal intent or potential risk is reported, the principal or designee shall: 

1. Refer the student to the School Social Worker or mental health therapist to complete a suicide risk assessment.
2. After a suicide risk assessment has been completed, the School Social Worker or mental health therapist consults with Comprehensive Crisis Services. Comprehensive Crisis Services may conduct an assessment to determine whether a 5585 hold needs to be put in place to keep the student safe.
3. Keep the student under continuous adult supervision and provide comfort to the student until the parent/guardian and/or appropriate support agent or agency can be contacted and has the opportunity to intervene.

If the risk is imminent:

1. Contact Comprehensive Crisis Services, paramedics, law enforcement (911) and/or other emergency assistance if a suicidal act is being actively threatened.
2. Remove other students from the immediate area as soon as possible
3. Contact the parent/ guardian
4. Keep the student under continuous adult supervision and provide comfort to the student until the parent/guardian and/or appropriate support agent or agency can be contacted and has the opportunity to intervene.

B. Parents, Guardians, and Caregivers

A referral process should be prominently disseminated to all parents/guardians/caregivers, so they know how to respond to a crisis and are knowledgeable about the school and community-based resources.

C. Students

Students shall be encouraged to notify a staff member when they are experiencing emotional distress or suicidal ideation, or when they suspect or have knowledge of another student’s emotional distress, suicidal ideation, or attempt.

Whenever schools establish a peer counseling system to provide support for students, peer counselors shall receive training that includes identification of the warning signs of suicidal behavior and referral of a suicidal student to appropriate adults.

Student identification cards for students in grades 7-12 shall include the National Suicide Prevention Lifeline telephone number and may also include the Crisis Text Line and/or a local suicide prevention hotline telephone number and the National Domestic Violence Hotline or the local domestic violence hotline.

D. Parental Notification and Involvement

SFUSD shall identify a process to ensure continuing care for the student identified to be at risk of suicide. The following steps should be followed to ensure continuity of care:

• After a referral is made for a student, school staff shall verify with the parent/guardian/caregiver that follow-up treatment has been accessed. In the event that a student is hospitalized (5585 hold) strongly encourage parent/ guardian/caregiver to sign an authorization for release of information form with Comprehensive Crisis Services and the hospital so that the discharge plan can be shared with the School Social Worker and School District Nurse before the student returns to school. The school will schedule a Re-Entry meeting with parents/guardians/caregivers to develop a plan for supporting the student and incorporating any guidance from treatment providers.
• If parents/guardians/caregivers refuse or neglect to access treatment for a student who has been identified to be at-risk for suicide or in emotional distress, the staff member will meet with the parent/guardian/caregivers to identify barriers to treatment and work toward reducing barriers, understanding the importance of care, and supporting access to services. District staff will follow mandated reporting laws as necessary to report child neglect.

E. Action Plan for In-School Suicide Attempts

If a suicide attempt is made during the school day on campus, it is important to remember that the health and safety of the student and those around him/her is critical. The following steps should be implemented:

• Follow district protocol for calling Safety and Security and 911 and give them as much information about any suicide note, medications taken, and access to weapons, if applicable;
• Remain calm, remember the student is overwhelmed, confused, and emotionally distressed;
• Move all other students out of the immediate area;
• Immediately contact the administrator and/or site wellness provider.
• If needed, provide medical first aid until a medical professional is available;
• Parents/guardians/caregivers should be contacted as soon as possible;
• Do not send the student away or leave them alone, even if they need to go to the restroom;
• Provide comfort to the student.
• Listen and encourage the student to talk, if this helps calm them
• Be comfortable with moments of silence as you and the student will need time to process the situation;
• Review options and resources of people who can help;
• Offer help, and be respectful, but do not promise confidentiality;
• Student should only be released to parents/guardians/caregivers or to a person who is qualified and trained to provide help.

F. Action Plan for Out-of-School Suicide Attempts

If a suicide attempt by a student is outside of SFUSD property, it is crucial that the district protects the privacy of the student and maintain a confidential record of the actions taken to intervene, support, and protect the student. The following steps should be implemented:

• Designated staff should contact parents/guardians/caregivers and offer support to the family;
• Discuss with the family options for response to the attempt. Obtain permission from the parents/guardians/caregivers to share information to ensure the facts regarding the crisis is correct while protecting the confidentiality of the students and minimizing rumors;
• Provide care and determine appropriate support to affected students;
• Offer to the student and parents/guardians/caregivers steps for re-integration to school.

G. Re-Entry after a Mental Health Crisis

Steps to take after a mental health crisis include:

• Treat every threat with seriousness, approach with calm manner; make student a priority.
• Listen actively and non-judgmentally; let the student express their feelings.
• Acknowledge the feelings and do not argue with the student.
• Offer hope and let the student know they are safe, and that help is available.
• Do not promise confidentiality or cause stress.
• Explain calmly and get the student to a skilled mental health professional or designated staff to further support the student.
• Keep close contact with the parents/guardians/caregivers/families and mental health professionals working with the student.

H. Re-Entry to School After a Suicide Attempt

The following steps should be implemented upon the student’s re-entry:

• Obtain a written release of information signed by parents/guardians/caregivers/families and providers. (Authorization for Release of Information for SFUSD Wellness Programs, Comprehensive Crisis Services, and hospital where child was hospitalized)
• School or District mental health professionals:
  •  Confer with the student and parents/guardians/caregivers/families about any specific requests on how to handle the situation.
  • Confer with the student and parents/guardians/caregivers/families to develop a safety plan.
  • Inform the student’s teachers about possible days of absences,
  • Work with parents/guardians/caregivers/families to involve the student in an aftercare plan
  • Provide parent’s/guardians/caregivers/families local emergency numbers for after school and weekend emergency contacts.
• Teachers and administrators shall allow accommodations for student to make up work
• Mental health professionals or trusted staff members shall maintain ongoing contact to monitor student’s actions and mood.

I. Responding After a Suicide Death (Postvention)

A death by suicide in the school community (whether by a student or staff member) can have devastating consequences on students and staff. Therefore it is vital to have a plan prepared ahead of time in the event such a tragedy occurs, as part of the school’s Crisis Response Plan.  The plan shall include:

• No information shall be released about the death until after consultation with SFUSD Crisis Response Teams
• Contact the SFUSD Crisis Response Coordinator
• Notify District and Site Crisis Teams
• Contact SFUSD Communications
• Identify a staff member to contact the deceased’s family (within 24 hours);
• Coordinate an emergency all-staff meeting, to include:
  • Notification (if not already conducted) to staff about suicide death;
  • Emotional support and resources available to staff;
  • Notification to students about suicide death and the availability of support services (if this is the protocol that is decided by administration);
  • Share information that is relevant and that which school has permission to disclose.
  • Depending on the grade level, make a plan to share information with students. A script should be followed so all staff are sharing the same information. School Social Worker, administrator, or teacher informs students who were close to the student or staff member in a contained, trauma informed setting, while other students are being informed. Timing is critical.
• Prepare staff to respond to needs of students regarding the following:
  • Review of signs of emotional distress and suicide ideation
  • Review of protocols for referring students for support/assessment;
  • Talking points for staff to notify students;
  • Resources are available to students (on and off campus).
• Identify students significantly affected by suicide death and other students at risk of imitative behavior;
• Identify students affected by suicide death but not at risk of imitative behavior;
• Communicate with the larger school community about the suicide death and availability of support services;
• Consider working with family regarding funeral arrangements for family and school community;
• Requests for memorial must be approved by the Crisis Response Team, Secondary or Elementary Education and Safety and Security.
• Utilize and respond to social media outlets to identify what platforms students are using to respond to suicide death
• Include long-term suicide postvention responses:
  • Consider important dates (i.e., anniversary of death, deceased birthday, graduation, or other significant event) and how these will be addressed
  • Support siblings, close friends, teachers, and/or students of deceased

Suicide Prevention K-6 Explanation

Suicide Prevention

The district knows that suicide is a concern and tragedy that affects young people, families, and communities. All adults, both in and outside of schools, can help stop suicide. Adults at the school who speak with kids may be a big help to students when they are having thoughts about dying.

Teachers and other adults at school will learn about suicide awareness and prevention.

The Superintendent or Designee shall develop and implement preventive strategies and intervention procedures that include the following:

Overall Strategic Plan for Suicide Prevention

The district will talk with parents, school employed mental health therapists, social workers, school psychologists, and counselors as well as mental health professionals from community-based agencies, and read the county mental health plan to learn more about what help kids need. Science shows talking about the prevention of suicide works to prevent attempts.  A specific person at the district and each school will be in charge of making sure the plan is happening.

Prevention

A. Messaging about Suicide Prevention

Talking about suicide works to prevent the number of attempts. The district will check with experts to make sure they use the best information.

B. Training

Teachers and other adults will learn about suicide awareness and prevention.

Training:

• Once a year adults will be taught how to notice if kids are thinking about suicide.
• Adults at school will learn about
  • What to look for;
  • How to talk with kids about suicide;
  • Who to call when someone is thinking about suicide;
  • How to identify appropriate mental health services, both at the school site and within the community
  • How to refer students and their families to mental health services within the school and community;
  • Information about the feelings of kids at school;
  • The plan to help kids, staff, and others deal with their feelings when a suicide or suicide attempt occurs;
  • How to look for patterns in data from surveys and other places.

The district will do its best to help kids who are at higher risk of suicide. Kids who might be at higher risk are kids who know someone who died by suicide; kids with disabilities; kids with mental illness; kids who use drugs or alcohol; kids who are homeless or who are in foster care; and kids who are lesbian, gay, bisexual, transgender, or questioning youth.

C. The people who do the work will be experts

People who work for the district will only do the jobs they are allowed to do. People who work for the district should not try to detect or treat mental illness unless they have learned how. There will be some people specially trained to help kids that are thinking about suicide.

D. Training for experts

Even the experts will have lessons on how to better help kids who are thinking of suicide. The district will do its best to help kids who are at higher risk of suicide. Kids who might be at higher risk are kids who know someone who died of suicide; kids with disabilities; kids with mental illness; kids who use drugs or alcohol; kids who are homeless or who are in foster care; and kids who are lesbian, gay, bisexual, transgender, or questioning youth.

E. Parents, Guardians, and Caregivers Participation and Education

The district will give families information on the different reasons why kids might think of suicide. The district will also give families ideas on ways to help kids. The signs of suicide will also be shared with families. The district will make sure families know how concerning the problem of suicide is. The district will also tell families about what the district is doing to help. The district will remind families to talk to people at the school if they think they know a student who might be thinking of suicide. The district will also tell them who else might be able to help.

F. Student Participation and Education

The schools will use Social Emotional Learning curriculum/lessons to teach kids about their feelings and how to ask for help when they need it.

The schools will use Positive Behavior Intervention Systems (PBIS) to create positive and welcoming schools and provide support to all students (including activities and other ways to make kids feel like a part of the school and know that teachers and others at school care for them and want them to do well.

The school will teach kids how to deal with upsetting situations. This will also include lessons on how to stay calm and manage big or overwhelming feelings even when things go wrong. Finally, kids will be taught the warning signs of what to look for when others are considering suicide.

The schools will use a Multi-Tiered System of Support (MTSS) to find out give more support to those students that need it.

The schools encourage kids to tell teachers and other adults when they are thinking of suicide or when they think another student might be thinking of suicide.

The school will help kids when they tell someone they are thinking of suicide or try to die by suicide.

Intervention, Assessment, Referral

A wellness provider or administrator will be called if any adult thinks a student might be thinking of suicide. They will help.

A. Parents, Guardians, and Caregivers

Information for families will be shared so they know what to do and where to go for help.

B. Students

Students should tell teachers and other adults when they are thinking of suicide or when they think another student might be thinking of suicide.

C. Parent Notification and Involvement

The school will check with families to make sure any student who was thinking of suicide is continuing to get help.

If families do not get help, then the school will call to see if they can do anything to help. If the families still do not get help for the student who is at risk for suicide, the Child Protective Services will be called.

Action Plan for In-School Suicide Attempts

If a suicide is tried at school here are things the adults will do:

• Stay with the student;
• Remain calm;
• Move all other students out of the area;
• Contact the principal or wellness provider;
• Call 911 and give them as much information as they you know;
• Do what you can to help the student;
• Call the family;
• Listen and talk with the student;
• Let them know there is help;
• Be ok if the student doesn’t want to talk;
• Be patient with the student;
• Let the student know you will not tell everyone. Just the people who can help will be told;
• If appropriate, let the student go home with the parents or another person specially trained.

D. What will happen when a suicide attempt is made away from school

If a suicide is tried away from school, here are things the adults will do:

• Call the family;
• Talk to the family about how the school can help;
• Get permission from the family to share information with the people at school who can help;
• Pick an adult to be the one who talks to the adults outside of school who are helping;
• Work with the family to make a plan to help the student with their problems;
• Work with family to bring the student back to school when it is appropriate.

E. Supporting Kids after a Mental Health Crisis

After the crisis has happened adults will:

• Treat suicide seriously and stay calm;
• Listen to the student;
• Not argue with the student;
• Offer hope and let the student know they are safe, and help is coming;
• Get the student help;
• Keep talking to people who care for the student.

F. Coming back to School After a Suicide Attempt

When a student comes back after they say they are going to try suicide the adults will:

• Get permission from family to share information with the people at school who can help;
• Ask the student and family if there is anything the school can do to make coming back to school easier;
• Let the teachers know if the student will miss any days;
• Let the student make up any schoolwork;
• Keep talking to the student to make sure they are feeling better;
• Work with the family and student to keep getting help.

G. Responding After a Suicide Death

If a student or adult dies by suicide, the adults at the school will:

• Make sure it is true and not a rumor before responding;
• Call the family;
• Have a meeting of the adults chosen to respond;
• Talk to all the people who work at the school;
• Talk to the kids who knew the student or adult;
• Share resources and strategies with students and families to help students process and cope
• Make sure others get help if they are thinking of doing the same thing.