Meeting This Moment – Facilitating Suicide Prevention Workshops for Youth in School and Community Settings

In this episode, Mo talks with Anole about this toolkit, why it is needed, the research that informed its creation, and how it can be used in prevention.

Episode Transcript

(00:00):
Welcome to Resource On The Go, a podcast from the National Sexual Violence
Resource Center on understanding, responding to, and preventing sexual assault
and abuse. I'm Mo Lewis, Prevention Coordinator at NSVRC. On today's episode,
I'm talking with Anole Halper, Clinical Social Worker and
Public Health Professional, about the toolkit they created for the North

Carolina Coalition Against Sexual Assault called Meeting This Moment (00:20):
Facilitating
Suicide Prevention Workshops for Youth in School and Community Settings.

(00:48):
Thanks, Anole, for being here. I'm really glad that you are able to
be part of the podcast. I love this
toolkit. And I'm wondering if you can tell me just more about the
creation of it, where you got the idea, how it came to be.
Absolutely. Well, yeah, thank you so much for having me. I'm really honored
and excited to be here as well. So yeah, I've had an interest

(01:12):
in suicide prevention for many years and have practiced clinical or clinical
adjacent kind of social work with youth in mental health crisis for a
few years. I've talked through suicidality with many young people, minors
and adults. So a colleague of mine who I knew, known for many
years at the North Carolina Coalition Against Sexual Assault, reached out

(01:35):
to me because her rape prevention education grant
recipients, so these are folks who do presentations with youth in school
and community settings, and even though they were there to talk about sexual
violence prevention and consent and sexual health and stuff like that,
the youth they were working with were bringing up the serious emotional

(01:56):
distress and hopelessness and suicide that they were experiencing and that
their friends and friend groups were experiencing. And they were kind of
at a loss for how to navigate this, like they didn't have any
training on this and they felt like they needed some support.
So they reached out to my colleague at
NCCASA who oversaw that prevention program. And so

(02:19):
NCCASA contracted with me to come up with a model that could be
used by these grant recipients. So I definitely want to give credit to
NCCASA. This is their project. I was the consultant who worked on it.
So we kind of fleshed it out over a few years,
culminating in a toolkit about how to deliver these mental health workshops
to youth. Yeah, I love this toolkit. Being able to read through it,

(02:43):
I was thinking this is exactly what I could have used many years
ago. And I feel like it's something that many people can use now.
So what all is included in the toolkit?
Yeah, so it basically breaks down in 13
pages why and how to hold these workshops. So the way the workshops
work, I think we'll get a lot into the why

(03:03):
in this conversation, kind of explaining the necessity of this intervention.
But the way the workshops work, they empower young people to design a
crisis plan for themselves, maybe using an app or another tool in a
group setting where everyone around them is also sharing and normalizing
their experiences of distress and coping skills. So that's a lot of words.

(03:26):
Let me kind of explain what that might look like. So for example,
the facilitator says, how do you know when you're having a hard time?
And the participants are jotting this down in an app or on a
piece of paper that's called a crisis plan or a safety plan.
And then someone might also say at the same time,

(03:47):
I shut down and I stop talking. And the facilitator could be like,
oh, you shut down and stop talking. They could flip chart it.
They could be like, that's normal. Does anyone else have that kind of
thing happen? Does anyone else shut down when they're having a hard time?
Yeah, that can happen. And go through and really collectively
kind of build an understanding of this is what it looks like when

(04:08):
we're struggling and this is how we cope. So the coping skills are
also kind of the second piece of that. So how do you cope
when you're having a hard time? You send memes? Who else sends memes?
Right. We love memes. So the outline theoretical model workshop also includes
discussion of how to navigate boundaries with friends and how to loop in
adults because we know that young people talk to each other about suicide

(04:32):
and really depend on their friend groups. And research shows that these
peer groups are really helpful, but also that they feel ill-equipped to
navigate crisis. And so we want to support them in feeling resourced and
prepared to set healthy boundaries. I like all the elements that are included.
It seems so robust and it's a lot of things that I think

(04:54):
any sort of prevention educator would want to know about or have included
in this toolkit. And when I read it, I also was kind of
blown away at some of the things that were really different
about this toolkit than some things that we think about normally in doing
sexual violence prevention work. So a lot of times we talk about prevention

(05:17):
needing to be really specific to a community or group.
And this is like the opposite of being targeted. Instead of pulling people
out or talking with only specific groups or really making it specific to
a community, the recommendation here is to have it really be broad and
reach a wide audience. And so I'm wondering if you can say more

(05:39):
about why that is and why that works.
Absolutely. So yeah, I feel that I have a long answer to this.
So first I kind of want to lay out the existing kind of
landscape of conventional mental health interventions for suicide, especially
with youth. So if you look at a model like
Mental Health First Aid that's been widely adopted, the conventional model

(06:01):
for suicidality is you assess that there's risk, maybe do a little bit
of empathizing and active listening, and then get them professional help.
So it's like the referrer, referrer. So let's say that you're a 14
year old who's struggling, you finally work up the nerve to share that
with your teacher, they took a training, they're like, thank you for telling
me, I'm sorry, you're hurting, let's go to the counselor. So you're like,

(06:22):
okay, appreciate the empathy, but you're shuffled to the
office, it's a little bit disorienting. The counselor says, wow, thanks
for telling me, they ask you a bunch of questions, they do some
assessment, maybe they do a little bit of safety
planning, but they have 1000 clients at the
school, you're really at risk and they're worried and you can tell that
they're worried. And so they're like, I'm here for you, but you also
have to see a therapist in the community. And I also have to

(06:44):
tell your parents and, here's a list of
referrals, maybe they call your parents give them the list of referrals.
And I totally, Anole, I'm stepping out of this scenario, I get where
this is coming from. Folks want to get people the appropriate level of
care. And I think there's also a lot of concern in the world
about liability. But I think sometimes in that concern about liability,

(07:08):
we lose sight of the basics of what people with SI are actually
experiencing and what they need, and what actually works. And so yeah,
can I use my really crude metaphor that I used in... Yes. I love any sort
of metaphor. I feel like... Yeah, I said certain interventions for suicidality

(07:33):
are like covering your ass with something transparent. What's the point?
If this intervention doesn't actually work, we're not actually doing the
right thing for liability, like the school is saying, oh, we referred the
person out to the therapist, but the kid never sees the therapist because
they can't access the therapist because of when their parents work and insurance,

(07:55):
and they don't have a ride and whatever
else, how effective is that at checking the box? That box is unchecked.
It's a lot of roadblocks. Right, the school pretends they're checking boxes,
but the experience for the actual individual who's experiencing pain
is, yeah, one of the folks I quoted in the toolkit is like,

(08:16):
it's like navigating this maze of these riddles, it just feels really impossible.
So it's not just that you maybe get referred to a therapist who
doesn't take your insurance, and the ones who do have a waitlist,
and your parents are working and can't take you to the appointment.
It's the message that you got from this process. And so suicidality is
inherently alienating and isolating people experiencing as I feel alien

(08:39):
from those around them. And when we focus on plucking people out of
their world, and their social environment, we are reinforcing that message
on this really deep level. So if the primary causes of SI,
or kind of the emotional experience of it is disconnection and
disenfranchisement, and that model really reinforces both. And so the other

(08:59):
thing that you learn because of that as a 14 year old is
not to disclose again, because nothing supportive actually happened. And
the primary reason that young people don't disclose is fear of breaching
confidentiality, which happened in this case, right? And fear of hospitalization.
And there's a version of the story, especially for youth of color and
disabled youth or both, where the young person is restrained by police and

(09:22):
taken to the hospital and experiences trauma because a great number of people
that are hospitalized for SI do experience trauma, and only are released
after a 48 hour hold, a 72 hour hold, with no healing having
taken place with someone having strip searched them and watch them shower
and then thrown back into this milieu where they still don't know

(09:44):
how to get through the day, right? And how to function and how
to feel kind of safe in their own mind. And so people who
complete suicide tend to not disclose because of these fears. And in one
study, which are justified, right, they are rational. And in one study,
youth who died by suicide had engaged with mental health treatment at the

(10:06):
same rates as those in the comparison group who died by car accidents.
So that was kind of the random sample.
So expecting disclosure of suicidality and then alienating people for disclosing
isn't working. Which is not to say that we never have folks engage
with mental health treat. I think, yeah, this is kind of an aside,

(10:27):
but that is kind of built into the toolkit is like when is
BS being really transparent in the workshop about when a disclosure would
need to take place and allowing folks to share what they feel comfortable
sharing at their own pace and to practice informed
consent and rather than the goal being like to kind of get people

(10:49):
to disclose so you can pull them out and refer them to be
like giving them the option to disclose and letting them know what that
is really going to look like. That might look like we call your
parents or whatever, which is fair and rational
and makes sense. But we're expecting disclosure and then alienating people
for it isn't working. And so, yeah, I think the antidote to that

(11:10):
comes from radical mental health organizations and interventions like the
Icarus Project, the Fireweed Collective and mutual aid
groups and the answer is community. Right? And it's
empowerment, and it's like allowing people to kind of be in control of
their own process and to connect with others while they do that, right?
So that's kind of the basis for this

(11:31):
intervention, how to incorporate and center both those things. And so
yeah, some crisis plans specifically designed for group workshop settings
were designed by people with lived experience. And these democratically
developed tools are politicized. And that framing is particularly relevant
for marginalized youth who are most at risk of suicide and also least

(11:53):
likely to trust and engage with professionals, right? So youth of color,
LGBTQ youth just have higher rates. And yeah, very valid reasons to distrust
these systems. So to kind of wrap up the argument, according to the
2021 Youth Risk Behavior Survey, or YRBS, which is fully back on the

(12:14):
internet, about one in five high school has seriously considered suicide
in the past year. And that's noteworthy because it's the same as the
proportion who are sexually active. So our field recognizes that it's best
practice to provide young people with inclusive safer sex resources without
requiring them to disclose information about their sex lives or go to a

(12:36):
doctor's office. There's some information we recognize it's important to
have widely available, right? And so similarly, we
have to give youth the best tools available to cope with suicidality without
needing them to tell anyone in particular that they're thinking of suicide.
And that might require us to skill up. So just like issues like

(12:59):
sexual violence and STIs have required prevention professionals to learn
how to talk about sex, the youth mental health crisis means that we
might need to grow more comfortable talking about deep emotional pain,
similarly frank and nonjudgmental ways, which can be a little bit awkward.
And I want to acknowledge that. It also sounds so, I don't know,

(13:22):
normalizing. I'm thinking about something related to social norms with this
and just the impact that being in a group of all different people,
just your classmates, your regular everyday people that you have class with
and having people be like, oh yeah, I feel this way too,
or I feel similarly seems like it could have a really positive effect

(13:43):
for people to not feel so alone. Yeah, absolutely. I think that's the
idea. And to have a grownup just being really chill about it with them,
I think also can be, it can be really healing in and of
itself, right? Just that process. And so, yeah, I definitely think that's

(14:05):
part of the logic of it. So one thing I find so interesting
about this resource is that it's a single workshop. It's just like a
one-time 90 minute workshop that any instructor could do in any classroom.
And the reason why it's so interesting to me is because in prevention

(14:26):
specifically, we don't usually recommend that people do
one-time presentations. It's because of this potential boomerang effect
where harmful beliefs could be inadvertently strengthened. But this type
of one-time intervention has been shown to be effective in reducing distress
and risk. And I just, I think it's so cool. And I'm wondering

(14:48):
if you can share more about why this structure is effective.
Yeah, so I first just want to acknowledge that it's kind of the
caveat that we need to give of it's evidence informed, but not evidence
based. Right? So I suspect this will work. I have reason to believe
it will work, but I don't yet have the evidence I'd like yet.
And y'all can be a part of the process of collecting it and

(15:09):
creating that evidence. I did kind of dig into
the research on what they call single session interventions for youth mental
health, SSIs. And I think they're like adjacent, but they're typically,
I think they're typically individual, they're not kind of delivered in a
group setting. But I dug into kind of the principles of what make

(15:33):
them work or not regardless. And this one kind of lit review
came up with this little acronym about it, of course. And basically there
are like these four pieces. They work if they normalize concepts,
if they empower youths to have a helper or expert role,
if they have "saying is believing exercises" to solidify learning, to actually

(15:58):
be practicing it. And if they include testimonials and evidence from valued
others. So I think the only thing it's missing, they wanted brain science
to normalize concepts. So I don't have the brain science, but it is
normalizing the concepts anyway. So I think this has
three and a half out of the four principles of what supposed to

(16:19):
make a single session intervention work. But I think kind of we can
kind of conclude on a broader level why
the boomerang effect might not be there, right? And that's because it's
not about challenging people's existing beliefs. It's not like you think
this about masculinity, but it's wrong. It's about

(16:39):
building on and documenting what they already know about themselves and
have maybe just never put into words or put into words in a
group setting. And so even though the group setting is novel,
I think we've talked a little bit about why it's also really
critical, and I think really central. And I think it's really drawing from

(17:00):
these radical movements whose wisdom and knowledge I trust because they're
coming from folks with lived experience who we need to listen to, right?
And so according to the folks who created this similar intervention called
TMAPs, it's like a little bit more in depth. Person who wrote this
website was probably Sascha Altman DuBrul. He's the founder of the Icarus

(17:22):
Project. So he said, when we make and share our crisis plans with
others, they become potent tools for healing and liberation. Because the
workshop is a collective experience, the process itself can reduce isolation
and risk. Yeah, I don't know if that kind of answers your question.
It totally answers the question. I think it's so powerful to

(17:44):
have people build on their strengths and resources. And it's something that
I think is part of prevention. But I can just see this being
such a great add on or interwoven piece to prevention work that people
are already doing and it would really meet the need that so many young people

(18:07):
are having right now. Doing. And something like you were talking about before,
people going into do prevention, but finding that that's actually not something
you could do quite yet, because there are all these other things that
young people are focused on and thinking about. So yeah,
I'm really a fan. I'm wondering if you could envision people who are

(18:28):
already doing prevention work, like weaving this in or adding it to what
they're doing. Yeah, I mean, I think there's lots of different ways.
I think it could just... It's kind of written out in the toolkit
as like a, I think 60 or 90 minute workshop, I think folks

(18:48):
could absolutely deliver it that way. It includes all the components and
kind of how to deliver them. So hopefully, it feels accessible for folks.
And I also think they could be broken up maybe every week while
you're... Or often you're going into schools or into a community setting.

(19:09):
You could do a piece of it and do like this component or
that component, so that there's some space to air
these things that are really on folks mind. Because I think,
it was like 20% of young people had thought about suicide,
but 40% had experienced severe distress in the 2021 YRBS. And I think

(19:31):
when folks are experiencing that distress and hopelessness, yeah, it can,
like you said, it can just be really hard to focus on other
things, right? And so creating space to air,
yeah, this might be something that's coming up right
now. And you might be suffering with this, we're going to create some
room to talk about it can just allow folks the spaciousness to like,

(19:57):
be present to what you want to say about sexual violence prevention and
condoms, but also their math class, and maybe dinner that night. Because
I think so often when people are suffering, there's this cognitive,
this very painful cognitive dissonance between the daily tasks that they're

(20:19):
being asked to perform, and this intense existential pain that they're in.
And there's that mismatch can be maybe even more painful than the emotional
experience itself, right? And so by creating space, you're closing that
gap, and allowing folks to bring their feelings into their lives

(20:42):
in a way that I think is really powerful.
Yeah, I think so too. I'm envisioning that people will listen to this
and want to find it and want to use it.
And I know we were talking about how this is evidence informed and
not necessarily evidence based. And one of the things that I love,

(21:05):
I mean, I'm a big fan of things that are evidence informed,
because a lot of this officially research stuff is so
just not a possibility for people. So one of the things that I
love is that you included sample evaluation questions.
And I'm wondering, this is just me being

(21:26):
curious. Are you interested in people reaching out with their evaluation
experiences and how this works for them? Absolutely, I would really,
really love to see folks evaluation results, I would be so excited to
create a spreadsheet and start aggregating and analyzing that data and seeing
what happens. So yeah, folks can email that to

(21:54):
me, [e-mail], first name dot last name. Yeah, it would be
really wonderful. And also just, it doesn't need to be the official eval
results. I'd just love to hear what folks experiences. I'm open to feedback
on this intervention. I'm always down to iterate. Yeah. Yeah. This is great.
Thank you so much. I am wondering, where can people find this resource?

(22:16):
I mean, we're gonna include it in the show notes, of
course. But where else could people find it?
I feel like the show notes is probably the best place because
it's a really long web address and it was kind of... So yeah,
so the North Carolina Coalition Against Sexual Assault is hosting it on
their website. But yeah, the link will be provided directly in the show

(22:39):
notes. I love this. It feels so important
and timely, and unique, and also very deeply
resourced. And made up of so much good, like deep knowledge.
So I'm really glad that you made this. And I'm really glad that

(22:59):
NCCASA asked you to make this. And I'm really glad that you are
also making it available to everybody else. Me too, I'm also really excited
and I'm really appreciative that you kind of see what I put into
it because it's just a white paper, it's just on the internet and
sometimes you're just kind of researching into the

(23:20):
void and you don't really know how it's going to go.
So yeah, I really hope that everyone, that folks who are listening who
are interested, try it out, see how it goes and
give feedback, incorporate some of these ideas into their work and
take what works and ditch what doesn't and stay in touch in community.

(23:40):
Thanks for listening to this episode of Resource On The Go. For more
resources and information about preventing sexual assault, visit our
website at nsvrc.org. You can also get in touch with us by emailing resources
nsvrc-respecttogether.org.