Therapeutic Interventions

Outline the family history and take steps to prevent any suicide attempt by the child. (1, 2)

Require the child to sign a contract to not engage in self-destructive behavior and to contact a counselor or other concerned adult if the

1. Gather information about the family and the child's social/ emotional functioning, symptoms of depression episodes, and previous suicidal thinking or attempts.

2. Collaborate with the parents to develop a plan designed to prevent any suicide attempts (e.g., seeking immediate psychiatric intervention, remove all lethal weapons from the child's access, form a 24-hour suicide watch during the crisis period).

3. Assist the parents in eliciting a signed commitment from the child to control suicidal behavior and to contact a trained mental health professional, or a urge to die becomes overwhelming. (3, 4, 5)

3. Schedule an evaluation for the child at a psychiatric hospital or clinic to determine if hospitalization is needed to prevent a suicide attempt. (6, 7)

4. Seek medical intervention for the child to determine the need for antidepressant medication. (8, 9)

5. Communicate regularly with the child's treatment team suicide prevention hotline if the desire to commit suicide becomes overpowering.

4. Provide the parents with a 24hour suicide prevention hotline number and other emergency access numbers; strongly recommend that these numbers be carried at all times by the child and other responsible family members.

5. Assign the parents to encourage the child to disclose to a mental health professional any thoughts of suicide including specific plans, availability of lethal materials, written suicide notes, and previous attempts.

6. Facilitate the parents in scheduling a complete psychiatric evaluation for the child to assess the child's current suicidal thinking and to develop treatment recommendations.

7. Support the parents and the child in accepting hospitalization, if necessary, to prevent self-destructive behavior and return the child to emotional stability.

8. Advise the parents to consult with a physician to determine the need for medication or other medical intervention to treat the child's depression.

9. Encourage the parents to monitor the effects of antidepressant medication upon the child's social/emotional adjustment (e.g., be alert to any increase in strength of suicidal urge).

10. Assign the parents to attend appointments with the child's and assist the child in implementing all treatment recommendations. (10, 11)

6. Verbalize a deeper understanding of the child's self-destructive behavior, its causes, and recommended interventions. (12, 13, 14)

7. Explore the child's feelings related to suicide and depression and assist in identifying appropriate methods for expressing these feelings. (15, 16, 17)

treatment team; review and process the recommended treatment strategies.

11. Assist the parents in accessing the level of care recommended for the child's suicidal behavior (e.g., inpatient, residential, partial hospital, or outpatient).

12. Encourage the parents and the child to participate in a suicide support group.

13. Direct the parents and the child to informational resources offering interventions for preventing adolescent suicide (e.g., American Foundation for Suicide Prevention (AFSP): www.afsp.org; Suicide Prevention Advocacy Network (SPAN): www.spanusa.org).

14. Assign the parents and the child to read literature which describes adolescent suicide, its causes and coping strategies (e.g., Out of the Nightmare by Conroy, Suicide: The Forever Decision by Quinnett, or Choosing to Live by Ellis and Newman).

15. Assign the parents to encourage the child to express feelings of frustration, anxiety, hopelessness and helplessness by drawing pictures, writing songs or poems.

16. Assign the parents to engage the child in creating a list of close personal relationships, including family members, friends, teachers, mentors and role models as a network of caring people.

8. Attend drug rehabilitation or substance abuse group sessions. (18, 19)

9. Implement effective communication strategies with the child. (20, 21, 22)

17. Council the parents to help the child reframe situations that trigger feelings of fear, anger, abandonment or sadness by discussing events rationally and logically with their child.

18. Explore the family's history of substance abuse and encourage the parents to seek counseling and rehabilitation for any family members who are addicted.

19. Refer the parents to Alcoholics Anonymous, Alanon, a community drug rehabilitation program, or a school-sponsored class to deal with the child and/or other family members' problems with substance abuse.

20. Role-play with the parents the use of "I" statements (e.g., "I feel . . . when . . . because . . .") with the student as a first step in addressing behavior that disturbs the parent (see Parent Effectiveness Training by Gordon).

21. Meet with the parents and other supportive family members to teach them how to actively listen to the child's feelings (or assign the "Heart to Heart Smart Talks" activity from the Parenting Skills Homework Planner by Knapp).

22. Assign the parents to read How to Talk so Kids Will Listen and Listen so Kids Will Talk (Faber and Mazlish) or Parent Talk (Moorman) to develop additional positive communication skills for use with the child.

10. Implement methods to show empathy for the child's feelings. (23)

13. Encourage the child to participate in activities that promote healthy self-esteem. (24, 25)

12. Grant specific freedoms consistent with the child's demonstrated level of maturity and responsible behavior. (26, 27)

23. Teach the parents or other family members how to express awareness of and empathy for the feelings of helplessness and hopelessness that are contributing to the child's suicidal ideation.

24. Assign the parents to enroll the child in group counseling offered by the school, their faith-based organization or a community agency.

25. Instruct the parents to encourage and affirm the child's behavior that supports healthy self-esteem and positive goals for the future (e.g., engage in moderate exercise, connect with positive and upbeat friends, develop involvement in curricular and extracurricular activities).

26. Emphasize to the parents the importance of extending freedoms only after responsibility has been demonstrated by the child; brainstorm a list of acceptable and unacceptable privileges (e.g., acceptable: watching television after homework is completed; unacceptable: becoming engrossed in television and forgetting about homework) (or assign the "Earning Privileges and Freedoms" activity from the Parenting Skills Homework Planner by Knapp).

27. Teach the parents to use the phrase "Soon you'll be on your own" to encourage the child to earn freedom from parental monitoring and to respond with

13. Monitor the child's daily participation in class and completion of daily academic assignments. (28, 29, 30)

14. Encourage the child to increase social interaction with classmates and friends. (31, 32)

"When you show me you can make healthy and safe choices, you'll be on your own until then I will need to monitor your progress" when the child complains about too much supervision (see Parent Talk by Moorman).

28. Assign the parents to enlist the teacher(s) support in involving the child in compatible cooperative learning groups and projects and in monitoring the child's academic and social adjustment at school.

29. Instruct the parents to assist the child in creating a plan for completing all classroom assignments and to record weekly progress in a personal journal or an assignment planner.

30. Encourage the parents to reinforce the child's academic, family, and social successes by photographing completed projects that trigger personal pride and displaying the photos prominently in the home or in a family album.

31. Assign the parents to support the child in joining an extracurricular group or club in an area of interest sponsored by school, a religious group, or the community.

32. Instruct the parents to assist the child in planning for an after school or weekend activity or attending a school-sponsored function with a supportive friend or group.

15. Support the child in setting personal goals, describing personal hopes and dreams and expressing optimism for the future. (33, 34)

33. Assign the parents to brainstorm with the child the many factors that influenced the depression or thoughts of suicide; list strategies that can combat these threats to recovery and discuss how to implement positive behaviors to maintain the commitment to live a healthy, productive life.

34. Assign the parents to complete with the child the "Healthy Habits to Support Recovery" activity in the Parenting Skills Homework Planner by Knapp to define positive behaviors and activities can become antidotes to relapse into depression, substance abuse or suicidal ideation.

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