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Recognizing and Responding to Traumatic Stress, How to respond, Created by…

- - - - https://www.youtube.com/watch?v=1O3Y9ddzDG8&ab_channel=KatiMorton
    - - Disclosure of physical abuse, e.g. by child,
        friend, family member
      - Inconsistent or unlikely explanation for cause
        of injury
      - Wearing clothes unsuitable for weather
        conditions to hide injuries
      - Wariness or fear of a parent, carer or guardian
        and reluctance to go home
      - Unusual fear of physical contact with adults fear of home, specific places or particular adults
      - Unusually nervous, hyperactive, aggressive, disruptive and destructive to self and/or others
      - Overly compliant, shy, withdrawn, passive and uncommunicative
      - Change in sleeping patterns, fear of the dark or nightmares and regressive behaviour, e.g. bed-wetting
      - No reaction or little emotion displayed when being hurt or threatened
      - Habitual absences from the service without reasonable explanation, where regular attendance is expected
      - Complaining of headaches, stomach pains or nausea without physiological basis.poor self care or personal hygiene.
    - - References:
        
        Morton, K. [ Kati Morton]. (2018, October 18). Physical Abuse and Its Long Term Effects [Video]. YouTube. https://www.youtube .com/watch?v=1O3Y9ddzDG8
        
        Kaplan Early Learning Company. (n.d.). Responding to Child Abuse and Neglect. kaplanco. Retrieved December 6, 2021, from https://www.kaplanco.com/ii/child-abuse-neglect
        
        BHSCP. (2021, April 26). Physical Abuse. Retrieved December 6, 2021, from https://www.bhscp.org.uk/preventing-abuse-and-neglect/types-of-abuse-and-neglect/physical-abuse/
        
        NSPCC. (n.d.). Physical abuse. Retrieved December 6, 2021, from https://www.nspcc.org.uk/what-is-child-abuse/types-of-abuse/physical-abuse/#what
        
        Victoria State Government. (2016). Identifying and Responding to All Forms of Abuse in Early Childhood Services. https://www.education.vic.gov.au/Documents/about/programs/health/protect/EarlyChildhood_Guidance.pdf
    - - Report suspected child abuse immediately. As long as you have a sufficient reason to make a report, you are legally protected and cannot be sued. Be sure to give the person or agency you make the report to as much information as possible.
      - Do not act shocked or disgusted if a child reveals something about his or her abuse to you. Children are inclined to think that you are responding that way because of them, which can have a major impact on their healing and recovery.
      - Be supportive in your response and let the child know it is not his or her fault. Also remember that you can't promise not to tell since you're legally required to report any suspicion. The Crisis Manual for Early Childhood Teachers suggests the following response: 'I'm glad you told me. You did the right thing. I'm sorry this happened to you.'
      - Make sure children who are abused have plenty of ways to express themselves. Drawing, painting, and writing are all excellent creative outlets for children to express their thoughts and feelings about what happened to them.
      - Treat all children with kindness, respect, and empathy. This will help you build positive relationships with children and will also show abused children that a person does not have to use violence or humiliation in their interactions with others.
  - - - Physcial
        
        Signs of sexual harm (difficulty walking or sitting; frequent infections, pain, or other discomfort in genital area)
        
        Signs of physical harm (bruising, bleeding, etc.)
      - Behavioral
        
        Depression
        
        Thoughts of self-harm
        
        Difficulty in school (e.g., excessive absence, changes in grades)
        
        Inappropriate sexual knowledge or behaviors
        
        Becomes adverse to or seems threatened by physical contact
        
        Low self esteem
        
        PTSD
        
        Anxiety
        
        Alcohol/Substance abuse
    - - In the classroom
        
        Reduce anxiety
        
        Provide student with opportunities to control their learning situation (e.g., what to learn, where to learn, how to learn) and take control over a small part of their life
        
        Create and follow classroom norms about establishing and respecting people's physical boundaries
        
        Build student's self esteem through positive reinforcement
        
        Provide additional assistance/scaffolding so the student does not fall behind academically
        
        Keep an open-door policy for students to see the teacher as a trusted resource for reporting trauma
      - Outside the classroom
        
        Treat physical symptoms, as necessary
        
        See the counselor, if available
        
        Contact relevant authorities (e.g., police, child protective services), as required by law or school policy
  - - - https://www.youtube.com/watch?v=y7bKFMO0d-w
    - - Emotional Abuse Response Strategies
        
        Make sure the teachers mental and emotional needs are being met too. To deal with a student going through emotional abuse, the educators need emotional stability. The teachers cannot give emotional responses.
        
        Know the laws. The teacher and school management need to be aware of what scenarios require reporting to authorities
        
        Journal writing. Building a deeper emotional intelligence and self-worth in an emotional abuse survivor is vital. Journal writing can equip the student to better identify feelings, emotions and triggers.
        
        Give them responsibility. Slowly and carefully and with their consent.
        
        Ask for help. Teachers should not deal with the issues by themselves. Inform management, correspond with any outside therapists or services the child may be receiving, school counsellors or independent research can all be helpful.
        
        2x10 method. Discuss 1on1 with the student any topic of their chhosing that inerests them for 2 minutes a day, for 10 days.
        
        Self-administered optimism training. Trains the child to have less pessimistic interpretations of events.
        
        Modular cognitive behaviour therapy
        
        https://www.youtube.com/watch?v=zqYxcCWjzVY
- - - - Resources:
         National Parent Helpline: https://www.nationalparenthelpline.org/find-support
         Pediatrician: call your child’s doctor and ask for local recourses
         Therapist: connect with a psychologist, social worker, or toher metnla thealth expert, and make an appointment to discuss concerns
    - - use a "feelings barometer" - begin class or morning with discussion of how students feel
      - teach the use of a formula for solving problems and provide sample problems so the students can try it
      - structure learning projects to maximize use of cooperative activities and solutions - reduce competitive acitivities
      - teach conflict resolution and peer mediation skills
      - be warm and sympathetic teachers
      - provide a safe space in the classroom
    - - Plan for student engagements
      - Be Strong
      - Clear Rules & Expectations
      - Address the Behavior (not the person)
      - Remain Calm
      - Personalized learning
      - Authentic Praise
      - PBIS Systems
      - Wraparound Services
      - Be flexible
      - Utilize FBAs
      - Visit students outside school
      - Develop rapport
      - Never give up on child
      - Don't take it personal
      - Positive parent calls
      - Get to know the student
      - Unconditional love and care
- - - - Decision making
      - Stress management
      - Effective communication
      - Social interaction
      - Conflict resolution
      - Assertiveness
- - - - problem-solving skills
      - cognitive restructuring skills
  - - - A child with SAD worries a lot about being apart from family members or other close people. The child has a fear of being lost from their family or of something bad occurring to a family member if he or she is not with the person.
        
        Nightmares in which the content or emotion experienced is related to the separation
        
        Negative changes in children’s thoughts about the world, themselves, and others
        
        Feeling detached from others or, for children ages 6 and under, socially withdrawn behavior
        
        Constantly feeling on guard
        
        Irritable or aggressive behavior, including extreme temper tantrums
        
        Exaggerated startle responses
        
        Concentration difficulties
        
        Difficulty falling and staying asleep
        
        Avoidance of reminders of the separation
    - - Provide Comfort
        
        Let children have things that comfort them
        
        Offer to play with, hug, read, or sing to children
        
        Speak calmly and use language that children understand
      - Inform and Reassure
        
        Reassure children that they are safe and set and enforce with warmth limits that foster a safe environment
        
        Let children who have been separated from their parents know that the separation was not their fault, nor the fault of their parents
      - Listen and Validate
        
        Let children know that it is okay to feel scared, angry, confused, etc.
        
        Acknowledge children’s feelings without judgment and allow them to express how they feel, provided that they do so in safe ways
        
        Recognize that overwhelming emotions may lead children to “act out” or behave aggressively and that this does not mean that they are “bad” kids
      - Offer to help
- - - - Strategies: medicine, counseling, strong supportive network of friends, family, teacher, pets, kindness acts, treat the person as you would like to be treated yourself
        :<3:
        
        References:
        Mental Illness Causes, Symptoms, Diagnosis, and Treatment | Merck Manual Consumer Version. (2020, August 24). [Video]. Mental Health: In Our Own Words. (2014, October 8). [Video].
- - - - STRATEGIES & RESPONSES
        
        Community peer mentoring programs like Big Brothers Big Sisters, Village of Peace or Harlem Children's Zone.
        
        Expression of emotions through poetry, art, writing and journaling.
        
        Knowledge, know the incarceration rates and statistics for your area.
        
        Sensitivity, prohibit jokes about prison or criminal acts in the classroom.
        
        Include incarcerated parents in students' lives when possible. Video call for parent-teacher conferences.
        
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      - feelings of shame
        
        social stigmitization
        
        loss of financial support
        
        weakened familial ties, often if a parent is incarcerated the child is transferred to an alternate caregiver. This is especially true in cases of single motherhood. Visitation policies at prisons often make it difficult for children to keep contact.
        
        increased risk of physical and emotional neglect or abuse
        
        increased likelihood of inter-generational criminality
        
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        Visitation Issues:
        
        Prisons often located outside city center.
        
        Hours of visitation limited.
        
        Lack of public transit to facilities.
        
        Difficult, possibly traumatic or intrusive, check-in policies.
    - - There is no formal policy of notifying the schools if a household member is incarcerated.
- - - - Unexplainable injuries
      - Lost or destroyed clothing, books, electronics, or jewelry
      - Frequent headaches or stomach aches, feeling sick or faking illness
      - Changes in eating habits, like suddenly skipping meals or binge eating.
      - Declining grades, loss of interest in schoolwork, or not wanting to go to school
      - Sudden loss of friends or avoidance of social situations
      - Self-destructive behaviors such as running away from home, harming themselves, or talking about suicide
      - Feelings of helplessness or decreased self esteem
    - - Try an ounce of prevention
        
        Set the tone from the day one. Make sure the students get the message that bullying is something you take seriously and will address directly and consistently
        
        Make reporting feel safe.
        
        Not letting the small stuff slide.
        
        Communicate appropriate consequences.
      - Know the signs
        
        Keep an eye out for:
        
        A student who spends less time around other children.
        
        Mood changes, which can be acute or prolonged
        
        Sudden tearfulness, fear, sullenness, or anger, particularly after an incident of bullying
        
        Self-deprecating remarks
        
        Physical marks, such as redness on skin, bruises, torn bookbags, or dirt or food on clothing
        
        Attempts to cover up a physical feature or other characteristic that others have ridiculed
      - Address the student sensitively
        
        (https://www.youtube.com/watch?v=xspJJPn5sLI)
      - Talk to the family
        
        Families can provide unique and critical insights that deepen your understanding of the situation and what the child might need.
      - Refer to an administrator or a mental health professional
        
        Issues of bullying and abuse can be complicated to address. Talking to the colleagues at school for support and guidance, and remembering to follow protocols that might require us to report our concerns to others is important.
- - - - Over a third (37%) of female students at mixed-sex schools have personally experienced some form of sexual harassment at school.
      - Almost a quarter (24%) of female students at mixed-sex schools have been subjected to unwanted physical touching of a sexual nature while at school.
      - Almost one in three (32%) teachers in mixed-sex secondary schools witness sexual harassment in their school on at least a weekly basis. A further 36% say they witness it on a termly basis.
        
        Teachers and faculty may also be the perpetrators of sexual harassment in schools.
        
        While the data shows that female identifying students are commonly experiencing sexual harassment, individuals who are intersex, androgynous, nonbinary, and or are part of the LGBTQ+ communities, also experience forms of sexual harasment leading to sexual trauma.
        
        It must also be noted that sexual harassment can happen to students that identify as male. Too often, their cries of sexual harassment is ignored as male sexual trauma is not taken seriously in society.
        
        How to combat sexual harassment in the school and protect students from sexual trauma.
        
        Be mindful of gendered language,
        
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  - - - Early warning signs
        
        Students may complain about or exhibit signs of fatigue, anxiety, irritability, depression. Caregivers may explain their child is complaining of body aces and or difficulty sleeping.
        
        Signs of a triggered trauma response may be but not limited to : hypervigilance; heightened emotional experiences, such as depression, anxiety, and anger, which compromise a student's ability to engage at school
    - - School Aged Children (6-11)
        
        Older Students (12-17)
        
        These students typically have a better understanding of racially based events and the implications of issues such
        as racial trauma.
        
        Children display a range of emotions and responses in regards to racial trauma. They may perceive traumatic events as something that can and will happen to them.
        
        Children may become disruptive in class due to anxieties about their own safety or the safety of friends.
    - - For older students, discussing ways that they can promote positive
        changes in their communities can help prevent racial trauma and overcome such traumas.
        
        For younger students, providing a physical space
        for the child to feel safe is effective in aiding such students with trauma.
  - - - Addressing race and trauma in the classroom - nctsn.org. (n.d.). Retrieved December 8, 2021, from https://www.nctsn.org/sites/default/files/resources/addressing_race_and_trauma_in_the_classroom_educators.pdf.
        
        Alber, R. (2017, January 27). Gender equity in the classroom. Edutopia. Retrieved December 8, 2021, from https://www.edutopia.org/blog/gender-equity-classroom-rebecca-alber.
        
        It's just everywhere - sexism in schools. NEU. (n.d.). Retrieved December 8, 2021, from https://neu.org.uk/advice/its-just-everywhere-sexism-schools.
- - - - Unstable living situation. Student is vague when talking about home. Student exhibits signs of fatigue like sleeping in class. Student has heightened stress or anxiety levels. Student often wears the same clothes or has an unkempt appearance. Student gets off the school bus at different locations. Poor attendance, frequent tardiness or truancy.
        
        EFFECTS
        
        STRATEGIES AND RESPONSES
        
        McKinney-Vento Act - Federal policy which addresses assistance for the homeless.
        
        School districts employ a liaison officer to deal with cases of homelessness discovered in the schools. Teachers are trained how to recognize signs and how to appropriately contact the liaison.
        
        Liaison will provide financial assistance to cover the cost of transport to school as well as facilitate referrals to community and educational resources for the student.
        
        IN THE CLASSROOM
        
        Prioritize sensitivity. Avoid jokes and don't allow teasing or bullying based on socio-economic status.
        
        Be caring. Offer additional support and nurture to the affected student. Make time after school to help with homework.
        
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        Higher rates of emotional, behavioral and immediate as well as long-term health problems. Students suffering from homelessness often struggle with self-esteem issues. This raises their risk for drug abuse, self-harm and other negative practices. 4 out 5 student affected by homelessness have been exposed to violent acts before the age of 12.
        
        Higher rates of academic difficulties. Students who suffer homelessness display higher instances of learning disabilities. They often miss school and have poor attendance. They commonly have below-grade level reading abilities. Without a stable living space there is no place to do their homework or feel safe. They are less likely to move on to the next grade or graduate.
        
        Members of the LGBTQ community are disproportionately affected by homelessness. They are often subject to neglect and exploitation. Oftentimes, family rejection can lead to homelessness causing trauma and an increased risk to engage in substance abuse and the development of mental disorders.
    - - Definition = when a person, “lacks a fixed, regular, and adequate nighttime residence, and if they sleep in a shelter designated for temporary living accommodations or in places not designated for human habitation.”
        
        As of 2019, there are 1,384,000 students defined as homeless enrolled in US public schools. Although actual numbers may be much higher.
- - - - Common Physiological
        Reactions:
        
        Headaches
        
        Complaints of vague aches
        and pains
        
        Overeating or loss of
        appetite
        
        Skin problems
        
        Sleep problems
      - Common Emotional and
        Behavioral Reactions:
        
        Loss of interest in
        activities
        
        Poorer school
        performance
        
        Disruptive behavior
        
        Resistance of authority
      - Common Regressive Reactions：
        
        Competing with younger
        siblings for attention
        from parents or other
        primary caregivers
        
        Failure to perform
        chores and fulfill normal
        responsibilities
    - - Common Physiological
        Reactions:
        
        Headaches
        
        Complaints of visual or
        hearing problems
        
        Sleep problems and
        nightmares
      - Common Emotional and
        Behavioral Reactions:
        
        School phobia
        
        Social withdrawal
        
        Irritability and
        disobedience
      - Common Regressive Reactions:
        
        Clinginess with parents
        or other primary
        caregivers
        
        Crying or whimpering
        
        Requests to be fed or
        dressed
    - - Common Regressive Reactions：
        
        Resumption of earlier
        behaviors and attitudes
        
        Decline in previous
        responsible behavior
      - Common Physiological
        Reactions:
        
        Headaches
        
        Sleep problems
        
        Digestive problems
        
        Vague physical complaints
      - Common Emotional and
        Behavioral Reactions:
        
        Increase or decrease in
        physical activity
        
        Depression
        
        Isolation
        
        Antisocial behavior
    - - Common Physiological Reactions:
        
        Loss of appetite
        
        Overeating
        
        Indigestion and other
        digestive problems
      - Common Emotional and
        Behavioral Reactions:
        
        Nervousness
        
        Anxiety about being away
        from parents or other
        primary caregivers
        
        Irritability and
        disobedience
      - Common Regressive Reactions：
        
        Bedwetting in a child
        who before the disaster
        was toilet trained
        
        Thumb-sucking
        
        Greater fear (of
        darkness, animals,
        monsters, strangers)
- - - - Increased risk of mental health problems
        
        Loneliness
        
        Impaired social relationships
        
        Reduced self esteem
        
        Threats to emotional well being, e.g. anxiety, depression, perceived lack of control over what happens in one’s life
        
        Sensitivity to stress
        
        Increased mortality risk during childhood, adolescence and into early adulthood
        
        Increased long-term risk of suicide
        
        Concentration difficulties
        
        Behavioural problems
        
        Lower competence (than non-bereaved youths) in the areas of work and future education planning
        
        Interventions
        
        Support groups/camp activities
        These provide emotional support; to normalize the children’s experiences after the loss; to provide a safe environment where the child can express emotions and thoughts; to facilitate the child’s grieving process and to aim to improve the child’s physical and mental health.
        
        Examples
        
        “Writing for recovery” age 12–18 years
        
        Group intervention “Writing for recovery” age 12–18 years
        
        6 sessions in school during three consecutive days, each day consists of two 15-min sessions
        
        Writing about traumatic experiences to decrease negative thoughts and feelings
        
        Writing sessions progress from unstructured expressive writing about innermost feelings and thoughts about the traumatic event/loss, to more structured writing where children reflect on what they would have given as advice to another in the same situation as themselves. In the last writing session children are asked to imagine that 10 years has passed and they look back and think about what they have learned from their experience
        
        "CAMP MAGIC'
        
        Groups consisting of 5–8 children (separate groups for children age 7–11 and 12–17 years)
        
        Camp activities such as ropes course, canoeing, archery, interacting with new friends
        
        6 Counseling sessions during a weekend (Friday-Sunday)
        
        Focus on trauma experience; trauma and loss reminders; post-traumatic adversities; interplay of trauma and grief; resumption of developmental progression
        
        Grief-oriented tasks and cognitive behavioural aspects such as exposure, cognitive restructuring, stress inoculation techniques
        
        Activities related to grief processing such as creation, play, puppetry show, memorial service
        
        Psychoeducational workshop for parents about children’s grieving process
        
        Bereavement groups for inner-city children
        
        Groups consisting of 6–8 children, age 6–12 years
        
        12 sessions divided into 3 phases, each of 4 sessions
        
        Opening phase: rules of confidentiality, conduct, purpose of the group; focus on the children’s relationship to the deceased and the impact of the loss on their family; sharing experiences related to death; supportive environment; normalizing bereavement issues
        
        Working phase: focus on children’s feelings of sadness, anger, ambivalence related to the loss; demystifying irrational thoughts and fears about the death; identifying and expressing painful feelings
        
        Ending phase: the termination of the group as another loss; encourage children to utilize their family as support system; children were reassessed to determine the need for further treatment
        
        Family Intervention
        
        Family therapy sessions, with children age 0–16 years and their families
        
        6 family therapy sessions spaced at 2–3 weeks intervals, in the families’ homes
        
        Focus on: help with emotional and practical problems arising from bereavement; promote mourning in both children and surviving parent; improve communication between children and parent; improve communication about death; encourage children to talk about the dead parent and their feelings of loss and grief; encourage expression of grief in the family
        
        Separate sessions for parents alone to enable him/her to talk about his/her own grief, anger, needs
      - Cultural and religious factors impacting bereavement
        
        While death itself is universal, the ways in which people respond to it are remarkably varied.
        
        Grief, mourning and death rituals vary in different cultures and are often highly influenced by religious practices and doctrines.
        
        This includes factors such as how and when rituals are practised, as well as differences in duration, frequency and intensity of the grieving process
        
        Some studies have found that Hispanic students displayed greater outward expression of grief, as well as more severe physiologic reactions than Anglo students.
        
        People of faith are also more likely to find support in coping with the loss of a loved one through their religion, while the religions themselves provided different perspectives on what occurs following death, such as reincarnation or heaven and hell.
      - Ensure that information about the death is shared with the school community in a sensitive and targeted manner:
        
        With friends/peers of the bereaved child
        
        with parents/carers of those friends/peers
        
        with all school staff who will come into contact with the bereaved child
  - - - Being There for Grieving Children (Early Years) https://www.youtube.com/watch?v=PcaStFB36kg
        
        It's Time We Reframe Grief for Children
        https://www.youtube.com/watch?v=66kgittqUwY
        
        No Child Should Ever Grieve Alone
        https://www.youtube.com/watch?v=YR9eokO8cFA
        
        How can I support a grieving child?
        https://www.youtube.com/watch?v=imu3pRNQnDs&t=27s
        
        When a parent has died : young people share their experienceshttps://www.youtube.com/watch?v=h-qFkRaPRYY&t=122s
        
        Building resilience in a bereaved child https://www.youtube.com/watch?v=qOYk05YwNVU&t=118s
        
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- - - - Response Strategies include getting medical attention, rest, physical therapy, occupational therapy, cognitive therapy, and support from teacher, family, and friends :<3:
  - - - Response Strategies depend on the child's needs. Strategies include: behavioral communication therapy, educational therapy, family therapy, speech therapy, & occupational therapy :<3:
- - - - Self-harm is common among young people. At least ten percent report having self-harmed.
        
        It is more common among girls than boys, especially in early adolescence.
        
        Young people particularly vulnerable to self-harm include:
        
        Those with depression, anxiety, low self-esteem, ADHD, an eating disorder, or those on the autism spectrum
        
        Those with family issues such as mental health difficulties in their parents or carers, poor parental relationships, conflict with parents, or abuse or neglect.
        
        Those who have experienced bullying, peer rejection, have friends or family who self-harm, or are influenced by social media that encourages self-harm.
        
        How to recognize self-harm
        
        Students may have unexplained cuts, bruises, or burns.
        
        Students may keep themselves covered by avoiding swimming or changing clothes around others.
        
        Students may become withdrawn or isolated.
        
        Students may experience low moods or lowering academic achievement
        
        Students may have a sudden change in behavior, such as becoming irritable, angry, or aggressive. They may blame themselves excessively.
        
        How to respond
        
        Have an open conversation with student while remaining calm, understanding, and non-judgemental
        
        It can be helpful to let the student know you understand the functions of self-harm to encourage them to open up.
        
        Confidentiality is important. If a student is self-harming, you should share this information with a school counselor who should usually share this information with the student's guardians, but it's important to listen to the student's concerns.
        
        Help the student develop postive ways of coping. These can include:
        
        Building support networks of family, friends, and/or members of staff.
        
        Replacing self-harm with other safer activities. You should get to know the student and their interests. These could include exercise, taking a dog for a walk, watching TV, or taking a hot bath.
        
        Clenching ice cubes until the melt
        
        Hitting a pillow or another soft object
        
        Breathing exercises
        
        Using resources such as helplines or websites like Childline or YoungMinds
  - - - Suicide rates for teens age 15 to 19 jumped by 76% from 2007 to 2017.
        
        Suicide rates for children aged 10 to 14 nearly tripled during that same time period.
        
        Of more than 11,800 children ages 9-10 participating in the longitudinal Adolescent Brain Cognitive Development study, Barch and Whalen found 2.4 percent to 6.2 percent of the children reported thinking about or planning suicide
        
        A little more than 1 percent actually attempted to kill themselves.
        
        1 in 10 reported non-suicidal self-injury such as cutting, pinching, or burning.
        
        Common Misconceptions
        
        Younger students don't understand suicide.
        
        Early elementary students who are depressed or suicidal have a better understanding of death than children who are mentally well.
        
        Younger students don't have the same kinds of problems as suicidal teenagers.
        
        Children and adolescents gave the same reasons for feeling suicidal or wanting to self-harm.
        
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        Children have to be depressed to consider suicide or self-harm.
        
        While the children who reported suicidal thoughts or self-harm were more likely to have a family history of depression or suicide, children also frequently reported thinking about suicide in stressful or sad situations.
        
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        According to the CDC, 10-15 percent of middle and high school students consider killing themselves at some point.
      - Factors that can increase risk
        
        Mental health disorders, such as depression and anxiety.
        
        Substance abuse
        
        Access to a means to kill themselves, such as guns or medication
        
        Previous sucide attempts
        
        Family history of suicide or mental health disorders
        
        Childhood abuse, neglect, or trauma
        
        Exposure to suicide of another person
        
        Stressful life circumstances
      - Signs for immediate or serious risk
        
        Talking about or making plans for suicide
        
        Expressing hopelessness about the future.
        
        Displaying severe or overwhelming emotional pain or distress
        
        Withdrawal from or change in social connections or situations
        
        Increased or decreased sleep
        
        Anger or hostility that seems out of character or out of context
        
        Recent increased agitation or irritability
      - We can be proactive by creating a comprehensive suicide prevention program.
        
        Key components include:
        
        Schoolwide programs that promote connectedness and mental well-being
        
        Identifying and screeing students at risk and connecting with them
        
        Staff education and training
        
        Guardian outreach
- - - - Provide any additional information to the counselor that will help with their assessment of the student.