Creating a Family: Talk about Adoption & Foster Care

Suicide Awareness and Prevention

April 24, 2024 Creating a Family Season 18 Episode 33
Suicide Awareness and Prevention
Creating a Family: Talk about Adoption & Foster Care
More Info
Creating a Family: Talk about Adoption & Foster Care
Suicide Awareness and Prevention
Apr 24, 2024 Season 18 Episode 33
Creating a Family

Click here to send us a topic idea or question for Weekend Wisdom.

Join us to talk about the very important topic of youth suicide. Our guest will be Dr. Angela Tunno, a Licensed Clinical Psychologist and Assistant Professor at Duke University Medical Center, Department of Psychiatry and Behavioral Science. One of her areas of specialty is trauma-informed suicide prevention.

In this episode, we cover:

  • Suicide is one of the leading causes of preventable death in the US. 
  • How prevalent is suicide in the US for all ages?
  • How common is suicide for people under 21? 
  • How common is suicide for children and youth in foster care or otherwise connected to child welfare?
  • Why are youth in foster care at greater risk for suicide?
  • What are some warning signs that a child or youth may be considering suicide?
  • What are the risk factors for a youth or child who may be at greater danger of suicide?
  • Are youth with other diagnoses more at risk for suicide? (For example, ADHD?)
  • Who is in the position when a child is in foster care to recognize these signs? 
  • If you are worried that a child/youth may be contemplating suicide, what are the evidence-based steps you should take? How to be trauma-informed when helping to prevent a child or youth from committing suicide? 
  • Get support or therapy for yourself to help you cope and to help you support the youth better.
  • When should we take the youth to the hospital?


This podcast is produced by We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:

Please leave us a rating or review

Support the Show.

Please leave us a rating or review. This podcast is produced by We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them.

Creating a Family brings you the following trauma-informed, expert-based content:

Show Notes Transcript

Click here to send us a topic idea or question for Weekend Wisdom.

Join us to talk about the very important topic of youth suicide. Our guest will be Dr. Angela Tunno, a Licensed Clinical Psychologist and Assistant Professor at Duke University Medical Center, Department of Psychiatry and Behavioral Science. One of her areas of specialty is trauma-informed suicide prevention.

In this episode, we cover:

  • Suicide is one of the leading causes of preventable death in the US. 
  • How prevalent is suicide in the US for all ages?
  • How common is suicide for people under 21? 
  • How common is suicide for children and youth in foster care or otherwise connected to child welfare?
  • Why are youth in foster care at greater risk for suicide?
  • What are some warning signs that a child or youth may be considering suicide?
  • What are the risk factors for a youth or child who may be at greater danger of suicide?
  • Are youth with other diagnoses more at risk for suicide? (For example, ADHD?)
  • Who is in the position when a child is in foster care to recognize these signs? 
  • If you are worried that a child/youth may be contemplating suicide, what are the evidence-based steps you should take? How to be trauma-informed when helping to prevent a child or youth from committing suicide? 
  • Get support or therapy for yourself to help you cope and to help you support the youth better.
  • When should we take the youth to the hospital?


This podcast is produced by We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them. Creating a Family brings you the following trauma-informed, expert-based content:

Please leave us a rating or review

Support the Show.

Please leave us a rating or review. This podcast is produced by We are a national non-profit with the mission to strengthen and inspire adoptive, foster & kinship parents and the professionals who support them.

Creating a Family brings you the following trauma-informed, expert-based content:

Please pardon any errors, this is an automated transcript.
Dawn Davenport  0:00  
Welcome everyone to Creating a Family talk about foster adoptive and kinship care. I'm Dawn Davenport. I am the host of this show, as well as the director of the nonprofit creating a Today we're going to be talking about suicide awareness and prevention. It is a tough topic. But it's an important topic because many in our audience have faced this with their children or other loved ones. We will be talking today with Dr. Angela Tunno she is a licensed clinical psychologist and assistant professor at Duke University Medical Center, the Department of Psychiatry and Behavioral Science. She also specializes in trauma informed care and social justice and community led work. One of her areas of specialty is trauma informed suicide prevention efforts. Welcome Dr. Tunno to Creating a Family. Thank

Speaker 1  0:55  
you for having me. I, I appreciate the opportunity to be here.

Dawn Davenport  0:59  
Yeah, as I said, this is a tough topic. It's every parent's nightmare. Every loved ones nightmare. And you know, suicide is one of the leading causes of preventable death in the US. How prevalent is suicide in the US for all ages, not just kids? Yeah,

Speaker 1  1:17  
I so appreciate you holding space for just how difficult this topic is. And I just want to remind the listeners or people who are listening to this podcast to do what they need to do, you know, during this time together, as we're talking about such a difficult topic, and that question you asked, you know, you see a lot of statistics and headlines from the news that give you these numbers. So I really like to break it down. And I went and I looked on the news and saw that the most recent numbers was from ABC News. And it was provisional data from the CDC in 2022. ABC News, that number of suicides in the US reaches record level. Yeah, yeah.

Dawn Davenport  2:02  
Great. Right,

Speaker 1  2:03  
right. And so I went in and looked a little bit deeper, because I wanted to break it apart and underscore that that provisional part, that provisional data, just meaning that it's not confirmed quite yet, the numbers aren't confirmed quite yet. But for right now, it looks like it's 14 points, three deaths per 100,000. And going into 2020. One's data, which is confirmed, basically, I won't go into specific number, but there's about one death for every 11 minutes. Yeah, yes,

Dawn Davenport  2:35  
just, yeah, I mean, the numbers, we don't need to go into depth on the numbers. But it does speak to the fact that this is a real problem that so many people face in their loved ones face and

Speaker 1  2:48  
their loved ones face. And what's really important too, is just aggregating that data, or breaking it apart, looking at who's most impacted by different identities, race, ethnicity, sexual orientation, gender identity. And one of the things that continues to be shown across for Gen numbers is that those who are most impacted are Native American, American Indian and Alaskan Natives. There's also a higher rate for LGBTQIA plus population, and the fastest growing rate for our black youth in particular.

Dawn Davenport  3:23  
Interesting. Is there a breakdown on male or female?

Speaker 1  3:27  
Yeah, so for males, they are four times as likely to die by suicide for females, they are more likely to have suicidal thoughts and attempts to men are more at risk to die by suicide.

Dawn Davenport  3:42  
Gotcha. Okay, interesting. Now, that's the general data. So how common is suicide for people under the age of 21.

Speaker 1  3:51  
CDC breaks apart in different age groups. They've tracked this for years and years, and they break it apart 10 to 14 and 15 to 24. So I'll use those two age ranges. And we've known for years years that suicide is the second and third leading cause of death for that age group 10 to 14 and 15 to 24. So it's been hovering between second and third leading cause of death for years.

Dawn Davenport  4:22  
All right, so it is a problem for our young people, for sure. Now, specifically, the people we're speaking to are raising youth and children, either in foster care have been in foster care or otherwise connected to child welfare. So how common is suicide for this population of children and youth? Yeah,

Speaker 1  4:43  
I was. I was thinking about that question, just knowing who I'd be talking to. And one of the things that I think is really important is to acknowledge how multi layered that is. So involvement in foster care, child welfare, there's many factors Go into that things like, perhaps higher rates of experiences of trauma, higher systems involvement, and stressors like that. And so that we do know that there are risk factors that do exist. Looking at studies that have been out there, there's only a handful that looks specifically at suicide rates, especially for those involved in child welfare. There is a relation that exists, but it's not super clear, because all of those multilayer factors, we can go into the relationship between trauma and suicide risk two, and other factors. But it gets really complicated when you're breaking it apart that way, I did

Dawn Davenport  5:42  
want to then move into why are youth in foster care at greater risk for suicide? You just mentioned the obvious first one, and that is, almost all of our kiddos in our youth have experienced trauma, if for no other reason than just being removed from their biological family is a traumatic event. So our kids have experienced trauma almost universally if they are connected with the foster care system. And many children are adopted through the foster care system. So trauma is an obvious one. Are there other reasons that our children and youth are at greater risk?

Speaker 1  6:17  
One of the things that I'm talking about risk factors in general, is to acknowledge to that there is not one risk factor that predicts suicide. Part of that reason is to say that you can look at all the risk factors and the warning signs, and still not know everything. So it's, I want to say a caveat with that, especially for those people who have lost a loved one to suicide as well. So just giving that caveat. But I think the risk factors, are you seeing in particular for those involved in child welfare? Or just Is

Dawn Davenport  6:48  
it primarily just that they have experienced trauma? Then we're going to move into the warning signs as well. Is there anything other than trauma that would make our youth more susceptible to suicide?

Speaker 1  7:02  
I think it depends on the youth, like you said beautifully is that a lot of these youth have experienced trauma being separated from their homes and their communities? I think community is healing connection is healing isolation is a huge risk factor. Yeah. So feeling isolated, experiencing traumatic stress. Having that support system, and these wonderful families that I'm talking to that are caring for youth, I think that is a protective factor. But we do know that traumatic stress is associated with an increased risk of suicide. They call it a dosage effect. But it's the more traumatic events you experience, the higher the risk is for suicidal thoughts and behaviors.

Dawn Davenport  7:47  
I think it's really important for parents to realize that there is a correlation between the amount of trauma and how it impacts the child, and suicidal ideation and then behavior. So let me pause this really important discussion for just a moment to welcome our listeners, for our old listeners. Welcome back, we are so glad that you support us for our newbies, Welcome, we are so glad to have you. And we hope you become a regular listener and subscriber. To do that you can just whatever app you're currently using, type in creating a family and click subscribe. Alright, I want to now talk about warning signs that a child or youth may be at risk for suicide. And I'm glad you gave the caveat early on, that not all children or youth give a warning sign. The stat that I've read was four out of five individuals considering suicide, give some sign of their intentions, either verbally or behaviorally. But I was glad that you pointed out that that isn't universal. And that's important for loved ones who feel like if we're talking warning signs, and they didn't see it, if they had seen it, they could have prevented it or whatever. And then that might be their thought. So anyway, accepting that let's move in to talking about if your loved one your child or adolescent is giving verbal or behavior, what are some of the verbal behavioral warning signs that we would look for?

Speaker 1  9:16  
Yeah, and really breaking down like that warning sign versus a risk factor. So warning sign meaning imminent risk, meaning they're showing signs that there's an acute risk that we need to pay attention to, right. So things like being a burden, feeling as though they're a burden, different sorts of statements that they want to leave this world or they hate themselves. They wish they were dead, that sort of language that suggests wanting to die or thoughts of death. So it's like

Dawn Davenport  9:50  
I won't, I won't be around much longer. You'd be better off without me or things along those lines. Exactly.

Speaker 1  9:56  
Exactly. Exactly. And then really changes that caregivers can notice. Things like appearance, lack of hygiene, a change in that a change in their academics, a change in their sleep, they may be more isolated than usual, may not be interested in things that they used to find interesting. Okay?

Dawn Davenport  10:21  
That makes sense is depression, either diagnosed or undiagnosed a warning sign as well.

Speaker 1  10:27  
Depression is associated with suicide risk. And if you think about the symptoms of depression

Dawn Davenport  10:34  
symptoms will be the warning sign. I see your point. Yeah, so yeah, yeah, the things

Speaker 1  10:37  
like sleeping a lot more, perhaps living a lot less eating a lot more, eating a lot less isolation, they called Anhedonia. But lack of interest in things they used to find interesting. But seeing those changes, and really that talk of, I'm not going to be around here anymore, why bother other things like that. Another thing is giving away belongings can sometimes see folks making a plan to not be here anymore, writing letters, saying goodbyes, giving away price items that they used to cherish. And one of my colleagues, Dr. David Goldston, he talks about that period of acute risk or that high imminent risk, that warning sign risk, folks in this state usually have blinders on that that's the only option they can see because of how much pain they're in. And so you'll hear talk like that, and nothing's going to make this better. I can't see any way out, I want to die. I don't want to be on here anymore. Things like that.

Dawn Davenport  11:39  
Yeah, making those final arrangements. And at that point, they often do have blinders on because they don't see any other options. What about, we certainly hear about this in the news, some, and that is the preoccupation with death or suicide, and it not just talking but in their art in their writing, things like that. Do you see that as well as a warning sign?

Speaker 1  12:02  
It depends. So that's my favorite answer and the question, hands on the youth. But I do think that it doesn't necessarily mean that they are going to die by suicide or planning on that. But it is a launching point to talk to them about if you know of this drawing, like what's this about? And we'll get into this later. But things that you can say, to have that conversation and get close not leave to be able to have those conversations and get curious about what those drawings could be about.

Dawn Davenport  12:32  
Okay, excellent. Let me take a moment to tell you about a resource we have at creating a family that I'm really proud of it is an interactive training or support group curriculum for obviously foster adoptive and kinship families. It's a library of curriculum, I think we have 25. Each curriculum comes with a video, a facilitator guide, a handout and an additional resource sheet, as well as a certificate of attendance. It's a turnkey, so if you are running support groups, or running trainings, it is an easy way for you to train your families or to run a really high quality support group, you can get more information about this curriculum and training at parent support, that is parent support Or you can go to the creating a website, hover over the word training and click on it that way as well. I was glad you made the distinction between warning signs and risk factors. And if I understood you correctly, warning signs would be imminent, or it's the action that's it may be taken sooner rather than later. Risk factors, just let us know which children are at to be redundant here at greater risk, greater likelihood of suicide. So let's move to risk factors for youth or a child who may be at greater danger of committing suicide. Yeah.

Speaker 1  14:02  
And there is and again, I want to say it again, just no single factor. And that is a scary thing to sit with. Yeah, it is. And we do know that risk factors do exist. And as a provider, that scares me to you, you know, as a psychologist that sees youth and cares very much about the youth and families I work alongside. It is scary to acknowledge that all these risk factors exist, and there's not one that 100% predicts it. So I'm going to go into just a few because there's a lot out there. And I break it down into different categories, the first one being precipitants. And really, that just means things that happen that are stressful, right before things like a breakup, conflict and relationship, a sudden loss, grief, those sorts of things that you can't really predict right have I had this major breakup and I saw my life with this partner or this person. So there's there's that category. There's also I spoke a little bit about this when I was talking in the beginning about disaggregating data, but different intersecting identities are how we identify ourselves. So, again, with age, and we see with the youth, it's the second third leading cause of death. With gender identity and sexual orientation. We do know that for our youth through identifying the LGBTQIA plus population, there's lots of data out there to show that there right now, it says three times ever to make an attempt when you compare to their cisgender heterosexual peers. For years, we have known that Native American Alaskan Native populations are most impacted by suicide, followed by white youth. And what's really important to highlight that doesn't get a lot of attention is for our youth and black communities, that over the past years, their rate of suicide is growing the fastest. So look at it broken apart by racial groups, it doesn't look the highest, the highest is American Indian Alaskan Native, but it's growing the fastest and the most recent years, Johns Hopkins actually put out, I think it was in 2018, actually, but don't quote me on that. They put out a report called ringing the alarm to highlight this trend. And also, they just now put out another one called still ringing the alarm. So I want to make sure to really highlight that of looking at breaking it up by different intersecting identities and how it does disproportionately impact some and not as much others. Going along with that is inequities too. So lower access to mental health care, lower access to food, lower access to clean water, clean air, other disparities that exist structural inequities, one of the things that I like to talk about, and we'll talk about it more is that, you know, social justice, trauma prevention, that is suicide prevention. So we have to really look at those inequities, too.

Dawn Davenport  17:11  
So we've been talking about some of the factors that make our youth greater at risk. All right, are there some other factors that would make our youth greater risk social factors, things such as that, take

Speaker 1  17:24  
the words out of my mouth. So social factors, things like feeling alone, feeling isolated, economic hardships, there's also, you know, relationship stressors as well, feeling unsafe, or even being in abusive living situations,

Dawn Davenport  17:41  
which our children often come from. And the hallmark of being a foster child Upon removal is a feeling of alone and isolated. So these are things that are directly related to the kids we serve.

Speaker 1  17:53  
Absolutely, absolutely. And the hopeful part about the position that you all are in is that connection is healing. Connection is healing. And community connection is healing. And I want to continue to highlight that message to

Dawn Davenport  18:10  
you, but we'll talk more about that in a little bit. But yes, absolutely. Okay.

Speaker 1  18:14  
And then there's also History of suicidal behaviors as a risk factor, not just for yourself, but we know also in the family, that that is a factor. Yeah. So it can be a history of having thoughts, engaging in behaviors previously, but also a family history of that. We also talked about traumatic experiences being associated with higher risk of suicidal thoughts and behaviors. I also want to highlight something that you pointed out actually, was you mentioned depression, either diagnosed or undiagnosed. And one of the risk factors are untreated mental health conditions. And I also want to highlight not having access to that care, you know, the mental health field right now. It's not easy to navigate. We'll just say it that way, particularly

Dawn Davenport  19:03  
for children. You know, it's hard for adults, but boy, it's hard to find CARE for Kids.

Speaker 1  19:09  
Yeah. And I work in it. And I have a hard time navigating to get myself yeah, I work alongside families trying to navigate it. And that access to quality, quality mental health care, that can really help and there's also substance use difficulties are related to suicide risk. And I also want to underscore I didn't mention this before, but access to lethal means. And we do know that overall firearms are the method most often used for death by suicide.

Dawn Davenport  19:40  
Gotcha. Followed by overdosing on substances as well. Yes. Okay.

Speaker 1  19:45  
And for young youth, actually, for 10 to 14 year olds, certification is actually the most common method. And as folks get older, it turns to firearms.

Dawn Davenport  19:56  
Interesting, okay. Is there a greater pa possibility of suicide ideation in young people who experience bullying? Yeah, I

Speaker 1  20:05  
get asked that question a lot. And my answer to that is it's so multi layered and complex, we can't parse it apart to that one thing. It's all those risk factors, if we're looking at it acknowledging that not one accurately predicts suicide 100% of the time, then it's a cumulative effect. So if you think about the level of stress can increase risk for suicidal thoughts and behaviors depends on the youth and how they experience it, I would say much like trauma, that for some youth who experience one event, they may experience it as traumatic and for another youth, they may not. So it's really about how it affects that youth in particular. So experiencing bullying can also go along with feelings of isolation. That's something that we talked about being othered, and how that disproportionately impacts. And we talked about those different intersecting identities for folks as well. So there's all those layers that go to it, or a question like that.

Dawn Davenport  21:05  
So one of the things that I have thought about a lot is that many of our youth have diagnosis for other mental health conditions. You've already talked about depression as a risk factor. I wonder about things that impact impulse control, like ADHD? Do you know of any research that connects kids who are highly impulsive to a greater risk?

Speaker 1  21:29  
Yeah, the answer to that the honest answer is I don't know, is the impulsivity risk, but I do know that impulsivity can be related to taking action and not thinking it all the way through. So when you think about having those blinders on, that those blinders may apply to other things as well other risk taking behaviors as well, where this moment in time, if I'm in pain in this moment, in time, that's all there is like there is just this. So I think it is really important, especially for caregivers, to be able to, we call it riding the wave. And I think about that often when someone is feeling impulsive, and in that wave of pain, so riding the wave up and riding the wave down. But when they're at the peak of the wave is where it's that most pain, where impulsive behaviors could live. And being able to ride that wave with the youth to let them know that they're not riding it alone. That impulsivity that exists to get out of that pain, I'll be here with you in it. So it's really important to have that connection

Dawn Davenport  22:38  
comes back to the word connection, which we're going to circle back to in just a minute here. So who is in the position when a child is in foster care to recognize the signs? I would say, everyone,

Speaker 1  22:51  
everyone, I am lucky enough to work with the National Child Traumatic Stress Network or the NC TSN. And we often talk about suicide as a public health problem that requires a public health response and that we all have a role in suicide prevention, I think to one of my favorite people that I've been able to share space with her name's Kim Pavia, and she does a lot of social justice work here in North Carolina. And one of the quotes that she has said to me in countless spaces is the medicine is in the community. That community is healing connection is healing, especially for youth who are in care who have been removed from their community, even if the community was not the best for them at the time, right. So making sure that for caregivers who are working and caring for youth, how can we keep them connected to their culture, their beliefs, their communities, in some way? Because that is healing? I think that connection is absolutely so so important. The mental health system, we already talked about it, it is difficult to navigate, and making sure that we as a system really look inward to say, how are we doing? How are we doing our people who need us? Are they easily able to access us? And how can we widen our care for our children to make them safe care for it and nurtured and one of those things is let's partner with communities. There's wisdom that lives in communities of healing, have ways to connect, and other things we can do where are the safe spaces or are you most impacted?

Dawn Davenport  24:38  
Let me summarize though, before we move on for who is in the position where child and child welfare, as you said everyone that will include caseworkers, resource parents, obviously, but biological family members, teachers, coaches, you know, just anyone who is in contact with the child is in a position to recognize As risk factors and warning signs as well. So we all have a vested interest in protecting these children. This is such an important topic that we are talking about. And I really do hate to interrupt it. But I want you to know about some free courses that we have sponsored by and provided through the generous support of the jockey being Family Foundation, the courses are one hour, they are online, you take them at your own time, you can get a certificate of completion, if that is important to you, there is a quiz if you need to have that certificate. Otherwise, you can just take the courses and learn and grow as a parent, you can find these at Bitly, slash j, b, f support, that's bi T dot L, y slash j, b f support. So if you're a caseworker who is working with these kids are a resource parent or a teacher or a coach, whomever. If you are worried that a child or a youth may be contemplating suicide, what are some of the evidence based steps you should take? So how to be trauma informed when helping to prevent a child or a youth from committing suicide? What are some things that we should proactively do as people who are involved in care for these children and youth? Yeah,

Speaker 1  26:22  
that's a good question. I like to start with this on purpose, which is to take care of yourself. First, these conversations are very difficult. And when you're in it, you may have an urgency to fix it, you may have an urgency to get help right away or ask more questions. But I would say the first step would be take care of yourself, take a deep breath, really sit and be with them in their wave, right in their wave of pain. And one of the things I think about often is listening to learn, versus listening to talk or fix, it's really hard to hear us talk about wanting to die, it will break your heart. And it's so important at that moment, to connect with them and have them know that they aren't alone in this. And that's one of the things that I would say is listen to learn. Take a deep breath. Make sure you're regulating yourself throughout. Oftentimes, we want to ask more questions. Well, what makes you feel that way? Or why would you do something like that? Or

Dawn Davenport  27:32  
you say you'd have friends? But what about Jose? He's your friend, I you know, and you talk about him? You know? Yeah, exactly.

Speaker 1  27:39  
You want to fix it, or you want to fix their thoughts? Because a lot of times again, let's think about those blinders, right? They aren't wide. And yet, all they see is that pain, and to be able to start to widen the blinders, they need someone to be able to sit in that pain with them. Right. And that's hard to do

Dawn Davenport  27:58  
is sit in that narrow space, because it is narrower at that point, because the blinders are making it narrower, but to sit with him in that narrow space. Yeah.

Speaker 1  28:06  
And doing what you need. In that moment. If you need a drink of water, and I've had these conversations with youth, I will feel my back on the chair, I will put my feet on the ground to like get myself grounded, so that I can just sit in it with them. I would also encourage ask directly, you're not going to put the idea in their head. These are words and conversations that youth are having. And it's a really hard thing to say. Yeah, things like, are you thinking about killing yourself? Or sometimes when folks feel sad, or like they have no friends? Or do they don't want to do X, Y and Z anymore? Whatever the youth is telling you. They think about taking their own lives. Are you thinking about that? Practice those words,

Dawn Davenport  28:54  
it is scary as a parent? Because you are fearful that well, what if they hadn't thought about it? Now I'm giving them this idea, right?

Speaker 1  29:02  
And you will not these are words that they have heard. And by not saying it directly, it could miss something. putting words on it, saying it out loud, can be relieving. And in fact, we've had youth say, I am so glad they said that out loud. Because now I can say yes, it was too hard to say those words myself. Yeah, putting words on it is really, really important.

Dawn Davenport  29:27  
Would it be helpful for parents and caseworkers or anyone to practice? I mean, it's a hard thing to actually verbalize to practice saying, I care about you. You seem really distraught. You seem really upset. Are you thinking about killing yourself? Does it help to actually say the words out loud before you say him to the youth? Yes, yes, I could see that.

Speaker 1  29:50  
And I would. And even when I was in training, I can speak for myself and when I'm helping train and teach and work alongside new therapists We do that we roleplay with each other, we say these words out loud, because it's so important to be able to sit in that with the youth. And I would say not just for parents, I think if we could partner with schools, with churches, with community agencies with safe spaces to practice those words, as well, and to know what to look for, I would say don't leave them alone. Stay with them, if they're feeling suicidal, and let them know that they're not in this alone, that you hear them. And that you're gonna get help together. what that could mean is a number of different things just based on how high the risk is, and being able to navigate that with them, just knowing that they're not going to have to do this alone. And part of that is really listening to their story. Real quick story from some of the work that we did at Duke is Dr. David Goldstein, Dr. John Sarno and our team, we were able to interview and learn from and with youth who've had experiences in the hospital with suicidal thoughts or ideation, and things that they really took home with them in terms of their experience there and how they would like it changed or what it made them feel like when they were being asked these questions. Oh, fascinating. Yeah. And what they did say was that they could tell when there was worry, or a checkbox to be marked of this person is at risk. I need to do this XY and Z. How serious are they? And they said, I felt like they were more worried about what to do with me, than to learn about me. Yeah,

Dawn Davenport  31:42  
I'm just a checkbox. Okay. Are you suicidal? Check? Alright, yeah, as opposed to really caring about what the answer would be, I guess. Right,

Speaker 1  31:49  
right. And these refer you from all over? I had thought about that. And I thought is that sometimes how folks can feel when they're being asked these kind of rapid fire questions? Instead of, you're thinking about killing yourself? Tell me more. What's going on? Something as simple as that. And even though you might want to interject, and you might want to know that can't be true. Or, like you said, you said, you have no one. But what about your friend Jose, and you want to challenge those thoughts. And that'll be important work to do. We're not saying it's not, but really just sitting and listening to the story is so important. Validation first. And then we can talk about behavioral change and healing and all of that. And if there is a crisis, there are crisis numbers that do exist. 988 is one of those that was launched. So really easy to remember, right, it was previously the Suicide Prevention Lifeline, and change to 988. That is a crisis number always available. The Trevor Project Lifeline is also a really good one they have, and so does 988. They have a text option. And the Trevor Project Lifeline has a web presence, we're going

Dawn Davenport  32:57  
to be listing these, and I do think it is so important to have both a text and a I'm so glad. And this has been been around for a while now, but at 1.988 wishes to number but now it is text, and these are 24/7. I certainly know 988 And the Trevor Project are 24/7 support. Yeah. And the beauty of 988 is short and simple and easy to remember. That's right. And the Trevor Project is not exclusively, but they really are focusing on LGBTQ plus kids.

Speaker 1  33:27  
Right? That's right. The other thing I would say, too, for caregivers is that if there are firearms in the house, or substances, even sharps is when I think about like knives or things that youth could use to cut, I would highly encourage getting them out of the house temporarily just in this acute risk and really prioritize if, if that's already happening is safe storage of where do you keep these things locked away and safe. Because again, during this acute risk time, the blinders are on impulsivity can be high, and you want to make sure those things are safely stored or just not in the house all together. And

Dawn Davenport  34:08  
substances would be included in that look for what substances are in the house, look through your medicine cabinets, because you didn't take all the whatever the pain prescription that was given to you for you know, back problem last year, and you may still have it. So get rid of those. But what about suffocation? The objects people use to suffocate themselves are often everyday objects. So are there some objects? Are there specific things that parents should be aware of? Yeah,

Speaker 1  34:37  
that is one that is really tough, because no matter how safe you keep your home, there's always going to be something right that a youth could harm themselves with. So it's you do the best you can. And I think the main thing is just in that acute, don't leave them alone and stay with them. If you're worried those crisis lifelines exist for you He's in. And therefore caregivers as well, if you're calling and you're curious about, are they safe? Should I take them to the hospital? What should I do to keep them safe or my home safe, and making sure you have somebody else to walk through that with you aren't alone in and either these help

Dawn Davenport  35:16  
lines are not just for the person contemplating suicide, they're also for their loved ones, or the people who are trying to care for them. I'm really thankful you raise the issue of when do we keep the child at home? What should be the impetus to say, I've got to get this child into a place where they're going to have eyes on them all the time, as you discuss the acute period? How do we evaluate that as parents so hard,

Speaker 1  35:43  
even as a provider? That's one of the questions that I often have to ask myself, right of the goal is to keep families and communities in a safe space together, if it's a safe space, the main question for that is, are they going to be safe in this home, it really boils down to that, if you're used to saying, I don't care what you do, I'm gonna kill myself, and the parent can't stay with them 20 477 days a week, it's time to take a look at is a higher level of care needed, and really thinking about the hospitalization so that they are for those acute periods of time they are for stabilization. What's most important is are you connected to care to community to those safe spaces ongoing? Because again, it is that acute period, we just need to make sure that they're getting the care they need throughout, but it is that line of do I feel like I can keep my child safe? And they can keep themselves safe here? And the answer to that is no, then of course, you're gonna want to get support. Obviously,

Dawn Davenport  36:50  
during the acute period of time, you're going to be, as you say, trying to be with them all times, or getting them into a place where someone else can be with them. But one of the things that's a struggle is after what you think the acute period leaves, the blinders have widened somewhat, you can't be with them, of course, 24/7 for the rest of their lives. But first of all, the practical thing is how to, if they go to a friend's house, it's your responsibility to contact a friend's parents and say, Do you have guns? What should you do? Once the immediate what you think is the immediate crisis is over? How as a parent, do you start? And should you start removing some of the protections you've set in place?

Speaker 1  37:34  
So first, asking another parent, if they're spending the night if they have guns, I think that's a good idea. I also believe that part of walking through when do I start kind of getting a bit more open with my environment and letting them also be able to leave the house and things like that. That's something where I feel as though caregivers need that community to have keeping, making sure that we're surrounding and supporting our caregivers, you all that are that are listening to this, of having a mental health provider also help you have that conversation and help you navigate that as well. One of the things that I often talk with youth and their families about is Okay, so let's talk to Sally about how she's feeling in terms of spending the night at so and so's house. And, you know, how have you been doing lately? And there's one really cool thing that I actually learned from a young person and their caregiver was they had a little code word or a code emoji, where they would text their caregiver, that we don't have to talk about it. I'm not going to ask you a ton of questions. But it means that I'm having a hard time and I need your company or I need a distraction. I need something to distract me. I don't feel like being asked all these questions. But can we watch Netflix? Or can we make a meal together and listen to music. And that can be something where it's maybe the young person doesn't want to talk about the details of why they're feeling bad or be asked a ton of questions. Because, you know, with teenagers, sometimes they don't want to be, but I do need to have fun. And I just need you here. And that's one of those really quick ways that you can do that as well. That's a

Dawn Davenport  39:24  
great idea. And it also requires it seems to me that you've had this conversation with the child ahead of time, and acknowledged that there are times when you really just need company, you just need the connection, but you don't want to talk about it creating a family. We have a Youth Advisory Council. In our last meeting, one of the youth said, what grownups don't understand at times is that we don't always want to talk about it. Sometimes we just don't want to talk about it. And I kept my mouth shut but I was going I think she's talking to me I sense that that could be directed at me because as parents, it's the only thing we know to do, it's sometimes the only thing we can do. And they're a blank slate at times, and we want to have access. And that is particularly the case if our kids are at risk for suicide. And even more so if our kids have shown some warning signs. So I love that suggestion of the emoji because it allows number one to have had the conversation with the child about I understand that sometimes my questions seem overwhelming, and that you really don't want to get into the details, but you may just want to hang out. Right. I love that, because that's a great conversation to have. And the second one is it gives the parent the heads up to say, Okay, right now, is it time for me to keep my mouth shut?

Speaker 1  40:45  
It gives you some leeway to which I'm glad you so mentioned that because I think one of the most protective factors is continuing to have conversation and just leaving the door open, just leaving it open for them to walk through and work on that safe, secure relationship that they know you can repeat it, even if you get an eye roll. I'm here for you. Anytime that you want to talk. If they're saying I don't want to talk right now. And that's fine. It's just the door's always open. I always find that caregivers will often say car rides. Yeah, when you throw in the backseat, sometimes with friends, you'll learn a whole lot by being silent car

Dawn Davenport  41:22  
rides, they also are somewhat of not somewhat completely a captured audience. Their phones valid point Yeah, actually very valid point. Yeah. And the idea of getting their undivided attention when they're sitting in the backseat with their phones is is a myth. So give us some examples. You did give us an example right then of the language to use. So one of the protective factors is keeping the conversation moving. But at the same time respecting that they're always want to have the conversation. So give us some examples. You just said, I'm always here to talk when you're ready. That's a great example. How do we bring it up, though? And I'm not speaking of the acute because when they're in an acute crisis mode, it seems to me that conversations and help are going to be required at that point. But once we're past that, or before that happens, but we are worried we have reason to be worried. How do we bring up the conversation without being like, that's all we talk about, or that's the fear, that's all we're talking about. Because quite frankly, from a parent's standpoint, that's all we're thinking about. That's right.

Speaker 1  42:27  
And even monitoring that in yourself as a caregiver is so important and hard and very hard, because it'd be all that you are thinking about. And we have received feedback from us as well, saying, I was less likely, I'm not saying this is global, or for everyone, but it's something that we did here, I'm actually less likely to tell my parent because I know I'm gonna get asked 1000 different questions about it. That's all they're gonna talk about. It's really hard to say I am here for you, and the door is open and walk away. But I do think there's opportunities because again, connection is healing. What are things that they like to do? People talk about parents to monitor the youth? And I think that sounds very kind of punitive. And we don't want it to be that way. So what are shared activities that you can do together? Or you can keep an eye on but also connect? Yeah, what do they like to do? Do they like to watch anime on on Netflix? Do they like to cook? Would it be nice time to go for a walk? And at those times, there's conversations that can be had, and they may just open up to you. And if they do, just listen. And also you have every right to ask questions. It's just monitor how many questions you are asking, and how much you are validating because we want a lot of validation, and, you know, rightful questions to be had.

Dawn Davenport  43:56  
And validation would be things such as there has to be really hard, that must feel awful. Things such as that.

Speaker 1  44:04  
So validation does not mean agreement. And that's a good distinction to have is that you may not agree with how they perceive things right now. It's about seeing what they're perceiving. It's about oh, like you said, that must be really hard. Or oh, I didn't know you were carrying all of that on your own. Thank you for sharing it with me. It's stuff like that. And even if you don't agree with it, you can still validate that someone is experiencing it in that moment.

Dawn Davenport  44:29  
So saying things like, Is there something I can do to help rather than immediately go I will go talk with the teacher or I will I will deal with this or I will help but asking if there is something you can do.

Speaker 1  44:42  
Now going straight to problem solving. There's times where you can even ask and this goes for any relationship is do you want someone to just listen or do you want somebody to problem solve and have them tell you? Is this just a listen moment? Is this a problem solve moment because I can Do either just let me know. And that can be one way that you can start the conversation with any relationship. Honestly,

Dawn Davenport  45:06  
that's just good communication techniques. Yeah, often want to say to them, believe me, I could problem solve, just please just let me it's

Speaker 1  45:14  
just human nature, I want to fix this problem, I want to take your pain away. And it's really hard to accept that it's not that easy for this. And really, what's needed is to sit in the pain alongside someone who's experiencing something like this. One other thing is, and I should have started with this and didn't, for caregivers, as cliche as it is putting your mask on before you put your mask and somebody else on an airplane, it that is so incredibly true of how you are taking care of yourselves, how you are taking care of each other. Again, community is healing. And I really do believe it takes a village and you are part of that village. And I want to make sure caregivers also have their own village. Because you may need to go and vent and cry and have a safe space of your own after sitting and having these conversations with youth that you're caring for. So I just want to make sure that that's priority. Always.

Dawn Davenport  46:09  
It's such a good point. And again, we've mentioned a couple of the help lines and lifelines 988 And that can be used by a caregiver or the youth themselves. The Trevor Project, which is predominantly aimed at LGBTQ plus youth, the National Alliance for Mental Illness helpline is another good one. Have you used that?

Speaker 1  46:28  
I haven't used the helpline, but I do know their work. And that is really good.

Dawn Davenport  46:33  
Yeah. And there's also I have not used this one, but I have heard of it the National Parent and youth helpline. Are you familiar with that one

Speaker 1  46:42  
that's new that was new to meet you. I would love to learn about it. I have

Dawn Davenport  46:45  
not used it, but I have heard good things about it. But that's about all I know. Well, thank you, Dr. Angela tuna for being with us today to talk about a hard but important subject of suicide awareness and prevention.

Speaker 1  46:57  
Thank you for having me. I again, really appreciate the opportunity and hope this was helpful for those that were listening and thanks again for having me.

Dawn Davenport  47:08  
I know I've said this before, but it is the truth. This show would not exist without the support of our partner agencies. And these are agencies that believe in what we do, which is to support train and strengthen foster adoptive and kinship families. One of those agencies is Vista Del Mar. They are a licensed nonprofit adoption agency with over 65 years of experience helping to create families. They offer home study only services as well as full service infant adoption, international adoption, home study and post adoption services and a foster to adopt program. You can find them online at vista del

Transcribed by