INVENTORY OF STATE 
INITIATIVES

IN ADDRESSING YOUTH SUICIDE

National Program Inspection 
.. SOWICts 
""d1C 
OFFICE OF INSPECTOR GENERAL 
OFFICE OF ANALYSIS AND INSPECTIONS

November 1986
 . . 
"'"
.I 
Office of the Inspector General

The mission of the Office of the Inspector General 
(DIG) is to

promote the efficiency, effectiveness and integri 
ty of programs

in the United States Department of Health and Human Services

CHHS). 
It does this by developing methods to detect and prevent
fraud, waste and abuse. 
n 1976, the
Created by statute 

Inspector General keeps both the Secretary and the Congress fully

and currently informed about programs or management problems and

recommends corrective action. 
The DIG performs its mission by

conducting audi ts, investigations and inspections wi

approximately 1, 
200 staff strategically located around the
country. 
Office of Analysis and Inspections

This report is produced by the Office of Analysis and Inspections 
(OAI), one of the three major offices within the DIG. 
The other
two are the Office of Audit and the Office of Investigations.
OAI conducts inspections which are, typically, short-term s tudi es
designed to determine program effectiveness, efficiency and 
vulnerabili ty to fraud or abuse. 
This Report

Enti tied  " Inven tory of State Ini tiati ves in 
Addressing Youth
Suicide, 
" this inspection was conducted to collect information to 
supplement the work of the HES Task Force on Youth Suicide. 
The report was prepared by the Regional Inspector General, Off ice
IX. 
of Analysis and Inspections, Region  Participating in this
project were the following people: 
aye D. Kidwell, National Project Director
, Region IX,
Seattle, WA

Kathy Admire, Senior Analyst, Region .
IX, Seattle, WA
i tans, 
Ta Z  Headquarters, Washington
, DC
Alana Landey, Headquarters, Washington
, DC

Lucille Cop, Reg ion II, New York Ci ty, NY

William Counihan, Region 
II, New York City, NY

Phil Onofrio, Region V, Chicago, IL

Neil Merino, Region IX, San Erancisco, CA
 INVENTORY OF STATE INITIATIVES

IN ADDRESSING YOUTH SUICIDE

RICHARD P. KUSSEROW

INSPECTOR GENERA  NOVEMBER 1986 
CONTROL tP-09-86-00099
 TABLE OF CONTENTS 
Page 
INTRODUCTION 
OVERVIEW OF STATE INVOLVEMENT 
GRAPH: STATE INVOLVEMENT BY TYPE OF AGENCY 
STATE-BY-STATE SUMMRIES 
TABLE  STATE PROGRA INVOLVEMENT IN YOUTH SUICIDE 
II: 
TABLE  STATE INVOLVEMENT IN YOUTH SUICIDE 
2-3".  INTRODUCTION

In recogni tion of the effect youth suicide has on society as a 
whole, President Reagan
, pursuant to Senate Joint Resolution 
proclaimed June 1985 as Youth Suicide Prevention Month.  53,
As part
of the federal government' 
s response to the call for action on
this problem, the Department of Health and Human Services 

(DHHS)

cosponsored a National Conference on Youth Suicide during 
June,
and established a high-level HHS Task Force on Youth 
Suicide.

The Task Force includes senior officials from the National

Insti tute of 
Mental Health, National Institute of Drug Abuse,

National Institute of Alcohol Abuse and Alcoholism, Centers for 
Disease Control, and the Office of Human Development 
Services'
(OHDS) Administrati9n for Children, Youth and Families. 
The Task Force' 
s mandate is to "
assess and consolidate 
information which currently exists and to recommend or initiate 
activities which will attack-- head on' --the youth suicide
dilemma " and to generate research on the factors which place 
young people at risk of suicide. It sponsored three national
conferences on (I) Risk Factors, (2) Prevention and Intervention

and (3) Strategies for the Future between May and November 

1986.
The Task Force will culminate its work wi 

th a series of reports

and final recommendations which will be presented to the

Secretary in January 1987.

The Off ice of Inspector General 
(OIG) was asked to conduct a
quali tati ve national 
program inspection of youth suicide which
would supplement the work undertaken by the Task Force. 
The

focus of the inspection was to 
(a) assess the extent to which

HHS-funded programs are involved in efforts to prevent youth

suicide, 
(b) review how states and selected communities are

responding to the problems associated wi 
th youth suicide and

(c) identify barriers and gaps which hinder deli 
very of services 
to suicidal youth and/or their families. 
The results of this inspection are reflected in two reports. 
enclosed report, enti  The
Inventory of State Ini tiati ves in
Addressing Youth Suicitiedd e 
, has a very specific focus on state
issue. 
government efforts to address this 
During April,
telephone interviews were held with state officials of 5 program 
areas in each of the 50 states, including: 
education/public instruction 
men tal heal th

maternal and child health

drug and alcohol abuse

children' s services (foster 
care, child abuse and neglect,
and children 
s protective services). 
These agencies were selected because of their involvement wi 
youth, as well as their fiscal relationship wi 
th our Department
(all but the education agencies receive HHS funds). 
In some  states, knowledgeable representati ves from governors ' and 
lieutenant governors  offices, legislatures and planning agencies 
were also contacted.  A total of 283 officials were interviewed 
for the inventory. 
A companion report, enti  Youth Suicide , reflects study 
tIed 
findings based on 170 in-person interviews in 9 states and 178 
telephone interviews of community service agencies selected at
random.  issues, 
The report focuses on a range of youth suicide 
including magni tude of the problem, trends, communi ty response, 
detection and treatment, and gaps and barriers to serving youth 
at risk of suicide.  OVERVIEW OF STATE INVOLVEMENT

Forty-seven states reported involvement with youth suicide issues 
in at least one of the program agencies contacted. The only 
exceptions were Missouri, New Hampshire and South Dakota. 
(page 21) sumarizes 
Table I  which agencies are addressing this 
issue in each state. It should be stressed that this inventory
of state acti vi ty  1986. At 
is current only as of April  the time 
of the survey, many program efforts were evolving, and
undoubtedly there has been considerable acti vi ty subsequent to 
our contact with state officials. Some agencies which reported 
no current activity anticipated that they would be addressing 
future. 
youth suicide in the near  Some states are focusing 
efforts specifica ly on suicide prevention, while others are 
addressing the broader spectrum of self-destructive behavior and 
including suicide as one component in looking at the problems of
"high-risk" youth. 
As the following graph indicates, involvement 
varies across state agencies. 
STATE INVOLVEMENT BY TYPE OF AGENCY

JENT  L TH 
itCH 
SEm: 
(35 states) 
Nearly three fourths of the state education agencies 
suicide. 
have mounted some type of initiative to address youth 
Efforts range from compiling bibliographies of pertinent

materials on youth suicide to training school personnel and

parents in identifying and intervening with high risk youth

and/or developing specif ic curricula for students. Some are in 
the process of testing materials on a pilot basis while others 
are encouraging local school districts to develop their own 
programs. 
Manuals and brochures have been developed by a number
of the state agencies. 
A few have special teams to work with the  schools in developing suicide prevention programs or addressing 
crisis. 
the aftermath of a suicide-related  Peer programs are 
states. 
being implemented in a number of 
Over half (28 states) of the mental health programs are

addressing youth suicide. In states which have created statewide

or interagency task forces to address this issue, the mental

heal th programs are frequently assuming lead agency

responsibili ty. Some are identifying youth suicide prevention in

state plans or are involved with sponsoring training through

workshops and conferences. 
The 21 maternal- and child health programs are involved in a broad
array of acti vi ties 
impacting on youth suic ide. Many programs 
have identified suicide as one of several high priority 
adolescent issues: Maternal and child health programs have 
sponsored a number of conferences and other training sessions for
service providers as well as youth. 
They are also involved in 
funding some direct services such as hotlines for youth and 
settings. 
special risk screening in health clinic 
Nearly one-third (IS states) of the drug and alcohol programs 
reported some involvement with youth suicide, primarily by 
training service providers to identify and intervene wi
suicidal youth. 
There is strong recognition of the link between
drug and alcohol abuse and suicide. 
The tone of the interviews with the childrens ' services programs

(i. 
e., foster care, child abuse and neglect, and children
protecti ve services) was markedly different from di 
scussions held 
the other four program agencies. 
wi th  Fewer than 20% (9 states) 
reported any involvement at all wi th this issue. The childrens 
services programs were rarely involved in any interagency
ini tia ti ves, 
whereas the other four programs surveyed were nearly 
always involved in state task forces, commissions and advisory
councils. 
Legislation addressing youth suicide has been approved in II 
states and a number of bills are ei ther under active 
consideration or will be introduced during the next session in 
other state legislatures. Governsotrast eors .L ieutenant Governors have 
assumed a leadership role in 10  These are the states
that most frequently have created statewide ini tiati ves such as 
interagency task forces or advisory councils. Many of these

states have placed considerable focus on developing programs in

the schools.

Table II (page 23) identifies types of activities currently 
underway in the various states, such as legislation the 
r-6rce. 
development of printed materials or creation of a t 
A sumary of ini tiati ves in each state follows.  STATE-BY-STATE SUMRIES

Based on interviews with 283 state officials representing
children  s services, mental health, drug and alcohol, maternal
and child health, education, and occasionally legislative and 
sumary of state 
gubernatorial offices, following is a 
invol vement with youth suicide issues as of April 1986. See 
ini 
Tables I and II for the tabular sumaries of state  tiati ves 
involvement. 
and specific program 
ALABAM  The State Board of Education is considering a 
resolution which would require that suicide prevention be 
included in school health and mental health programs. 
(I) emphasize, within the 
Specifically, the resolution would 
comprehensive counseling and guidance plan, the improvement of 
mental health programs in schools and (2) direct schools to 
provide teacher training at all levels on how to recognize and
deal with high risk-youth. 
ALASKA  The drug and alcohol program includes a presentation-en 
the relationship between suicide and substance abuse at their

annual training conference. Mental health staff recently

1984, a 38%

completed a study which found, for the period 1978 to 
increase in legally-determined suicides in addition to those

The 
reported to the National Center for Health Statistics. 
largest number of unreported suicides were among Alasukna dNeart.i ves,

The
a significant number of whom were youth aged 24 and s
pecialist, 
educa tion agency recently hired a health education 
th the

who is currently researching youth suicide issues wi 
objective of developing training materials and intervention

strategies for teachers.

ARIZONA  Last year, staff from the family and children I
servi  es program con-ducted a special study with the health 
department to examine possible links between child abuse and
suicide. 
The results were inconclusive, because the incidence of
s uic ide was so low. 
ARANSAS  The lieutenant governor established the Arkansas Youth 
Suicide Prevention Commissions,t awtheic.h  has published a brochure for 
distribution throughout the  Future plans include 
th the 
producing a film for use in the schools and working wi 
legislature toward enactment of a youth suicide prevention 
program in the schools. As chairman-elect of the National

Conference of Lieutenant Governors, the lieutenant governor has

also established a special task force to study this problem

nationally. 
Hearings are planned. 
Mental health program staff report that one of their state-

operated community mental health centers has spearheaded an

county-wide ini tiati ve  led Lifesavers. Under the

extensi ve, 
general direction of a steering committee, five operating

have been established wi th a focus on teachers, school 
commi ttees  media. Activities 
administrators, survivors, parents caanrdi ntgh ec o
mmittees, " consisting

(I) establishing "
have included:  nurse, at each junior and

of students and a counselor, parent and 

senior high school to serve as referral resources for troubled

youth, with mental health professionals donating time as

(2) training peer counselors on youth suicsiudiec,i daen,d 
as

consul tants, 
(3) co-sponsoring a local television program on youth 

well as televised public service announcements.

In 1981, the legislature convened a hearingc oomnm yiottueteh. 
CALIFORNIA 
, which

suicide, which led to the creation of a state advisory 
suicide. 
A year of fact finding led to the enactment of legislati

created a three-year pilot program to deter youth 

Envisioned as a collaborative effort among local sycehoaorl.
  Activity
districts, suicide prevention centers and the state education

agency, the pilot program has entered its second 

schools. The

to date has focused at two suicide prevention centers, which are 
segments; 
developing and testing a curriculum for use by the 
curriculum consists of classroom lesson plans, awareness 
for parents and school personnel, and a brochure for parents. 
will be tested in selected schools in Spring 1B9y8 61 9a8n7d,  wtihlel program

eventually be adapted for younger children. 

will expand to additional school distryiecatrs  owfi tthh ea  pgiolaolt  owfi
ll focus

statewide implementation. The third 

on evaluating the effectiveness of the program and preparing a

comprehensi  report to the legislature. 
year youth suicide 
A second piece of legislation launched a five
 let 
preventi  program, to be coordinated by the mental health 
first year, the department has 

department. Currently in the 
(I) a statewide evaluation of the problem of

contracts for: 
youth sulcide, including a statistical analysis, profiles of

youth at risk and a determination of needs and existing resources

ties and (2) development of a film that

in schools and communi  schools. '

will be shown on television and in 

The maternal and child health program reports that as part of an

It has also

adolescent family life program, clients are profiled for life

- threatening indicators, including risk of suicide. 
suicide. 
held a workshop for local maternal and child health directors on
the identification of youth at risk of 

The mental health program is analyzing data of youth 
COLORAO 
invol ved in the mental health system on both an inpatient and 
a patient profil

outpatient basis. The study will provid  for the

strategies. 
identificatio  of risk factors and recommendatio 
development of prevention, intervention and treatment 
The maternal and child health program is in the process of 
updating a 1982 study on adolescent health, including mental 
report, scheduled for release in

heal th and suicide. A  of the probl

resolution. Maternal and child
september 1986, will include a descriptio

pertinent data and strategies for 

th the Suicide prevention Allied 
is also involved wi 
heal th  Effort 
(SPARE), which conducts workshops, develops local
Reg ional 
 coali tions, promotes networking and collects materials for

information and referral.

CONNECTICUT  The maternal and child health program reports that 
youth are assessed for risk of suicide at school-based health 
clinics and young parents' classes.

DELAWARE  The children' s division of mental health has funded 
publication of a brochure on youth suicsidtea,t ewh.i ch was distributed 
to high school students throughout the  The education 
agency has sponsored youth suicide workshops for school personnel 
and incorporated lesson plans on suicide into its health 
education curriculum for grades four through twelve. Both the 
mental health and education agencies are actively involved in a 
council of public and private representatives which advocates for 
the prevention of" teenage suicide. The council has helped create
several support groups for survivors and adolescents at risk of

psuriecivdee anndt iohans  ltorbabiiendi nthge  gfeonerr aslc ahssoemobll yp teo rmsanodantne esuli.c ide

FLORIDA  In 1984, the legislature enacted legislation which--" 
required the Department of Health and Rehabilitation Services, 
in conjunction with the Departments of Education and Law 
Enforcement, to develop a state plan for youth suicide 
prevention. The intent of the legislation was to develop 
prevention, intervention and treatment strategies with an 
emphasis on detection, clarification of the responsibility of 
school counselors, cooperation between school and communi 
resources, and the timely referral toife shi.g h-risk youth to 
professional help in their communi  To achieve this mandate, 
a statewide task force, as well as eleven district task forces,
were established to create local plans and an overall state plan.
The state plan was finalized and sent to the governor and the 
1985. 
legislature in January  Key elements addressed in the plan 
incluQe the need for: (I) improved planning, coordination and 
coopera tion among service agencies, (2) increased public 
awareness, (3) systematic training of professionals and 
nonprofessionals who work with youth, (4) special emphasis on 
training school personnel and addressing youth suicide in the 
life management skills" curriculum, (5) expansion of toll-free,
24-hour crisis hotlines into counties lacking  this service,
6) model crisis centers, funded ini tially 
on a pilot basis , with 
a strong evaluation component prior to statewide implementation 
and (7) improved data collection. To date, lack of resources has 
resulted in minimal implementation of the plan. 
GEORGIA  The maternal and child health program has identified 
adolescent issues, including suicide, as a priority. 
distributes materials on risk factors for troubled youth and 
includes a component on youth suicide in its workshops. The 
identification of potentially suicidal adolescents in the 
classroom will be a major thrust of a conference scheduled in 
October for teachers and public health workers.  HAWAII  The state education agency is conducting a study which 
includes youth at risk of suicide. 
A number of community
agencies are involved in gathering data for the 
report, and other
state agencies have been asked to contribute available data on 
youth suicide. The preliminary report is scheduled for release

in August 1986 and will serve as a basis to design programs to 
respond to study findings. 
In addi tion, the agency is increasing
an emphasis in school counseling programs to 
(I) identify and
work wi th high risk youth and their families and 
(2) create a
school climate which will encourage kids to surface problems. 
The mental health program is just beginning to explore the 
relationship between drug abuse and 
suicide, and suicide
prevention has been identified as an objective to be achieved by
1990. 
The agency is encouraging its community mental health
centers 
(state-operated) to address youth at risk of suicide.
Program funds support a private general crisis hotline and a 
crisis support team directly involved in suicide intervention. 
IDAHO  The mental health agency is establishing a statewide
youth suicide prevention committee, with representation from
thin and outside state government. 
wi 
The state education agency
recently sponsored a conference which focused on peer support 
groups, and included training specific to suicide 
ILLINOIS  In 1985, the legislature passed legislation which 
would allow schools to include a number of topics in the school 
suicide. 
curricula, including 
The state education agency will
develop the resource materials. 
The legislature is considering a

bill which would provide for the development and implementation 
of suicide prevention programs through the schools. 
The maternal
and child health program has 
(1) sponsored teen conferences which
include suicide, (2) funded three demonstration programs which
feature a case manager for each teenager to assure access t 
care 
and preclude the risk of suicide and 
crisis ,  (3) funded a toll-free 
hotline for kids. 
INDIANA  The division of nursing, of which maternal and child 
heal th is a component, has spearheaded a number of youth suicide
tiati ves: 
ini 
(1) developing a training manual, wi 
th input from
I ,	 the mental health and education agencies, which has been 
distributed to school corporations, school nurses and communi 
mental health centers, 
(2) sponsoring a series of conferences for
school and public health nurses which focused on youth suicide

awareness, and (3) 
county.  organizing a youth suicide task force 	 each
The issue will be addressed again in a second serinies of 
conferences on violence and crisis intervention. 
IOWA. 
The maternal and child health program has produced a
maal 
on adolescent health issues. 
Youth suicide is
incorporated into the section on counseling. 
Training on use of
the manual, including a workshop on youth 
throughout the state for public heal  suicide, will be held
th nurses, school counselors
and. other health professionals. 
Maternal and child health is 
also cataloging efforts to address youth suicide by various  school districts, 4-H groups, etc., and will be making 
recommenda tions to schools, communii stys ugero.u ps and other 
appropriate organizations on this  The state education 
schools. 
agency has helped implement peer programs in 210 high 
Peer helpers have received specific training on suicide 
awareness. 
The agency is working with the State Agricultural 
Extension Service and 4-H Program on crisis intervention 
strategies to address the impact of the farm crisis on youth and 
their families. The children s services agency sponsored 
workshops for its youth service workers and staff in juvenile
insti tutions 
on suicide awareness and prevention. 
KANSAS  Each sumer, the drug and alcohol program sponsors an
intensive five-
day training program for school teams which 
consist of an administrator, two teachers, a support person
(e. g., nurse or counselor) and a community person (e.g., parent). 
Although the primary focus is on alcohol and drug prevention and 
youth,
intervention, other problems associated with high risk 
including suicide, are also addressed. Ongoing training and 
technical assistance continues throughout the school year. The 
drug and alcohol program also funds prevention grants and one-Of 
these grantees recently held a conference on youth suicide. 
th/ 
The state education agency and the mental heal 
KENTUCKY 
mental retardation agency are implementing a joint youth suicide

prevention program. The primary purpose of the program is to 
train public school teachers to identify, assist and
appropriately refer high-risk youth. 
The training also addresses 
what to do in the event of a suicide emergency at school and how 
to handle classroom education for students on suicide-related
issues. 
Training will be delivered to public school teachers by 
a team consisting of one person from the local regional communi 
system. 
mental health center and one person from the school  The 
agencies are in the process of conducting regional workshops for
these, training 
teams (i. e., training the trainers) who will then 
ties. A 
make training available to schools in their communi 
manual has been developed for use in conjunction with these
training sessions. 
The mental health program has also joined 
sumer school for 
wi th the drug and alcohol program to sponsor a 
substance abuse and mental health staff. A workshop on youth 
agenda. 
suicide is included on the 
LOUISIANA  The state education agency has a cadre of trained 
teachers, 
staff who are working with guidance counselors, nurses, 
awareness. They conduct 
administrators and parents on suicide 
workshops at professional meetings and in communi ties, with a

strong emphasis on communi ty-wide participation. When a suicide

or attempted suicide occurs, the team is available to work with a

crisis. 
community, marshalling local resources to address the 
The agency also has a separate initiative to identify a range of

suicide. 
high-risk youth, including those at risk of 
MAINE  The mental health program published a report in

March 1986 on suicide and self-destructive behavior among
 teenagers. The report has been widely disseminated and will

force, which will prepare

serve as the basis for a statewide task  1987. 
The maternal
recommendations to the legislature by January 

and child health program is helping to fund a p1r9i8va6t.e  agency to

The state
conduct a conference on youth suicide in June 

education agency participates on the Maine Commission of Youth

Suicide, a private agency.

MAYLAND  The legislature recently passed two bills refloartcien,g to

youth suicide: (I) establishing a gubernatorial task
based
which will begin work in July 1986 to develop broad-
(2) charging the mental 
strategies to address youth suicide, and 
health and education agencies to jointly develop model projects 
s Office on Children and Youth recently

in schools. The Governor' 
published a brochure on youth suicide which has been widely

ffice also published a book in January 1986

disseminated. The 

on the status of children, which includes a discussion of youth

suicide. 
day workshop for

The drug and alcohol program sponsored a two-
substance abuse workers, school personnel, police and parents.

included. The agency a

Special sessions on youth suicide were 
is heavily involved with peer leadership training, which includes

The agency stresses the strong link

training on risk of suicide. 
suicide, emphasizing that the warning

between substance abuse and 
signs for suicide are essentially the same as for substance

abuse.

based health

Maternal and child health staff fund school-

ze comprehensive services, including

projects, which emphasi 
The focus is on youth and their 
addressing risk of suicide. 
families. The agency is also funding a conference in SpMriantegr n1a9l8 6 
issues, including suicide. 
on a broad range of health 
and child health has received a special demonstration grant from

HHS to ,establish a data base on the health needs of youth 
The goal of the grant is to 
offenders and wards of the court. 
develop training for intake workers on such issues as identifying 
kids at risk of suicide and knowing how to act in these
si tuations. 
In 1985, the governor convened a task force on 
MASSACHUSETTS 
youth suicide, which is chaired by the mental health agency and
thin and outside state

consists of representation both from wi 

report of the task force is scheduled to

government. The final  1986. Major recommendations include: 
go to the governor in June 
programs with other

(I) to integrate suicide preventio 
adolescent prevention programs (e. g., substance abuse, teen

pregnancy), (2) to strengthen services to older youth and improve

(3) to develop aggressive

the transition toward emancipation and  incl"1in.g: . 
tradi tional 
al ternati ves to  service approaches, 
(b) developing specific intake

(a) establishing peer programs, 
procedures for crisis intervention and maintaining adolescent

staff specialists at community mental health centers,

(c) developing procedures for immediate response to suicide
 attempts at hospitals and health clinics, maintaining adolescent

specialists on staff and requiring that referrals be made

following emergency treatment, (d) training other staff who work 
youth in crisis intervention (e. g., children' s services 
wsi tuh  icide. 
workers), and (e) recognizing the key role of the schools and 
ensuring they are able to detect and respond to youth at risk of
As of April 1986, the legislature had reported out of committee

an omnibus health and education bill which addresses youth

suicide by 
(a) creating a discrete grant program for planning and 
(b) establishing a 
in-service training in the schools and 
ttee and local 
statewide health and human resource advisory commi 
coordina ting committees, upon which funding for youth suicide

prevention is contingent.

(both
The alcohol and drug program funds 8 prevention centers 

school and communi ty based), as well as 51 early intervention

destructive behaviors.

programs which deal with interrelated self-
Training on prevention skills, including the prevention of

suicide, is available to teachers. In June, the children'

services program is sponsoring a training session for staff on-

youth suicide. Maternal and chil  health staff completsetda tae f.i ve-

For
year (1980-84) statistical analysis on suicide in the 

1985, they are studying the circumstances of all deaths,

including suicide, to determine which children had been involved

. wi th state service agencies. Maternal and child health also 
funded the Samaritans, a private suicide prevention haogtelnincey,. to
develop a school intervention program, including a 

MICHIGAN  The mental health program has funded a pilot program 
in one county which features (I) peer counseling at a highskills,
school, 
(2) teaching coping, problem solving and survival 
of which suicide will be a component, in the eighth grade 
school, 
curriculum at a middle  (3) training teachers to recognize 
high risk kids throughout the county and (4) dcevreilsoipsin.g  a

Depending 
proacti ve plan on how to respond to a suicide 
on the study results, the approach may be expanded to other
counties. 
The state education agency reports that the governor
ini tiated 
a special interagency work group to develop a 
It is 
comprehensive school health education curriculum. 
uni ts 
anticipated that the eighth grade curriculum will include 
th a

on problem solving, developing coping skills and dseualiciindge .wi

number of problems facing adolescents, including 

MINNESOTA  The state education agency recently sponsored a 
think tank" meeting with the University of Minnesota Agriculture 
Extension Program to develop state strategies regarding youth
suicide.  education, 
The meeting, representing a broad range of 
state agency and community interests, was sparked by 4-H Club 
representatives who saw a need to examine the stresses on youth 
brought about by farm failures. As part of the effort, the

recently completed a series of three surveys which

uni versi ty  suicide,
focused on stress and depression as precipitators of 
 with..  he resulting recommendation tshkati lslcsh.o ols emphasize coping, 
communication and problem solving  sTuhiec iadgeen.c y has also 
Furthermore, 
sponsored a statewide conference on youth 
risk, 
the State Board of Education is addressing learners at 
including those at risk of suicide, with a plan to build on 
schools, 
existing chemical dependency prevention programs in the 
beginning at the elementary level. One of the Board' s stated 
goals is to raise the level of understanding among policy makers,
incl uding legislators, through a series of meetings, written 
reports and recommendations, of the difficulties of teaching at-
risk learners. 
Finally, the education agency will sponsor a 
teleconference with schools in the fall of 1986, concerning their

role in prevention and crisis intervention wi th high-risk kids.

The maternal and child health program (a) recently published a

state plan, which identifies suicide as a key problem and (b) has

a SPRANS grant wi th the Uni versi ty of Minnesota to develop a 
base. 
model national adolescent data 
MISSISSIPPI  The maternal and child health program sponsored a 
World Health Day for adolescents, and youth suicide was one of
five issues addressed. Students were selected from schools . 
throughout the state and were expected to share this experience 
schools. 
wi th the other students at their respective 
MISSOURI.  No involvement. 
MONTANA  The state education agency has developed a resource 
guide of films, articles and other materials available to school

personnel on a range of topics, including youth suicide. The 
guide has been distributed to all school districts.

NEBRASKA  The children s services staff is developing a program 
on youth suicide to be aired on educational television during

Sumer 1986. 
The film is being developed in response to an 
A study guide to 
expressed training need by foster parents. 
accompany the film will be distributed to foster parents and

other interested persons. The state education agency is 
suicide. 
beginning to formulate a strategy to address youth 
Existing curricula and manuals on suicide awareness and

reviewed, and school personnel are 
prevention programs are being 
being surveyed to determine the level of interest in a training

package. 
NEVADA  The drug and alcohol program recently drafted a protocol 
for the identification of high risk youth and steps to take in a

suicidal emergency. They plan to pilot the protocol at a

residential treatment facility and, if effective, adopt the

statewide. 
protocol for use in treatment facilities 
No involvement. 
NEW HAMPSHIRE. 
NEW JERSEY  In 1985, the legislature enacted a law which would 
(I) establish youth suicide prevention pilot programs in three
 regions of the state, to include classroom instructional 
materials, training of school personnel, parent education 
programs, programs for the families of suicide victims and 
linkages with community-based programs, (2) create a 10-member 
Youth Suicide Prevention Advisory Council and (3) require a full 
report to the governor and legislature on the outcome of the 
vi ties of the Advisory Council. 
pilot program and the acti  The 
legislature intended that the pilot programs be developed by 
community mental health centers, in consultation with local 
school boards. The pilot programs are in operation in selected

schools in three suburban communi ties and will soon be evaluated

for effectiveness by independent evaluators. Officials hope the 
legislature will provide additional funds to adapt the pilot 
ma terials for testing in rural and innerci ty settings, which 
eventually will result in a model school curriculum for use 
throughout the state. The state education agency has developed a

raining manual, which shtaast ebe.e n widely 
suicide awareness 
 Training is
distributed to educators throughout the 
available on a regional basis. 
NEW MEXICO  In 1985, the governor established a time-limited 
task force to promote coordination among various agencies wi  ; an 
interest in youth suicide. A conference was held in 1985 and a 
second conference is scheduled for 1986. To date, staff support 
for the task force has been from wi thin the immediate off ice of 
the governor, but staffing and lead agency responsibili ty will 
soon be transferred to the Department of Health and Environment. 
Wi th the exception of the children s services program, all the 
programs surveyed have been involved in thew geovlle.r nor' s ini tiati ve 
and are pursuing their own initiatives as  The state 
education agency has co-sponsored three statewide workshops on 
youth suicide for school personnel and other state and local 
public employees who are in contact with youth. 
The mental health program has designated a suicide prevention

coordinator, who has been working wi th the New Mexico Chapter of 
the National Committee on Youth Suicide Prevention on a series of 
regional workshops for adults who work with adolescents, as well 
as a special workshop for adolescents. The mental health program 
is also working with the Uni versi ty of New Mexico s Department of 
pediatrics to address youth suicide at selected teen clinics 
. health program is 
throughout the state. The maternal and child
spearheading an adolescent health promotion task force and has 
several thrusts: (I) sponsoring a conference for Fall 1986 on

intervention strategies, (2) through a special maternal and child

heal th federal grant, addressing injury control from self

destructi ve behavior, including suicide, on Indian reservations,
and (3)  issues. 
working wi th the legislature on pertinent 
The drug program is currently developing information on youth

plan. 
suicide to be incorporated in the substance abuse state 
epidemiologist wi thin the health department has recently

completed a special study of youth suicide, based on the review

1984. Study findings include: 
of mortality records from 1962- (I) the highest incidence of suicide was among Native Americans,

(2) the greatest increase in suicide was among Hispanics and

(3) suicide among younger children, aged 5 to 14, increased among
all ethnic groups. 
The results will bes tpautbeli.s hed and a sumary 
disseminated to all physicians in the  The legislature has 
created a special subcommi ttee to study youth suicide, with the 
goal of developing legislative proposals by January 1987. 
NEW YORK  In 1984, the lieutenant governor established a special 
task force to address youth suicide. After leaving office, he 
created the National Committee on Youth Suicide Prevention (based 
chairs. 
in New York City), which he currently 
The Governor' s Youth Suicide Prevention Council, consisting of a 
broad public and private representation, was charged with 
outlining what is known about teen suicide, as well as making 
specific recommendations for administrative, budgetary and 
legislative steps designed to reduce the incidence of teen 
suicide. An interim report was published in 1985, and a fin 
1986. 
report is expected in June  Recommendations from the
interim report include: 
(I) developing a compendium of program 
models, critical evaluations and community strategies for 
addressing youth suicide, (2) developing and maintaining a 
information, 
clearinghouse of teen suicide prevention 
(4) establishing a state policy 
(3) supporting research, 
funded teen 
requiring an evaluation component in all new state-
suicide prevention programs, (5) holding regional and statewide 
seminars for the media regarding their potential role in the 
prevention of suicide, as well as encouraging the media to 
suicides, 
develop voluntary guidelines for the reporting of teen 
(6) developing recommendations regarding hospital emergency room
practices, and 
(7) developing recommendations regarding the 
reporting practices of medical examiners. 
In addi tion to having lead agency responsibility for the task 
force, the mental health agency is developing a manual, which 
Sumer 
will be available by  1986 and which describes various 
approaches communi ties might take in developing suicide 
prevention efforts. The agency, in conjunction wi th the health 
department, has been charged with developing a protocol and 
guidelines for hospi tal emergency rooms, which include linking up 
youth with adequate follow-up services upon discharge from the 
hospi tal. In addition, a pilot project has been funded to allow 
community mental health centers to develop a curriculum on youth 
suicide prevention, which can serve as a basis for training 
ties. 
people in their communi 
The state education agency has developed a manual on youth 
suicide prevention, which has been distributed to every school in 
the state. Schools have been instructed to incorporate into 
their guidance programs, a protocol for dealing with high risk 
suicide. 
The agency has 
youth, including those at risk of 
jointly funded several pilot projects, all of which have a school 
component, but where services are delivered in a variety of  settings. 
Finally, the agency has helped match up schools with 
suicide. 
communi ty agencies who can help them address youth 
Maternal and child health staff have conducted two research
projects: (I) 
profiling youth who have completed suicide and 
(2) examining the impact of a television docudrama on hospital 
emergency room admissions and calls to regional poison control
centers. 
They have also worked with adolescent health providers 
suicide. 
to develop a plan to reduce youth 
The drug program sponsored training specific to youth suicide as 
part of their school-based junior and senior high programs. The 
alcohol program has identified youth suicide in its five-year 
the rei 
prevention plan and is developing a paper on  tionship of 
alcohol use and y uth suicide. 
The legislature is considering providing addi tional funds to

school districts who have developed a plan for identifying 

children at risk for a number of problems, including suicide

NORTH CAROLINA  The mental health agency has developed a 
training curriculum on youth suicide for personnel wi thin the
juvenile justice and public school systems. 
The curriculum has a
self-
instructional component so that participants can train
others. 
Training is also provided for mental health 
professionals with an emphasis on emergency services and crisis 
stabilization. The agency plans to initiate three public forums, 
using a format developed by the American Association of 
Suicidology. The state education agency has sponsored workshops 
for school personnel and is developing a training package, which 
will include a videotape, manual and workshop, on the subject of 
Suicide will be addressed. 
children under stress.  The package 
will be structured so that counselors can use the materials to 
train others. 
NORTH DAKOTA  The governor has established a Commission on Youth 
at Risk, which is staffed by the statewide mental health
association, a private organization. 
The commission is studying 
a range of problems, including youth at risk of suicide. A 
Sumer 1986. 
report is anticipated by  The mental health 
association has also developed a manual on youth suicide, which 
is used in workshops, and has a special federal suicide 
prevention demonstration grant from OHDS to set up networks at 
the community level for runaway and homeless youth. The maternal 
and child health program is participating in a five-state 
looking at 
research project on the epidemiology of suicide (e. g., 
the increased incidence of suicide in farm communi ties) . The 
program also funds the printing of materials developed by the
mental health association on youth suicide. 
OHIO  The maternal and child health program has identified 
suicide in its five-year state plan as the second leading cause 
of death among youth, aged 15-19, and has established a specific 
1990. Maternal and child 
objecti ve to reduce the suicide rate by  heal th also has funded eleven demonstration projects,c awhriec.h  are 
designed to provide comprehensive adolescent health  Each 
demonstration includes a youth hotline and walk-in clinics, where 
agencies. 
youth are triaged and referred to appropriate service 
State education staff are available to make presentations, which 
include youth suicide, to schools and at regional conferences.
Li terature and films on youth suicide are available. The drug 
and alcohol program holds a sumer institute for student leaders 
and school advisors. The primary emphasis is on prevention of

addressed. 
drug and alcohol abuse, but youth suicide is also 
OKLAHOMA  In 1985, the legislature authorized funds for youth 
emergency services, including suicide prevention and

intervention. 
Funds were used to: (I) hire youth crisis workers 
and set up emergenceyr ss,e rvices systems for children at community
mental heal th cen  (2) guarantee payment to local psychiatric 
units for the hospitalization of youth, and (3) develop a pilot 
mobile crisis intervention team in the state' s most populous

. county. 
The mental health agency is developing a screen to 
profile youth at risk of suicide, schizophrenia and severe mental 
disorders. The screen will be used throughout the state by 
schools, day care centers, health clinics, and hospitals. It-
intended for use with children of all ages and places a strong 
emphasis on family and environmental factors. A statewide and 
three regional conferences are planned to train people to use the
screen.  staff, 
Workshops on teen suicide are available to school 
parent groups, etc., through guidance centers staffed by county 
departments. 
heal th  Requests for training are made through the 
state education agency, which has a cooperative agreement with 
the health agencies. 
OREGON  In 1985, the state education agency conducted a study of 
youth suicide, which culminated in a series of reports to the
state Board of Education. 
Subsequently, the superintendent and 
state board have encouraged schools to develop programs to

address suicide. The agency has published a manual for

distribution to schools and has conducted special workshops for

counselors. The maternal and child health program has recently

established four school-based health clinics. One focus of these 
clinics is the early identification of depression and other 
suicide. 
mental health problems, including assessing for risk of 
tes. 
There are plans to expand this program to other school si 
PENNSYLVANIA  The governor has requested funds from the
legi slature to 
enable the state mental health, drug and alcohol 
and education agencies to mount a collaborative youth suicide 
include: (I) 
initiative which would  developing a curriculum on 
teen suicide for school personnel, (2) training of school

personnel and (3) providing funds to community mental health 
being 
centers to evaluate and treat youth who are identif  d -
at risk of suicide. The proposal would build on an existing
prog ram which identi f ies and intervenes with youth at risk of 
substance abuse. The legislature is actively considering the

governor I s proposal and has approved a resolution to hold  hearings, develop a report and make recommendations that would

address this issue. A select commi ttee on teen suicide held

1986.

hearings throughout the state in Spring 
The state education agency recently developed a pamphlet on teen 
Sumer 1986. 
suicide, which should be available by 
The publication will be distributed to all school districts for 
The agency has 
use by teachers, counselors and administrators. 
also sponsored workshops on children at risk, including risk of
suicide. 
The school drug and alcohol program is broadening its 
scope to encompass training on the relationship of substance 
suicide. 
abuse to other problems, including teen 
RHODE ISLAND  In 1985, the general assembly passed a joint 
resolution, creating a Task Force on Teenage Suicide Prevention 
the lieutenant governor. 
to be chaired by  The task force, which 
has broad statewide representation, has established the following
goals: (I) 
compile a statewide data base on youth suicide, 
(2) formulate policy and legislative recommendations for state

and local governments and (3) guide school systems in developing

A report is anticipated by "
suicide prevention programs. 
June 1986.  for 
Future acti vi ties include planning a conference 
guidance counselors and investing in the establishment of a model
surveillance system. 
The task force has also introduced 
legislation to the general assembly which would (I) require 
incorporation of a suicide awareness program into the high school
curriculum, 
(2) establish workshops for teachers and 
(3) distribute materials to schools, libraries and other public
buildings. 
This legislation is the product of a special pilot 
program which was developed by the Samaritans, a private suicide 
prevention agency, under a grant from the National Conference of 
funds. 
state Legislatures and state maternal and child health 
The pilot program is evaluating the effectiveness of a model 
suicide awareness program in four high schools and includes an 
orientation workshop for teachers, lesson plans for students and 
an evening session for parents.

The mental health program is developing a comprehensive plan of 
component. 
which youth suicide is a  The agency provides 
in-service training and is evaluating youth suicide materials to 
select appropriate ones for distribution to community mental 
health centers. The state education agency is completing a

. comprehensive health education curriculum guide, of which youth 
suicide is a component. There is a statewide policy to test all 
children in the third and sixth grades, including mental health 
questions. The testing will be expanded to grades eight, ten and 
suicide. 
twelve and will include risk of 
SOUTH CAROLINA  The mental health agency works wi th heal 

education centers, which provide training on a wide range of

suicide.

topics, including youth 
No involvement. 
SOUTH DAKOTA.  . The state 
TENNESSEE  education agency has incorporated suicide 
into its new comprehensive health education curriculum. The
heal th department 
recently completed a study of suicides over the 
past five years and found that the IS to 29 age range was the 
increase. 
only group which experienced an  The greatest increase
was among young adults, aged 20 to 24 (117%), followed by the 15
to 19 year old age group (56%). 
TEXAS  As part of its, statewide conference for school 
counselors, the state education agency has used schools with

model suicide prevention programs as trainers in workshops on

youth suicide. Virtually all counselors in the state have

participated in these workshops. 
Counselors have been given a
curriculum developed by the American Association of Suicidology.
The mental health agency is planning a state conference on teen
suicide, tentativ  1986. 
ly scheduled for Fall  Mental health 
staff have participated in a special study, commissioned by the

HHS Youth Suicide Task Force, surveying communi ty efforts at

youth suicide prevention.

UTAH  The mental health and drug and alcohol programs recently 
collaborated with a local hospital to sponsor a statewide 
conference on youth suicide. The mental health program also 
recently received a federal grant from the National Institute of 
Mental Health to develop a network of school counselors, 
communi ty mental health centers, other local service providers 
suicide. 
and parents to identify youth at risk of  The drug and 
alcohol program is working with the state juvenile justice 
program under a federal Juvenile Justice Demonstration Program 
grant to better serve troubled youth, including those at risk of
suicide. 
The state education agency is exploring the integration
of . suicide prevention into the state alcohol and drug curriculum 
for grades one through twelve. 
VERMO  The mental health agency has a clinician under contract 
to do training, upon request, for schools, mental health clinics
and nonprofit agencies. 
The agencsyt aalfsfo.  held a workshop on youth 
suicide for mental health center  In addition, under a 
National Insti tute of Mental Health grant, youth suicide has been
identif ied as a priori ty child 
and adolescent service and funds 
issue. 
have been earmarked to address this  Both the children 
services and drug and alcohol programs have sponsored workshops 
or encouraged staff to attend training sessions on youth suicide. 
VIRGINIA  The state education agency has identified youth 
suicide prevention in its comprehensive heal th education 
curriculum plan. The agency has also sponsored workshops for 
school administrators and teachers and is updating a list of 
youth suicide resource materials available to school personnel.
The mental health agency is co-sponsoring a workshop on 
adolescent depression and suicide with the state Parent Teacher 
Association. The maternal and child health program reports that
screening for depression is a priori 
ty at its child development 
clinics and has resulted in the identification of youth at risk 
of suicide.  WASHINGTON . The mental health agency is implementing an early 
intervention project in ten school districts, which entails 
teachers screening elementary sChool-aged children for risk of 
mental health problems, including suicide. Most of the emphasis 
is on children in kindergarten through third grade. This is a 
collaborative effort between mental health centers and school 
districts, and hopefully will defuse the stigma of mental health
referrals. 
Teachers will identify and refer students with 
problems to mental health centers. The children' s services 
program funds a family reconciliation services program which
assists families wi 
th acting-out children resolve problems 
through mediation and counseling. Risk of suicide is a frequent
issue. 
Emphasis is on conflict resolution, understanding family 
dynamics, and developing coping skills. The state education 
agency sponsors an annual health education conference and is 
including a session on youth suic de in this year' s agenda.

WEST VIRGINIA  The state education agency has conducted several 
workshops on youth suicide, primarily for counselors and scbopl
nurses.  for 
The children' s services program sponsored a workshop. 
group shelter staff and has paid for local caseworkers to attend 
seminars. The State Health Education Council and the health 
department co-sponsored a conference on prevention for public 
heal th personnel in Spring 1986, and youth suicide was included 
on the agenda. 
WISCONSIN  In 1985, the legislature mandated that the education 
agency and health and social services agency collaborate in
developing a youth suicide prevention program. Major components
include: (I) 
creating an advisory council with representation 
from these two agencies plus the Wisconsin Council on Criminal 
plan, 
Justice, to assist in the development of a state 
(2) creating a referral system that is clearly defined and

understood by all school and community agency staff and

(3) establishing communi ty-based suicide awareness programs and a 
statewide school curriculum by the 1989-90 school year. The two 
designated state agencies are to provide technical assistance to 
school districts as they establish these programs and train 
school personnel and other community service providers. The 
state 
s 12 cooperative educational service agencies were provided 
with limited funds to assist in this effort. . The intent of the 
legislation is to involve mental health and crisis intervention 
centers, other community agencies, health providers and parents 
schools. 
in a cooperative effort with the 
First year emphasis of this ini tiati ve 
has been on communi 
awareness. Trainers and special technical assistance teams from 
both the education and mental health programs have conducted

workshops and special presentations for over 2,000 school and

communi ty agencies. A manual suggesting guidelines on how to

based, school-focused suicide 
plan fQr and implement a communi ty-
all 
prevention program was developed and will be distributed to 
school districts, county welfare agencies, drug and asltcaohtoel.
  
programs and community mental health centers in the  The  manual focuses on conducting a communi ty needs assessment,

developing a network of community services and a clearly defined

referral system, an action plan to follow if a suicide emergency
occurs, and the importance of a community based approach. It is 
anticipated that all 432 school districts will have a suicide 
awareness program in place by Spring 1987 and that all will have

a formal classroom curriculum (probably incorporated into the 
1988. 
ninth grade health education curriculum) by July 
The thrust of the Wisconsin approach is that (I) schools cannot 
ty
address youth suicide alone--that programs need to be communi 
based and built on existing resources, (2) suicide is one more

youth issue, not to be viewed in isolation from other serious

problems affecting youth and (3) rather than  reinvent the

wheel, " communi ties should build on existing models, adapting 
systems. 
programs to their - own needs and the existing service 
WYOMING  The state education agency is urging lidoceanlt ifsychinogol,  
districts to adopt policies and procedures for 
preventing and addressing youth suicide. The agency serves as an 
information exchange among districts. The agency has also 
sponsored a workshop on teen suicide at a conference for school 
administrators and board members and anticipates hiring a staff 
youth, 
person who will specialize on issues relating to high risk 
including suicide. The drug and alcohol program participated in

a special multi-agency, interdisciplinary crisis team that

addressed the problem of a cluster of youth suicides on an Indian

reservation. The children s services program reports that one of

their county child protective teams held a workshop on youth

suicide.  TABLE I 
STATE PROGRAM INVOLVEMENT IN YOUTH SUICIDE

(As of April 1986)

MATERNAL

STATE  CHSEILRDVRIECNE SI  S  HHEENATL  ATHL   DARLCUOGH 6O: L  6:H CEAHLI LTDH
  EDCATION  INVOLVEMENT  STATE PROGRAM INVOLVEMENT IN YOUTH SUICIDE

(As of April 1986)

MATERNAL 
CHILDREN'  MENTAL  DRUG &:  &: CHILD
STATE  SERVICES  HEAL TH  ALCOHOL  HEAL TH  EDCATION  INVOl VEMENT 
Totals 
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