Boise School District Policy 3320 Revision Comment:

Submitted June 10, 2024

This is a public comment to the Boise School District revisions to Policy 3220: Suicide Prevention. The 2018 policy. The May 2024 redline. The July 2024 redline. I am publishing this comment as I think there are material and important comments that are being ignored and not incorporated in any meaningful manner in the Boise School District’s proposed revisions to its suicide prevention manual. I will link to additional comments, advocacy and proposals that have been made subsequent to this July 8, 2024 comment.

Maisa Space contains two sections and subscribers can choose which of them they would like to receive posts for here. The advocacy section is going to be technical and talk about suicide prevention in detail. Also linking to

Samia

’s resources that she has diligently assembled.

Dear Ms. Mast, the Google comment form appears to strip out certain information such as footnotes, references, font, formatting, etc that change the substance and context of the comment. I would like this email PDF as my full comment or to be read in conjunction with the Google Form for consideration. Thank you for taking on this important and difficult topic.

In addition to overt statements, and third party information, the proposed intervention suggests that if a student is making statements about feeling hopeless, helpless or worthless then that should start the Suicide Intervention Process. An issue with this procedure is that the percentage of children that unfortunately fit that criteria is almost mind boggling.

The CDC reports that in 2021, 22% of high school students seriously considered attempting suicide¹. The CDC also notes that during the 12 months before the survey, 44.2% of adolescents experienced persistent feelings of sadness or hopelessness, and 9.0% had attempted suicide². The number is even higher for females, 57%³. Therefore, it seems that since the conditions that should precipitate the Suicide Intervention Process are almost half of the student body, that perhaps children should be universally screened by those with the requisite training and expertise to assess, and work on intervention plans when it is deemed necessary. How can the school effectively screen the entire student body, since approximately half meet the criteria?

The Suicide Screener

The proposed policy suggests that the Columbia Suicide Severity Rating Scale (C-SSRS) be used, or an “adapted” form. It is unclear what the adaptation is exactly. This should be made clear. The C-SSRS appears to be a well-established and widely used tool for assessing suicide risk⁴. It is crucial for school personnel to be trained in using the C-SSRS to identify students at risk of suicide. How is this actually going to be accomplished?

Limitations of the C-SSRS in Autistic Individuals

Recent scientific papers suggest that the C-SSRS is not validated or applicable to autistic individuals due to differences in communication, interoception issues⁵, and difficulty with the expression of emotions (alexithymia)⁶. It is essential for school personnel to be aware of these limitations and consider alternative approaches or modifications when assessing suicide risk in autistic students⁷. Even the term self-harm might be interpreted differently between autistic and non-autistic groups, as some with ASD may engage in self-harm as a restricted, repetitive stimming behavior, and not with suicidal intent and answer the question literally⁸, ⁹.

The Policy Should Address that Some Groups are at a Heightened Risk of Suicide

A large and growing amount of research indicates that the risk of suicide death is much higher in certain populations, LGTBQ+, certain minorities, and those with ASD/ADHD (both diagnosed and undiagnosed)¹⁰,¹¹,¹². School personnel should receive additional training on recognizing and understanding the unique signs and risk factors of suicide in neurodivergent students, including those with autism. A suicide prevention policy should be geared toward identifying and providing support, mitigating risk factors where possible, for those groups at the highest risk of suicide attempts and death.

The C-SSRS may need to be adapted or supplemented with other tools such as the Ask Suicide-Screening Questions (ASQ), Adverse Childhood Experiences (ACEs) and adaptations that are more suitable for assessing suicide risk in neurodivergent and especially autistic individuals.

Another idea that would be helpful with any action plan, is to screen children for adverse childhood experiences via an ACEs questionnaire. As an example, autistic persons are 3-4x more likely to report bullying as a trauma in ACEs¹³. It is known that bullying is a large contributing factor in suicide in children overall, especially those that are autistic and/or ADHDers. Anti-bullying Policy, from peers and even teachers need to be part of risk reduction strategy for an efficacious suicide reduction policy. Hurt people, hurt. The heightened risk of suicide actually even applies to those that engage in bullying behavior¹⁴.

Self-Care Plan

The same factors that might impact the ability of autistic and other neurodivergent children to understand and be able to complete a Suicide Screener would also impact the ability to have an efficacious Self-Care Plan. Since some autistic children think better in pictures, or struggle to understand their emotions, a one size fits all solution is destined to fail. As an example one child used color associations and thermometers previously learned in cognitive behavioral therapy to describe emotions¹⁵. Furthermore, self care plans for autistic students need to incorporate an understanding of their unique sensory needs. An example of a self care/safety plan that might be more helpful for autistic is at Mentally Uncovered¹⁶.

Close Collaboration with Mental Health Professionals

School districts should collaborate with mental health professionals who have expertise in working with specific groups and need to be well versed in rarer neurotypes, such as autism, ADHD, LGBTQ+ individuals to develop and implement appropriate suicide prevention and risk mitigations. The Boise School District should employ multiple neurodivergent identifying mental health professionals to support this population of students. It is possible that these children will need extra support in their school environment, interventions to address bullying, sensory issues, test anxieties, attendance issues due to school trauma, etc. Regular consultation with these professionals can help ensure that the school's approach to suicide prevention is effective and sensitive to the individual and unique needs of each student.

Ongoing Training and Education

School personnel should receive ongoing training and education on suicide prevention, including updates on the latest research and best practices for working with neurodivergent students. This training should also include information on how to support and communicate with autistic, ADHD, dyslexic and other neurodivergent students and their families in a way that is respectful and inclusive.

Definitions:

The Proposed Policy has undefined terms. Action Plan is referred to, but is vague without any specificity or guidance over what that actually means. Additionally, National Best Practices is referenced as well, without any real understanding of from where, or what that entails. These terms should be specified as they appear meaningless in their current form.

Conclusion:

By incorporating these revisions into Boise School District Policy 3320, the district can better address its suicide prevention are both targeted, effective and sensitive to all students, but especially those at higher risk of suicide, such as LGPTQ+, certain minorities, and those with neurodiversity. Since autism presents differently in those with higher cognitive functioning, higher IQ, and females, there needs to be qualified mental health support in these areas. There really should be a school district liaison whose whole focus is on determining what is the National Best Practice for suicide prevention, and to ensure that the best practices also address the risks that might be necessary for specific at risk groups.

1. Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021.

2. Id.

3. Id.

4. Jessica M Schwartzman, Rachael A Muscatello & Blythe A Corbett, Assessing Suicidal Thoughts and Behaviors and Nonsuicidal Self-Injury in Autistic and Non-Autistic Early Adolescents Using the Columbia Suicide Severity Rating Scale, 27 Autism 2310 (2023), https://doi.org/10.1177/13623613231162154 (last visited May 14, 2024).

5. Dr. Emma Goodall, Interoception and Mental Well Being (March 16, 2022\) available at https://www.autism.org.uk/advice-and-guidance/professional-practice/interoception-wellbeing.

6. Schwartzman, Muscatello, and Corbett, supra note 4

7. Id.

8. Id.

9. Katie Johanning-Gray et al., Preventing Suicide in Youth with Intellectual and Neurodevelopmental Disorders: Lessons Learned and Policy Recommendations, in Youth Suicide Prevention and Intervention: Best Practices and Policy Implications 125 (2022).

10. Kairi Kõlves et al., Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark, 4 JAMANetw. Open e2033565 (2021),

https://doi.org/10.1001/jamanetworkopen.2020.33565 (last visited May 1, 2024).

11. Johanning-Gray et al., supra note 9.

12. Fatima Malik et al., Missed Opportunities for Suicide Prevention in Teens with ADHD, 12 J. Affect. Disord. Rep. 100482 (2023), https://linkinghub.elsevier.com/retrieve/pii/S2666915323000215 (last visited May 1, 2024)

13. Daniel W. Hoover & Joan Kaufman, Adverse Childhood Experiences in Children with Autism Spectrum Disorder, 31 Curr. Opin. Psychiatry 128 (2018).

14. Marci Feldman Hertz, Ingrid Donato & James Wright, Bullying and Suicide: A Public Health Approach, 53 J. Adolesc.Health Off. Publ. Soc. Adolesc. Med. S1 (2013).

15. Johanning-Gray et al., supra note 9.

16. Suicide Prevention for Individuals with Autism or Neurodivergence, Mentally Covered, https://www.mentallycovered.org/blogs/support/neurodivergence (last visited Jun 9, 2024).