Suicide Prevention Program
8The Crisis Program for Children and Youth, an NGO in Tallinn, Estonia, was founded in 1994 in response to the need for some structure to alleviate the trauma caused by the Estonia ferry disaster, which involved more than 800 deaths and af-fected nearly every Estonian family. As Riis said, everyone knew someone who knew someone who was killed. Because there was little knowledge in Estonia at the time about crisis work, the program adopted lessons learned from existing Scan-dinavian, U.S., and other programs, such as Save the Children Sweden. Since its
7This section is based on remarks made by Andr´as Sz´ekely at the end of his presentation, the bulk of which is summarized in Chapter 4.
inception, the program has provided long-term bereavement intervention following several other disasters involving the death of family members, including the Palu school-bus accident, the P¨arnu methanol catastrophe, the Hiiumaa plane accident, a boating accident and traffic accidents in Ruhnu, and various other disease-, suicide-, and homicide-related tragedies. Today, the Crisis Program for Children and Youth is the only NGO in Estonia with concentrated knowledge of and experience with grief and trauma among children and youth.
Riis explained that the program’s main function is to provide long-term inter-vention in grief support for children and teenagers who have lost a close family member. The program has three major components:
• Acute crisis intervention for schools and other children’s institutions, as well as communities, after a tragedy. Riis emphasized the importance of cri-sis intervention work following tragedy as a means of preventing further tragedy and the need for more work in this area, especially in schools. Many teenagers attempt or complete suicides following tragedies. She remarked on the phenomenon of “suicide contagion.” For example, after a classmate has committed a suicide, many children indicate that they have had thoughts of suicide but not the courage to do what their “brave” classmate had done. The Crisis Program for Children and Youth provides a one-year follow-up grief support program for all at-risk youth, when possible (see below).
• Guidance and information to bereaved families after a traumatic event.
There are often questions about what kind of information to give children (e.g., whether the death was an accident or not).
• Teaching in civic institutions and universities; and sponsoring seminars on crisis response, grief, and trauma.
5.6.1 The Grief Support Program
To date, approximately 600 children have participated in the program’s one-year grief support program. The program has five phases. Riis described in detail the first three phases (network interview, assessment, rehabilitation) but did not elabo-rate on the final two phases of the program (evaluation and referral).
Network Interview
This phase of the intervention involves gathering information when traumatic events involving children occur (e.g., information about the child’s support system, ability of the child or children to cope). Usually, the program conducts a family in-terview in cooperation with a local specialist who has already been in contact with
the bereaved family. After the initial interview, the program continues to work in cooperation with the at-risk child’s support system (e.g., teacher, family physician, relative).
Pre-assessment
Assessment involves a lengthy pre-assessment of the child’s stability (e.g., risk of displaying suicidal behaviors, history of juvenile offenses) to identify high-risk children. This typically involves conducting a structured parent-and-child interview (i.e., questions about the circumstances surrounding the death, earlier traumatic ex-periences, medical history, school performance, acting out/behavior, availability of family/social support, substance abuse, violence in the family, poverty, communi-cation skills in the family); gathering self-reported measures from both the affected child and the child’s parents to get a sense of the severity of the impact of the event (see below); and conducting an interview with a local specialist or someone from the child’s support system (e.g., teacher, family physician or psychiatrist, social worker, psychologist).
Riis commented on how self-reported measures about a child’s feelings, thoughts, and behavior often differ markedly between the at-risk child and his or her parents. She emphasized the importance of gathering information directly from the child. Examples of the types of self-reported measures collected for children include “I worry too much,” “I’m withdrawn,” “I cry a lot,” “I’m sad,” “I have angry outbursts,” “I blame myself for his/her death,” “I blame somebody else for his/her death,” “I talk or think about dying,” “I say or think that life is meaningless,”
“I’m afraid something bad will also happen to other members of my family,” and
“I keep my worries to myself.” Parents are asked similar questions but also about the impact of the event on the child.
Riis also commented on the value of pre-assessment in establishing trust with the traumatized family. Trust is key in motivating families to actively participate in other components of the grief support program and to seek help.
Rehabilitation
Because of limited access to services, the program operates in a camp setting. It accommodates 40–45 children annually. The experience involves an 8-day summer camp and two 3-day follow-ups—one in the fall and one in the spring. The children are divided into five age groups, with each group facilitated by two group leaders.
The camp environment mixes grief support work with child-friendly fun, play, and relaxation, with a wide range of creative activities aimed at helping children ex-press themselves in different ways and improve their self-esteem (e.g., concerts,
painting and music workshops, outdoor games, and other physical development and teambuilding activities).
The rehabilitation work is based on and inspired by the work of Dr. Atle Dyregrov at Bergen Crisis Psychology Centre (Norway); Lotta Polfeldt and G¨oran Gyllensward at the Crisis Centre for Children in R¨adda Barnen (Sweden); Soili Poijula, a trauma therapist (Finland); Margareta Thun, an expressive arts thera-pist (Finland); Sandra Wielend, child trauma psychotherathera-pist (Canada); Reet Oras, psychotherapist and Eye Movement Desensitization Reprocessing (EMDR) child trainer, Uppsala University Hospital (Sweden); and Marge Heegard, William Wor-den, Ben Wolf, Nancy B. Webb and other American specialists. Methods include grief therapy for both individuals and groups; trauma therapy (e.g., EMDR); psy-choeducation (i.e., specialized according to cause of death); parent guidance; ex-pressive arts therapy; and rituals. Riis noted that with respect to psychoeducation, different causes of death require different types of explanations/help. For example, children traumatized by suicide often wonder what role they played in the family member’s death. Together, these various methods allow the children to interact with each other in a safe setting; share difficult feelings and thoughts associated with loss in an age-appropriate way; receive emotional support; develop affect tol-erance, relaxation, and other healthy coping skills; and improve self-understanding.
Riis shared some comments from children who have participated in the camps:
“I’ve expressed myself here knowing that the people who are listening understand me. I guess that without this camp I would have been very bitter and withdrawn today, but that’s not the case now. This camp has helped me a lot” (Anu, 15). “It’s great to be here where you can express yourself freely and don’t need to keep your thoughts and feelings inside. There should be more camps like this” (Kaarel, 16).
“It helps you get over the grief” (Karl, 7).
The rehabilitation phase of the program’s one-year grief support program also involves arranging family meetings across Estonia, giving bereaved families op-portunities to meet and provide support to each other and learn about grief from program specialists.