Community Engagement

Episode 5, Understanding Firearm-Related Injury and School Violence Podcast Series

In this episode, we are joined by Dr. Cynthia Ewell Foster. Our discussion focuses on youth suicide prevention methods and the importance of community engagement in preventing firearm-related injury and youth suicide. We conclude our series with a message of hope and a special recognition for educators.

Explore the Series

  • Access the full Understanding Firearm-Related Injury and School Violence here
  • Listen to the series on YouTube

Resources

This podcast was produced by Katy Hunter, Research Assistant at the National Center for School Safety.

Transcript

Cindy Ewell Foster: What YST is is so simple. It’s just asking kids who is in your life that cares about you, that you feel like you could talk to. We would train those people very briefly about how to support that child. And these people were amazing and they cared so much about these kids, and they just needed to know what to do. There’s been study after study looking at whether asking young people if they’re thinking about suicide is harmful versus helpful. It is helpful. One of the major lessons is just this idea of making sure that kids know that they matter to the adults around them, and that they feel like they belong.

Katy Hunter: Hello and welcome to Progress Report. This podcast is produced by the National Center for School Safety based out of the University of Michigan. We serve as the STOP School Violence program’s national training and technical assistance center, and we are focused on improving school safety and preventing school violence across the United States. This is the last episode in our Understanding Firearm-related Injury and School Violence Series. We will be exploring what schools can do to support students and combat firearm-related injury, as well as how community engagement helps reduce harm in the issues of school violence and youth suicide. Throughout the podcast, you’ll hear the phrases “firearm injury” and “gun violence”—what we are really referring to here is injury or violence related to or involving firearms.

To start off, who are you and what do you do? 

Cindy Ewell Foster: My name is Cindy Ewell Foster, and I’m a child clinical psychologist by training. Actually, I am an Associate Professor in the Department of Psychiatry at Michigan Medicine and I’m affiliated with U of M’s Institute for Firearm Injury Prevention also.

Katy Hunter: What got you interested in this field? 

Cindy Ewell Foster: So, as I mentioned, I’m a child clinical psychologist by training. I’m a licensed clinician, and so I started my career doing a lot of clinical care for kids and families. I’ve also done a lot of clinical education. So, you know, working with folks who were training to be psychologists, social workers, psychiatrists, but also along the way have been really consistently engaged in both research and public health evaluation. I specialize in suicide prevention. I think one of the things that I feel really fortunate to be able to do in my job is this blending together of both really understanding the experience of kids and families who are dealing with suicide risk, having an opportunity to develop and contribute to our scientific knowledge about how to prevent suicide.

And then also in my role with public health evaluation, my collaboration with the Michigan Department of Health and Human Services and their injury and violence prevention section, I’ve gotten to walk alongside communities across the state of Michigan and support them in implementing what we’ve learned to be best practices in terms of suicide prevention. So it’s like this wonderful mishmash of experiences and, you know, hopefully that’ll be helpful to some of your listeners today. The thing that I’m really most interested in is how we can open our eyes and see the strengths that are existing in families, in schools, in communities, and other systems that are around kids, how we can really optimize and maximize those strengths with the ultimate goal being preventing suicide in young people.

Katy Hunter: I like to ask in interviews, how did you find your way into this work? 

Cindy Ewell Foster: Yeah, it’s kind of fun to reflect back. I know you have a lot of listeners who are school people and educators and teachers and it’s funny, you know, when I was in college, I knew very early that I loved working with kids. Like I was the person who was babysitting and a camp counselor and teaching ballet to five-year-olds and, you know, all that stuff. And I really thought I wanted to be a teacher. And then it became very clear that I didn’t actually wanna teach them anything. I just wanted to like hang out and talk to them. And I thought, well, maybe I should be a psychologist so I could just, you know, talk with them. I just thought kids were so interesting and, you know, what they had to say was so important. So anyway, I started my path in psychology that way.

But my first research experience, as an undergraduate, we were studying the intergenerational transmission of depression. So when moms had depression, how their depression impacted their parenting and how that impacted their kids. And we did a lot of interviews with kids about the stressors in their lives and what was hard for them versus, you know, what was protecting them. And I think one of the big light bulbs that came for me in that experience in my 20s was, oh gosh, you know, these systems that kids are living in, their families, their schools, their communities, their churches, they have this, you know, great capacity to either be a protector for kids or to be a stressor for kids. And I think as a community, as a society, our interest is making sure these systems are taking care of kids, and not being the thing that kids are talking to their therapist about as being the thing that is so hard for them. Right? 

And I think, you know, all of us who care about schools and care about kids, you know, we wanna be sure that kids are having a good experience with us. So that really kind of started my interest in these issues. And I actually didn’t start working in suicide prevention until I got to the University of Michigan. 

Katy Hunter: Could you share more about your experience at the university and how you got inviolved with the YST research study—the Youth-nominated Support Team?

Cindy Ewell Foster: I came to U-M as a postdoc and started working on suicide prevention and again, had a really formative experience. It was working on a research study of an intervention that was developed at the University of Michigan called the Youth-nominated Support Team. And we recruited kids who were on our inpatient unit at the University of Michigan. They were there because they were really seriously thinking about ending their lives, or they had tried, and this was a randomized controlled trial. So half of the kids in the study got YST. And what YST is, it’s so simple, it’s just asking kids, “Who is in your life that cares about you, that you feel like you could talk to?” and kids would nominate people.

We would train those people very briefly about how to support that child in those months after their hospitalization, which is a really high risk time. And it was just a beautiful experience. There were homeroom teachers, math teachers, school counselors, grandparents, the neighbor, Sunday school teachers, your coach, high school soccer coach. And these people were amazing and they cared so much about these kids and they just needed to know what to do to try to protect these kids. And our findings for YST, you know, when the study was over, we’re not that earth shattering, but when we followed up with those kids 10 to 15 years later, we really saw the power of that intervention and we lost many more kids who did not receive YST than we did kids who did receive YST. And so it’s really one of our nation’s few interventions that has a demonstrated impact on mortality for kids. And it’s simple, and I love, for people to know about it because I think it empowers all of us to remember what we can do to support the kids that are in our communities.

Katy Hunter: While we are discussing these community support systems, I wanna ask, what are some things that schools and their community partners can do to keep kids safe? 

Cindy Ewell Foster: Yeah, I have a bunch of ideas. So let me start again with this idea of like upstream prevention and connectedness. And I thought I would just share, you know, about another study that we worked on at U-M. So, you know, YST I talked about already, and for me, the message of YST is the support team. They didn’t do anything that was rocket science. They got an hour’s worth of education about what was going on with that kid. They had depression or they had bipolar disorder. What does that look like? This kid’s been in the hospital, they thought about ending their life. This is a really high risk time. You know, what are some of the warning signs? And then really we ask them to just call that kid once a week, check on him, how are you doing? You wanna go out for ice cream? You wanna go take a walk? What’s going on in your life? Just be a caring presence, a caring adult in that child’s life, and follow their lead. You know, if they had something going on, they wanted to talk about it, great. If they didn’t, no problem. 

And we also ask those folks to encourage the young person to stay in treatment because a lot of kids, even if they can link to treatment, they don’t stay in. And they really need their community to support them doing that. And so the kids who’ve got YST, they did end up having more sessions of psychotherapy and more sessions of substance abuse treatment. So I think that was really powerful. One of the major lessons is just this idea of making sure that kids know that they matter to the adults around them and that they feel like they belong.

And so all of these issues around school climate and being a positive adult presence in a young person’s life, I just think that we all need to remember that that is really critical. It’s an evidence-based suicide prevention strategy. Related to that, you know, the Centers for Disease Control and Prevention, one of their real focus areas in terms of suicide prevention is connectedness, right? The idea of making people feel connected to another individual, to their community, to their school. A number of years ago, our research team led by Dr. Cheryl King, who’s one of our nation’s experts, was the PI for the Youth-nominated Support Team. We did a study that was funded by the CDC trying to look at this idea of connectedness in kids. Is this a suicide prevention strategy? And the kids in our project were recruited from Flint, Michigan, and these kids had had just a lot of really challenging things happen in their lives.

Just the exposure to violence, you know, the bereavement, the economic challenges in families, just the losses that kids, the adversity. And what was so interesting is that despite all of that, just even at baseline, when we looked at, you know, what predicts whether or not kids are thinking about suicide, if they felt connected to their school, they were less likely to be thinking about suicide. And I just want folks in schools to remember how much power there is in that, right? I mean, in this sample of kids with so many things going wrong, if they felt like somebody at school cared about them, they were less likely to tell us that they were having symptoms of depression. They were less likely to tell us they were thinking about suicide. So please remember that what you’re doing making kids feel like they’re important is just, you know, really, really critical.

Okay, so that’s one thing I wanted to highlight. I think another thing I really wanna highlight and recommend, you know, acknowledging capacity issues is making sure that your school has initiated some kind of evidence-based gatekeeper training. You know, we know that when someone is at risk for suicide, one of the most important lifesaving things we can do is notice and talk about it, right? And there’s a myth out there that “I don’t wanna say the word suicide, I’m gonna put the idea in their head, they’re gonna go and do it. It’s gonna be my fault because I gave them the idea.” That is absolutely not true. There’s been study after study, even randomized controlled trials looking at, you know, whether asking young people if they’re thinking about suicide is harmful versus helpful. It is helpful. It’s helpful. And so that’s scary. I know most of us feel like a little bit of ick in even saying the word suicide, you feel like you’re getting in people’s business, you’re worried you’re gonna do it wrong, please take a training.

There are trainings that range in length from like 60 minutes all the way up to like two full days. But there are many accessible and available and cost-effective trainings for schools. And I really recommend that folks who are working with kids have that training. It’s just critical. There’s lots of guidance out there about how schools can develop helpful protocols for teachers too. Like if they’re worried about a kid, they have the training, they ask, then what? You know, then what should I do? So really giving people guidance inside the school system about those protocols for risk identification and getting kids help and talking to parents and all that kind of stuff. The more we can follow a cookbook, the more likely we are to do those things. So I think that’s another recommendation. I think the last one is to really think about how we can provide education to families about firearm safety.

So I’m gonna kind of circle back to that issue of firearms. So I hear a lot from folks we talked to a second ago about that myth, like, oh, I don’t wanna say the word suicide, I don’t wanna ask about it. You know, people are gonna, it’s gonna put the idea in people’s heads, not true. I think another myth that we hear a lot in the field of suicide prevention is if somebody really wants to end their lives, they’re gonna find a way to do it. And whether or not there’s a firearm available isn’t really relevant and that’s just, it’s just not true. So what could schools do related to this? You know, it’s a family education, you know, opportunity, right? To kind of dispel some of those myths. Encourage people to be stewarding safely. Here in Michigan, we have some new legislation that’s just passed around child access protection laws.

You know, schools could help educate families about what that law means and how they could be adherent to that. In my own school district, when we do our back to school paperwork, now there is a blurb and you know, when I’m giving everybody’s emergency contact information and their allergies do they have, you know, my permission to have medication at school? All those things that you do in August, we now have a blurb that, you know, gives some really important information about firearm safety for kids, and we’re asked to sign a pledge that we’re storing safely. And you know, I think some of those things are opportunities for schools. Certainly there’s a lot to learn, you know, about the effectiveness of that from a research standpoint, but I was pretty excited to see that in my own back to school paperwork.

Katy Hunter: A big concern that folks have been sharing with us is capacity in terms of reductions in staff turnover and struggling to find teachers, substitute teachers and support staff. Do you have any thoughts or advice for educators that have been dealing with these issues? 

Cindy Ewell Foster: I should say, you know, I’m a parent. I have three kids in public schools. I have so many dear friends in education and, you know, it’s been a really hard time to be in education and, you know, I’ve started this conversation talking about the kids right? But the whole analogy, you know, when the plane is going down fix your mask first before your child, and not that the plane is going down, but I just think it’s really important that we all are mindful about the mental health and the wellbeing of our educators and people that are working in education. It’s been a really hard time and I am concerned about, you know, the number of things that we’re asking our educators to do for kids. So I certainly hope that what I’m saying isn’t received as like, oh my gosh, this is one more thing that I’m supposed to be doing.

And I do think that that is a challenge and capacity is a challenge, and we all can only do what we can do, and we have to make sure that we’re, you know, taking care of our own mental health and wellbeing before we start trying to take care of other people. So I think I just wanna say thank you to everybody. I feel like I go to every parent teacher conference for my own kids, and I start by saying thank you for not quitting during COVID. Thank you for staying. Thank you. My kids are so lucky that you’re still here. So I extend that out to everybody listening. Thanks. Thanks for just showing up every day and caring about the kids that are in your community.

Katy Hunter: What resources would you recommend folks check out? 

Cindy Ewell Foster: I should share that I am also happy to send you the link to the paper about YST. So if anyone is interested in reading more about that, there’s also a great guide that SAMHSA just put out around different interventions for youth suicide prevention and YST is covered in that, and that’s free and publicly available if people don’t have access to, you know, scholarly journals. So I’m happy to share some of those links with you.

Katy Hunter: Those resources can be found in the episode description. As a quick summary in this series, we have learned that means matter for cases of school violence, youth suicide, and youth intimate partner violence. So an important part of harm reduction for these issues is locking up firearms safely and securely. We discussed how policy can be used to combat firearm violence with funding allocations and extreme risk protection orders, which are civil court orders that restrict access to firearms for people who are deemed at risk of hurting themselves or others. We got an overview of how research can be used to identify the best practices and most effective programs in school safety. Lastly, we talked about the importance of community engagement in keeping kids safe. 

Before we conclude, are there any other thoughts that you would like to share? 

Cindy Ewell Foster: Yeah, I just wanna thank again, you know, all of our colleagues who are working in education and supporting schools and supporting kids. Thank you, thank you, thank you. I think there’s a lot of worry about how kids are doing right now. You know, we’re talking about children’s mental health crisis and I know that it’s really difficult to think about asking a kid if they’re struggling when you know that the therapist in your town have a 12-week waiting list. I think, you know, all those things are real and there are barriers and there are challenges.

But, you know, I guess I would just like to end with a message of hope and encouragement. The way that we change this dynamic is that everybody has to play a role. You know, everybody has to get out of their comfort zone a little bit. We all have to do something a little bit different than what we’ve been doing for the past 20 years. I think if we keep doing the same thing, we’re gonna see this pediatric mortality rate continue to increase as it has been. 2021 was the first year that pediatric mortality increased in the United States, and it’s not acceptable. I just, you know, wanna encourage you. I know it’s hard. I know sometimes it’s scary to, you know, do something different, but I think, you know, there’s many of us who are here to support you and thank you for what you’re doing for kids.

Brent Miller: Thank you for tuning into this episode. For more information about the National Center for School Safety, visit our website nc2s.org. You can also check us out on Twitter and Facebook. This episode of Progress Report was produced by the National Center for School Safety at the University of Michigan. Additional resources and information can be found in the show notes and music is thanks to Mackay Beats. This project was supported by Cooperative Agreement number 2019-YS-BX-K001, awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the US Department of Justice’s, Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime and the Office of Sex Offender Sentencing, Monitoring, Apprehending, Registering and Tracking. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the US Department of Justice.

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Duration

20:16

Topic Areas

Mental Health

Crisis Timeline

Prevention Planning

Audience

Mental Health Professionals, Parents & Families, School Personnel

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