When Your Work Finds You: Dr. Arielle Sheftall on Child Suicide Prevention and Career Purpose

Episode Description:

In this compelling episode of Never the Same, Dr. Tony Pisani speaks with Dr. Arielle Sheftall about the critical issue of youth suicide prevention, with a particular focus on children under 12 and suicide rates among Black youth.

Dr. Sheftall shares insights from her groundbreaking research and discusses the importance of having direct, honest conversations about suicide with young people.

From her journey from car seat safety researcher to leading youth suicide prevention expert, Dr. Sheftall reveals how protective factors and cultural understanding can make a difference in preventing youth suicide.

Key topics include:

• How Dr. Sheftall didn’t initially set out to study child suicide but was drawn to this vital work
• The way her career evolved from car seat safety to becoming a leading voice in youth suicide prevention
• The reality of suicide risk in children as young as 5-12 years old
• Understanding and addressing racial disparities in youth suicide
• How to have direct, age-appropriate conversations about suicide with young people
• The role of family, community, and cultural strengths in prevention
• Building protective factors for at-risk youth.

Guest:

• Dr. Arielle Sheftall is a faculty member at the University of Rochester Center for the Study and Prevention of Suicide. Her research focuses on understanding and preventing suicide among pre-teens, with special attention to addressing disparities affecting Black youth. She was a key contributor to the Congressional Black Caucus "Ring the Alarm" report and continues to lead innovative research on supporting young people and their families.

Host: 

• Dr. Tony Pisani: Dr. Tony Pisani is a professor, clinician, and founder of SafeSide Prevention, leading its mission to build safer, more connected military, health, education, and workplace communities.

Referenced Resources 

• American Foundation for Suicide Prevention 
• National Alliance on Mental Illness: NAMI - Parent Support Groups 
• Congressional Black Caucus "Ring the Alarm" Report
• Collaborative partnerships with families

Crisis Support

• National Suicide Prevention Lifeline (US): 988
• Lifeline (Australia) - 1800 551 800
• Lifeline (New Zealand) - Phone: 0800 543 354 or Text 4357

Transcript

Tony: I'm so grateful to share a conversation with Dr. Arielle Shefthall, a brilliant and mission- driven colleague who focuses on suicide prevention for younger children, those in the preteen years. Arielle is a powerhouse, and I left this conversation energized and inspired. I think you will too. Now, suicide among children is a heavy topic.

Tony: Arielle and I both feel it's important to talk about it, and we take great care to do so in a safe and sensitive manner. But that doesn't mean that listening to an extended conversation like this will be helpful or healthy for every person. So, I encourage you to think about that and decide if this episode is for you.

Tony: If you're listening with an earshot of children, or you are a young person listening, be aware that some of what we discuss could be upsetting, and it's wise not to listen alone. Finally, I want to note that I'm a Professor of Psychiatry and Pediatrics at the University of Rochester. While this podcast is separate from that role, it's part of the same mission to prevent suicide and to develop, discover and share resources that improve health, productivity and well being. Our guest today is Dr. Arielle Sheftall. She's a faculty member at the University of Rochester Center for the Study and Prevention of Suicide, where I also work. She works on suicide prevention among children broadly, but with a special focus on understanding and addressing the alarming increase in suicide among Black youth.

Tony: She was a key contributor to the Congressional Black Caucus Ring the Alarm report, which revealed that Black children under 13 are twice as likely to die by suicide compared to their white peers. This groundbreaking report sparked changes in national policy. Her current research focuses on supporting pre-teens and parents and finding ways to eliminate barriers to mental health support for young people when they need it.

Tony: So, welcome Arielle

Arielle: Thank you so much for having me.

Tony: Before we get into this topic, um, you know, the death of any person is sad. Yes. Suicide is especially sad. And it's not like whether somebody's young or old means that it's any more, their life is any less valuable or anything, but there is something like particularly painful and in a, in a certain way about suicide when it happens to a child.

Arielle: Yes.

Tony: Um, and I'm just wondering just to start off with, how do you handle, you know, studying this topic? How do you work with your team around it? And maybe for people who are, you know, listening in on our conversation, how, how do we. How do we deal emotionally with talking about this?

Arielle: Yeah, well I think the first thing is to actually recognize that it is an emotional topic. It is a very hard topic to discuss. Um, and also to understand. Um, and I think for my team, especially my team, because they're talking to teens, they're talking to young people that have actually attempted, that have actually had thoughts of suicide. Also, ones that are at in crisis at the moment when they come in for research appointments. So, I am always an opening ear to everyone. I want people to know that they are 100 percent able to talk to me at any time, any point where they are having some struggles themselves, but I also actually promote them talking with others. Um, so just recently I actually, uh, sent them our employee assistance program, um, email address as well as the website. It's a free service for all employees as well as people in their households to get services to talk with someone, whether it be about the stress that they're experiencing at work or even just stress that they're experiencing in general. Um, so being a provider of resource is something that I really promote.

Tony: Now. I know that you're one of the most, um, you know, energetic and, and contagiously positive person. Thank you. So how do you stay positive when you're working with things that are so challenging.

Arielle: Yeah. I think, I think back to when I was actually just getting started in the pre-teen suicide world. And I had to read narratives of these youth dying by suicide. And these were kids five to 12 years of age. And to read that information, um, was really hard to do. It was very hard to do. But I had to recognize that I was doing this as a service to our community, as a service to clinicians that are working with youth at this younger age range, and understand that even though this is hard for me to actually get through reading these narratives and coding these narratives, it actually gives us insight to how to prevent suicide in this age range. Um, so for me, I have to always think about the positive side that the work that I am doing even though very hard and very difficult at times can actually help others and actually help families who have kids 5 to 12 years of age. Yeah. So, yeah. I'm sorry. Yeah. No,

Tony: no, no. Please. So you've been, you've been really, you know, part of raising awareness about suicide in this younger age group. So do you think around what age do you, is it? Is it pre-teen? When you say pre-teen, what age group is that?

Arielle: Yes. So primarily 5 to 12 years of age. 5 to 12 years of age. I, I think that for a long time in our field, we didn't even want to think that this was happening and I wonder if that's part of why, you know, there's been so little attention so little research up until now is that almost like none of us wanted to think this is real, right?

Arielle: Absolutely. So a lot of the research that's been conducted for suicide, suicide prevention has been primarily in adolescents and adults. And I think 100 percent like we never wanted to realize that a six year old could even have thoughts about killing themselves. So, to recognize that children are actually dying by suicide at this young age is really hard. Um, it's really hard as, you know, myself that have been doing this for many, many years now, but also just for parents and caregivers to realize that my kid at this really young age can actually have these thoughts about wanting to hurt themselves and wanting to die.

Tony: Yeah. No, I know as a parent for me, I mean, my children are past that age now, but just to think about that. Yeah, it would be really hard and and um whenever I've worked with families, too there is a certain part even families that really want to engage and help, they also just sort of like don't want to believe this is actually happening. It's like the nightmare that you know you, you just never want.

Arielle: Yes, absolutely. And thank goodness we aren't seeing huge numbers. Yes. That's important to say at this young age range. Yes. So right now we're about 180, somewhere around there per year. With the last, um, statistics that we have, it's 2022, so about 184 ish. Um, young people, five to 12 years of age had died by suicide again. That's still a large number. Any number is too many.

Tony: Right, but it is important to put it in the context that compared to some of these other age groups and it's, this is not, um, it's such large numbers, but it's still so important to pay attention to. It's still happening. And if we combine that though with, with kids who maybe have said things like that or had thoughts like that, I mean, it does get to be bigger. And, and one of the things that I, I know your work has, um, focused attention on is that there's been increase in that age group. Absolutely.

Arielle: Could you talk about that a little bit? Yeah. So we, we actually plotted out the data. We always look at CDC data, um, to kind of figure out how many deaths by suicide have occurred in each age group. And we wanted to understand better for this specific age, five to 12 years of age, what was going on? Because again, a lot of the research that's been conducted was really focused on, you know, 13, 14 and above. Um, and even the elderly, um, there was more research conducted in that age range than there was for this pre-teen age range. So from 1990 to about 2022, we looked at the data and from just the past decade, we've actually seen a 68 percent increase in suicide deaths. Um, so for that 12, excuse me, for that five to 12 year old age range. So again, even though we are seeing great success in certain groups. So, if you look at older teens, actually the numbers have decreased, which is great news. It's great news, but our younger youth are actually experiencing an increase and also different groups of youth are experiencing that increase.

Tony: Yeah. So I, I, well, let's, let's get into that a little bit. Um, I'll, I'll want to circle back a little bit. You've mentioned a moment ago that, you know, when you first started getting into this, I'm kind of interested in how that transition happened, but you, um, your research has been, um, focusing um, on a really alarming trend in black youth suicide. Um, and I, I read in, in the, um, in one of the articles that you published a six or six little over 6 percent annual increase. Yes. Among black girls ages 12 to 14. Uh, so. Can you talk about, um, how this is affecting different groups in particular since you're focusing on, on, on black children? What, what are you learning there and what are you seeing?

Arielle: Yeah. So I recently had to get a presentation ready. Um, I'm going to be speaking, thank goodness, it's, an amazing opportunity with the interim director from the National Institute of Mental Health, and we're going to be talking about youth suicide and where do we go from here. And what I noticed when I was plotting out the data just from 2018, we've seen again great decreases, wonderful decreases in certain groups of youth, but for our black youth, we've actually seen an increase. And this is surprising because everybody believed that suicide was not a problem with black youth. They did.

Tony: They really did.

Arielle: Yeah, I've heard that before from other colleagues and friends that I have that it was sort of like, "Oh, we don't, we don't do that". It's not part of our. Yeah. Yeah. Yeah. Well, what's behind that?

Arielle: Yeah. So I think, um, you know, we as a people. Um, have really been shown to be very strong, like very resilient. It's a history of resilience. It's a history of resilience. Uh, we've gone through many, many traumatic experiences and still to this day, do. And as a people, the strength that we have has been something that we've always carried and passed on from generation to generation to generation and Family has been such a strong piece of our puzzle. Religion, going to church actually, you know being highly involved in spiritual ritual, so to speak. I'm going to church every Sunday and being with the family and having Sunday dinner. And not that that doesn't occur now, but I think less and less of that does, occur. Um, a lot of individuals of color are moving out to the suburbs versus staying in the inner city because a lot of the school settings, unfortunately, are not doing so well in the inner city. So a lot of people are spreading out more, um, into the suburbs. A lot of the families are not sticking together as much as what they used to. Um, and there seems to be a little bit of a distance between family members. Not that we don't get together on holidays and, and so forth. But before I remember I would go right across the street to my aunt's house, you know, my great aunt's house. Um, or we would get together every Friday night, every Saturday night, every Sunday night. We were always with family, um, but now we live many estates away. Uh, so I, I think opportunity, unfortunately, has given us a lot of movement, so to speak, in, in where we are, um, and we're not always right next to our grandmothers and our aunts and our uncles and our cousins that we used to be.

Arielle: Um, so I think that, um, potentially that strength that we had in having family and having, um, not only, you know, the family that we're living with on the, you know, in the, the distant relatives, we're just right next door. Right. Just kind of kin in general. Yes. It's not the same as what it used to be. So I think that has changed a little bit of this dynamic of what we're seeing with mental health. So that might be part of it. That might be part of it. But also another big part is that suicide and suicidal behavior wasn't really recognized with people of color. Um, it was kind of shunned or, um, there was tons of stigma surrounding mental health and suicidal behavior within the community. So even having a conversation like this that we're having today wouldn't happen. It wouldn't happen. You were always told to kind of brush those feelings away and keep on moving forward and keep on being strong and keep on being resilient and do the next thing, do the next thing, do the next thing. And we weren't really recognizing that people were suffering, um, that they needed someone to talk to. And that was within the community. And then outside the community, that was also happening as well. Right? They're strong. They don't need a therapist. They don't need a counselor. You know, it's, it's not them. It's fine. It's fine.

Tony: You helped, um, along with others to really raise awareness about these changes that were occurring. I know you participated in, um, uh, a report that the Congressional Black Caucus published called Ring the Alarm. Yes. Um, which really kind of brought the, the, the nation's attention here in the United States on, um, on this problem. Could you talk about that and some of the things that have kind of occurred since that report?

Arielle: Yeah, no, thank you so much for bringing that up. Um, so Dr. Michael Lindsey at NYU, he's now the Dean of Social Work. Um, and he's great, good people. Um, but he got a group of us together. Um, researchers, uh, clinicians, um, some individuals that were just community leaders, and we all came together and wrote this report. And what we really wanted to do is spread the word that suicide was happening. In, black youth in, black individuals, because again, there was this misconception that that wasn't occurring. So he spoke with Representative, Bonnie Watson Coleman, who was is very passionate about this specific topic, and we decided right then and there that we were going to write a report. We were going to talk about the most recent research that was conducted in this area. But not only that, give some policy recommendations, um, to actually make a difference. And some of that has come and transpired, which is amazing. Um, so NIH actually had some grant proposals that were dedicated to studying black youth suicide, which was amazing. That was one of our recommendations. Um, so there are studies actually going on, um, policies a little bit slower than what we would like. Um, but I think it actually did raise attention and, and made people well aware that this is not just a quote unquote white people problem that this is actually happening in black youth in black individuals. And that it doesn't matter what your race ethnicity is. Suicide touches everyone. Yeah.

Tony: Yeah. You said that policy has been slow, but I understand that there has been legislation that has followed that at least took up some of the recommendations, could talk about that?

Arielle: Yeah. So the legislation that actually did occur. It came to the floor. Um, uh, but unfortunately, did not get voted on to my knowledge. Um, it's it's slow moving. But I think again, just to be able to bring that to the floor is is a definite win.

Tony: Yeah. What was that? going to do?

Arielle: Yeah. So it's actually going to be, um, really focusing more energy on getting the resources needed for black youth within the school settings. School settings. Yes. So thinking about how, you know, kids go to school and they're in schools for six hours a day. It's another environment where protection can actually occur. Um, so actually recognizing that suicide prevention is necessary and that culturally relevant suicide prevention is really needed in order for us to make moves, um, in terms of decreasing the rate of suicide deaths that we're seeing in our Black youth. So recognizing that culturally appropriate prevention is really important and actually can make a big difference if implemented the right way in school settings. Yeah.

Tony: Um, maybe let's talk about that a little bit on the like intervention side. Now I realize that this is still an emerging topic. This is true, you know, in, in my work with respect to suicide prevention, nobody has figured this out. Right. We're, you know, we think we move closer. Um, and we have some ideas about things that are better to do than others, and there's evidence behind some and some have become sort of accepted practices, but we're all kind of still figuring this out. I don't think anybody can say. Oh, well, here's follow this three step plan and we'll, we'll end suicide, right? So given that it is a painful and difficult problem and, um, and so many factors, there's never one thing.

Arielle: No.

Tony: What are some ideas, maybe if you could talk at different levels, you know, what schools or communities or individuals or people who are, who are helping professionals or parents. I mean, what are the things that we seem to think are, are heading in the right direction?

Arielle: Yeah. Well, I think for me, I have two pre-teens in my household, so I can speak to my own experience as well. But first and foremost, I think having conversations early about emotions. Acknowledging that emotions are real, acknowledging that some days we're going to have good days, some days we're going to have bad days. And that's okay. Um, I think having an open door and an open ear actually will help kids, um, be able to come to you and actually say, you know what? I'm not doing so hot. I need to have a conversation with you. I need to have just, just some one on one time and, and make sure that I'm in a good space. Um, of course kids aren't going to say it that way, right? Um, but you know, being able to actually have real conversations with kids I think is the number one first step. And that can start as young as three years of age, honestly. Because you can acknowledge Yeah. That made you happy. Oh yeah. That made you sad. Um, and, and, and it's okay to be sad. I get sad sometimes and acknowledging that these are 'okay' feelings to have. So I think that's the first step.

Tony: Just to tap on that for a second. Yes. Um, in, uh, one of the, um, programs that I was part of developing, um, at SafeSide Prevention, which develops, um, different kinds of programming to, to help people learn about suicide and intervene. And one of the programs that we developed was, uh, we, we did a lot of work with, um, groups, parent groups and others here in the community. Uh, this is brought together by the Hillside Family of Agencies and, and several of the, the families that participated in this collaboration were African American. And one of the bits of feedback that they gave us, we were developing a scenario where, um, a. Uh, caseworker was, was in a family's home working with a, um, an African American mother and her son. And the feedback that we got from this family was that you really have to make, show the mom getting angry when her child was talking about suicide. And in fact, we had to go back two or three times because we really wanted to get this right. Um, and so as we engaged in this, we would kind of bring back different options and, and work on it together.

Tony: And it kept coming back. No, you got to really make her mad because if you want to prepare, uh, you know, professionals or, or other people or counselors or whoever you're going to prepare to work with, with and within our community, they have to be ready, um, for how we're really going to respond. And I'm not saying that that's true, how everybody would say, but that was our experience with that group that we worked with, um, to develop that. So I wonder if you could just reflect on that, the, the, the, the keen awareness, and this was true for, you know, all the family that were like, yeah, yeah, yeah, show, show her more mad. Yeah. Um, to get, to have it be realistic. I wonder if you, you know, come across that and, and what reflections you have about that.

Arielle: Yeah. You know, it, that is a great. Unfortunate concern. I will definitely say so. A lot of youth that I have worked with of color have indicated that talking with their parents is not the best way to go because they will get mad. And I always thought that was so counterintuitive, honestly. But, um, I'm also in this field, right? I let my kids talk to me about anything, um, which, you know, some people might be very uncomfortable about, but that's, that's just how we operate. Um, so, uh, yes, I would say why. One of the reasons I think is that, okay, first and foremost, you're talking about something that is very stigmatized. Mental health is very stigmatized in populations of color. It just is, unfortunately. So, um, Now you're saying that you are suicidal. You're having thoughts about dying. How could you hmm? This is a reflection of "Me, not so much you" and I know that sounds very impractical, you know, but it sounds as if okay. You have a problem that is very serious and that says I'm a bad parent That says that I can't parent well. That says I don't have it together. That's the feeling.

Tony: That's the feeling.

Arielle: I think it creates, um, in certain families, not every family. Yeah, I would say

Tony: probably many. Yes. I mean, um, I know, I, I, I think, and that's something that's limited to people of color at all. Yes. That feeling that, um, my, my child is experiencing this. What? Have I done right?

Arielle: Right. What have I done wrong? You're supposed to be strong. I'm supposed to be strong. You're supposed to be resilient. I'm supposed to be resilient. And this is how I've been parented all my life. And how, how could you, how could you have thoughts about killing yourself? And it's not so much that, you know, again, I think it's just very stigmatized and you need to pray it out and, and you need to not have those thoughts and, and keep on brushing them off and moving forward because that's what I've done. Right. Um, so I think it's, it's, it's something that, that parents do unfortunately get mad about.

Tony: One of the things we also learned from that, that same group was sort of like, well, where do you go with that? Right. And one of the things they said was that it's actually coming from a place of intense love. Yes. That this is because I, I, I love you so much and I, and I, I can't even fathom, you know, anything happening to you. Um, and. You know, and, and I think so, so kind of bringing that out was their suggestion of like, you know, this is, this is hard to hear from somebody that you love so intensely and would do anything for. Um, and so kind of leaning into that and understanding that that's really where it's coming from. Um, it's, it's a, it's a, um, it's an anger of protection in a way was what we heard. I don't know if that rings true for you.

Arielle: No, I think that's, that's a really smart way of educating others. Um, because I think unfortunately when you see someone get mad about something that's so serious, um, you can actually have some thoughts brought to your own mind about this parent or about this caregiver, right? Yes. And then you bring those biases into those counseling sessions. Oh, you're, you're not. Yeah. You know, there's certain feelings and thoughts. I think that's a big deal. I think that's a very big deal.

Tony: Very big deal, Arielle, what you're saying. Yeah. Yeah. Yeah. I think we see that a lot. I think, especially people who are drawn to kids.

Arielle: Yes.

Tony: I think, and they see the kids struggling. I think sometimes professionals have this same idea that like, maybe if I could just, protect them from their parents, absolutely. It'd be okay. Yeah, I don't know if that's really the no, because if you think about it,

Arielle: They live with those people. They are seeing those people way often than you are so and that's why i'm a big component of systems theory honestly, because I feel like you have these individual youth in the systems of care. But not only that, you have them living in systems, right? You have their parents, their caregivers, you have their siblings, if they have any in the home, you have potentially a grandparent that's living in the home. You have all these people that are interacting with this child on a regular basis within the home setting. And then even outside the home setting, you have schools, you have their teammates, you have their coaches, you have all these other people that they're interacting with. And if you can't actually start with the system level, then how are, how is this child going to get better? How's this child going to see that their life is actually worth living if you're not attacking not only the individual themselves, but the system that they're living in.

Tony: So maybe let's talk a little about, about schools. Yes. Um, you know, what, what are some strategies that you know, for schools to, to address, you know, suicide among, among these very young children. Yes. But also, um, maybe particularly the, the, the disparity where black children are, are experiencing these things at greater, uh, greater numbers. What kind of ideas do you have?

Arielle: As you stated already, we're really struggling. We're really struggling to understand what works best at the older age range. Now we're seeing these increases happening at this younger age range with specific populations of youth. What, what works best for them? So we don't have any prevention programs specifically for this younger age range. That's not something we have currently because again, as stated earlier, um, suicide was not seen as a problem at this younger age range. So we're trying to figure that out. We really are. Um, I think educating teachers about the problem, just from a very basic foundational level, understanding that yes, suicidal thoughts and behaviors can occur at this younger age range can actually open the door to that conversation of how do we do better with preventing suicidal thoughts and behaviors in this younger age range. Um, so that would be my, my one piece of information. You know, it's a lot to, to think that even at this younger age it's happening.

Tony: Just, I'm just, uh, reflecting on what you said earlier in our conversation about Um, you know, potentially one of the things going on with an increase in, um, you know, black suicide among youth and children was this, uh, these changes in the you know kind of family networks, community relationship networks. Um, And I wonder if if if those are strengths that you think have been there historically, and maybe are eroding a little bit here or there depending upon what you know for different reasons I'm, just wondering what your thoughts are. Is that part of the, you know the is the flip side part of the key to protection as well?

Arielle: A hundred percent. I I a hundred percent agree that that is an area where we should focus um for prevention specifically for black youth something that I I spoke with, uh, I was helping believe it or not the the Tennessee's, uh, Suicide Prevention um Office and I was a subject matter expert for them. And we talked about how maybe we could just have grandmas and grandpas just sit on a bench and have a sign that says, come, come talk to me. I'll listen. But not only educating them on just to have that conversation, but also educating them on what to do when individuals like youth, like others, are experiencing a crisis. Um, I think unfortunately, the mental health sector, um, and not only that, just general health has a very bad taste in African Americans mouths. There has been a lot of experiences in the medical field, uh, where black individuals have not been taken seriously. They have not been, um, treated well because of the color of their skin. They've been discriminated against. They've, um, there's unseen biases that come into the room with doctors, with nurses, and they don't want to go there.

Tony: There's mistrust.

Arielle: There's a lot of mistrust in the system. So what about bringing it back to a source where they do trust that source to actually help them? So churches, grandmas, grandpas, you know, just having that, that, that, um, what's the word I'm looking for? That elder. So to speak, that you can talk with and share your thoughts and feelings with that can actually get you the help that you need.

Tony: In a, in a more natural environment,

Arielle: In a more natural environment. Yes, absolutely.

Tony: Yeah. Yeah. It's, it's like we, it, I mean, I really kind of need both, right. We need to, we don't, we don't want to just sort of like. But we want those systems to improve. Absolutely. We want healthcare systems, mental health to be more responsive.

Arielle: Yes.

Tony: And we also need to recognize that there needs to be other kinds of alternatives.

Arielle: Absolutely.

Tony: This is a really striking theme that, you know, I've really become aware of in the last like maybe five or 10 years. Um. Working in different, especially I work in a few different geographies, different countries, different groups. And it seems like this is really a theme in many different marginalized groups. Yes. We want things to be better. Yes. In mental health and health care. And there needs to be, um, you know, sort of options and more investment in the, the natural environments and, and units that are, uh, where, where people are living.

Arielle: Absolutely. And I think that goes back to that cultural, cultural relevance, right? You have to be really mindful that these groups are bringing to the table, different cultures, different beliefs, different, um, thoughts about mental health just in general. And if we're not taking that into consideration, then we're not really doing a good service. Or not. So I think it's really important for us to have folks that are at the table that are helping us to actually think about prevention differently, and to also create potentially that prevention strategy that's going to work best.

Tony: Yeah. Now, I know that you didn't start off working on suicide prevention, um, that you were really focused on, uh, attachment and families. Yep. Um, so could you tell me about, maybe about some of that early work and, and how did you end up, you know, really now? So, so focused. So devoted. Yes. Um, you seem on a mission.

Arielle: I am ...

Tony: um, related to. Uh, suicide.

Arielle: Yeah. So my, my first work when I was doing my, um, master's program was actually looking at co- parenting. So how parents, parent, um, and I was looking at teens, so teenage parents and how they parented their own children together with their partners and how attachment actually played a role in that.

Tony: Can you describe what attachment is? Yes, absolutely. So

Arielle: Attachment is basically how we, um, interact in relationships. And it starts out very, very young. Um, so back in the day with Bowlby and John Bowlby and Ainsworth, Mary Ainsworth, they all created this system, so to speak, to look at Attachment in young kids, super young kids, infants, and it basically was how they saw the world and people in that world. Um, so they, they had the strange situation, which was, um, when they basically had the kids come in, super little people, um, infants, um, I would say probably toddlers. Uh, and they would come in with their primary caregiver. They would basically interact, play together, you know, and they would code that video. Um, and then they would have the caregiver leave, which was very stressful as you can imagine to a little person. And then a stranger would come in. So that's why it was called The Strange Situation.

Tony: And stressful for some people more than others. And that's the point.

Arielle: Yes. So by that stress, they could understand how that child saw relationships. Um, but then the parent would come back in after the stranger left. And that reaction was really, really important.

Tony: Really important. Some of the healthier. Kids would just kind of embrace their mom or dad. Yes. Mostly mom, I think. Yeah, yeah, yeah. Mostly

Arielle: moms. Yeah. For, for, unfortunately. Um, yes.

Tony: Yeah. But then ones that were less healthy, what kinds of things?

Arielle: Yeah. So some things that you would see is that the kids would ignore their parents. So they would go into the corner and kind of try to soothe themselves by rocking sometimes or other, other kids would actually hit their, their moms when they were turned, um, to kind of punish them for leaving. Um, so those specific ways that they would interact with that primary caregiver, determined what type of attachment style they had.

Tony: Okay. Yeah. So zoom that into your work, so, and we, we know from research that, that those attachment styles yes. Predict a lot about how people lived their other parts of their lives, the relationships they have, the, the marriages they have, a lot of different things. Yes. So, so you were looking at this attachment idea, uh, and I appreciate you taking the time to explain it. Yes. Uh, this attachment idea with, with teen parents.

Arielle: Yes. Yep. So in between teen parents, so to speak, looking at how they, um, saw their relationships, but also how did they interact with that partner in caring for their child?

Tony: Okay. Yeah. So then. How did we get to suicide from that? I know.

Arielle: So, if you think about it. Um, actually, so, I did my Masters thesis looking at that topic specifically. And then I got, I got burnt out, to be honest. Um, so I took some time off. I took some time off and I said, you know what, if I want to go back for this Ph. D. thing, I have to do what Ph. D. s do, which was research and teaching. And I was at, um, I was in Columbus, Ohio at the time. So I said, okay, I'm going to go teach at Columbus State Community College as an adjunct professor. And then I'm going to get a research job and do both and see if this is what I want to do. So I started out actually as a researcher that looked at booster seat use. And car seat use. Okay. Definitely not suicide research, as you know. Um, but I was really good at installing car seats and, and we created. That's really hard to do. Yeah. Oh my goodness. So every, all my friends, all my friends came and were like, please, can you install this? And I don't know why it's

Tony: so hard. I don't know. in 2024.

Arielle: I know. I know. So I, I installed many car seats. Um, Which was great, great opportunity to actually do something immediately and see how well kids would be protected, um, when they were driving in their parent's car or their caregiver's car. So, um, we created this tool actually that was really cool that, showed you what seat was the right seat for your kid and it was, it had a tape measure attached to it so you could like measure out your child to see how tall they were because seats are dependent upon the child's height. Okay. So again, really cool. Yeah, really cool, right? Just not for me. So I, I, I didn't find it as exciting, um, as probably others did very good, very important research, but not something that I was like, Oh, yay, I'm going to work today. Right.

Tony: Right. Some people would feel that.

Arielle: Absolutely. And, and it wasn't, um, something that I was really passionate about. So, um, psychology was something that I always wanted to get involved in. Something I always loved. Um, and I taught psych classes at the community college, taught child development at the community college. So I was like, you know what, maybe I should look for a psych position. And lo and behold, Dr. Jeffrey Bridge. Oh, yes. Yes. Yes. He's the man. He is the man. Um, he was actually, he just started at Nationwide Children's Hospital and, um, had a position open for a research associate and I said, you know what? I don't know suicide in any way, shape or form, but I'm going to try. I'm going to try.

Tony: Yeah.

Arielle: I'm going to try. And that's how I got involved.

Tony: Yeah. You know, this is actually really helpful. You know, we, there are a number of early career people who listen to this podcast and, and, and watch and, and, um, and one of the things we really are trying to draw out lessons for this. This is a fairly interesting, I mean, I think so many people who are going into their careers think things are going to be a straight line. No, no, no,

Arielle: no, no. I can tell you. Or when

Tony: they're, when they're lost about what to do, feel like, Oh my gosh, I have to figure this out. But one of the things that I, I mean, I'm just wondering if, you know, what you said was I just decided just to try, and, um, uh, one of my, uh, uh, a therapy supervisor that I had, who I really, really loved gave me this metaphor that you can't steer a car that isn't moving.

Arielle: That is very true. That is very true. And it sounds

Tony: like you moved that car.

Arielle: I did.

Tony: You were doing something, you know, worthwhile. Yeah. With the booster seat intervention. Absolutely. You know, but it wasn't really you. It wasn't really there. Yeah. You didn't know what was next, but you're like, I'm gonna move this car.

Arielle: Yes. Yes. And he actually, at that time, he had an early career award. Um, it's called a K01, um, where he was looking at kids, actually teens, who had attempted suicide, were on an inpatient unit, I had to go interview the kids and their parents on the inpatient. So I full fledged, I jumped in, jumped right in. Um, there was no like easing in. Um, I jumped right in. So my first week, you know, we Arielle, this is what we're going to do. I'm going to have you get introduced to the inpatient unit people and blah, blah, blah. And I'm just like, deer in headlights because I'd never been on an inpatient unit. Never. Right. Um, and never. So I was a little intimidated, as you can probably imagine, but honestly, it was one of the best experiences I had ever had. Yeah. Um, just listening to their stories and getting them to actually talk about the care that they've had was really just, compelling. Honestly, to, to really think about, okay, what do kids really need when they're in an inpatient unit setting to actually get better? Yeah.

Tony: Yeah. Yeah. You can't just read about this stuff.

Arielle: No, no, you can't. And, and, um, you know, it was one of those things where, of course, attachment is, still near and dear to my heart and still is today. I still measure attachment, um, in all of my studies that I have. Yes. It's just something that has always been my foundation, so to speak. So I talked with Jeff and I said, you know, can we add this measure of attachment? He said, sure. So I did, I did. And he was like, you know, Arielle, you have really great ideas. And I said, well, thank you. He's like, so important

Tony: to have somebody recognized. Yes.

Arielle: Yes. And he was like, I think you need to go back to school. I said, no. And, you know, I'm very grateful that he encouraged me to do so. I went back for my PhD and like you had said, no line is straight, a hundred percent true. It is a hundred percent true. It was not a straight line for me to get to where I am today. I did my PhD. Then I went to Texas, believe it or not. University of Texas Health Science Center in San Antonio. Great place. Great place. Um, learned even more about inpatient units, learned even more about serotonin, the neurotransmitter in our brains that helps us to feel happy, and um, learned a lot, a lot of information, but did not get the independence as much as I would like. Um, so I decided I unfortunately needed another postdoc. So I did two postdocs all together. Yeah. Yeah.

Tony: So you kept, you kept going. At this point, you're getting momentum here now. Yes. You're starting to get your ideas about these things. Yeah.

Arielle: Yeah. Yeah. So I went back to Columbus. Yeah. Um, and I was very clear about my goals. Yeah. Um, I came with a list.

Tony: Mm.

Arielle: I really did.

Tony: So now you're in a very different position. Yes. From I don't know what I'm going to do. Yes. To, uh, yeah, yeah, wow. And, you know, another thing, just a reflection on what you just said, you know, going into that, you know, I think, you know, sometimes people, um, might wait until they feel comfortable or competent. Like they feel like I know what I'm doing and then I'll do something. Yes and I don't know about you but I've sort of found that like it's actually the opposite like the way you feel like you you're gonna know what you're doing is by doing things that you don't know what you're doing in,

Arielle: Yes,

Tony: working with great people and then getting some skills and competence and that's how you get there. You can't wait to do something until you feel like you're ready.

Arielle: No, you cannot. No, that's 100 percent true. And I, I wasn't ready to be honest, to be an independent researcher after my three years in Texas. And I knew that to be the case, but I knew that my second postdoc had to have certain things for me to be ready. I knew, I knew that, um, but I also knew that because I talked with great mentors. So even when I was in Texas, um, I reached outside the box, um, and, and talked with individuals from different, you know, uh, departments. And even old, you know, Columbus mentors. I still was in contact with them to kind of just talk through, you know, I'm, I'm struggling here. What, what do I do? What do I need? Um, how do I get to a point where I feel. That my research is important, but also can actually stand above all the others. It's extremely competitive field.

Tony: It is 100%. It sounds like you were really, um, courageous in seeking out mentors.

Arielle: Yes. Yes. And even to this day, I still talk with my mentors, you know, from different points of life, uh, because it's really important to have those people in your world to be able to be real, honestly, like, oh yeah, that's great. You do all these things, but, um, you haven't published in a while. You need to get it together. Or, oh, that aims page. Not so much, it's not great. You need to do X, Y, and Z. What about this thing? What about that thing? Um, so it, it still really helps me to grow. Um, mentorship is Um, but also now I have people that I'm mentoring myself and being able to make sure they're very fortunate. Well, thank you. I don't know. I always questioned myself, honestly. Um, but making sure that I'm meeting their needs, um, and making sure that they don't have to unfortunately experience some of the things that I did experience. Um, and making sure I'm, I'm, I'm hitting the bar, honestly, so that they are successful in their fields that they've chosen. Yeah.

Tony: To giving, if you, um, were giving advice to a person earlier in the career, maybe to an earlier, an earlier you. Yeah. Um, what advice do you have about, Uh, getting mentors, you know, someone might be sitting there like, I'd love to have three amazing mentors. But how do I, you know, getting mentors, maintaining, you know, kind of what, what, what advice do you have about, about that?

Arielle: So I think the first thing I would advise is that mentors don't have to be in your area of expertise. It's actually better that they aren't because they can think in a different light and see the problem differently than what you can potentially. And if you, so the whole part about writing grants is writing to an audience that has no idea what you're talking about. They try. They absolutely try to get an expert that is going to be in your field, but it's not always necessary that that's the case. Because that person may be in conflict with you. Because they know you. So they can't read your grant. So you have to be able to break this down in a way that is digestible to individuals that are not in your field. So I think that would be my first recommendation is look outside the box. Look outside the box.

Tony: That's a really good suggestion.

Arielle: Yeah, get someone that actually is willing to kind of help in areas where you might be lacking. Um, maybe someone that's in a community organization that you want to connect with. Um, maybe someone in the school system, you know, that you want to get involved with. Um, maybe someone that, from the public health world, right, where, where you're trying to think, okay, how do I kind of get this prevention program within the school setting and get public health individuals excited about it. So thinking a little bit outside the box would be my first recommendation. It's always good to have a content expert. Don't get me wrong, but I think having a mentor that also comes from the other side of the coin is actually really helpful.

Tony: It's really helpful. Yeah. Thanks. So switching back to some of your current work. Yes. Um, and um, you know, kind of what's right on the, on the edge for you want to talk about one, um, I, I paper that you just published with a group of other people too, which is about, um, developing pathways for younger children, pre-teens, um, who might be seen in one of in a health in a health setting.

Arielle: Yes

Tony: Could you talk about that work a little bit?

Arielle: Sure So I was very very honored to actually work with some of the leading experts I would say in the pre-teen field of suicide so we actually came together and realized that there really isn't a clear path not only for for parents or caregivers, but for clinicians or mental health workers, or even folks that are in the medical field to actually ask kids about suicide and suicidal behavior. And where do they go if they do get a yes? And there's no recommendations right now. Until just recent actually, the American Pediatric Association just came out with some recommendations for, um, us to follow, but it was really vague, honestly, well do this, don't do that, so we wanted to really clear it up for folks, really make it a solid plan, so to speak, um, for clinicians for doctors to actually follow. So they were not just unfortunately a deer in headlights, when they did have a youth member say, yes, yes, I'm having thoughts about suicide. So that's, that's what this article is all about. Yeah, that's really helpful.

Tony: And one, I think an encouraging bit about that for people in the general public is that. People are being equipped. Yes. Although we shared before that we don't know all the answers. We don't know how to solve suicide but there is progress occurring and it's more and more the case that if you did, you know, seek support that you'll find somebody who's, who's prepared and you're, and we're both I know committed to try to make that more so.

Arielle: Yes, absolutely. Yeah. So I think, um, from what I have experienced clinicians as well as, you know, some medical professionals, they really want it to be black and white. Honestly, they really want a very clear guideline so that they can follow it every single time, all the time. But unfortunately, when it comes to suicidal thoughts and behaviors, um, whether it be in an adult, whether it be an elderly individual, whether it be in a pre-teen youth. It's not always black and white. Yeah. It's not always black and white. Um, just the language that I think some of the kids use isn't always necessarily as clear cut.

Tony: Could you talk about that? Especially with the youngest children. That's the part that seems the most difficult for people that I've talked with, whether you're a teacher or a parent or a clinician is that, you know, somebody as young as the age as you're talking about, you know, they're not, they're not going to share things in the way that the, you know, You know, some textbook might say that I share. So what, what can you tell us about? Um, the, either the language or, or ways that these kinds of concerns show up in those much younger children.

Arielle: Yeah. So I think from my experience, just asking the question can lead to a conversation about those feelings and those thoughts.

Tony: And how would you ask that question to a, to a young child?

Arielle: So I am very straightforward, guys. Uh huh. I have to admit, and I don't want to sugar coat anything because, I believe that creates more stigma surrounding mental health and suicidal behavior and suicidal thoughts. So I'm very straightforward with kids. So when we have them in our research appointments, we just ask. We just say, hey, you know, has there ever been a time where you wished you were dead? Or wish you'd go to sleep and never, ever, ever wake up again? Yes. Yes.

Tony: And how do people respond to that question?

Arielle: I want kids to tell me no every single time, all the time. But then there's some times where it's a yes. Yes, I have had that thought. And then we ask, okay, well, well, is it more about wishing you were dead? More about wishing you go to sleep and never, ever, ever wake up again? Which thought is it that you've had more of? Um, and then we can talk a little bit more about, okay. Thank you for answering that. We always want to give thanks.

Tony: I think that's a big one. We

Arielle: always want to give thanks because I think that is a scary thing to admit. Just even for an adult to admit that they've had those thoughts.

Tony: I think that, and that's often helpful for me because sometimes I don't know what to say. Right. Right. Even though I've obviously been working on this for a long time. Yeah. But still, because I'm talking with a human being, uh, whether it's very young. Yes. So sometimes just saying, I really appreciate you telling me.

Arielle: Yes. Yes. Yes, absolutely. a thank you can go a long way, honestly, um, because it is, again, something that's really scary to admit for some kids that they've had those thoughts for some individuals just in general to think, Oh my goodness, I have had that thought before. Yeah.

Tony: And then how do you move into exploring whether they're actually thinking about, you know, taking some action in that direction?

Arielle: Absolutely. So again, very straightforward because we don't want to stigmatize any of their thoughts or behaviors. And we just ask them up front, has there ever been a time where you thought about killing yourself? And sometimes again, no, you know, never. Um, but sometimes there are yeses. And then we ask, okay, when's the last time you actually had that thought? Because we want to make sure again, that our kids are a hundred percent safe before they leave our, our lab, so to speak, um, which isn't really a lab. Um, it's, it's, it's two interview rooms and, and it looks very nice, I promise. Um, but we want to really make sure that everybody is safe before they leave. Um, so if we need to call our mobile crisis unit, we do. We call them immediately and we let the parent know because again, we want to make sure that that child is safe.

Tony: You want to involve everybody in that sort of thing. Yeah. Well, that's helpful to hear kind of how, how you might go about, um, how you might go about asking somebody. Um, it does sound like it's very gentle. And, and I think, you know, people also have to use the words they're comfortable with. Yes. For some people say just. Saying kill yourself is too confronting. So maybe they adjust that a little bit, but they you do want to be direct

Arielle: Yes,

Tony: direct about it. Yeah, make sure you're really asking the thing that you want to know.

Arielle: Yeah, absolutely Other ways you can ask that question. It's really about the intention honestly. Has there ever been a time where you hurt yourself on purpose and didn't want to be alive anymore? Um, When you hurt yourself. So really getting at that intention is what's really important.

Tony: And you found

Arielle: that pretty young children can answer those questions. They can. Um, and I think that's what's is most surprising is that young kids that actually do have those thoughts are willing to answer that question and are actually thankful sometimes for you asking them that question because it's been bottled up. They haven't been able to talk to anyone else. Yeah. Uh, or tell anybody else because they don't feel like they can, um, so actually having an opportunity to actually say, yes, I actually have had that thought, but then I can do something about that if it's something that they've currently have or it's something that they've recently had. So I can, I can give them the help that they need.

Tony: And what about the concern that some people might have that you could give a child the idea by asking them?

Arielle: Tons and tons and tons of research has been conducted. I even, I published a paper back in the day when I was in Texas about asking the question about suicide. So, um, in that study we asked kids every six months about suicidal thoughts and behaviors. Every single, every six months, every six months, um, twice a year basically. And every time it decreased. Every, every age group that we looked at, it decreased. Every racial, um, background, every ethnicity, it decreased. So research proves that asking the question actually can potentially protect that child and give them an opportunity, if they are experiencing those thoughts, those behaviors, to actually talk to somebody about them. But that doesn't necessarily put that idea in their mind.

Tony: And there was another really seminal piece by a close colleague, dear friend, Dr. Madeline Gould, who's at Columbia University. And, and they found something similar, you know, and it seems like there's kind of keeps coming back to the same. And they've actually found that there were, they had, they had a group that was asked and a group that wasn't asked. Um, and, and we're actually able to find that, you know, especially those, those people who had more, you know, problematic ways of thinking about suicide being asked was, you know, actually looked to be maybe more helpful. Um, so it's, it's helpful for you to, to, for you, for you to say that. And, and, and for people to know that it's, it's, it's really not how it, not how it goes is that you ask somebody and then they say, oh yeah, I never thought about that. Right. And now, you know, it's, it's, it's not, um, Just, just not how it happens. No, it does not. Yeah. So as we're, um, you know, we talked about a lot of different things here. Yes. Um, one thing I'm curious about is as you, you know, think about the work that you're doing now, what are some things that maybe you've changed your mind about? Things that have evolved over since you've been studying, you know, suicide among children and youth and maybe black youth specifically, however you want to take the wherever direction you want to take the question, but what's something you've changed your mind about?

Arielle: Well, I think just like everyone else in the field, I did not recognize that suicide was happening at this young age range. So five to 12 years of age, definitely something that I did not know, um, much about. Um, we were focusing primarily on adolescence when I first started, uh, looking at suicidal behaviors. And to just acknowledge the fact that it actually is happening this young. And that unfortunately certain age groups, um, have this racial disparity present, um, so this younger age, more Black youth are actually dying by suicide than any other racial group. Proportionally, yeah. Wow. So that is a concern. Yeah. And, and again, that's the reason why I am dedicating my work to this field. Yeah. Um, because I think that, number one, we didn't know. We didn't know. Um, number two, we didn't acknowledge that it was actually happening. But number three, we didn't even know that there was this disparity present. And how can we actually make change if we don't acknowledge the fact that it is happening and it's happening in different ways, so to speak, um, than what we have seen in other age groups.

Tony: So what's next for this field? What are you working on right now? Like what's on the edge for you and what's, what's next in this line of, of research?

Arielle: Yeah. So a lot of things. Um, I am working on many of, of, of articles. Um, I am trying to get, 'trying' quote unquote, to get a paper out that looks at black youth have actually been involved in the welfare system. Um, so Lynsay Ayer has a plethora of secondary data. Um, so data that has been collected for many, many years, and we're looking at black youth specifically that have been involved in the welfare system and trying to better understand for that specific population of youth. What are those protective factors that actually decrease their risk? Um, so I really wanted to get away from the risk factor world, to be honest, and really focus primarily on protective factors, because I think that is where the money is, to be honest, where we can actually make a change happen. Risk factors, unfortunately, are really hard to change. Um, and with a population of youth that unfortunately experiences so many risk factors and do on a regular basis, um, thinking about changing discrimination, thinking about changing stereotypes, that is going to take a lot of effort.

Tony: Hugely important. Yes. But that's, that's a long term project.

Arielle: Absolutely. Yeah. And we know those risk factors are related to suicidal behaviors, in black youth specifically, but I am only one person and cannot change, um, discrimination. So how do I actually make more protective factors, um, seen, so to speak, as beneficial? to Black youth, and how do we go about promoting those protective factors to build that resiliency? So that's where I'm focusing my energy right now.

Tony: Yeah, that's kind of like where we began with those different things that have kept, um, you know, Black people strong over the years. Yes, yes. In, in that, um, you know, through, uh, many, many, you know, decades, and I guess centuries of, um, of, of challenges. And so you're looking to, to figure out how can we bring those protective factors. Um, to bear in this particular problem that, that you're, that you're working on. Yeah.

Arielle: But not only that, talking with black individuals about the problem. You know, getting their insight and kind of, um, understanding from their perspective, what do they think would be most beneficial when it comes to prevention programming? And where should it take place? Where shouldn't it take place? Is school the best space for suicide prevention for black youth? Or is it better at an after school program? Is it better at a community organization? Uh, where would it be best suited for youth of color? Um, or black youth specifically. Um, and, and changing our perspective on what works and what works well is the first step.

Tony: So it's not just, uh, what you're going to target, but where and what environment and how. Yes. And who, who,

Arielle: right? Is it better to be

Tony: involved?

Arielle: Absolutely. Is it better to have that teenager that's doing the teaching, so to speak, or is it better to have a pastor? Is it better to have a youth pastor? It's like, so who is it that would be well suited for this position?

Tony: Maybe lots of those. Um, so speaking of involvement, I wonder if you could share with, you know, people who are watching or listening, um, who say, you know, I'd like to help with that. Um, maybe people who are in a situation where they know somebody who, um, you know, child they're concerned about.

Arielle: Yes

Tony: Maybe what, what, what would you have them to take away? And then what about people who are just, you know, want to get involved, want to support youth suicide prevention? Yeah.

Arielle: What suggestions do you have for those different people? Absolutely. So we do have research programs that are running right now. Um, they span the age range. So we're looking at kids, uh, nine to to 11 in one study. And then we have another study that's looking at 13 to 17. Um, so we're trying our best to again, better understand those potential protective factors and interventions that actually could work for youth. Um, so there's always an opportunity to get involved, um, with research that that's one thing. Um, the other thing is really just having those conversations, being open and being honest with youth, um, to just break the ice, break the ice and really just say, you know what, I have had those thoughts before, or, you know, I have been really sad lately, and I just want to check in with you and see how you're doing, because it's really important for us to really just have that conversation, and maybe kids, your kid is perfectly fine. That's great. Yay. Right? But maybe your kid is actually struggling, and needs some assistance, and needs to talk to someone. Um, there's always, always, always the Lifeline, the National Lifeline, 988.

Tony: That's the number now, which, thank goodness, is now the number. The National Suicide Prevention and Crisis Line.

Arielle: Yes. So you can call us in the

Tony: U. S. and, um, I mentioned earlier, uh, during the introduction that they'll, we'll have resources in the notes for people in different countries as well.

Arielle: Absolutely.

Tony: Yeah. And what about if someone has, um, lost somebody to suicide, especially a, uh, a young person, um, what kinds of, you know, what, what can you say to them?

Arielle: Yeah. There's a couple of support um, groups out there. Um, so they're through American Foundation for Suicide Prevention. They have a whole, I would say, division, so to speak, that's dedicated to individuals who have lost someone to suicide. And there's

Tony: online resources that will point to there from the American Foundation for Suicide Prevention. So

Arielle: just getting, even just getting involved. As much as you need, honestly, um, is what's works for you, right? I can't tell you what works best for you. You will know that information. But I think these are definitely resources that can be utilized and, um, NAMI, the National Alliance of Mental Illness, they have a parent support group that actually, um, is available, um, for parents who have lost, uh, youth to suicide or parents that are, um, that have a youth that has mental health concerns. So, there are support groups out there that are an opening ear and, and a place where you can actually talk with individuals that do experience or have experienced what you have experienced.

Tony: Okay. Yeah. I just wanted to clarify one thing. You mentioned your research. Can people participate in that who are outside of the area where you live?

Arielle: Yes, they can.

Tony: Yep. So we Buffalo, Syracuse. What about nationally or internationally?

Arielle: No, unfortunately, only in upstate New York at this time. Um, we are really trying our best to kind of gain some insight from other countries as well. Um, So I, I do a little bit of collaborating with one of my colleagues, Ellen, Ellen-ge Denton, Dr. Ellen-ge Denton um, who works with countries not within the U S, um, other countries to understand suicidal behavior, youth suicidal behavior better. So do a little bit of collaborating with, with her. Um, but I have not gotten to that level of international, um, yeah, I'm just

Tony: curious. I think people might hear, oh, and they want to get involved and contact you. So yeah, but maybe we'll also point to some other research occurring in this area that people might be able to participate in. Absolutely. Absolutely. Arielle, thank you so much for sharing what you have today. I mean, I really, um, it's a hard topic. Um, so important to talk about. I appreciate your work on this. Thank you. Also for sharing your journey that, oh yes, it's not, as we said, the, not the straight line, which I know will be encouraging to people who are listening as well, you know, to see all the ways that you're, all the things you've accomplished and are, and are contributing. Um, and you know, to help people remember that if somebody is listening and they're just no idea what they're doing, right. Um, Um, that get that car going and move in a direction and you'll find, you know, you'll find your path. Get those mentors. Yes. Uh, speak to people and, um, and, and be open, open minded. Yeah, absolutely. Well, thank you. It's a really pleasure to talk.

Arielle: Thank you so much for having me. I appreciate it. Thanks. Thank you.