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The North Dakota Suicide Prevention Follow-up Program through Firstlink is designed to help maintain the safety of individuals at risk of suicide. The primary aims of the program are: 1) to support the physical and emotional safety of participants, 2) to empower and motivate participants to use resources available to them 3) to reduce service gaps by promoting continuity of care and well-being of all patients treated for suicide risk 4) to promote suicide prevention screening as a core component of emergency department protocols. These goals will be achieved by offering the program to individuals after they are referred by a participating hospital emergency department, healthcare facility or callers to the National Suicide Prevention Lifeline and attempting to call them within 24-hours of receiving the referral. The primary goal of this project will be to offer this program to individuals who are being discharged from hospital emergency departments.

Centerstone proposes the Enhanced Follow-Up Project to promote linkages to mental health and related resources, promote engagement in services and reduce suicidal ideation and risk among individuals who are referred through the National Suicide Prevention Lifeline (NSPL) and Southern Tennessee Regional Health System-Lawrenceburg by developing and implementing cross-system suicide prevention strategies, including rapid and enhanced follow-up for 1,040 unduplicated individuals (720 through NSPL callers; 320 through partner ED referrals). Centerstone currently provides Crisis Care Services to individuals across the nation who call Centerstone's Crisis Line, NSPL, NFL Lifeline, Courage Beyond (a program of Centerstone Military Services), Solutions EAP, Dawson McAllister Hopeline, and Tennessee's Statewide Crisis Line. Centerstone Crisis Care provides telephonic follow-up services to callers identified as high risk, having presented during the initial call with current or recent suicidal ideation, as well as individuals seen by Centerstone's Mobile Crisis Team. On average, Centerstone's Crisis Care Services receives 3,000 incoming calls per month. On average, this service initiates 1,500 outgoing follow-up calls per month to high risk individuals. In 2015, 6 percent of all follow-up contacts originated from callers to the NSPL. There were 18,928 total follow-up calls made; 1,046 were NSPL callers.

The Institute for Family Health, a designated Lifeline Crisis Center and federally qualified health center network, proposes to serve 1,080-1800 individuals experiencing suicide ideation in Ulster County, NY. The goal of the program is to reduce the rate of suicide in Ulster County by facilitating culturally competent, timely outreach and engagement for suicidal patients who call the Institute's Crisis Center or are discharged from the emergency department (ED) at HealthAlliance of Hudson Valley (HAHV). Specifically, the program will engage in outreach and engagement strategies in order to reduce individual barriers to accessing outpatient mental health care and other needed services. The Institute expects to follow-up with 120-240 hotline callers and 240-360 HAHV ED patients annually. Create a Consumer Advisory Board who will meet quarterly with Institute staff to explore needs of suicidal patients, identify/discuss disparities in care, and implement course corrections. Provide trainings to Institute and HAHV providers on assessing for suicide risk and caring for suicidal patients. By year three of the program, the Institute expects to educate approximately 50-70 Institute and HAHV providers through in-service trainings. To achieve these objectives, a licensed mental health clinician will serve as the suicide prevention project coordinator. The suicide prevention coordinator will collaborate closely with HAHV to ensure program deliverables are met; provide direct mental health services, including linkages to care and care coordination/follow-up services to high-risk suicidal individuals; coordinate and facilitate Consumer Advisory Board meetings; and track and analyze program data.

The Lines for Life Follow-Up project will further Lines for Life's mission to prevent suicide and substance abuse and will assist Providence Portland in their aim to successfully transition all patients with suicide attempts and/or suicide ideation to safe and ongoing care. Of the 33 states with a population of greater than 2.6 million, Oregon has the 3rd highest suicide rate. In 2015 Lines for Life, as Oregon's only affiliate to the National Suicide Prevent LifeLine, responded to 13,745 callers on the National Suicide Prevention Line. The purpose of this project is to reduce the suicide rate of individuals leaving the hospital after a suicide attempt and/or suicide ideation. This will be accomplished through a partnership in which the hospital refers patients to the LifeLine and Lines for Life follows-up with these patients. Research shows after a person presents to an Emergency Department (ED) for suicidal crisis, they are at most risk 24-48 hours after discharge from the ED. The project will increase the number of individuals screened for mental health related interventions, increase the number of individuals referred for follow-up, increase referrals to mental health related services and increase the number of individuals who come in contact with Lines for Life who go on to obtain mental health related services after receiving a referral. Lines for Life will employ the following evidence-based practices: Applied Suicide Intervention Skills Training, Motivational Interviewing, Dialectical Behavioral Therapy and the Stages of Change Model.

Provident, Inc. will support intensive case management services for 198 Missouri adults annually that are considered at-risk for suicide due to recent suicide attempt, history of suicide attempt(s), suicidal ideation or self-injury. The program will serve Missouri adults of all genders, ethnicities, socioeconomic backgrounds, and sexual orientations. The HopeAfter Phase III program will serve a total of 594 clients over the lifetime of the project. The proposed interventions include: A) Initial and Ongoing Assessment, which cover the core principles and subcomponents of the National Suicide Prevention Lifeline (NSPL) Suicide Risk Assessment Standards, rating the client's suicidal desire, suicidal capability, suicidal intent, and buffers/connectedness. Assessments also include a PHQ9 assessment, standard mental health screening, and suicide risk assessment; B) Intensive case management services, including development of a safety plan, review of hospital discharge plan, creation of personal goals, access to care and social supports, connection with outside treatment, such as counseling, psychiatric care and/or medication, substance abuse counseling, and any other advocacy calls or activities on behalf of the consumer. Consumers will be referred from Hyland Behavioral Health at St. Anthony's, from Provident's Life Crisis Services crisis hotline, or from other area hospitals or crisis hotlines. The HopeAfter Phase II program has been in practice since July, 2013, and has demonstrated a 55 percent graduation rate. The HopeAfter Phase III program is also expected to have a 55 percent graduation rate, with graduation noted as clients exhibiting at least two of the following: ability to manage a job, completion of two personal goals, ability to avoid negative triggers, completed and followed safety plan, and improved assessment scores.

The DuPage County Health Department (DCHD) seeks to strengthen the agency's Crisis Center follow-up services for National Suicide Lifeline callers and suicidal persons who are discharged from the Northwestern Medicine Central DuPage Hospital emergency department. This grant will build on the follow-up structure developed as part of SAMHSA's 2013 Crisis Center Follow-up Program and continue efforts to improve behavioral health care in DuPage County. The overall goal of the project is to build on the follow-up structure established during SAMHSA's 2013-2016 Suicide Prevention Lifeline Crisis Center Follow-Up program and increase the number of suicidal persons receiving follow-up services. The objectives to achieve this goal are as follows: 1) Refer 25 suicidal persons per month to the DCHD Crisis Center Follow-up Program from Northwestern Medicine Central DuPage Hospital, the National Suicide Prevention Lifeline, and DCHD Crisis Center respite services. 2) Refer 300 suicidal persons to the DCHD Crisis Center Follow-Up Program, annually. 3) Enroll 195 individuals in the DCHD Crisis Center Follow-Up Program (65 percent of those referred to the program), annually. 4) Eighty percent of Crisis Center Follow-up Program enrollees will be linked to mental health services upon program completion. DCHD will use a combination of evidence-informed practices to provide effective care to individuals screened and enrolled in the Crisis Center Follow-Up Program. These include programs from SAMHSA's National Registry of Evidence-based Programs and Practices, as well as implementing the National Suicide Prevention Lifeline's Risk Assessment Standards and Guidelines for Responding to Callers at Imminent Risk.