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New Yorkers Advancing Suicide Safer Care (NYASSC) The New Yorkers Advancing Suicide Safer Care (NYASSC) project will reduce suicide attempts and deaths by implementing Zero Suicide (ZS) in health systems across all five mental health service regions in New York. The project will also create a Suicide Safer Care Network in a high-risk county by linking emergency departments, inpatient psychiatric units, outpatient mental health and substance use disorder treatment settings, and primary care practices to create a local zero suicide safety net. The project anticipates assessing 281,596 individuals served by the project sites for suicide risk over five years, and projects that of those assessed, 197,116 will receive suicide-specific interventions. The Office of Mental Health will partner with the Center for Practice Innovations at Columbia University and the University of Rochester to advance implementation of Zero Suicide across the state. Providers will develop competency in the NYS Suicide Safer Care Model which includes screening and assessing for suicide risk, developing a prevention-oriented risk formulation, suicide care management plan, providing suicide specific evidence-based treatment and brief interventions, and protocols for transition of care and follow up when patients move to a different level of care. The four goals of the project are to 1) implement Zero Suicide in health systems in each of the five regions of NYS, 2) develop a Suicide Safer Care Network across all health systems in one high risk county, 3) disseminate statewide implementation of Zero Suicide based on lessons learned at project sites in the first 3 years of the grant, and 4) evaluate the project’s impact on clinical service delivery and utilization and on suicide attempts and deaths. With input and guidance from individuals with lived experience and members of the NYS Suicide Prevention Council, project goals will be accomplished by accomplishing the following objectives: engaging health systems leadership, conducting learning collaboratives, training providers, developing and implementing site-specific protocols, developing and conducting fidelity checks for clinical components, developing and disseminating materials and trainings, creating a robust suicide surveillance infrastructure, and by conducting an outcome evaluation to assess impact of the project on suicide attempts and deaths. In Year 4, the NYS Suicide Prevention Conference will be devoted to introducing health systems, county leadership, and providers across the state to Zero Suicide, to the NYS Suicide Safer Care Model, and to lessons learned from a county’s development of a Suicide Safer Care Network of Health Systems to create a local zero suicide safety net.

The Choctaw Nation of Oklahoma is committed to integrating the Zero Suicide Model firmly into the tribal health system. If funded, Choctaw Nation Health Services Authority (CNHSA) will implement Project Zero in an integrated health care system so that we can provide prevention and intervention for individuals who are 25 years of age or older, with the aim of raising awareness of suicide, establishing stronger referral processes, and improving the care and outcomes for individuals who are at risk for suicide. The target populations for Project Zero will be 1) approximately 1,200 American Indians age 25+ and their family members, who live within the 10½ county jurisdictional boundaries of the Choctaw Nation; 2) approximately 125 health providers who serve this population; and 3) 50 partner health providers in other county and state facilities. A nurse will serve as project director to train the hospital medical professionals in QPR for Physicians, Physicians Assistants, Nurse Practitioners and Nurses. These trainings will build the capacity of the CNHSA to better identify and address patients who present with suicidal ideation/behaviors. He/She will be available to travel to the nine other clinic sites for oversight, training and collaboration purposes, ensuring that all 10½ counties served by the CNO will benefit from increased suicide awareness, support services and that integration of Zero Suicide is implemented. Services of two Integrated therapists will be offered as well, increasing the therapeutic response to suicide. They will be based out of the two counties, LeFlore, the location of the CNHSA hospital, and Pittsburg, which houses the second largest CNHSA Behavioral Health unit. They will operate out of Poteau and McAlester, Oklahoma. Choctaw Nation of Oklahoma is well positioned to launch Project Zero, having already implemented some components that have been very well received. The Zero Suicide model, a comprehensive, multi-setting approach to suicide prevention and intervention in health systems will be the driving force of this project. CNO’s Project Zero will be inclusive of all elements of the Zero Suicide Model throughout the five year funding cycle. We expect that the long-term impact will be the complete transformation of the Choctaw Nation Medical and Behavioral Health system to enhance our ability to identify, treat, refer, and ensure continuity of care for individuals at risk for suicide and suicidal behaviors. This project will follow the Choctaw concept of Achchukmali Imabachi Sa Banna, which describes a special caring – “teaching to make better”. This is the basis for the Project Zero. Caring and teaching/training are woven throughout as we build a system wide embrace of our people, our families, our providers and our community to intervene in, and reduce suicide.

Zero Suicide Program Summary: The University Health System Zero Suicide program will implement a comprehensive, multi-setting suicide prevention and intervention approach under the framework of the seven essential elements of the Zero Suicide Model. In partnership with University Medicine Associates (UMA), the Health System aims to reduce suicide attempts and deaths among adults, 25 years and older, especially veterans and individuals with serious mental illness. Population: The Zero Suicide Program will screen 300,000 adults, 25 years and older, including veterans and individuals with serious mental illness, who are at-risk for suicide across 21 ambulatory clinics, including specialty care clinics, in five regional areas. Of these 300,000 it is estimated 5,400 will screen positive for suicidality. Zero Suicide Model: To ensure the successful implementation of the Zero Suicide model, an implementation team, including survivors of suicide, will build upon the strengths and weakness identified by the Zero Suicide Organizational Self-study and embed the seven elements of the Zero Suicide Model across the five regional clinic areas in yearly phases. In conjunction, the Zero Suicide Data Elements Worksheet will be utilizing to develop a data-driven, quality improvement approach to maintain fidelity and improve care, training, and policies. Goals and Objectives: The overall purpose of the Health System’s Zero Suicide program is to raise awareness, establish referral processes, and improve care and outcomes for patients at-risk for suicide by creating a leadership-driven, safety oriented culture. Measurable objectives are to (a) To transform the health system by implementing the Zero Suicide model, establishing an implementation team, and providing training to all UMA staff; (b) Improve care and outcomes for patients at risk for suicide by enhancing the EMR and providing evidence-based treatment; (c) Identify and engage patients at risk for suicide by increasing screening, comprehensive assessment, and safety planning; and (d) ensure continuity of care by increasing formal agreements with community behavioral health