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Grants to Implement Zero Suicide in Health Systems

RSBCIHI SAMHSA Zero Suicide Project

MCCC Zero Suicide Initiative

Centerstones Zero Suicide Initiative (ZSI)

Marimn Health Zero Suicide Project

Implementing Zero Suicide in Emergency Departments with Diverse Populations in Michigan

Rural West Texas Zero Suicide Initiative

YKHC Zero Suicide Project

CNS Healthcare Zero Suicide Initiative: to expand agency standard of care for people at risk of suicide and to create a collaborative of suicide-informed communities

Mental Health America of the Mid-South's Zero Suicide Project

Grants to Implement Zero Suicide in Health Systems

Implementation of Zero Suicide in Health Systems in Kansas.

Louisiana Zero Suicide Initiative

Yakama Nation Zero Suicide in Health Systems

Montgomery County Zero Suicide Project

Project Summary: Shawnee Mental Health Center, Inc. will enhance and build upon the current Zero Suicide components that have been implemented in our behavioral health program and expand our implementation activities to all other programs within our integrated community mental health center and FQHC-Look Alike for adults 25- years old and older in three Appalachian Ohio counties (Adams, Lawrence, and Scioto). Target Population: Adults 25-years-old and older receiving services at Shawnee Mental Health Center, Inc. regardless of presenting condition or diagnosis. This includes people with acute and chronic physical health conditions, acute and serious mental illnesses, substance use disorders, veterans and those with co-occurring diagnoses. Strategies/Interventions: We will strengthen our current Zero Suicide protocols so that they align with best practices and implement the components of the Zero Suicide model that are absent from our current practices. This will include leadership recommitment to a culture that focuses on reducing suicides; involving survivors of suicide attempts and suicide loss in our activities; training all members of our workforce; assessing level of competence and confidence of the workforce; screening all clients served; conducting suicide risk assessments; implementing structured transition protocols; introducing brief intervention and follow-up practices; using evidence based treatments and fostering a data-driven, quality improvement approach. Project Goals and Objectives: The overall project goal is to raise awareness, establish referral processes, and improve care and outcomes for people 25 years of age and older by fully implementing the Zero Suicide Model. This will be accomplished by enhancing the current infrastructure and processes, implementing an electronic system to collect and track data points to inform system changes, enhance workforce confidence and competencies to provide suicide care through training, and delivering evidence based treatments that target suicidal thoughts and behaviors. Consumers Served: We intend to serve a minimum of 3,000 clients during the life of the grant: Six hundred for each of the five years of the project.

With the Florida Launch Engage Activate Departments and Systems for Zero Suicide (FL LEADS) Project, Florida will transform and improve suicide care practices, standards, and outcomes in health and behavioral health systems through a theory driven, multi-system and interconnected three part approach (Synthesis and Translation; Creating Implementation Infrastructure, Program Monitoring) of implementing the Zero Suicide (ZS) model and associated culturally competent, evidence-based (EB) suicide prevention/intervention trainings. The goals/measurable objectives are to: 1) Develop partnerships/capacity to promote/train state, regional, and local leaders in the ZS model and revise policies, procedures, and organizational cultures; 2) Develop a confident/ competent workforce (administrators/frontline professionals) to identify, assess, manage, treat, and follow-up with high-risk adults by providing EB adult gatekeeper skills training (QPR), LINC to Life Safety Planning (L2L) training, Suicide Risk Assessment and Management (SRAM) training, training on Dialectical Behavioral Treatment (DBT) for treating suicidal clients, and care coordination training (Linking Individuals Needing Care, LINC); 3) Increase the utilization of EB screening and assessments to improve identification of suicide risk and behavioral health problems (including serious mental illness [SMI]) in high-risk adults; 4) Increase/enhance policies, protocols, and trainings that address suicide care management pathways from identification, to safety planning, to appropriate referrals/linkage for high-risk adults; 5) Conduct focus groups with high-risk populations and health and behavioral health administrators to develop social awareness messaging that will be disseminated and used to increase knowledge, intentions, and utilization of EB services and treatment for suicidal individuals; 6) Enhance the facilitation of rapid and coordinated referrals, linkages, and follow-up care for high-risk adults by trained mobile crisis teams; and ultimately 7) Improve clinical (e.g. mental health/substance abuse, suicide ideation/ attempts symptoms, deaths), adaptive (e.g. coping skills, functioning), and service utilization outcomes for high-risk age 25+ adults (e.g. veterans) at risk for suicide and experiencing behavioral health (including substance abuse addictions), SMI, and socioeconomic/ employment/health disparities within rural and urban catchment areas (15 high-need counties) of targeted health and behavioral health systems, including emergency departments, behavioral health organizations, Department of Health clinics, Veterans Health Administration (VHA) clinics, etc. Through the partnership between the University of Central Florida, University of South Florida, Office of Substance Abuse and Mental Health, Statewide Office of Suicide Prevention, Florida Behavioral Health Association, Department of Health, VHA, regional managing entity networks, and behavioral health organizations, Florida will train 1,100 persons/year and 5,470 persons over the 5 years of the project, serve 130 high-risk clients/year and 650 persons over the entire project, and over 8,000 individuals will be exposed to suicide prevention social awareness messages.

Endeavors’ Zero Suicide Initiative seeks to change the trajectory and accelerate positive outcomes by training both clinical and front-line staff (receptionists, intake workers, housing counselors) who are typically the first to encounter the public. These individuals will be trained to ask brief, relevant questions of all adults age 25 or older and, when indicated, connect them to a case manager or clinician for a risk assessment and the provision or coordination of treatment. Two significant outcomes will accrue: screening will move upstream, creating an opportunity for early intervention, and identification of need, and access to care will be enhanced for rural residents and other unrecognized, at-risk individuals.

The ISK Health System Zero Suicide project will transform the system’s approach to suicide prevention and treatment serving serve adults age 25 and older at risk of suicide in Kalamazoo County. Kalamazoo County (population 259,830) is an urban county located in southwest Michigan. Adults 25 and older make up 62% of the population (161,274), with a slightly higher female population (52%). The County has a diverse population of 79% White, 12% Black/African American, 0.5% American Indian and 5% Hispanic/Latino. English is the predominant language spoken (92.88%) with Spanish at 2.98%). Gender makeup is 49% male, 51% female, 3.8% LGBTQ and 0.6% Transgender. The county poverty rate is 18.3% and there are 13,768 Veterans in the County. Individuals at greater risk are homeless, involved with the criminal justice system, diagnosed with Substance Use Disorder, and identify as LGBTQ. The ISK health system is a community-based behavioral health care organization providing a publicly funded network of services that are integrated with health systems across the county. This includes ISK, a Certified Community Behavioral Health Clinic (CCBHC), and a network panel providing comprehensive, community-based behavioral health care. Goal 1: Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Objective 1: Create a cross system suicide prevention leadership team that actively guides and directs the Zero Suicide model of care and includes survivors of suicide attempts and suicide loss in leadership and planning roles Objective 2: Complete Zero Suicide Organizational Self Study and incorporate data/ findings to guide development of culture. Objective 3: Develop and implement a system wide strategic plan to address gaps identified in the Organizational Self Study. Goal 2: Provide effective, evidence-based treatment and services for those at risk of suicide. Objective 1: Using the Assessing and Managing Suicide Risk (AMSR), provide training to100% of clinical staff across the health system that is position relevant, and includes content specific to identification, assessment, management and treatment, and ongoing evaluation of individuals in order to increase core suicide related clinical competencies. Objective 2: Enhance and expand delivery of evidence-based treatments for 100% of enrolled individuals through workforce development in the use of Motivational Interviewing, CBT-SP and DBT. Objective 3: Provide annual suicide prevention and awareness trainings (safeTALK and ASIST) for health system staff. Goal 3: Develop quality Suicide Care Management Plans for every individual identified at risk of suicide. Objective 1: Develop capacity of EHR to better identify, engage, and monitor individuals at risk of suicide. Objective 2: Develop and implement protocols for effective rapid follow up post discharge on individuals that have attempted suicide or experienced a suicidal crisis. Objective 3: Develop and implement protocols that include safety planning and reduction of access to lethal means. The project will serve 100 individuals Year 1, 150 individuals Year 2, 200 individuals year 3, 4, and 5 for a total of 850 unduplicated individuals by end of Year 5.

The overarching goal of the Hope Network Zero Suicide initiative is to implement the Zero Suicide model throughout the health care system in the State of Michigan to raise awareness and improve care and outcomes for individuals age 25 and older who are at risk for suicide. Hope Network will implement this initiative throughout the state. Hope Network will serve approximately 30,000 individuals age 25 and older annually with Zero Suicide. The focus population is individuals age 25 and older who are at risk of suicide, however particular attention will be paid to the following vulnerable subgroups: veterans, homeless, unemployed, reentry citizens coming out of prison, and individuals with traumatic brain injury. Research shows that these subgroups have higher rates of suicide than the general population. Zero Suicide will enhance behavioral health services, focusing on suicide reduction, through professional development; increase consistent, uniform screening and referral; and improve health systems across the state through implementation of evidence-based practices. The project will achieve the following objectives: 1) To train 5,596 professionals in the mental health care, primary care, emergency department, and related workforce in the Zero Suicide model and other mental health-related practices/activities by the end of year five. 2) To support 281 programs/organizations in implementing Zero suicide prevention practices and activities as part of general operations by the end of year five. 3) To screen at least 30,000 individuals age 25 and older for suicide risk and mental health needs each year for five years. 4) To provide evidence-based mental health services to at least 10,300 individuals age 25 and older as a measurable result of the Zero Suicide initiative each year for five years. 5) To ensure that two members on the Zero Suicide Implementation Team are consumers. 6) To refer at least 4,000 individuals age 25 and older falling under the identified sub-populations of veterans, individuals experiencing homelessness, unemployed, reentrants, and individuals with TBI for mental health or related services each year for five years as a measurable result of Zero Suicide initiative interventions. 7) To reduce the number of suicide deaths of individuals age 25 and older served in Hope Network by 50% over baseline by the end of year one, and an additional 75% over the year before each subsequent year to the end of year five. 8) To reduce the number of suicide attempts (unsuccessful) by individuals age 25 and older served in Hope Network by 50% over baseline by the end of year one, and an additional 75% over the year before for each subsequent year to the end of year five. 9) 100% of individuals in clinical and non-clinical service lines who screen positive for suicide risk will be placed on a Suicide Care Management Plan.

The Commonwealth of the Northern Mariana Islands (CNMI) Zero Suicide Project will focus on implementing suicide prevention and intervention services and support for individuals 25 years of age or older. The project will serve the communities on Saipan, Tinian, and Rota. The CNMI Zero Suicide Project aims to achieve the following goals: (1) implement evidence-based direct service interventions and supports aimed at effectively reducing the incidence of suicide; (2) build a leadership-driven, safety-oriented culture that will positively contribute to the implementation of suicide prevention and intervention efforts; (3) increase system-wide capacity to deliver effective suicide prevention and intervention services; and (4) improve the usefulness of data surveillance systems to effectively inform suicide prevention and intervention efforts.

OK Narrative – Grants to Implement Zero Suicide in Health Systems – No. SM-20-015 The Oklahoma Department of Mental Health and Substance Abuse Services will build upon our statewide Zero Suicide Initiative to create the Pathway to Hope initiative (PTH). This initiative is a partnership to reduce the number of suicides by 15% in 18 counties. CREOKS, Green Country Behavioral Health (GC), and The Lighthouse Behavioral Health Centers (LH) will take PTH to scale throughout three behavioral health systems for persons 25 years and older. These three CMHC service areas were chosen through: 1) mining data and identifying highest need areas; 2) requesting information to determine readiness to implement, and 3) establishing a commitment to a partner. With the increased resources, technical assistance, and training provided through PTH, we can move the needle toward eliminating suicides. Furthermore, PTH will provide leadership and a pathway for other community mental health centers (CMHCs) statewide. The ODMHSAS and our CMHC partners embarked on a statewide Zero Suicide Initiative in 2016 with our first-ever state Zero Suicide Summit. Through clinical workgroup recommendations adopted by Directors, a common screening, assessment, and treatment protocol was adopted throughout our Oklahoma system. Providers moved at different speeds toward implementation. We will utilize SAMHSA funding to: and 1) bring CREOKS, GC and LH to full implementation of the essential elements of the zero suicide model throughout their entire behavioral health systems; and 2) provide further training and technical assistance to all 13 of our CMHCs, moving the needle statewide. This will be guided through a clinical leadership workgroup taking recommendations to the CMHC Directors’ monthly meetings. The result will be fewer suicides. PTH will screen all Adults served who are over 25 years. Of these, we project PTH will serve 408 in Year 1; 449 in Year 2; 494 in Year 3; 543 in Year 4; and 597 in Year 5, for the project total. Highlights of goals and objectives include: 1) Lead: a) Convene the local and statewide zero suicide workgroups; b) Conduct self-studies; c) Modify existing protocol: 2) Train: a) Complete workforce surveys; b) Arrange training and distribute training calendar, and train clinicians, case managers, and peer recovery support specialists; c) Train all levels of staff at CREOKs, GC and LH; 3) Identify: a) Modify screening protocol statewide and current results; b) Modify electronic health records to reflect suicide care pathway and create dashboards; 4) Engage: a) Make improvements in zero suicide care pathways starting with enhanced engagement protocols; b) Provide targeted technical assistance to CREOKs, GC and LH to fully implement zero suicide care pathways and incorporate into their electronic health records; 5) Treat: Beginning day one: a) Treatment begins in all areas; b) Revise data reporting to track usage of CBT-SP and Collaborative Management of Suicidality (CAMs); b) Require everyone trained in EBPs to commit to participate in ongoing consultation; 6 & 7) Transition and Improve: a) Train and deploy outreach staff for rapid follow-up; and b) Increase usage of mobile crisis 24/7 and outreach.

The geographic catchment area for this Zero Suicide Implementation into the health system is the Greater Manchester NH area, which is comprised of the city of Manchester and the seven towns of Candia, Hooksett, Auburn, Bedford, Londonderry, Goffstown, and New Boston, and directly serves a population of about 207K or about 15% of the population of New Hampshire. The partners in this endeavor includes a level 3 (Catholic Medical Center) trauma hospitals, the VA Medical Center of Manchester, and the Mental Health Center of Greater Manchester (MHCGM) and will be supported by the Manchester Health Department, Amoskeag Health, and Manchester School District. Combined the partnering organizations engage with 250k+ people a year whether as patients or their family from the greater Manchester area and across the state. All of these partners are located in Manchester, which constitutes New Hampshire’s urban center, and is a federal refugee resettlement zone. The population of Manchester is 77% White, 10.5% Hispanic, 5.5 % Asian, 4.2% Black/African American, and 2.3% two or more races. The issue with rising suicide rates have been well documented across the United States by The Washington Post, USA Today, local and national news just to name a few. Whether it is the 123 suicides a day or that suicide is the number two cause of death in 10 to 34 year olds, or that there are more than two times the number of suicide deaths as there are homicides in the US, the data is staggering. New Hampshire has not escaped these issues, in fact over the last eight years the suicide rate for New Hampshire has increased each year and the data for NH is much worse. Suicide is the 8th leading cause of death in NH, the state Ranks 17th in the nation for highest suicide rate at 4.77 people per 100,000 higher than the national rate (18.77 to 14.00), and 5.2% of adults in NH had thoughts about suicide which is higher than the national (4.1%) and regional averages (4.2%) . Beyond these statistics there are the disturbing mental health and other social determinant data that paint a dark picture of this issue in NH. The number of drug deaths per 100,000 in the state of NH is 35.2 compared to the national average of 19.2, 19.7% of youth have 2+ Adverse Childhood Experiences. Zooming in closer to our proposed service area the statistics get even starker. Recent data has shown that 13.4% of adults within the service area report frequent mental distress more than 1.2% higher than the national average . According to AMR Manchester Suspected Opioid overdose reports in 2019 there were 568 overdoses in Manchester with a 10% fatality rate. Meanwhile there was a 2016 DCYF report that found that 9.5% of people in greater Manchester have experienced 4 or more Adverse Childhood Experiences (ACE). Research has found that both of these factors Opioid use and experienced ACEs increase the likelihood of suicide and suicidal thoughts by almost 2 times. The Goal of this projects is to decrease the Suicide rate for people 25+ within the designated Health System service area from the current rate of 18.77 people per 100,000 to below 10 per 100,000 within 5 years and create a health system that is leadership driven, safety oriented, and committed to reducing suicide that has fully embedded the zero suicide model within all identified health system organizations

The goal of the proposed Zero Suicide in Indiana University (IU) Health System project is to prevent suicides in Indiana, particularly among individuals age 25+, by raising awareness of suicide, formalizing referral processes, and improving care and outcomes for individual at risk for suicide. The population to be served is the entire state of Indiana, a state in which the suicide rate has been increasing more rapidly than the national average over the past seven years. The current Indiana rate is 16.6 (defined as the number of deaths per 100,000 population, 2019) compared to the current national rate of 14.5. The suicide rates in Indiana among those age 25–54 are also higher than national averages. Objectives include: (1) By 8/29/2021, IU Health will fully establish a system infrastructure aligned with the Zero Suicide framework, including robust tracking mechanisms and health care workforce training; (2) By 12/30/2020, IU Health will implement a comprehensive risk assessment/screening and reassessment processes for individuals with suicidal ideation in all 15 of its emergency departments (EDs) statewide; (3) By 12/30/2020, ensure that all patients presenting to IU Health’s 15 EDs with suicidal ideation are connected with appropriate treatment and follow-up support through evidence-based Caring Contacts; (4) By 4/30/2021, IU Health will establish mechanisms for data tracking and individualized safety planning that will demonstrate a reduction in the number of suicides and suicide attempts among patients who present to IU Health’s 15 EDs with suicidal ideation and/or suicide attempts; and (5) By 8/29/2021, connect at least 51% of patients who present to IU Health’s 15 EDs with suicidal ideation and/or suicide attempts—including veterans and individuals with serious mental illness—with outpatient behavioral health treatment, and increase the percentage of connections by at least 10% each subsequent year. IU Health plans to serve 21,435 patients in Year 1 based on the anticipated number of patient encounters in the 15 EDs with behavioral health diagnoses (i.e. the number to receive C-SSR screenings in EDs). Based on literature and internal data, IU Health anticipates a 37% annual readmission rate, resulting in 13,507 to be served per year in Years 2-5 for a total of 83,391 over five years. IU Health plans to collect six month follow-up National Outcomes Measures (NOM) data on at least 35 patients in Year 1, 101 in Year 2, and 203 per year in Years 3-5, representing patients in rural areas that will receive more intensive transition services than patients in non-rural areas. All patients at IU Health EDs statewide who present with suicidal ideation will be provided safety planning and referrals from trained health care staff.

The Wichita and Affiliated Tribes Zero Suicide Initiative is a multi-Tribal collaborative of federally recognized Tribes to provide holistic and comprehensive suicide prevention care for all American Indian adults in three rural Oklahoma counties in Southwestern OK. Services include suicide surveillance, screening, clinical therapies, and client follow-up, plus work force development all emphasizing culturally appropriate Native values and Native participation. Our large project area of 3,479 square miles comprises all of Caddo, Comanche, and Grady counties where Natives live in racially mixed communities, not reservations. The Native population (alone or in part) is 25,791 of which an estimated 14,027 are over age 24. Six federally recognized Indian Tribes have headquarters in Caddo county, home of the Wichita and Affiliated Tribes, where Natives are 29% of the population of 29,173, the third highest ratio of Natives of any OK county. The county has one of the few Native boarding schools with about 600 Native youths enrolled. Nevertheless, there are significant Native health, behavioral health and economic disparities. Native suicide rates are higher than state and national averages and Caddo county is a Health Professional Shortage Area and a Mental Health Professional Shortage Area, with no practicing psychologists or psychiatrists. Native poverty is twice (32.6%) that of Non-Hispanic Whites (14.1%). Median annual Native household income is $14,000 lower than Non-Hispanic Whites. Natives have double the rate of White uninsured. Goal #1: Provide suicide prevention- and treatment-related care to all Tribal and family members 25 years of age and older living in Caddo, Comanche, Grady and adjoining counties. Goal #2: Implement workforce development activities. Goal #3: Transform the Wichita and Affiliated Tribes Health Services Administration to be a leadership-driven, safety-oriented culture committed to reducing suicide among Native people and to embed principles of the Zero Suicide framework within their agencies. Conclusion of a 5-year Garrett Lee Smith program leaves a tremendous gap in community capacity to blunt a recent 3-year history of suicide clusters. The GLS suicide surveillance program comprises a unique source of data for the 39 federally recognized Tribes in Oklahoma, for regional authorities, and for SAMHSA. Substance abuse and mental health services and follow up case management will be provided by a state Licensed Behavioral Health Drug Counselor (LPC, LCSW, or LADC). All participants will be screened for suicide ideation, substance use disorder (SUD), and will be given treatment plans according to their assessed needs. Culturally appropriate programs and treatment modalities will be used alongside evidence-based therapies. Grant funding will establish policy and create services to implement Zero Suicide at Wichita and Affiliated Tribes and in proximal counties. The program will serve approximately 100 clients annually (500 total) over a five-year period. Project goals align with the Zero Suicide model.