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Kalamazoo Suicide Prevention Project

Expanding Continuity of Care to Prevent Suicide in Pennsylvania

Colorado NSSP

SD NSSP

Building Bridges

Integrated Services of Kalamazoo will partner with Gryphon Place, a private, non-profit agency providing suicide prevention and crisis support services, including a 24/7 suicide and crisis line to impact suicide death rates in Kalamazoo county. This project will utilize the Zero Suicide model as a foundational framework and will incorporate recommended best practices for the implementation of required activities. Population of Focus: ISK’s population of focus for the Kalamazoo Suicide Prevention Project is adults age 25 and older at risk of suicide in Kalamazoo County. Geographic catchment: 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%). Based on 2017 Census, 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 ad 0.6% Transgender. The county poverty rate is 18.3%, and there are over 38,000 Medicaid enrollees in the County. There are 13,768 Veterans in the County. Strategies/Interventions: ISK seeks to reduce the number of suicide deaths and non-fatal suicide attempts by individuals age 25 and older through the application of these strategies: 1) implement a community wide suicide prevention plan, 2) train clinical staff working with individuals involved in the behavioral health system presenting with ideation, and 3) implement effective follow-up and care transition protocols for populations with the highest rate of suicide is our three pronged strategy proposed to address local needs. Goal 1: Implement comprehensive suicide prevention plan to ensure the greatest reach and system change. Objective 1: Strengthen community support and participation in SPAN by increasing number of organizations participating and attendees at meetings. Objective 2: Add staff capacity to coordinate and implement SPAN workplan. Goal 2: Increase community and service providers’ knowledge, awareness, and ability to respond to suicide risk. Objective 1: Provide 45 suicide prevention and awareness trainings (safeTALK and ASIST) for community at large by end of Year 3. Objective 2: Increase clinical staff competence and confidence in suicide assessment, safety planning, and treatment through AMSR and CBT-SP trainings as measured by pre-/post-survey. Goal 3: Improve community response to and safety of individuals most at-risk for suicide. Objective 1: Develop and implement effective suicide prevention follow up protocols. Objective 2: Develop and implement effective care transitions to help ensure patient safety. Objective 3: Provide in-person follow up and care transition services to 275 high risk individuals by the end of grant year 3. The project will serve 75 individuals Year 1, 100 individuals Year 2, and 100 Year 3 for a total of 275 unduplicated individuals by end of Year 3.

Expanding Continuity of Care to Prevent Suicide in Pennsylvania will implement a two-tiered approach that includes 1) sustaining and expanding prior statewide youth suicide prevention efforts in schools, colleges, and primary care into adult-serving service systems (Tier 1); and 2) enhancing continuity of care in five regions through training and screening within behavioral health systems to improve care transitions for high-risk individuals (Tier 2). This project extends current SAMHSA-funded youth suicide prevention efforts in PA while capitalizing on the groundbreaking initiatives of a newly developed Governor’s Suicide Prevention Task Force and Executive Order targeting a reduction in suicide firearm deaths. Suicide deaths of those age 25 and older in PA (19.59 per 100,000) exceed the national rate (18.59; CDC, 2020). Five regions were selected for this project due to increased suicide rates and/or high volumes of suicides. While these counties only represent 26% of adults in PA, they accounted for 38% of suicide deaths in 2017. Several counties have rates significantly higher than the national average in multiple age groups (25-44 years, 45-64 years, 65+ years). Of particular attention will be the National Guard, where the suicide rate is the highest among military components (Department of Defense, 2019) and Pennsylvania has the second largest contingent of National Guard in the country. We will also focus on local jails, where 33.1% of all deaths are suicides. As a whole, Pennsylvania is 75.9% Caucasian, 10.6% African American, 3.5% Asian American, 2.1% biracial, and less than 1% all other races. About 7.6% identify as Latino. Approximately 3.6% of all PA residents identify as LGB and 0.4% as transgender. The project has four primary goals, with associated objectives and key implementation strategies. Goal 1 is to promote early identification and referral of adults at risk of suicide within adult-serving systems, including primary care, emergency departments, and community settings through evidence-based training and screening (Tiers 1 and 2). Goal 2 will increase capacity-building among behavioral health providers to screen, assess, manage, and treat those at risk of suicide (Tiers 1 and 2). Goal 3 will expand partnerships to support care transitions, reentry, and follow-up for those admitted into and discharged from hospitals and treatment centers (Tier 2). We will increase the number of service systems that have established protocols to facilitate care transitions and increase communication between crisis and other systems. Goal 4 is to develop a comprehensive and sustainable model for continuity of care for suicidal adults based on lessons learned from county-level efforts through engaging broad stakeholders, including those with lived experience, to develop a toolkit that can be implemented statewide (Tier 2). Based on extensive data from previous GLS projects, as well as projected similarities in terms of scope and approach, we project to serve approximately 15,000 through training, 12,000 through screening, and 200,000 through awareness activities, for a total of 227,000 served.

This project will implement state strategies for suicide prevention for adults 25+, as well as intensive efforts in El Paso, La Plata, Larimer, Mesa, Montezuma, and Pueblo counties. The Colorado Office of Suicide Prevention will achieve reductions in the suicide death rate and attempt hospitalization and emergency department visit rates by implementing evidence-based practices and research-informed strategies and supporting infrastructure at the local level. The core strategies of the project include local county leadership and coordination, expansion of the Zero Suicide framework into additional healthcare settings, telephonic follow-up services post discharge, clinical evidence-based training, community gatekeeper training, focused engagement tools to reach and support men in the middle years, and lethal means safety strategies. Colorado NSSP will accomplish the following goals during the three-year project: Goal 1: Reduce the suicide death rate among adults age 25 and older in Colorado from 27.0 deaths per 100,000 residents in 2018 to 21.6 by 2023. Goal 2: Reduce the suicide attempt hospitalizations rates among adults age 25 and older in Colorado from 53.73 suicide-related hospitalizations per 100,000 residents in 2018 to 42.9 by 2023. Goal 3: Reduce the suicide-related emergency department visit rates among adults age 25 and older in Colorado from 100.9 suicide-related emergency department visits per 100,000 residents in 2018 to 80.72 by 2023. The Office of Suicide Prevention will assure that project implementation is culturally relevant, addresses disparities, and is based on a data-driven continuous quality improvement process, and is inclusive of identified priority populations.

South Dakota's National Strategy for Suicide Prevention (SD NSSP) will focus on adults aged 25 and older who are at-risk for suicide. Our approach will include system-wide implementation of training behavioral health providers, direct care staff, employers and family members, and implementing a rapid follow-up plan for those discharged from an inpatient behavioral health unit for suicidal ideation or attempt, to ensure a holistic approach in supporting these high-risk adults. As the Single State Authority, the South Dakota Department of Social Services, Division of Behavioral Health (DSS-DBH), will lead the project in collaboration with the Helpline Center, behavioral health and primary care providers, and inpatient behavioral health units to identify, leverage, and enhance community-based resources in the area of suicide prevention and behavioral health services. The project will be lead by a DSS-DBH Prevention Program Specialist, with enhanced project support through key personnel to assess, identify, and support the implementation of strategies that directly address DSS-DBH's goals and outcomes of this funding opportunity. Key goals and outcomes will include improving continuity of care and targeted follow-up to individual at risk for suicide after discharge from inpatient behavioral health units by establishing or enhancing care transition protocols in addition to increasing confidence and competence among critical stakeholders to better identify those at risk of suicide. Another key focus is on the veteran population in South Dakota. Veterans in South Dakota approximate 51,000, or 8.2 percent of the state's population, according to the most recent census data. Our goals for the veteran population is to increase the available interventions and engagement with at-risk veterans who are not currently receiving services through the Veterans Health Administration (VHA) by utilizing information through state clearinghouses, such as the Department of Motor Vehicles and South Dakota Department of Veterans Affairs, as well as established veteran's organizations to meet the needs of at-risk veterans throughout the state. The total number of individuals to be served through the life of the grant is 68,456 (Year one: 17,080, Year two: 32,706, Year three: 18,670).

Building Bridges will prevent suicide and suicide attempts among American Indian/Alaska Native (AI/AN) adults age 25 and older to reduce the overall suicide rate and number of suicides in the Fairbanks North Star Borough (FNSB) of Alaska. It will build systems and bridge service gaps, integrating critical components of the National Strategy for Suicide Prevention and the Tribal Behavioral Health Agenda in alignment with AI/AN culture. The population of focus is AI/AN adults (ages 25 and older) in the FNSB, where, as documented in the Need section of this proposal, AI/AN have some of the highest suicide mortality and attempt rates in the nation. In 2017, the suicide attempt rate (per 100,000) for FNSB AI/AN was 882.4. The suicide mortality rate was 51.9, nearly twice that of all Alaskans and more than three times that of the nation. And these rates are steadily increasing. In order to address these escalating rates, Building Bridges will connect critical systems and reduce service gaps to develop a comprehensive continuum of care for adult suicide prevention and care. This will be achieved through two critical goals; 1) to initiate community systems change while addressing suicide for adults aged 25+ through the efforts of an Adult Interagency Transition Council (AITC); and 2) to fill existing service gaps in the suicide continuum of care to provide the full continuum of suicide services including prevention, screening, follow-up, and treatment to AI/AN in the FNSB. Project services will include community-wide systems change and community mobilization through the AITC, which will be patterned after and mentored by the 17-member youth/young adult Interagency Transition Council which has been in place for six years. The AITC will address the overall system of services and supports and ensure collaboration among system of care providers. It will develop protocols for rapid service access and for rapid follow-up, address access to lethal means, and establish follow-up and care transition policies for services after discharge from Emergency Care. Services will include rapid follow up and transition for those who have attempted suicide, screening and referral to treatment and support services, case management, clinical training for Behavioral Health staff, evidence-based Question, Persuade, and Refer Gatekeeper Training to staff and the local system of care providers, and inclusion of veteran organizations, including a veteran on the AITC. The result will be a service continuum which will include Prevention, Screening/Brief Intervention, Rapid Follow-up, Case Management and Behavioral Health Outpatient and Residential Treatment. Building Bridges will serve 143 community members, 13 AITC members, three staff, and 319 clients for a total of 478 people served during the three year life of the project.