Grantee Types: Garrett Lee Smith State

The Rhode Island Department of Health’s Violence & Injury Prevention Program proposes continued implementation of the Rhode Island Youth Suicide Prevention Project (RIYSPP) to maintain and expand an innovative, comprehensive, and coordinated youth suicide prevention program for RI youth ages 10-24 that builds upon the successes of the past five years. The public health approach presented in this application is informed by the 2012 National Strategy for Suicide Prevention and the Social Ecological Model (SEM). The Social Ecological Suicide Prevention Model is a four-tier framework that guides the planned activities of the RIYSPP, with corresponding evidence-based suicide prevention strategies implemented statewide and at community, relational and individual levels. Goal 1: Provide early intervention and assessment services and timely referrals to appropriate community-based mental health services for youth at risk for suicidal behaviors by enhancing the current Suicide Prevention Initiative (SPI) and evaluating annually. Goal 2. Train professional staff and individuals in diverse community settings to identify youth who are at risk for suicide and evaluate annually. Goal 3. Work with child-serving professionals and providers to ensure they are trained in youth suicide early intervention and prevention strategies and timely response systems, including SAMHSA-sponsored technology and training resources, and evaluate annually. Goal 4. Work with external partners to provide post-suicide intervention services, care, and information to individuals, programs, organizations and statewide systems, solicit input from individuals with lived experiences, and evaluate annually. Goal 5. Conduct a broad public awareness campaign to improve the public’s knowledge of mental health and awareness of available suicide prevention resources in RI. Goal 6. Collect and analyze data on statewide youth suicide early intervention and prevention strategies to monitor program effectiveness throughout the 5-year grant cycle. The unduplicated number of individuals projected to be served annually over the project period is estimated at 6,000 individuals ages 10-24 or 30,000 throughout the lifetime of the project. The numbers are based on individuals directly served by project activities that link school districts and the RI juvenile justice system with community- and hospital-based mental health services. The estimated number of individuals served does not include individuals who will benefit from project activities through gatekeeper trainings, technical assistance/support from RIYSPP funded staff or the statewide media campaign. Over the past 5 years, the RIYSPP has demonstrated the ability to leverage support and resources from other state agencies, private/public organizations, and community stakeholders to meet the stated goals and objectives of SAMHSA’s grant funding. The RIYSPP will build on and expand this work to meet the six goals presented above.

PA Resource for Continuity of Care in Youth-Serving Systems and Transitions (PRCCYSST – “PERSIST”) will implement a two-tiered approach that includes 1) sustaining and expanding prior statewide youth suicide prevention efforts in schools, colleges, and primary care (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 youth (Tier 2). Among the more than 2.4 million youth in Pennsylvania between ages 10-24, 51% are male and 49% are female. For youth between 10-19, 69.9% are White (non-Hispanic), 12.7% are Black or African-American (non-Hispanic), and 10.4% are Hispanic or Latino. Statewide data from the Pennsylvania Youth Survey (2017) indicates that 16.5% of PA middle and high school students reported seriously considering suicide and 9.7% reported attempting suicide one or more times within the past 12 months. The five regions that will be targeted for Tier 2 efforts through this project represent 22% of PA counties, yet they account for 55% of suicides in youth ages 10-14, 46% of suicides in youth ages 15-19, and 40% of suicides in youth ages 20-24. Nearly half of the identified counties have higher percentages of non-white and Latino populations than the state, overall. The project has four primary goals, with associated objectives and key implementation strategies. Goal 1 is to promote early identification and referral of youth at risk of suicide in schools, colleges, and primary care (Tiers 1 and 2). PRCCYSST will sustain past prevention efforts and increase the number of professionals exposed to evidence-based training and screening. Goal 2 is to increase capacity among behavioral health providers to screen, assess, manage, and treat youth at risk of suicide (Tiers 1 and 2). PRCCYSST will increase the number of providers trained in evidence-based suicide risk management and family-centered engagement and treatment practices. Goal 3 underscores a targeted approach to expand partnerships to support care transitions, reentry, and follow-up for youth admitted and discharged from hospitals and treatment centers (Tier 2). PRCCYSST will engage existing stakeholder groups in 5 regions (15 counties) to improve communication between county crisis response teams and other youth-serving systems in order to facilitate care transitions. Goal 4 aims to develop a comprehensive and sustainable statewide model for continuity of care based on lessons learned from targeted county-level efforts. PRCCYSST will engage broad stakeholder groups, including several statewide organizations with youth and family members with lived experience to develop a continuity of care toolkit that can be implemented statewide. Based on our success in our last grant and estimates based on future projects, we expect to expose 220,881 individuals to prevention messages, 19,423 to obtain gatekeeper and clinical training, and 15,474 youths to screening. Thus, we anticipate serving approximately 255,778 individuals throughout the course of this project.

The Oregon Garrett Lee Smith Youth Suicide Intervention and Prevention Initiative, managed by the Oregon Health Authority Injury and Violence Prevention Program (IVP), will focus on youth age 10-24 in at least 4 counties with youth suicide rates higher than the national average (Deschutes, Jackson, Josephine, Umatilla). The population of youth served is estimated at 206,545, which comprises 27.3% of the youth population in Oregon and accounted for 26.9% of deaths by suicide among youth from 2015-2017. Oregon’s rate of youth suicides almost doubled from 7.2/100,000 in 2010 to 14.1/100,000 in 2017 (OPHAT, 2019). In response, IVP will build on successes and lessons learned from three previous GLS grants to sustainably implement youth suicide prevention and early intervention strategies in schools, educational institutions, and a variety of child- and youth-serving organizations. Project goals are to (1) Increase capacity of counties with higher than average rates of youth suicide to implement sustainable, evidence-based youth suicide prevention strategies; (2) Increase the number of youth-serving organizations able to identify and refer youth at risk of suicide; (3) Increase capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; and (4) Improve the continuity of care and follow-up of youth identified to be at risk for suicide. Objectives to be achieved by project conclusion in 2024 include the following: In support of Goal 1, IVP will subcontract with up to 10 direct service provider organizations to expand or establish local initiatives to undertake evidence-based youth suicide prevention, intervention and postvention. IVP and Lines for Life will develop new content pages for the Oregon Suicide Prevention website and track page views. A youth suicide prevention track will be incorporated into the annual statewide suicide prevention conference, and local prevention coordinators will have supported youth suicide coalitions in up to 10 counties. In support of Goal 2, 120 child welfare personnel will become suicide prevention gatekeeper trainers and provide training to 3,000 CW staff and foster parents. An additional 8,450 staff in youth serving organizations will receive training in QPR, ASIST, and safeTALK and ongoing training for students and staff will be established in selected middle and high schools. In support of Goal 3, 500 clinicians will receive training evidence-based suicide risk assessment, management and treatment; all 76 school-based health centers will implement evidence-based suicide risk assessment; and up to 16 health systems will participate in a Zero Suicide (ZS) Academy. In support of Goal 4, selected communities will develop and implement continuity of care and follow-up plans for youth identified to be at risk for suicide. Up to 32 healthcare systems will actively implement ZS and 100% of youth discharged from ED and inpatient psychiatric units identified in those systems will receive referrals to a mental health provider, safety planning (including lethal means counseling), and one or more caring contacts from the health system.

Healthy Connections for OK Youth, an enhanced continuation of the Oklahoma Youth Suicide Prevention and Early Intervention Initiative, improves our ability to ensure that once a young person is at risk for suicide, they are compassionately and promptly connected with the appropriate level of care. The target population for Health Connections will be Oklahomans ages 10-24, with a special focus on students served by schools partnering with OK Systems of Care for Behavioral Interventions and Support Services (BISS). As a Cohort I, IV, VI and IX grantee of SAMSHA’s Garrett Lee Smith initiative, the State of Oklahoma has been able to take important steps toward the development of a public health infrastructure to promote the prevention of suicide. Through improved connections between our state’s strong prevention efforts and robust youth mental health care system, Health Connections will streamline the process of linking a young person in distress to the appropriate lifesaving level of care and support for themselves and their families by linking a comprehensive approach to school based suicide prevention with personalized wrap around behavioral interventions and timely access to mental health care. Project goals are to: 1) Increase the capacity of school personnel and staff from youth serving entities to identify a young person in distress and compassionately connect them with the appropriate level of assistance. 2) Increase the number of youth at risk for suicide who receive the appropriate level of care in a timely manner. 3) Increase access to healing supports and resources for those impacted by suicide. Initiatives to achieve project goals include providing online evidence-based suicide prevention gatekeeper training to k-12 school personnel statewide, then working closely with selected school sites to implement comprehensive suicide prevention, intervention and postvention training to create effective policies and protocol for the identification and referral of students at risk as well as a “return to learn” protocol for assisting students and their families with a smooth transition back to school following a hospitalization. Combined training initiatives will enable this project to provide training to behavioral health staff serving Oklahoma’s most at risk youth for mental or emotional disorders, including those in foster care, juvenile justice and allow us to reach their families with healing resources following a suicide attempt or death. This project will impact the lives of 350,000 Oklahomans over the next five years.

Cross-Sector Coordination to Ensure Life (XSCEL) aims to decrease the rate of suicide attempts and completions among 10-24 year olds in New Mexico through a continuum of local and statewide strategies. These strategies will coordinate and align multiple intervention levels across sectors including schools, communities, and healthcare settings. This project is urgent because New Mexico’s suicide rate rose to 32.3 per 100,000 for 15-24 year olds in 2017 after already being about double the national rate for the past decade. Geographically-focused strategies will be implemented in five counties with higher rates of suicide and/or risk factors compared to the rest of the state. One focus county is urban and the rest are predominantly rural; three have a high percentage of American Indian/Alaska Native populations and four have a high concentration of military members. XSCEL’s partner organizations have experience reaching and serving Native and military populations with accessible and culturally-appropriate strategies. XSCEL’s primary goals and objectives are: Goal #1: Improve coordination and alignment of suicide prevention and treatment activities across sectors at the local and statewide levels. Objectives: Engagement of individuals with lived experience; alliance-building activities; statewide suicide prevention coalition; changes in systems, policies, and practices. Goal #2: Improve multi-level suicide prevention practices in schools. Objectives: Gatekeeper train-the-trainer; screening, referral, and follow-up by School-Based Health Centers and school nurses/counselors; school safety plans. Goal #3: Improve multi-level suicide prevention practices in communities. Objectives: Gatekeeper training with community members; media campaign; non-clinical support by Navigators for referral completion; non-clinical EBP training for suicide prevention. Goal #4: Improve multi-level suicide prevention practices in healthcare settings. Objectives: Postvention services; screening and referrals in emergency departments; clinical EBP training for suicide prevention. When all project strategies are being implemented, XSCEL will serve the following number of people annually: Gatekeeper training (560); school crisis prevention and intervention training (130); screening (10,100); referrals for those with suicide risk (2,550); Navigator services (250); behavioral health services (917). Some strategies will not be implemented all five years because they require development work, and some of the annual numbers will include some of same individuals in multiple years. Therefore, over the course of the project, we expect to serve: Gatekeeper training (2,800); school crisis prevention and intervention training (650); screening (22,000); referrals for those with suicide risk (6,000); Navigator services (1,000); behavioral health services (2,000). Thus, XSCEL will have a broad enough reach and intensity of services that we expect to positively impact rates of suicide attempts and completions in the focus communities and impact systems, policies, and practices for suicide prevention throughout the state.

Leveraging the innovative Integrated Delivery Networks (IDNs) created through New Hampshire’s 1115 Waiver Project and the corresponding Regional Public Health Networks (RPHNs), NAMI New Hampshire and its project partners have designed New Hampshire Nexus Project 2.0 (NHNP2), a cross-systems, collaborative approach to reduce suicide incidents among youth by improving pathways to care and offering comprehensive training to provide youth-serving organizations with the resources to identify, screen, refer, and treat at-risk youth. Population to be served: Based upon the most recent NH youth suicide data, NHNP2 will focus on youth/young adults ages 10-24 in IDN 2 (Capital) and IDN 7 (North Country/Carroll County). IDN 2 reported 14.5 youth suicides per 100,000, while IDN 7 reported 12.3 per 100,000. Both regions are higher than the US rate of 10.57 per 100,000. These 2017 rates indicate a 67% increase in Region 2, and a 50% increase in Region 7 since 2016. Strategies: 1. Leverage the infrastructure of NH’s IDNs to enhance functional inter-agency care systems and improve care coordination, continuity of care, and provider communication. 2. Enhance the ability of child and youth-serving organizations to recognize and engage youth at risk of suicide; establish referral pathways and cohesive procedures that connect high risk youth with appropriate services; and increase the capacity of communities to respond to suicide risk in a timely manner. 3. Build upon existing public/private partnerships to enhance the statewide capacity to recognize and respond rapidly and appropriately to suicide risk among youth/young adults. Goal: Reduce suicide incidents among youth/young adults by strengthening cross-systems collaboration, improving pathways to care, and offering comprehensive training opportunities that provide youth-serving organizations with the resources to identify, assess, refer, and treat at-risk youth. Measurable objectives: 1. Develop a Care Liaison role in each region to facilitate pathways to care for high-risk youth/young adults. 2. Leverage technology to advance screening and assessment and improve care coordination and cross-systems communication. 3. Convene and train regional implementation teams comprised of providers serving high-risk youth in suicide prevention/intervention/postvention. 4. Engage regional teams in planning to build infrastructure around best practices for suicide prevention/postvention. 5. Develop youth/young adult leadership in regional youth suicide prevention efforts. 6. Engage statewide organizations that interface with at-risk youth/young adults in suicide prevention/postvention training and planning. 7. Promote safe messaging in accordance with the NAASP framework. 8. Enhance and expand NSPL Lifeline follow up calls. Number to be served: The project will train an estimated 10,456 stakeholders and providers working in child and youth-serving organizations in suicide prevention, intervention, and postvention. The Care Liaison will work with approximately 60 high-risk youth/young adults annually. Approximately 10,756 individuals will be served over 5 years (Yr. 1 = 2,106; Yr. 2 = 2,302; Yr. 3 = 2,159; Yr. 4 = 2,038; Yr. 5 = 2,151).

The purpose of Nebraska’s proposed project is to reduce the number of suicides and attempts for youth ages 10-24 with a focus on outreach to15-24 year olds because their suicide rate is increasing in Nebraska, exceeding the US rate. Prevention activities are concentrated in southeast Nebraska because the youth suicide rate for this area is over the state and US rate. We reach the entire state by including suicide prevention in coordinated school health plans for K-12 schools and workforce development for clinicians serving youth in crisis. Nebraska will promote the zero suicide approach for health and behavioral health organizations along with evidence based strategies and practices to prevent youth suicide. The project has four goals. 1) Decrease the youth suicide rate 80% in Region 5 by 2024. 2) 100% of Nebraska public school districts will have policies and protocols in place for suicide prevention, post-suicide intervention, and transition back to school after a suicide crisis by 2024. 3) Twenty (20) Nebraska providers or healthcare systems will implement the zero suicide approach by 2024. 4) 100% of Nebraska’s child serving systems will adopt evidence-based practices to follow-up with youth after a suicide attempt or hospitalization by 2024. During the course of the grant we will reach 70,000 15to 24-year-olds in Region 5, and embed suicide prevention practices in 244 school districts reaching 187,000 public school students in grades 5-12 statewide. We will train at least 200 clinicians by introducing 30 organizations to the zero-suicide initiative, embed suicide screening with school psychologist services in 17 educational service units and 12 treatment organizations, We will implement evidence based follow-up after youth experience a suicide crisis in five child serving systems and two healthcare systems, and implement evidence based post-suicide intervention practices on five post-secondary campuses impacting lives of 40,000 college age students.