Grantee Types: Garrett Lee Smith Tribal

Riverside San-Bernardino County Indian Health, Inc. is the largest tribal health care organization in California. Our project will screen 3,687 medical patients aged 10 to 24 for depression, suicidal ideation, and other risk factors. We will deliver real-time evaluation, education, treatment, and follow-up services to them when needed. We will also train 2,880 youth-serving organization staff members to identify suicide risk and deliver culturally competent intervention. We have established three (3) project goals: 1) increase our capacity to assess, manage, and treat youth at risk of suicide; 2) improve the continuity of care and follow-up of youth at risk for suicide, including those discharged from emergency department and inpatient psychiatric units; and 3) increase the number of youth-serving organizations who are able to identify and work with youth at risk of suicide. To accomplish these goals, we will hire four (4) new clinical staff members who will deliver real-time evaluation, education, referral, and follow-up to youth during their medical visit at our health centers. Using other funding sources, our Behavioral Health Services (BHS) department will: 1) deliver outpatient psychiatric and mental health care to youth and their family members; 2) refer youth to emergency services and other treatment providers; 3) deliver suicide-attempt follow-up; and 4) deliver postvention services to those who have survived a suicide. Finally, we will use two (2) existing staff members, who are professional SafeTALK trainers, American Indian/Alaska Native (AI/AN) cultural competency trainers, and ASIST providers. They will train staff members in these approaches at tribal and public schools, universities and colleges, social services and juvenile justice agencies, health care organizations, and other youth-serving organizations. Our project will screen 3,687 (737 each year) unduplicated youth medical patients for depression, suicidal ideation, and other risk factors. We will deliver real-time evaluation, education, treatment, and follow-up services to approximately 988 youth (198 each year) who will screen positive for depressive symptoms in our medical departments. We estimate that 462 (92 youth each year) will receive education and/or brief supportive counseling due to mild symptoms and 527 (105 each year) will receive education and treatment due to moderate to severe depression. To increase community-based youth support and assistance, we will train 2,880 (600 each year) youth-serving organization staff members so they are prepared to identify suicide risk and deliver culturally competent intervention. Finally, we will work with at 120 (24 each year) organizations to integrate our suicide risk screening and intervention services with their programs.

The Pueblo of San Felipe GLS Tribal Youth Suicide initiative KEYWAH III (Katishtya Embraces Youth Wellness And Hope III) will build on and expand the work of the previous GLS grant initiatives in the community. The purpose is to expand suicide prevention and early intervention strategies in schools, tribal courts, and the tribal behavioral health program, in order to: (1) increase the number of youth-serving organizations able to identify and work with youth at risk of suicide; (2) increase the capacity of clinical service providers to assess, manage, and treat youth at risk of suicide; (3) improve the continuity of care and follow-up of youth identified as at risk for suicide, including those who have been discharged from emergency department and inpatient psychiatric units; and (4) develop infrastructure to sustain & expand programming beyond grant funding. These goals will be accomplished through school-wide prevention programming, universal screening of all students accessing primary care at the School Based Health Center, referral to clinical services for those at risk of suicide, training of gatekeepers (e.g., school staff, teachers, tribal law enforcement) and other child-serving providers on Mental Health First Aid, training primary care providers on Zero Suicide, training clinicians on CBT-SP, and ongoing use of data for continuous quality improvement. The target population is San Felipe youth 10-24 years old at risk for suicide. Over the past 10 years, suicide prevention has become a core priority for the Pueblo of San Felipe, with efforts aimed at implementing the National Strategy for Suicide Prevention Goal 8 (promote suicide prevention as a core component of health care services) and Goal 9 (promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors). Although tribal leadership has consistently supported suicide prevention programming in the schools, loss of life due to suicide remains a significant challenge. A recent suicide of an 11- year-old boy enrolled at the San Felipe Elementary School, for instance, highlighted the gaps in collaboration between the Bureau of Indian Education (who runs the elementary school) and the Bureau of Indian Affairs (law enforcement). Developing greater collaboration through review of policies and procedures is critical, as is continuing to expand awareness and programming beyond behavioral health providers to other child-serving entities such as Family Services (child welfare/foster care), tribal law enforcement and the schools. KEYWAH III, in alignment and support of the National Tribe Behavioral Health Agenda (TBHA), will, therefore, continue to build and implement strategies where youth at risk for suicide are connected to protective factors and culturally-based supports in the San Felipe community. The unduplicated number of youth served annually will be 225, with 900 served over the life of the grant.

The Tribal Health Services Department submits this proposal for implementation of a Tribal Youth Suicide Network-TYSN utilizing EB and a zero suicide approach as guides. Native American reservations nationally present with the highest level of trauma, loss with limited resources. Goal: Develop a tribal-wide zero suicide like approach utilizing seven core elements; Lead, Train, Identify, Engage, Treat, Transition and Improve to adapt the current tribal suicide care approach into a comprehensive care network designed to raise awareness of suicide factors, provide early intervention, trainings on enhanced referral processes, treatment, follow up crisis, post suicidal emergencies to improve care and outcomes for youth at risk for suicide. Objective 1 By the end of five year cooperative agreement TYSN will screen over 1,500 youth (ages 10 to 24) provided assessment, early intervention, referral EB treatment and follow up on crisis post suicidal supports to over 400 tribal youth individuals. Objective 2 TYSN will provide Suicide prevention enhancement skills training to up to 50 professional, para-professional staff annually (250 total) and up to 300 community members, parents annually (1500) key factors, awareness and resources for suicidal tribal youth. TYSN will provide services to schools, substance use, mental health foster care and group home agencies. The Sewa U’usim Community Partnership will be the lead agency, with over twelve years’ experience as a tribal Medicaid provider and a SAMHSA System of Care grantee. The tribal partnership; Centered Spirit Mental Health, Community Nursing, Child Protective Services, Foster Care, YK Boys Group Home and the Health Services Division will coordinate services to implement the new cultural Tribal Suicide Network into a Tribal Network of Care. Sewa U’usim (SU) as a cultural community based behavioral health provider and program of the Tribal Health Services Division will directly work towards the implementation of the enhanced, coordinated approach to serve, treat and refer suicidal, GLBT/Bullied youth for health, behavioral health needs. Together TYSN will develop a an enhanced network for the Tribe located 50 miles from the Mexican Border a tribe with a mean age of 19.5 and heighten levels of historical trauma, risk factors for tribal youth and families on the New Pascua Reservation. TYSN will use the cultural, Honoring the Children, Mending the Circle EB model for treatment enhancement and the Wraparound in Indian Country model to engage families. The TYSP will also use social media, live youth presentation, web based training options to enhance outreach. TA support will help TYSN staff select screening and assessment interventions and components for new protocols for tribal services. TYSN will enhance our current efforts through our Native Connections program using Ben’s Bells, Be Kind community awareness campaign and tribal advisory committee to build a network of sustainable consistent treatment program. The TYSN also uses expressive therapies through third party funds to providing; equine, wellness, relaxation and meditation services and an array of services with an aftercare array of cultural, substance use, violence prevention services.

Housed at the Northwest Portland Area Indian Health Board, the THRIVE project (Tribal Health: Reaching out InVolves Everyone) has worked with the NW tribes to prevent suicide since 2009. The NPAIHB is a tribal non-profit organization that represents 43 Federally-recognized American Indian tribes in Washington, Oregon, and Idaho. In collaboration with the NW Tribes, tribal clinics, and regional partners, THRIVE will build regional suicide prevention capacity and prevent suicide among American Indian and Alaska Native youth 10-24 years old. Our approach builds upon a strong tribal network and acquired expertise in culturally-relevant intervention strategies and expands the most effective activities carried out by THRIVE during our prior GLS grant (cohort 9). Our goals are to: Goal 1. Improve protective mental health knowledge, attitudes, coping skills, and help-seeking behaviors among AI/AN youth (10-24 years old) nationwide, by delivering evidence-based suicide prevention interventions. Goal 2. Promote mental health and the social acceptability of mental health services for AI/AN youth and their families. Goal 3. Enhance organizational practices in NW tribal clinics, tribal health departments, and tribal colleges to improve suicide prevention, screening, referral, treatment, and post-suicide services for AI/AN youth (10-24 years old) and their families. Goal 4. Improve and expand the delivery of suicide prevention and early intervention strategies in tribal settings, including: tribal clinics, tribal and public schools, tribal colleges, juvenile justice systems, substance use programs, health departments, foster care systems, and other community settings by focusing on youth and returning veterans. Over 353,000 AI/ANs reside in Idaho, Oregon, and Washington, representing 6.8% of the nation’s AI/AN population. Over five years, our project activities will reach: 325 AI/AN youth during THRIVE’s youth conferences; 1,000 AI/AN young adults with mental health skill-building tools delivered via text message and social media; 300 AI/AN youth with caring messages; 120 AI/AN veterans with caring messages; 800,000 viewers with suicide prevention social marketing campaigns (#WeNeedYouHere); 200 AI/AN youth (10-24) with other culturally-appropriate EBIs; 5,000 AI/AN youth (10-24) with screening, assessment, treatment, and case management; and 3,500 youth-serving adults with gatekeeper training. Additionally, our monthly eNewsletters will be sent to 2,000+ contacts throughout the U.S, and our suicide prevention social media messages (delivered via We R Native) will reach 31,000 AI/AN viewers per week across the U.S. Our tribes, clinics, and partners are deeply committed to completing this scope of work, fulfilling elements of the Tribal Behavioral Health Agenda using socio-cultural-ecological approaches to improve adolescent mental health in the Pacific Northwest.

Billings Urban Indian Health and Wellness Center (BUIHWC) under the nonprofit status of Native American Development Corporation (NADC) will be submitting a SAMHSA Garrett Lee Smith State/Tribal Youth Suicide Prevention & Early Intervention Grant application. The purpose of this project will be to implement youth suicide prevention and early intervention strategies. The purpose of this project, submitted by the Native American Development Corporation (NADC) and the Billings Urban Indian Health and Wellness Center (BUIHWC) is to achieve measurable reductions in suicides among American Indian (AI) youth, ages 10-24 years of age, through implementation of the Zero Suicide model and culturally appropriate programming in five Montana (MT) cities served by Urban Indian Health Centers (UIHC). BUIHCW will lead and launch the project, Standing Buffalo Strong, in Billings, MT, which has the largest AI total and youth population. Billings is the largest community in MT—located nearby the Crow and Northern Cheyenne Reservations—has three major health care providers, a Veterans Administration clinic and is the largest medical/health community in the state. It is also a regional commercial center, attracting large numbers of AI families and children seeking diverse services. The following chart provides population data for Billings and the 4 other communities served by UIHC. Major Goal: To implement a culturally appropriate suicide prevention care model at the 5 Montana Urban Indian Health Centers (MUIHC) to ensure all AI youth, ages 10-24 years and their families receive immediate, safe and personalized suicidal care. To accomplish this, NADC/BUIHWC will lead and implement the Zero Suicide model and culturally appropriate treatment/services to achieve (or facilitate) a cultural shift away from fragmented suicide prevention and care toward a comprehensive approach. Working with the other 4 UIHC, along with developing a network and commitment from health care providers, community organizations and educational institutions in Billings, Helena, Missoula, Great Falls and Butte. With these partners, BIUHWC will be able to introduce AI youth suicide prevention efforts that include traditional and cultural treatments/services. This was identified by the MNYSRSP as a gap in suicide treatment. BUIHWC, as it takes on the leadership role in working on the youth, i.e. 10-24 year population, will coordinate with both the State of Montana, DPHHS Zero Suicide grant/program funded by SAMSHA (targeting AI over 25 years) and the ongoing MNYSRSP efforts. BUIHWC work will be complimentary, focusing on off-reservation youth and their families.

MCNDH wishes to continue to utilize funding provided through GLS to build on previous success and to create a network throughout the entire health system to identify potential suicidal patients, to treat patients who have attempted suicide, and to continue successful community outreach and education events to build resilient and mindful communities. MCNDH will successfully create a comprehensive network within our by implementing electronic patient assessments in outpatient and inpatient facilities, expanding clinical support specific for at risk patients, and creating care coordination for discharged patients