Garrett Lee Smith Tribal – Page 9 – Suicide Prevention Resource Center

Mississippi Band of Choctaw Indians

Youth suicide risk among American Indian/Alaska Native (AI/AN) populations has increased since 2003 and remains highly concentrated among AI/AN youth. The proposed program, the Mississippi Choctaw Youth Resilience Initiative (CYRI-MS), will augment and extend previous suicide prevention efforts implemented by the Mississippi Band of Choctaw Indians (MBCI). The MBCI is a self-governing vibrant Native American tribe of 11,000, but has historically faced the compounded disadvantages of cultural marginalization in one of the nation’s most impoverished, racially segregated states. Many tribal members live in rural areas of Mississippi beset by significant health disparities and other challenges that accompany residing in rural underserved areas. Current data indicate that young MBCI are especially at risk of suicide. CYRI-MS will (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; and (3) improve the continuity of care and follow-up of youth identified to be at risk for suicide, including those discharged from emergency department and inpatient psychiatric units. The key population of focus will be MBCI citizens 10-24 years old, with the goal of2500 youth served (500 per year of project implementation). Fidelity and impact will be determined through a rigorous evaluation predicated on continuous quality improvement. Strict adherence to cultural competence standards will ensure that all services are delivered in an appropriate manner, and efforts will focus on generating a series of improvements that will provide sustainable gains in the face of this significant problem. The following nine activities are required as part of the project and will be delivered after the brief four-month preparation period: (1) Provide early intervention and assessment services for MBCI youth; (2) provide timely mental health care referrals and follow-up for MBCI youth at risk; (3) collect and analyze data on tribal youth suicide, intervention, and prevention strategies; (4) provide post-suicide intervention services, care, and information; (5) ensure that educators, childcare workers, etc. are trained in suicide risk identification; (6) ensure that child-serving professionals are trained in early intervention and prevention; (7) use SAMHSA resources including ATTCs to deliver prevention-related training and technology; (8) ensure that informed consent is obtained from parents/guardians prior to intervention; and (9) secure input from individuals with lived experience, including survivors, in all efforts. A combination of evidence based programs and practices (EBPs) will be used, with cultural adaptations undertaken as directed by tribal leaders: (1) QPR, (2) ASIST and AIM-SP, (3) Hazelden Lifelines, (4) EIRF, and (5) other infrastructure enhancements (e.g., policy, data, evaluation), including the design and administration of a Choctaw Youth Risk & Resilience Surveillance Survey (CYRuS). This project will improve the MBCI tribal prevention infrastructure while expanding AI/AN EBPs.

The Suicide Prevention Resource Center at the University of Oklahoma Health Sciences Center is supported by a grant from the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), under Grant No. 1H79SM083028-03

The views, opinions, and content expressed in this product do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS.

Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians

The Gun Lake Tribe (GLT) will develop a framework for suicide prevention and early intervention activities to increase program capacity, effectiveness and efficiency to identify, respond, assess and treat those identified as being at risk. The three-year We Walk Together Project will serve 160 community individuals, focusing on youth ages 10-24. GLT offers programs and services to citizens of federally recognized tribes who reside in Allegan, Barry, Kalamazoo, Kent, and Ottawa counties of Michigan. Roughly, 30% of Gun Lake Tribe Citizens who reside within the five-county service area are youth ages 10 to 24. Of that number, over 50% of GLT youth in this age range live in Allegan County, where the Tribal Government Office and Health and Human Services Department are located. The geographic catchment area where services are delivered is a rural area with limited access to hospitals and health centers. Needs Statement: GLT HHS department has basic suicide screening and intervention practices in place for individuals who access services; however, is in need of expanding services to identify, respond, assess and treat those identified as being at risk. In order to address the need, staff will accomplish two goals over the course of a three-year project: Goal 1: Develop and implement comprehensive and sustainable preventive, clinical and professional practices to enhance awareness, identification, referral and treatment strategies for American Indian Youth, ages 10-24, and household members in the GLT community focused on warning signs and risk factors for suicide, suicide and suicidal behaviors; and, Goal 2: Increase data collection and analysis to effectively address youth suicide in the Tribal community. The Zero Suicide Model was selected to develop team-based guidance and support to operationalize a suicide care plan into practice, while evidenced-based Screening, Brief Intervention and Referral to Treatment (SBIRT) was chosen to systematically screen, assist and refer people with substance abuse, suicide and suicide risk factors. The project will also incorporate staff and community training to better identify, assess and increase referrals. Over the course of the three-year project, staff will work with Cheryl Endres, evaluator, to increase data and analysis, and with Western Michigan University partner, Dee Sherwood, Ph.D. for implementation of prevention and early intervention activities. Existing relationships with Allegan County Community Mental Health Suicide Prevention Coalition will be leveraged during the project for training, strengthening resources and connections and capacity for referrals.

Kawerak, Inc.

Northwest Arctic Wellness Initiative (NAWI) is an intertribal Youth Suicide Prevention Cooperative Agreement between the Bering Strait Region and Northwest Arctic Borough of Alaska, with an aim to expand its tribal partnership statewide. NAWI primarily serves Alaska Native youth and young adults ages 10-24 in 27 villages located just above and below the Arctic Circle where the highest suicide Rates in Alaska and the nation have been reported. NAWI provides comprehensive, culturally relevant, training and intervention to create self-sufficient, sustainable, community-level suicide prevention, intervention and post-vention for Alaska Natives.

The Goals of NAWI are to:

Expand NAWI to build a statewide collaborative partnership to advance, develop, and promote Alaska Native Suicide Prevention best practices.
Increase youth wellness activities, mentor supports, and youth leadership to build positive relationship with peers, role models and elders in their community and throughout the region to decrease Alaska Native youth suicide.
Increase youth and community dialogue to change the norms around suicide to something that can be prevented.
Provide appropriate suicide intervention response, care and recovery activities for

Alaska Native young people in the Bering Straits Region (BSR) and Northwest Arctic Borough (NWAB). Through its multiple strategies, NAWI will reach approximately 3,600 individual school aged children and 2,275 village adults annually. Over the length of the funding period, the project will reach 4,150 unduplicated youth (including those who are beyond school age or are leave school) and 2,275 unduplicated adults.

Measurable outcomes include:

Recruit and train Youth Leaders in the BSR and NWAB (162 Youth Leaders annually, 324 total),
Provide training for youth and community members to create digital stories to share as a foundation for community conversations (7 village sites trained annually, 27 village sites total, 90 individuals annually, 450 individuals total).
Provide school and community support through workshops in each village annually to promote prevention efforts (41 workshops annually, 205 workshops total, 1060 individuals per year, 3900 individuals total).
Train village-based counselors (VBCs), who are Alaska Native community behavioral health workers serving their home villages, to implement monthly talking circles, community outreach, and cultural events that include messages of suicide prevention and awareness (324 total activities annually, 1620 total)

Johns Hopkins University

The White Mountain Apache (WMAT), Navajo Nation, and Johns Hopkins (JHU) are uniquely poised to respond to Grant SM-19-006. WMAT-JHU have contributed Native American data on current evidence-based interventions, adaptions of EBIs, and new culturally grounded upstream approaches to the suicide prevention field. The current proposal, Celebrating Life, will bring back this multi-tiered prevention strategy for youth and expand it to the Shiprock area of Navajo. The proposed initiative will support community-wide education to promote protective factors and reduce risks led by local Elders and community leaders; early identification and referral of high-risk youth; and infrastructure and training for similar efforts in the Navajo Nation (Shiprock site), including an intervention with youth who attempt suicide and their families.

Great Plains Tribal Chairmen’s Health Board

Connecting With Our Youth (CWOY) is a values-based initiative to reduce the rate of suicide for American Indian youth in the Paha Sapa (sacred lands of the Black Hills) catchment area. CWOY is informed by Lakota culture values of caring and compassion for all (Waú?šila) and youth are sacred (Wak?á?yeža) to strengthen connections between American Indian youth and their culture.Lakota values will be used by CWOY to develop culturally-adapted evidence-based prevention and intervention strategies designed to increase social connectedness, reduce death by suicide and suicide attempt rates, and expand knowledge of how to support American Indian youth, families and relatives. CWOY objectives include (1) deploying patient navigators entrusted to work with key stakeholders to provide early intervention and long-term support; (2) sharing the CWOY prevention curriculum with American Indian youth and their relatives, behavioral health practitioners, police officers, corrections staff, and substance abuse counselors;(3) delivering a Lakota-based mobile suicide prevention and intervention smartphone application targeted to support American Indian youth who are not active in schools, who might be waiting for follow-up care without a patient navigator, or who are not sure what to do and are looking for a private and confidential path to support and connections.The mobile app is designed to provide support and conservation of resources through peer “”connectors””, who hold the potential for further disseminate knowledge of how to respond productively to suicidal ideations throughout the community. Housed in the Great Plains Tribal Chairmen’s Health Board in Rapid City, South Dakota, CWOY will serve American Indian youth in an eight-county catchment area characterized by high suicide rates, high proportion of American Indian population and strong cultural attachment to Paha Sapa in a collaborative effort to strengthen connections among American Indian youth and their culture, families, peers, counselors, doctors, and community members dedicated to their well being.

Fairbanks Native Association

Tribal System of Care: Through the SAMHSA HT, SAYA is developing a Tribal SOC; a coordinated network of community-based services and supports. SOC networks build important partnerships to address needs and improve functioning (Stroul & Friedman 2010). Our SOC includes the following service domains: Substance Abuse, Mental Health, Health, Housing, Education, Legal, Spiritual/ Culture, and Family/Child Welfare. It meets SOC guiding principles in that it is designed to 1) ensure availability and access to an services and supports; 2) ensure services and supports are evidence-informed; 3) provide case management; and 4) include continuous accountability and quality improvement (Stroul & Fiedman, 2010).Proposed Impact: Visions will reduce suicide deaths and attempts in the Doyon region by 20% per year, achieving zero suicide deaths and attempts by year five. It will ensure at least 50 at-risk youth per year are screened and provided with brief intervention, increase response time to suicide crisis by 50%, and integrate three new evidence-based practices into Doyon’s behavioral health system. It will strengthen the SOC, increasing collaboration and improving service delivery. Visions will provide suicide prevention training to 100% of SOC agencies, ITC agencies, and Youth Council members. It will increase contacts by 25% and referrals by 40%. It will strengthen existing suicide prevention efforts without duplicating efforts or supplanting funds. Descriptions of evidence based practices and anticipated outcomes are detailed in this proposal. Perhaps most important, Visions will give help, hope, and life to the Doyon region.

Confederated Salish and Kootenai Tribes

Target Population: American Indian youth, ages 10-24, who reside on the Flathead Indian Reservation in Montana. Strategies/Interventions: After school programming will be conducted in one of the most remote locations. With partners, they will identify a quarterly theme for the survivor activity, as a way for them to connect, heal, and be part of the prevention movement. Programming that supports interactions with elders and inclusion of cultural elements will be set up each year. Promote ongoing engagement; provide support groups and therapy to youth impacted by suicide. Support tribal/nontribal agencies in development of intervention and prevention activities. Goals: Decrease the occurrence of suicide on the Flathead Reservation by implementing evidence based trainings and providing information to expand community capacity for responding and referring at-risk youth; Raise tribal youth resiliency on the Flathead Reservation by offering culturally informed, evidence based activities that connect them to peers, elders, and the community; increase capacity on the Flathead Reservation for responding to youth at-risk for direct suicide with improved collaboration, system changes, and better use of technology and evidence based screenings; improve the emotional well-being of Flathead Reservation tribal youth with direct services by Mental Health Specialists and Case managers; cultivate better health outcomes for families and friends who have experienced a loss by delivering a battery of post suicide interventions. Numbers served annually/throughout the project: 27,235 Yr 1 3,845, Yr 2 4,750 Yr 3 6,210 Yr 4 6m,230 Yr 5 6,300.

Choctaw Nation Health Service Authority

The Choctaw Nation of Oklahoma, a Promise Zone as designated by President Obama, proposes to implement Tomorrow’s Hope. Tomorrow’s Hope follows the Choctaw way of Achchukmali Imabachi Sa Banna, a language concept which denotes a special caring and protection to make life better, teaching to make better. This traditional concept will guide us as we build a system wide embrace around our youth at risk for suicide, their families, the providers who serve them, law enforcement, and the community. For American Indians/ Alaska Native youth, age 15-34, suicide is the second leading cause of death. In fact, loss to suicide is 2.5 times higher for Natives than the national average for that age group. Of special concern to the Choctaw Nation is that, according to the Oklahoma state plan for suicide prevention, in the 10 county area served by the Choctaws, two of our counties report suicide deaths at 50%+ above the overall state rate, three counties report deaths at 25 – 49% above the state average, and four report deaths at 1 – 24% above the state rate. These losses are of great concern and as a result, the Choctaw Nation of Oklahoma proposes to implement Tomorrow’s Hope, a project that will better integrate the following services: medical, behavioral health, prevention, substance abuse treatment, Jones Academy (residential educational facility), domestic violence, Eastern Oklahoma State College, and law enforcement in an effort to firmly establish new linkages and strengthen a system wide response to suicide prevention /intervention. Tomorrow’s Hope proposes to annually: a) train 1,100 youth, service providers and community members in 40 QPR (Question, Persuade, Refer) trainings; b) train 100 medical providers in Emergency Department Means Restriction Education (NREPP Registry, 2014); c) train eighty Choctaw Nation Youth Advisory Board members and Jones Academy students (80) in Coping and Support Training (CAST, age 13 to 24); and d) refer/engage 240 youth and 120 family members per year in 3 to 4 month long outpatient treatment for substance use, mental health or both; offer law enforcement officers and campus police training opportunities related to suicide intervention and QPR. This means that this project will impact, minimally, 8,000 youth, health providers, college students, Jones Academy students, law enforcement and family members during it’s five year duration and hopefully, throughout their lives. Services proposed will be based out of the three counties (McCurtain, Pittsburg, and Latimer) that evidence the highest suicide rates. However, because Tomorrow’s Hope will build a system wide approach, all 10 counties served by the Choctaw will benefit since all counties utilize clinic and hospital services. Tomorrow’s Hope, will enhance already existing linkages, build new ones, strengthen the net of protection through education, introduce and expand evidence based interventions, utilize EHR to establish a Community Alert (a function within the EHR system to notify both medical and behavioral health to a patients risk for suicide), and reduce access to means of firearms, the leading method of suicide in the 10 county area of the CNO.

Cherokee Nation

The Cherokee Nation HERO Project aims to serve American Indian youth ages 0-23 residing within the Cherokee Nation reservation by creation of Project Sunale: Working together to build a better tomorrow. Project goals include expanding and building upon work and efforts of previous funding to improve capacity, effectiveness and efficiency of suicide prevention services for American Indian youth in Oklahoma and by providing evidenced based interventions/practices to treat suicide by working to decrease prevalence and suicidal behaviors in Cherokee Nation. Evidence based practices including community, school-wide, and individual interventions to address higher than average suicide rates among Native youth in Oklahoma will be implemented. Measurable objectives include community level evidence based practices such as creation of a social marketing plan and training project staff in Youth Mental Health First Aid to be disseminated across the Cherokee Nation reservation. Furthermore, the project will implement two school-wide interventions: Olweus Bullying Prevention Program and Lifelines Suicide Prevention Program. Olweus Bullying Prevention Program will be implemented in 3 K-8th grade schools, and Lifelines Suicide Prevention Program will be implemented in 3 high schools. Screening Brief Intervention and Referral to Treatment (SBIRT) will be implemented in identified school systems receiving a school-wide intervention. Clinical staff will be trained in Dialectical Behavioral Therapy (DBT) to address suicidality in clients. It is projected the program will serve 960 individuals the first year, increasing by 120 each year, totaling 6,000 unduplicated individuals served over the lifetime of the grant.

American Indian Health and Family Services of Southeast Michigan

The American Indian Health and Family Services of Southeast Michigan’s Manidookewigashkibjigan Sacred Bundle: R.E.S.P.E.C.T. Project, a State/Tribal Youth Suicide Prevention Initiative, serves youth and young adults ages 10-24 with a focus on American Indian/Alaska Native (AI/AN) youth in Detroit and Southeastern Michigan and with tribal communities statewide. In collaboration with State and County Suicide Prevention authorities and crisis centers, the Sacred Bundle Project has utilized evidence-based practice (EBP) interventions and treatment strategies, as well as culturally-infused Practice-Based Evidence to expand the safety net of suicide prevention and intervention for urban AI/ANs, who are at higher risk of suicide attempts and deaths than other racial/ethnic groups in the United States. The goals of the Sacred Bundle R.E.S.P.E.C.T. (Respecting, Engaging, Supporting, Protecting, Empowering, Connecting and Teaching) Project are to: • Provide screening and referral services with students at the Tribal Colleges in the State of Michigan. • Increase the number of persons in schools, foster care systems, juvenile justice programs, and tribal sites trained to identify and appropriately refer youth at risk for suicide. • Increase the number of clinical service providers trained to assess, manage, and treat youth at risk for suicide. • Improve continuity of care and follow-up of youth identified at risk for suicide who are discharged from emergency departments and inpatient psychiatric units. • Increase identification of risk, referral to and utilization of behavioral health care services. • Increase the promotion and utilization of the National Suicide Prevention Lifeline. • Comprehensively implement applicable sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicide ideation, attempts, and deaths in our communities. Four measurable outcomes include: 1) Increased Outreach for suicide awareness (1400 annually, 7000 total), 2) Expanded Training and technical assistance to improve ability of local and tribal community members and professionals to identify, manage and treat youth at risk (200 annually, 1000 total); 3) Continued Screening to increase identification of at-risk youth ((200 year one and an increase of 25% annually, 1640 total), and 4) Improved and expanded Treatment measured by an increase of at-risk youth receiving culturally appropriate behavioral health care (200 annually, 500 over 5 years). To successfully meet these goals and outcomes we plan to: 1) Increase the number of individuals trained including mental health professionals, educators, gatekeepers, youth workers, and community members, 2) Develop collaborative relationships with Tribal Colleges, local school districts, other educational institutions, and youth serving organizations and 3) Utilize the Hope and Wellness Toolkit to train our tribal communities and other community members currently supported by AIHFS. To ensure sustainability, the Sacred Bundle Project staff will provide support, oversight, and training during the implementation phase with the ultimate goal of independent utilization of the toolkit.