Vermont-Center for Health and Learning

The Center for Health and Learning (CHL) is a no-profit organization dedicated to creating prevention prepared communities in Vermont, by developing and implementing statewide youth suicide and substance abuse prevention and early intervention strategies, through public/private collaboration.  CHL has adopted the following goals for the 2011 State/Tribal Youth Suicide Prevention Grant: 

  1. Continue to build sustainable infrastructure in Vermont around youth suicide prevention and substance abuse prevention through collaboration across a broad spectrum of individuals, agencies, institutions, and groups that have not previously been involved, to ensure that suicide prevention efforts in Vermont are comprehensive.
  2. Continue to increase awareness that youth suicide is a public health problem that is preventable, and reduce the stigma associated with being a consumer of mental health, substance abuse and suicide prevention services.
  3. Implement effective evidence-based youth suicide prevention and early intervention programs and strategies in schools, communities and Vermont institutions of higher education in order to prevent suicide among Vermont youth and young adults.

To achieve these goals, CHL and its partners will implement strategic/activities including:  expanding the Vermont Suicide Prevention Coalition by formalizing involvement of missing organizations and agencies;  establishing a divers Youth Advisory Group; increasing the statewide cadre of trainers from a variety of agencies and professions qualified to lead all aspects of suicide prevention; developing cross-agency collaboration in which suicide prevention and substance abuse prevention are linked; implementing a public awareness campaign; implementing a comprehensive school suicide prevention program, based on the Lifelines Program including:  administrative protocols, building connections with Mental Health/Crisis, Gatekeeper training, education/awareness for all school staff and parents, and Lifelines student lessons; implementing an intensive community-based suicide prevention program including:  training professionals and community members on the Connect/Framework Program including:  Gatekeeper training, and professional & community-based protocols for suicide prevention/intervention and postvention; implementing Gatekeeper training for faculty and staff in the Vermont state college system, as well as providing resources and information to distribute to students.

The population of focus for this project will be all Vermont youth age 10-24, with a priority on outreaching, engaging and delivering programs to LBGQT youth and military young adults and their families.

Vermont – Center for Health and Learning

The Center for Health and Learning and the Vermont Department of Mental Health are partnering to strengthen and expand youth suicide prevention and intervention in Vermont through collaboration between multiple agencies and organizations. There are six major areas of focus:

1. Building infrastructure in Vermont for youth suicide prevent ion by engaging the Vermont Youth Suicide Prevention Coalition (VYSPC) in six meetings per year and writing a multi-year plan.

2. Development of a statewide public information campaign aimed at normalizing help seeking behavior for mental health issues, referring the public to resources (e.g., 2-1-1 line, local and web-based resources and including production of brochures, posters and media placements for targeted audiences) and collaboration with the United Ways of Vermont to promote the use of the 2-1-1 information line for suicide prevention.

3. Development of the Umatter for Schools Training based on the Maine Model. This includes four components: a) Gatekeeper Training b) Protocols Development c) Training of Trainers for those delivering the Lifelines student lessons d) Staff and Parent Awareness programs.

4. Gatekeeper training based on the Connect model developed by NAMI NH for four major audiences: a) Primary Care Providers b) Law Enforcement c) Youth Serving Professionals (AHS related), Mental Health and Substance Abuse Professionals, Juvenile Justice, Foster Care, Social Workers, community-based professionals, and d) Emergency Medical Care Providers. The latter two will be a Training of Trainers where participants will be asked to go back to their settings and conduct awareness-raising sessions.

5. Intensive community-based intervention by collaborating with the VT Department of Health on identifying two communities engaged in implementing the Strategic Prevention Framework for Substance Abuse prevention and implementing the New Hampshire Connect model.

6. Working with Vermont Child Health Improvement Program (VCHIP) at the University of Vermont to implement targeted interventions aimed at college-age students.

Utah – University of Utah

For decades, suicide prevention efforts have focused primarily on public school systems. Nationally, few efforts have been made to address at-risk youth in the juvenile courts. While suicide prevention in schools is necessary, unfortunately, the Utah Youth Suicide Study discovered that youth who die by suicide more frequently have contact with the juvenile court system than with schools in the year prior to death.

Pilot study findings show that youth in the intervention group who received appropriate mental health screening, referral for treatment and rapid access to family-oriented psychiatric outpatient and in-home family services demonstrated significant mental health status improvement, as well as increased suppression, which decreased the length of time spent in out-of-home court placements.

In 2006, Utah received a SAMHSA grant through the Garrett Lee Smith Memorial Act to expand family-centered suicide prevention services to youth at highest risk for suicide death; mentally ill youth involved with the juvenile court system. Nearly 70% of Utah�s juvenile court population screens positive for significant mental health problems. This grant provides early intervention resources, for mentally ill juvenile offenders who are younger and have fewer offenses than those who typically receive resources. Resources include in-home family service program (Families First), a psychiatric and family evaluation and follow-up appointments as needed. Utah�s Court administrators and judges support a web-based screening system (CARE: Courts and Agencies Records Exchange), which now includes the Youth Outcome Questionnaire (Y-OQ). The Y-OQ was developed to measure ongoing treatment progress of children and adolescents receiving psychotherapy for behavioral and emotional problems. It is a 64-item self or parent report measure of psychosocial functioning for children and adolescents, aged 3-18 years. Unlike other commonly used measures of youth functioning (e.g., the Child Behavior Checklist; [31]) the Y-OQ was specifically designed to be sensitive to observed changes in psychosocial functioning rather than diagnose or categorize specific forms of psychopathology. The Y-OQ is administered to all juvenile offenders currently in contact with their system. This allows multiple referrals for mental health treatment, as well as tracking of treatment outcomes. The Y-OQ system is interfaced with the current statewide web-based information management system for juvenile offenders (CARE), which allows ongoing monitoring of mental health status for a large group of at risk youth, and provides the opportunity for repeated screenings and referrals, rather than a single screening. In addition, it allows mental health treatment providers, probation officers, judges, and others to track the progress of youth in order to make necessary changes to ensure mental health status improvement.

Current findings highlight the importance of ensuring continuity of mental health care for juvenile offenders before out-of-home court placements are ordered, which require detainment. Ideally, mental health screening, referral, and treatment should be initiated early on, when youth enter the juvenile court system while youth remain with their families. Working with the juvenile court system has provided both opportunities and challenges. Based on data from this project, we will be able to provide an evidence-based model for screening, referral, and treatment services (the continuum of mental health care) within the context of the juvenile court setting and coordination of services across government, non-profit and for-profit agencies.

Texas Department of State Health Services

The Texas Youth Suicide Prevention Project (TYSP) will provide suicide prevention and early intervention activities statewide targeting youth at higher risk of suicide. The Texas Department of State Health Services (DSHS) will provide leadership for the TYSP whose purpose is to develop and implement youth early intervention and prevention strategies of the Texas State Plan for Suicide Prevention and the National Strategy for Suicide Prevention, and to monitor the effectiveness of the strategies. The goals of the project are to 1) provide information to the public about youth suicide, risk factors, and prevention; 2) train health, school and community representatives to identify and refer youth who are at risk of suicide; and 3) screen youth in military families and refer those at risk. DSHS will continue working with their project partners — Mental Health America of Texas (MHAT) in Austin and the Center for Health Care Services (CHCS) in San Antonio. MHAT will ensure that all statewide public awareness and capacity building grant activities take place. Activities include an annual symposium, bilingual education materials in a variety of media, prevention and postvention toolkit, nonproprietary gatekeeper development and training, model protocols, social marketing, and on-line web-based trainings. MHAT will also develop and maintain the website  Key numbers to be served in three years: gatekeepers for higher risk youth – 4,050; gatekeeper instructors trained 70; educational materials distributed – 142,700; symposium attendance 700. CHCS will be responsible for youth suicide screening assessment, referral and follow-up at Brooke Army Medical Center Child and Adolescent Pediatric Clinic and Fort Sam Houston Independent School District. CHCS began the first pilot study in the nation that focused on providing community mental health and suicide risk screening and referrals for youth in military families. Redstone Analytics will be responsible for data analysis and key aspects of the SAMHSA cross-site and local evaluation efforts. Key numbers to be served in three years: youth in military families -750.

Texas Department of State Health Services

The Zero Suicide in Texas (ZEST) initiative will provide suicide care services targeting youth at elevated risk of suicide. A comprehensive public health approach integrating best practices in prevention, assessment and intervention, modeled after the U.S. Air Force Suicide Prevention Program, will be developed in the public mental health system. This innovative best practice model will be implemented in Denton County initially and then expanded across Texas. The proposed initiative will target youth ages 10 to 24 in several high-risk categories. The suicide rate for this population in Texas is 7.52 (per 100,000), which represents 1 out of every 11.5 youth suicides in the U.S. The primary focus will be on enhancing screening, assessment and intervention services for youth with serious emotional disturbance (SED). Outreach will also target children of military families, young Veterans and lesbian, gay, bisexual and transgender (LGBT) youth through collaborations with organizations serving or coordinating support for this population and training of providers. The grant will provide enhanced suicide care services to 300 youth annually in Denton County, 900 in three years. These services will include 146 females, 35 Hispanic/Latino, 40 African American, and 10 LGBT each year. The goals of the ZEST initiative are to improve identification, treatment and support services for high risk youth by creating Suicide Safe Care Centers within the public mental health system; expanding and coordinating these best practice suicide prevention activities with other youth-serving organizations and community partners to create Suicide Safe Care Communities; and implementing research-informed training and communications efforts to create a Suicide Safe Care State. Measurable annual objectives are to (a) provide training to 250 members of the mental health workforce in Denton and at least 360 statewide, (b) develop policies and procedures to incorporate best practice screening, assessment, and clinical decision tools into care systems, (c) screen 700 youth and young adults annually and provide best practice suicide care to 300, (d) increase knowledge of the warning signs for suicide and skills for connecting to crisis care through gatekeeper training to 4,340 individuals annually, (e) provide effective communication campaigns with tools, products, and positive messages of hope for defined populations impacting 19,000 people, and (f) increase the coordination of suicide prevention efforts in communities through regional summits and a state conference with 500 participants.Public Health strategies to accomplish these objectives include changing policies within the public mental health system, building train-the-trainer infrastructure in core curricula, integrating best practice screening and assessment into business practices, developing implementation teams, creating a Zero Suicide Systems Toolkit, creating organizational endorsements, engaging partners in learning collaboratives, regional summits and state symposium, disseminating bilingual education materials in a variety of media, promoting prevention and postvention toolkits, and creating a website and social media messages promoting wellness and hope.

Tennessee Department of Mental Health and Substance Abuse Services

The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee Lives Count-Connect (Connect) to reduce suicidal ideation, suicide attempts, and deaths among youth and young adults ages 10-24 by developing and implementing statewide suicide prevention and early intervention strategies, risk screening/assessment, and enhanced follow-up for 6,250 unduplicated (Year 1: 1,000; Years 2-5: 1,250/year).

The focus area is the State of Tennessee, comprising urban and rural populations with multiple socioeconomic disparities (e.g., high poverty, unemployment) that contribute to high risk for suicidal ideation/behaviors among youth/young adults. Tennessee?s suicide rate for the focus population (8.83) exceeds the national rate (7.57) and 111 young Tennesseans died by suicide in 2010. Among the focus population, 20% experience serious psychological distress; 8% of adolescents ages 12-17 and 11% of 18-25 year olds have had a major depressive episode; and 7% of adolescents, 4% of 18-20 year olds, and 16% of 21-25 year olds have been admitted for substance abuse treatment ? all risk factors closely associated with youth suicide. Risk factors are exacerbated among subpopulations (children in state custody, juvenile justice involvement, veterans, and LGBTQ2S youth), with 50% having mental health and/or substance use disorders. Locally, suicide prevention, intervention, and follow-up resources are sparse and disjointed, and accessibility creates key service gaps for youth/young adults and their families.

TDMHSAS will partner with Tennessee Suicide Prevention Network and Centerstone of Tennessee to provide suicide prevention and postvention trainings for gatekeepers (schools, law enforcement, foster care, etc.) and training for primary/behavioral health professionals, screening/assessment, early intervention, follow-up, outreach/education, and linkages to treatment services, using the evidence-based Applied Suicide Intervention Skills Training (ASIST) and Columbia Suicide Severity Rating Scale (C-SSRS) models. Connect will also strengthen public/private collaborations and support higher learning institutions to train students in recognizing early signs of suicide and referring individuals needing help. Outcomes will include reduction in suicidal ideation and suicide attempts by 30% and suicide deaths by 10%. A Youth Advisory Council comprising stakeholders and focus population members will support Connect goals/objectives: (1) increasing the number of people in youth-serving organizations trained to identify/refer youth at risk of suicide, (2) increasing the number of clinical services providers/first responders trained to assess, manage, and treat risk for suicide, (3) improving continuity of care and follow-up for youth discharged from emergency/ psychiatric units, (4) increasing risk identification, referral, and behavioral health services utilization, and (5) increasing the promotion and utilization of the National Suicide Prevention Lifeline. Evaluation will report as required on participant outcomes and on progress and performance regarding infrastructure development.

Tennessee Department of Mental Health and Developmental Disabilities

The Tennessee Lives Count, Youth Suicide Prevention Early Intervention Project (TLC) is a statewide early intervention/prevention project designed to reduce suicides and suicide attempts for youth (ages 10-24).  TLC plans to build on the successes of its first two grant cycles by continuing its gatekeeper training projects but adding components related to youth access to mental health and crisis services and the implementation of postvention plans in schools after a crisis has occurred.
With an annual average of 94 Tennessee youth dying by suicide over the past ten years, the state suicide death rate is 7.7 per 100,000, exceeding the national suicide death rate of 7.1 per 100,000 (2000-2007).  The suicide rate for this age cohort further exceeds the nation’s rate in two of the state’s three grand regions (East at 7.9 per 100,000 and Middle at 8.8 per 100,000) (CDC, 2010; TDOH, 2009).
TLC will offer two-hour QPR to 1,500 participants and two-day ASIST workshops to 100 participants, as well as a one-day workshop addressing the issue of suicide among LGBTQ youth for 200 persons working with this population.  TLC will coordinate training for 100 Emergency Department staff and 100 clinical mental health providers.  All of these efforts to enhance the safety net for youth at risk of suicide will be in collaboration with other federal grant programs and state agency initiatives.
TLC will incorporate a pilot study involving youth identified by Youth Villages Specialized Crisis Service.  Of the 26,705 youth screened by Youth Villages between 2007 and 2010, 67.3% were assessed due to suicidal ideation, a suicide attempt, or an active plan for a suicide attempt.  As part of a pilot study, 250 youth in the Middle Grand Region of Tennessee will receive enhanced follow-up services to increase referral retention, enhance hope and promote connectedness.
TLC will also develop a postvention plan for a minimum of 35 schools, including a face-to-face training component for school administrators and staff on how to respond in the unfortunate event of the suicide death of a student or staff, as well as at least twenty telephonic and six face-to-face consultations after a suicide death has occurred.
TLC will build a collaborative network as a complement to the TSPN Regional Networks to address suicide among students in higher education.  Fifty tenured faculty and long-term staff will receive certification as QPR instructors who will in turn train 12,500 people within their campus community in the program.
Lastly, a targeted social marketing campaign will ensure that at least 100,000 Tennesseans are made aware of the National Suicide Prevention Lifeline, reducing youth suicide and mental health stigma.  All activities and the development of a sustainability plan will be under the oversight of the Tennessee Department of Mental Health, with advisory input from the TLC Youth Suicide Prevention Taskforce and the Tennessee Suicide Prevention Network.

South Dakota Divison of Mental Health

South Dakota?s Community Partnership for Suicide Prevention (CPSP) will strengthen the capacity in South Dakota communities and schools to plan, implement, and sustain evidence-based suicide prevention programs that reduce suicide attempts and fatalities. Local community Project Sites will also increase their ability to collect, analyze, and present local suicide related data. Additionally, the project will work with colleges or universities and veteran populations.
South Dakota?s suicide rate ranks as 9th highest in the United States across age groups and 7th highest for youth and young adults age 15 to 24. The suicide rate for this age group (20.2 per 100,000) is almost double the national rate (11.0). In people ages 15-19, the suicide rate in South Dakota (20.3) is more than two-and-a-half times the national rate (7.6). In an effort to reduce suicide attempts and completions in South Dakota, the CPSP will provide continued growth in the referral and service network between schools, community mental health centers, substance abuse providers, juvenile justice, and child protective services. This system of care will be strengthened through training and technical assistance so that communities can create a safety net for identifying, referring and assisting those at risk for suicide.
The CPSP is based on the South Dakota Strategy for Suicide Prevention, a state plan created by a public and private organization partnership, and will target youth and young adults aged 14-24. Specifically, the program will 1) create Local Community Groups (LCGs) that are public-private partnerships focused on suicide prevention; 2) provide trainings and technical assistance to members of each LCG and school staff; 3) provide a student curriculum in schools within Project Site communities; 4) organize a gatekeeper training for community members; 5) develop local suicide prevention policies among multiple agencies and groups within the community including methods and procedures for tracking suicide related data; 6) implement suicide prevention campaigns, 7) provide information to parents, 8) deliver information and trainings that provide attention to the culture of military personnel and their families. The CPSP hopes to reach 2000 youth and over 3000 adults with training, information and education throughout the life of the grant.

South Dakota?s Division of Mental Health (DMH) will support this grant project through grant funding to local community groups. The DMH will work with consultants experienced in suicide prevention to provide the training and technical assistance such communities require. The Workgroup that helped develop the state suicide prevention plan will serve as an ad-hoc steering committee and work with lead contacts from each community (who will form the advisory group) to provide oversight and feedback to the project.

South Dakota Department of Social Services

The South Dakota Youth Suicide Prevention Project will identify, support, educate and refer youth at risk to behavioral health services through targeting the youth directly and by training the clinical service providers and direct care staff who work with youth at risk.

The populations who will be targeted include youth who have made a suicide attempt or expressed suicidal ideation at an emergency department or inpatient psychiatric unit, youth attending institutions of higher learning, immigrant youth, LGBTQ youth, youth at K-12 school districts, American Indian youth in the juvenile justice system and military family members and veterans.

The project strategies include:

  1. Partnering with hospitals to provide extended follow-up support services to youths admitted to emergency departments and inpatient psychiatric units for suicide attempts or suicidal ideation.
  2. Partnering with three institutions of higher learning to introduce a crisis texting program for students and training staff in identifying, supporting and connecting students at risk.
  3. Providing training to clinical service providers on assessing, managing and treating at risk youth.
  4. Providing training to youth serving organizations to identify and refer youth at risk.

The objectives of the project include:

  • Improving the continuity of care and follow-up with youth identified at risk for suicide discharged from emergency departments and inpatient units.
  • Increasing the number of staff at juvenile justice programs, colleges, universities, high schools and middle schools that are trained to identify and refer youth at risk for suicide.
  • Increasing the number of clinical service providers (behavioral health providers and health professionals) trained to assess, manage and treat youth at risk for suicide.
  • Increasing the number of behavioral health referrals and the utilization of behavioral health services for youth at risk by improving the system across the state.
  •  Increasing the access points for youth at risk to receive assistance through a public awareness campaign, promoting the NSPL crisis line and promoting a crisis texting service.

The number of people that will be served annually by the project is 16,010 and throughout the lifetime of the project 80,050 people will be served.

Rhode Island Department of Health

The Rhode Island (RI) Youth Suicide Prevention Project will serve 10 – 24 year old youth at risk for suicide through universal, selective and indicated strategies implemented statewide. Interventions target those populations disproportionately affected by suicide risk factors. The project will create a streamlined system for crisis assessment, intervention, mental/behavioral treatment and follow-up services. Over 2,000 students and 5,000 young adults will be reached.

Public middle and high schools, worksites, community colleges and the RI Department of Children, Youth and Families will coordinate and share resources with Lifespan, the state’s first healthcare system. Mental health services will be provided by grant-funded Clinical Care Coordinators at Kids’link RI for youth aged 10-18 and Gateway Healthcare Inc. for youth aged 18-24 no longer in school. Unique to the project is a novel streamlined crisis evaluation tool to assess self-injurious behavior with and without suicidal intent, both of which increase dramatically around age 12. The new tool is innovative because it assesses two highly related problems and in doing so may reduce unnecessary emergency department (ED) visits for mental health evaluations. Goals, objectives and activities are aligned with the 2012 National Strategy for Suicide Prevention.

Goal 1: Enhance state agency infrastructure and capacity required to successfully execute all aspects of the proposed project, including program implementation and evaluation, for grant period 2014-2019 and beyond.
Goal 2: Implement and evaluate RI’s first multifaceted youth suicide prevention program, using a combination of universal, selective and indicated strategies.
Goal 3: Implement a novel streamlined crisis evaluation assessment tool and selective intervention strategies for at-risk youth ages 10-24 in multiple settings.
Goal 4: Implement RI’s first systematic linkage of health and non-health organizations to improve continuity of care and follow-up for youth aged 10-24 at risk for suicide.

Expected outcomes:

  • Increased numbers of persons trained to identify and refer at risk youth.
  • Increased number of clinicians trained to assess, manage and treat at risk youth.
  • Increased identification of risk, referral and utilization of behavioral health services.
  • Improved continuity of care, follow-up and accountability for youth with suicidal ideation, substance abuse disorders and/or depression, or identified as at risk for suicide seen in outpatient mental health centers, hospital EDs and inpatient psychiatric units.
  • Reduced ED use for mental health evaluations.
  • Increased promotion of utilization of the National Suicide Prevention Lifeline.c