Grantee Types: Garrett Lee Smith State

The Rhode Island Youth Suicide Prevention Program (RIYSPP) will implement evidence-based interventions in selected schools and community-based organizations serving adolescents and their families. The project provides a safety net for at-risk youth, instituting screening/referral protocols, gatekeeper training, enhancements to college curricula, and media strategies. Target populations include sexual minorities, racial/ethnic youth, military personnel and their families.

RIYSPP will focus on adolescents and youth adults, ages 15-24 living in Rhode Island’s “Core” cities. These cities are characterized by high rates of children living in poverty (15% or more), large minority populations, and other risk factors such as an over-representation of youth involved in the juvenile justice and child welfare systems, higher rates of child abuse, neglect and domestic violence. The six interventions proposed are: 1) SOS (Signs of Suicide) in high poverty “core” cities to train a minimum of 340 youth, 2) QPR (Question, Persuade, Refer) Suicide Prevention Program to train a minimum of 1,255 adults, 3) the American Foundation for Suicide Prevention (AFSP) Interactive Screening Program (ISP) implemented in three RI colleges/universities, 4) technical assistance to the RI National Guard and RI Veterans Administration to reach military personnel and their families, 5) integration of suicide prevention course content in Brown University’s Master of Public Health and medical clerkship curricula, and 6) one statewide means restriction media campaign. The objective is to connect a minimum of 460 youth with new or enhanced services over the three-year grant period.

In 2002, the RI Department of Health created a partnership of public, private and nonprofit agencies, and suicide survivors to develop the Suicide Prevention Framework for Rhode Islanders Ages 15-24 (The Framework). Plan recommendationswere developed utilizing surveillance data and statewide assessments of program resources, legislation, and state capacity. The 2005 and 2011 RI Injury Prevention Plans include Suicide Prevention Framework recommendations: 1) reduce the completed suicide rate and 2) reduce suicide attempts in three priority groups including youth 15 to 24. Recommendations for suicide prevention in the 2002, 2005, and 2011 plans were adapted from SAMHSA’s National Strategy for Suicide Prevention. The state plan was a three-year endeavor carried out by the RI Injury Community Planning Group Suicide Prevention Subcommittee, which functions as the state coalition. RIYSPP objectives align directly with the objectives and recommendations of The Framework and will be addressed through the following four program goals:

1. Build state agency infrastructure and capacity to implement and evaluate RIYSPP,
2. Improve coordination and delivery of suicide prevention programs in a variety of settings,
3. Increase awareness that suicide is a public health issue and that it is preventable, and
4. Expand and enhance state agency monitoring and evaluation capacity.

Anticipated number of people to be served: 5,000 per year, 15,000 over three years.

The Institute of Medicine’s the National Strategy for Suicide Prevention (U.S. DHHS, 2001a) clearly identified primary care as a potential source for identification, triage, and brief treatment for suicidal youth.  Youth Suicide Prevention in Primary Care (YSP-PC) will build on the success of our current SAMHSA State/Tribal Youth Suicide Prevention Grant by expanding our reach from three counties in northeastern Pennsylvania to eight additional counties in two new regions of the state (southeast and west), the counties with the greatest number of suicide deaths in the Commonwealth.  The project will provide primary care providers with the resources necessary to increase a) provider knowledge and comfort with assessing for suicide risk, b) the identification of youth at increased risk for suicide, and c) the number of youth referred from primary care who successfully engage in behavioral health treatment. 

In order to achieve this aim, we have five objectives:

1. Create state and county level advisory boards consisting of a broad range of stakeholders.
2. Provide meidcal practices with educational materials and training that will improve the PCP’s knowledge, confidence and skills to identify and refer at risk youth.
3. Provide PCPs free access to a web-based, patient self-report screening tool to assess for suicide and related risk factors.
4. Increase the integration of behavioral health services with medical services.
5. Provide clinical training to behavioral health providers who receive referrals and treat those at risk for suicide.

There are a number of cultural factors associated with our proposed efforts.  While our first grant focused mostly on Caucasian, on low income, rural practices, the YSP-PC project will expand to work with urban and suburban environments, families from a wider socioeconomic status, and broader range of ethnic groups (e.g., Asian, Hispanic).  Each demographic provides its own nuances related to risk that will be addressed by local advisory groups.  We are also collaborating closely with Pennsylvania’s Medical Home Program to recruit practices since these PCPs already engage in innovative practice models.  We have established a partnership with a medical and behavioral health clinic that specifically treats LGBT youth, a university-based health center, and will explore extending our screening program to both juvenile justice and military families.  All of these efforts will occur in primary care settings.  Our proposal will expand YSP-PC to at least 30 primary care practices by the third year of the project, enabling us to screen over 7,500 youth annually.  As with our previous grant, we will continue to call upon our Advisory Board comprised of public and private entities, including state medical associations, managed care organizations, state government, academic and clinical professionals, as well as survivors of suicide to provide oversight, guidance, credibility, and support to our project. 

The Suicide Prevention in Schools and Colleges initiative will implement suicide prevention and early intervention strategies for youth ages 10-25 across Pennsylvania. The grant will provide gatekeeper training, suicide risk management training, standardized screening, and training in empirically supported treatments. The project will raise awareness, increase identification of at risk youth, facilitate referrals to treatment, and improve treatment outcomes.

The problem addressed by our proposal is that suicide risk is being under identified in Pennsylvania’s schools, community colleges, and universities. There is no systematic training for professionals or standardized screening procedures to identify youth at risk. Therefore, too many young people are not identified and too many of those who are high risk are not being adequately screened, and not receiving treatment and support.

There are 500 school districts and 181 community colleges and universities in Pennsylvania. In the general state population, there are 2,570,000 individuals age 10-15 representing a wide range of cultures and demographic diversity. The majority are white, but there are also Black, Hispanic, Asian and American Indian students. We will focus on racial and ethnic, rural and urban cultural differences as well as the needs of the Veteran and the LGBT populations.

Building on the Student Assistance Program in Pennsylvania schools, we will provide gatekeeper training and state of the art screening tools to appropriate school personnel and the behavioral health systems that serve these schools. Building on the work of past Campus Grants, we will organize a coalition of community college and university representatives to develop model suicide prevention plans and processes for higher education throughout the Commonwealth.

Project goals and measurable objectives include: a) increasing the number of persons in schools, colleges, and universities, trained to identify and refer youth at risk for suicide, b) increasing the number of clinical service providers (including those working in schools, mental health, and substance abuse) trained to assess, manage, and treat youth at risk for suicide, c) increasing awareness about youth suicide prevention, specifically including the promotion and utilization of the National Suicide Prevention Lifeline, d) comprehensively implementing applicable sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicidal ideation, suicide attempts, and suicide deaths in their communities, and e) promoting state systems-level change to advance suicide prevention efforts in our public schools.

With gatekeeper training and awareness campaigns, we plan to reach 186,000 youth over five years. With screening in schools, colleges, and primary care practices, we plan to reach approximately 26,000 indicated youth over five years. Thus, our total impact will be felt by nearly 212,000 youth across Pennsylvania.

Oregon Public Health Division’s (PHD) Caring Connections Youth Suicide Prevention Initiative capitalizes on a long history of successful public/private collaboration and Oregon’s dynamic health care delivery system to reduce the burden of suicide among youth ages 10-24 by implementing comprehensive suicide prevention and early identification best practices. The Initiative targets 468,809 youth aged 10-24, with special focus on at-risk youth, which includes those that live in seven Oregon counties with a higher than national rate of youth suicide, military families, youth involved in the foster care and juvenile justice systems, Native American youth, Latino youth, and sexual minority youth. PHD multifaceted approach for comprehensive suicide prevention and early identification includes implementation of evidence-based and best practice strategies at both the state level, and intensely at the community level. Oregon’s proposal mobilizes 28 key partners, including the community mental health programs, public health, hospitals and health centers, schools, addictions and mental health clinicians, universities, juvenile justice, veteran organizations, Tribes, and the Coordinated Care Organizations in seven counties in the Willamette Valley, Southern Oregon, Central Oregon, Northeastern Oregon, and the Portland area to implement the following strategies:

Gatekeeper Training to increase by 30% the number of individuals in youth serving organizations trained to identify and refer youth at risk by: hosting quarterly Applied Suicide Intervention Skills Trainings (ASIST) to behavioral health clinicians, and/or Question, Persuade and Refer (QPR) or Safe Talk trainings to community members annually; establishing RESPONSE in 50% of the high schools in three CMHP catchments areas; and providing Kognito At Risk for High School Educators and Kognito Step In! Speak Up! LGBTQ module training to 20,000 educators and school staff.

Clinical Training to increase health, mental health and substance abuse clinicians trained to assess, manage and treat youth at risk for suicide by: hosting 11 trainings in Assessing and Managing Suicide Risk (AMSR) for 550 behavioral health clinicians; implementing Kognito At-Risk for Primary Care training for staff at all School-Based Health Centers, and to pediatricians in three counties; and implementing Kognito At-Risk for EDs for Emergency Department staff in all four Portland metro health systems that treat more than 300,000 patients annually.

Improving Continuity of Care for youth discharged from emergency departments and inpatient psychiatric units, and for veterans and military families receiving care in the community; and improved county crisis response plans for full wrap around services.

Comprehensive Implementation of Goals 8 & 9 of NSSP in Washington County, a Portland metro county that has adopted the Zero Suicide approach to reduce rates of suicidal ideation, suicide attempts, and suicide deaths.

Promotion of the National Suicide Lifeline and Project Evaluation with all partners.

Oregon’s Caring Connections Program will be implemented by the Oregon Public Health Division Youth Suicide Prevention Program in 14 counties and 9 Tribes. Project activities include: a coalition; community awareness campaigns; gatekeeper training; attempt reports by emergency departments to document patient access to community resources after discharge for treatment for a suicide attempt, and use of those data to determine the need for outreach; comprehensive high school based RESPONSE program; and evaluation. The nine recognized Oregon tribes will hold a youth gathering with educational, cultural, and team-building activities, speakers, and information to increase protective factors for youth. Suicide is the 2nd leading cause of death among youth. The goal is to reduce suicide among youth aged 15-24. The program is implemented in the county and tribal sites by existing Prevention Coordinators. Site selection is based on four criteria: suicide and suicide attempt rates, letter of intent, and finalization of contracting elements. Prevention coordinators will implement gatekeeper training, work with schools to implement RESPONSE, and convene an existing local coalition to implement community awareness campaigns. Emergency departments will report suicide attempts and results of follow up calls, and use those data to determine the need for outreach. The project evaluator will work with the State Advisory Committee to monitor progress and plan for future expansion of program activities statewide. Expected short-term project outcomes include: increased referrals to care, increased linkage to care, decreased barriers to care, increased knowledge among clinicians, crisis response workers, school staff, youth, and lay persons, and increased social support for survivors. The Oregon Caring Connections Program, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), is implemented by the Oregon Department of Human Services in partnership with the Association of Oregon Community Mental Health Programs, the Confederated Tribes of Warm Springs, Portland State University Regional Institute for Human Services, the Oregon Partnership, the Office of Multicultural Health, other advocacy organizations, and local care systems and educational institutions.

The State of Oklahoma proposes to utilize funding available from this State-Sponsored Youth Suicide Prevention and Early Intervention opportunity to continue the Oklahoma Youth Suicide Prevention and Early Intervention Initiative. Specifically, funds will be used to implement evidence-based youth suicide prevention strategies in selected high-need communities and implementation of the state suicide prevention plan. As a Cohort I, IV, and VI grantee of SAMSHA’s Garrett Lee Smith initiative, the State of Oklahoma has taken important steps toward the development of a public health infrastructure to promote the prevention of suicide. Universal and targeted projects have been initiated in communities, universities, schools, tribal governments, hospitals, faith communities, armed forces, mental health and substance abuse treatment facilities, and other youth-serving agencies.

Project goals are to:

1. Increase suicide prevention capacity and implementation within priority counties.
2. Increase suicide prevention capacity and implementation at the state level.
3. Increase the number of youth at risk of suicide who are identified and receive mental health services.
4. Increase the number of effective and evidence-based clinical suicide prevention practices implemented.
5. Improve and expand suicide surveillance systems.

The proposed service area is the state of Oklahoma and six high-risk communities. Contracted sub-recipients will provide gatekeeper training, and establish an emergency department suicide attempt database with follow up consent protocol. The project will reach nearly 50,000 individuals with suicide prevention training/education (including 900 clinicians and up to 25 colleges/universities). Approximately 40 communities statewide will receive suicide postvention/prevention consultation and training. Funding will also be utilized to continue statewide suicide prevention efforts initiated with Cohort I, IV, and VI strategies. The state will develop four Regional Suicide Prevention Chapters of the State Suicide Prevention Council, gatekeeper and clinical suicide prevention training statewide, and crisis response protocol in public school systems to specifically address student death by suicide. The project is expected to reduce the rate of non-fatal suicide attempts and deaths in youth aged 10-24.

The Ohio Youth Suicide Prevention and Risk Assessment Project (OYSP&RAP) will provide, 24 Ohio Screening Programs with assistance and training to initiate or expand research based culturally competent approaches for early identification of youth at risk of suicide and/or suffering with an undiagnosed and untreated mental disorder that may result in suicide. Risk assessment will be made available, with active parental consent, to a minimum of 35,650 youth ages 11-18. Screening programs participating in the project will screen youth and suicides will be prevented through early screening identification, professional assessment, and referral for treatment when necessary. Ohio?s behavioral health system consists of 50 county Behavioral Health Authorities who serve the 88 counties in the state. These authorities are statutorily empowered to plan, develop, fund and evaluate community-based mental health and substance abuse services. Within this infrastructure, the 24 Screening Programs will be identified and grant funds will be disbursed. The OYSP&RAP program model is a three year approach. In the first year of operation, the twelve Ohio Screening Programs already conducting risk assessment activities will be awarded mini-grants to support expansion of their activities and to coordinate services to assure immediate linkage to behavioral health care and other supports. Providing that targeted risk assessment outcome goals are achieved, these programs will continue to receive support over the remaining two years of the project. In years two and three and additional 12 (6 each year) Ohio Screening Programs will be selected and awarded mini-grants to support risk assessment activities. These programs will receive continued fiscal support in the following project year provided that targeted risk assessment outcome goals have been achieved. By year three, the total number of participating programs will be 24. The number of youths annually assessed for suicide risk will be increased by approximately 420%. Targeted and selected Screening Programs will have the option to utilize evidence-based programs such as the Columbia TeenScreen Program (CTSP), Signs if Suicide (SOS) High School Suicide Prevention Program and other proven effective, model programs. The evidence-based screening method selected by each county will be utilized in a variety of settings: schools, child welfare/foster care, mental health and substance abuse systems; pediatrician offices; emergency rooms; private and non-profit venues; and other community based locations where youth are most accessible. Further, in order to increase the number of trained professionals in suicide assessment in the targeted and selected Screening Programs, a ?train the trainers? approach using the ?Clinical Competencies in Suicide Assessment?, developed by the American Association of Suicidology (AAS) and the Suicide Prevention Resource Center (SPRC) will be provided to qualified professionals in Ohio. The OYSP&RAP will draw upon the expertise of The Ohio Suicide Prevention Foundation (OSPF), the Ohio State University (OSU), the Ohio State University Center for Family Research (CFR), and the Ohio Department of Mental Health (ODMH).

The North Dakota Department of Health/Division of Injury Prevention and Control developed a prevention and early intervention initiative for tribal and rural youth (ages ten to 24) whose risk of suicide mortality is 300% of the national average. The initiative is operating under the guidance of four goals:

• Promote collaboration between and within North Dakota communities to create sustainable infrastructure and programs in suicide prevention for youth aged 10-24;
• Increase public awareness that suicide is a leading cause of death among North Dakota youth and that suicide is preventable;
• Reduce the danger and harm of suicidal behavior;
• Plan for sustainable youth suicide prevention programming in North Dakota.

Since the first meeting of a North Dakota Suicide Prevention Coalition in March 2007, the Coalition meets on a quarterly basis to review the progress of six rural and tribal sub-grantees funded under the Garrett Lee Smith Youth Suicide Prevention Program. The mission of the Coalition is to empower communities to create suicide prevention programs and to strengthen resiliency to reduce injury and death.

The Chronic Disease Section Epidemiologist from the North Dakota Department of Health assisted the program to evaluate trends over the last ten years and works with a Data Subcommittee of the North Dakota Suicide Prevention Coalition.?

The six sub-grantee suicide prevention programs are approaching their goals from a variety of platforms, including utilizing Boys and Girls Clubs, Students Against Destructive Decisions, a Medical Center Community Volunteer Program, and tribal tradition-based programs.? The six programs train individuals, school personnel, community leaders, and professionals for recognition of at-risk behavior and delivery of effective treatment or services.? They are working in schools and community organizations to present gatekeeper programs including QPR, ASIST, and Sources of Strength.?? The sub-grantees each work with local coalitions to enhance their program reach and effectiveness.

A collaborative program, the initiative involves partnerships among tribal, rural, state, and private stakeholders, as well as consumers and families.

North Carolina’s youth suicide prevention program will focus on the needs of the following special populations: children of military families, youth within the juvenile justice system and the LGBTQ.

Provision of a comprehensive array of suicide prevention programs will address suicidal behavior, risk and protective factors of youth from military families. Programs shall include two levels of adult gatekeeper training, suicide prevention curriculum for students, parent education and postvention education.

Staffs who serve incarcerated youth in detention and youth development centers will receive postvention education and the needs of the LGBTQ youth population will be further explored through a collaborative partnership with the Rape Prevention Education (RPE) Program and focus groups with youth who identify themselves as LGBTQ.

The state’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services’ Centers for Prevention Resources (CPRs) that provide screening, assessment and referral services to youth at risk for suicide, mental health disorders and substance abuse will also receive suicide prevention/intervention training in order to increase their skill level to detect and refer any young person in North Carolina who is considered at-risk of suicide.

The state’s former Youth Suicide Prevention Task Force will be modified into an Advisory Council in partnership with state’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services. The Advisory Council will include youth serving providers and stakeholders including high school and college student representatives and youth members from the special populations identified: military families, juvenile justice and LGBTQ.