Grantee Types: Garrett Lee Smith State

Under the leadership of the New York State (NYS) Office of Mental Health (OMH) and with numerous partners and stakeholders, New York has mounted a major Suicide Prevention Initiative. Although suicide death rates vary across the state, each death from suicide is one too many, and prevention initiatives must be statewide. Many actions and foci populate the State’s Suicide Prevention Initiative and Suicide Prevention Plan. Among these, prevention of youth suicide is a critical priority and the focus of this proposed Youth Suicide Prevention Program. Within the total population of youth ages 10-24 in the state, several groups face heightened risk; youth in the child service systems (child welfare, foster care, runaway and homeless youth, mental health, juvenile justice, chemical dependence); Latina youth; Lesbian, Gay, Bisexual, Transgendered, and Questioning (LGBTQ) youth; youth in military families; and youth at risk of suicide due to exposure in their communities and schools. These groups form our population of focus. The interventions we propose are to: 1) build youth suicide prevention capacity through regional training centers, 2) provide early identification/gatekeeper training for caregivers through these centers; 3) improve suicide risk assessments, management and treatment for providers using evidence-based practices; and 4) provide resiliency training for adolescents. Cultural competence will be built into each intervention. We will also focus on two other areas of need: military families and high-risk communities. To build youth resiliency and ensure cultural competency for military families, the Sources of Strength program will be delivered to Fort Drum-affiliated families in Jefferson and Lewis Counties and to the training center clinical staff. For high-risk communities with a recent rise in youth suicides or suicide attempts, Competent Communities/Schools training using the Lifelines curriculum will be delivered. This approach will effectively embed youth suicide prevention practices statewide through regional dissemination of evidence-based, best practice, culturally competent training. Through execution of this comprehensive youth suicide prevention program, we will serve an estimated 42,000 staff, children and families throughout the 3-year project period. The cry for help from youth at risk of suicide in our New York State communities is substantial. The proposed Youth Suicide Prevention program will help to save lives of these at-risk youth and thus improve the overall public health of New York State.

This proposal targets both the moderate level of community adolescent risk for suicide, and the more acute level of risk that obtains in juvenile justice populations. We outline both well-established school-based suicide prevention efforts (TeenScreen) as well as those directed at youth in juvenile community probation (Project Connect). With the guidance of an expert Advisory Board, and in a partnership with state and local probation and mental health authorities, Project Connect offers a 2-day gatekeeper training that considers information about adolescent disorder, treatment options, and ways to better engage families in the referral process and to better connect with local mental health providers. The TeenScreen and Project Connect activities presented in this proposal address 26 of the NYS Suicide Prevention Plan’s action steps/recommendations that address adolescents.

Eighty-eight probation officers in four NYS counties have undergone Project Connect’s 2-day Gatekeeper Training. Training resulted in significant improvements in a range of scores: an almost 20 percent increase in mental health knowledge and a four percent increase in perceived mental health competency. While training increased officers’ knowledge in general, it was particularly beneficial for those without prior mental health experience, raising their scores to the level of their more experienced counterparts.

We collected baseline data on 584 youth in the four participating counties. We found that only 15% were already in mental health or substance use treatment at case opening, but that a further 24% were newly identified during their probation department contact as having mental health or substance use needs. Probation practices that would ease linkage to mental health/substance use providers were not universal, even for identified youths. Of those identified, approximately two-thirds (68%) received a referral, although POs actually implemented referrals for only about one-third of identified youths. Factors significantly related to the odds of being new identified with mental health needs included being a repeat offender, having a PO with higher scores on a test of Mental Health Knowledge, and residing in a county that did NOT have a documented shortage in mental health professionals. Not all charts indicated a reason for the identification a youth’s mental health status. Mention of internalizing problems was rare, with fewer than 5% of charts noting a problem that might reflect either an anxiety or affective disorder.

The New Mexico Department of Health (DOH) proposes a Statewide Suicide Prevention Project (SSPP) with the goal of reducing the rates of attempted and completed suicide among the state youth.The proposed project expands youth suicide prevention by building statewide capacity in communities and schools to support populations who are at risk of suicide, with a specific emphasis on Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) youth.

The SSPP will enhance efforts of DOH and its partners to provide a continuum of universal, selected and indicated strategies to support NM strategic plan for suicide prevention. Primary partners include University of NM, Center for Rural and Community Behavioral Health, the NM Suicide Prevention Coalition, and the Santa Fe Mountain Center.? SSPP is grounded in evidence-based practices, builds on culturally competent strategies and revolves around intensive gatekeeper training, school and community environment improvement, and means restriction.

Gatekeeper and clinical training will focus on key groups that interact with youth: (1) educators and school health staff; (2) primary care and behavioral health providers, and (3) community stakeholders such as juvenile justice, foster care, social service and parents and family members.Training will use evidence-based practices such as Question, Persuade, Refer (QPR), selected training to address LGBTQ populations, a train the trainer component to build capacity and promote sustainability, and advanced clinical training for school nurses, primary care and behavioral health providers. This will include facilitated peer supervision, clinical behavioral health supervision and case consultation. Process objectives have been established for increasing the number and level of knowledge of individuals who are trained, including new trainers. Training will work toward outcome objectives for improving referral networks and data collection and sharing, with a specific target of improving outcomes for LGBTQ youth.

SSPP will work to improve school environments through implementation of (a) youth-led initiatives for peer support, membership and leadership using programs such as Natural Helpers, Native Hope and Rez Hope; (b) programs that focus on school climate and school safety such as Olweus Bullying Prevention Program and Safe School Ambassadors; and (c) Gay-Straight Alliances. Process objectives have been established to increase the number of schools and students participating in culturally appropriate prevention and intervention programs. Outcome objectives will measure improvement in school climate and reduction in stigma.

The SSPP will include means restriction awareness and education encouraging use of gun locks Means restriction will be incorporated in all gatekeeper training. Objectives have been established for increasing awareness and improved means restriction.

All SSPP activities contribute to student-centered outcome objectives for increasing the number of students screened, identified, referred and receiving services, including increased use of the National Suicide Prevention Lifeline. SSPP will feature formative and summative evaluation.

A public-private partnership led by the New Mexico Department of Health (NMDOH) proposes to implement and evaluate a comprehensive model for suicide prevention and early intervention that incorporates eight Universal, Selective, and Indicated strategies. The proposed Initiative will serve four diverse rural communities that have experienced a rash of youth suicides, reflecting the State’s disproportionate rate which is twice the national average.The proposed initiative has seven specific objectives. 1. Signs of Suicide (SOS): Train high school teachers and staff to provide the Signs of Suicide education program to serve 850 youth per year; 2. Train approximately 25 high school students from each community per year to implement this peer strategy; 3. Refer students and community youth of high school age (grades 9-12) and screen at least 680 youth per year; 4. Provide ongoing case management to at least 170 youth identified as at risk to link them with appropriate behavioral health and social services; 5. Offer bi-weekly case consultation, support for crisis intervention, and ongoing in-service training by replicating the effective ECHO model that is based on telehealth technology; 6. Develop a Crisis Response Plan in each school that incorporates training, education, ongoing support, and postvention plans; 7. Provide more intensive 2-day gatekeeper training to at least 4-5 teachers, other school staff, parents, community behavioral health providers, and community advocates from each of the four communitie

The New Jersey Youth Suicide Prevention Project (NJYSPP) targets youth between the ages of 10 and 24 who are at risk for suicide through a comprehensive initiative that trains gatekeepers and clinicians in suicide prevention and intervention, establishes school and community screening to identify at-risk youth, reaches youth directly via a social media campaign, and leverages positive peer messaging to change dangerous norms around codes of silence and stigma around help-seeking for suicide, mental health, and substance abuse.  Programs are embedded in an existing statewide infrastructure of community partnerships.  Advancing five of the 10 goals of the NJ State Youth Suicide Prevention Plan, the NJYSPP targets high-risk youth including LGBTQ youth, Latina adolescents, African American male youth, survivors of suicide loss, as well as youth in colleges and universities, the juvenile justice system, and out of home placements.

Using information from the New Jersey Violent Death Reporting System (NJVDRS), the six NJ counties with the highest incidence of completed suicides for ages 10-24 during the years 2007-2009 have been targeted for specific attention.  An integrated training approach using evidence-based and best practice programs includes the following components:  Connect Prevention/Intervention trains individuals to identify at-risk youth and link youth to services, with 1,425 individuals projected to be trained by the end of the third year; Connect Postvention will train at least 1,425 professionals by the end of the third year to provide an integrated community response in the aftermath of suicide, reduce risk of contagion and promote healing; and Assessing and Managing Suicide Risk trains clinicians in the core competencies necessary to work with suicidal clients, with at least 450 clinicians will be trained by the end of Year 3.  Trained trainers in these curricula will ensure sustainability.

To enhance gatekeeper training initiatives, NJ integrates Sources of Strength peer leader training to increase the number of youth receiving suicide prevention and strengths-based messaging, revers norms of silence, increase help-seeking and connect at-risk youth with trusted adults.  By Year 3, there will be 16 peer leader teams, 500 peer leaders, and 80 adult advisors.  The NJYSPP also includes implementation of the Teen Screen program in schools and primary care.  The goal is to increase the number of schools and physicians using Teen Screen and referring at-risk youth for services.  A total of 36 schools will implement teen screen by Year 3.  The last component is a statewide Social Media Campaign to develop a social media strategy using Facebook, Twitter, and blogs to reach a potential 1.6 million NJ youth with suicide prevention messaging, linkages to NJ suicide prevention programs and to encourage use of the NJ Second Floor Helpline and the National Suicide Prevention Lifeline.

The National Alliance on Mental Illness New Hampshire (NAMI NH) served as the recipient in Cohort VIII for the SAMSHA State and Tribal Youth Suicide Prevention Program grant to expand, develop and direct New Hampshire’s youth suicide prevention and early intervention strategy, targeting high risk young people between the ages of 10 and 24. High risk populations within this age group included LGBT, those with co-occurring disorders, youth and young adults in the criminal justice system, those with military experience, minority and refugee populations , young adults not enrolled in college, justice-involved young people, and youth and young adults who have had an inpatient psychiatric admission. 

Interventions focused on four target areas.:

1. NAMI NH partnered with NH Hospital (NHH), the state’s only inpatient psychiatric facility, to provide youth/young adults and their families with enhanced discharge planning and follow-up care coordination and support in order to reduce the risk of suicide, improve engagement in recovery activities and avoid readmission.

2. NAMI NH worked with Headrest, certified crisis call center for all National Suicide Prevention Lifeline (NSPL) calls originating in NH, to provide follow-up to callers age 24 and under to reduce risk and encourage engagement with treatment resources.

3. NAMI NH collaborated with 3 Regional Public Health Networks (RPHNs) to create community-based interventions to specifically target high risk youth, especially those who are not enrolled in college, substance users and members of minority or refugee communities. The 3 regions selected have the largest number of resettled refugees in NH and demonstrate significant substance abuse rates among their youth, as well as high suicide and suicidal ideation rates when compared to national averages.

4. NAMI NH interfaced with the NH Suicide Prevention Council and other suicide prevention initiatives to strengthen statewide capacity for addressing state and national goals for suicide prevention and intervention.

Project Goal: to reduce suicide incidents by increasing access to essential care and supports through a systemic approach to identified high risk youth.

This grant concluded on September 30, 2016. The following activities and accomplishments were among the results achieved through this three year grant:

1. An Aftercare Liaison position was established at the state psychiatric hospital to work closely with youth through the age of 24 who were admitted for suicide risk. This liaison worked closely with these individuals and their support system to provide psycho education around mental illness and suicide risk, engage them in safety planning, link them with NAMI and other resources,  and arrange for a smooth transition back into the community. Through a holistic, collaborative approach, the AfterCare Liaison could help to ensure a successful recovery after hospitalization for up to 90 days post discharge. Evaluation  and review of the project results indicate that there was a 20% reduction in readmissions for  clients in this program and several adverse incidents were averted. This liaison position has been retained as a permanent position with the hospital since the grant has expired and has served as a model for other hospitals around the country.

During the period of the grant NH Hospital also established a suicide prevention task force to look at implementing best practices throughout the hospital through a Zero Suicide approach. Included in their strategies was to bring the Connect Suicide Prevention training into the orientation program for all new Mental Health Workers at the hospital, expand on the use of safety plans for patients admitted for suicide risk, and include suicide prevention information in all discharge packets. The NH Hospital suicide prevention task force continues to meet monthly in an effort to continue comprehensive implementation of best practices throughout the facility.

2. Based on the Caring Contacts studies that show a decrease in suicide risk and increase in engagement in treatment, NAMI NH worked with Headrest, the certified crisis call center for all National Suicide Prevention Lifeline (NSPL) calls originating in NH, to provide follow-up to callers age 24 and under to reduce risk and encourage engagement with treatment resources. Call backs were made to youth 24 years old and younger, and any special demographics have been noted wherever possible (i.e. callers who are LGBTQ, in the military, have co-occurring disorders, are over 18 and not in college, or other high risk minority populations.  A computer program implemented during the grant period enabled Headrest and evaluators to get data that identified how many callers received a call back and track the location of calls and categories that callers identified with under the target areas of the grant. Headrest has made a commitment to continue to make callbacks as part of sustaining this effort beyond the grant.

3. NAMI NH partnered with 3 Regional Public Health Networks (RPHNs) to create community-based interventions to specifically target high risk youth, especially those who are not enrolled in college, substance users and members of minority or refugee communities.  The 3 regions selected have the largest number of resettled refugees in NH and demonstrate significant substance abuse rates among their youth, as well as high suicide and suicidal ideation rates when compared to national averages. These regions conducted extensive training and planning using the Connect model to implement best practices across their regions, with notable changes in both prevention and postvention approaches, including numerous schools and communities that now have comprehensive crisis response plans, adult and youth leadership training  and postvention preparedness including the development or expansion of survivor supports. Over 80 Connect trainers were trained in prevention and postvention during the grant period, providing training to hundreds of community members, police departments, colleges and schools, and several statewide CALM and AMSR trainings were also offered to dozens of providers throughout the state. Connect Youth Leaders were trained in schools in every region. Broad knowledge and use of best practices have been illustrated in a variety of ways, such as through educating and guiding the media around safe messaging and rapid mobilization of supports and resources in the aftermath of a tragic suicide.

4. NAMI NH continued to work with the NH Suicide Prevention Council (NH SPC) and other suicide prevention initiatives to strengthen statewide capacity for addressing state and national goals for suicide prevention and intervention.  To this end, active work with the NH Suicide Prevention Council and the Youth Suicide Prevention Assembly (YSPA) provided oversight on the state plan and targeted work through SPC subcommittees around work with the media across the state with consistent results; support of the NH Gun Shop Project initiatives including the development of suicide prevention video created by the NH Firearm Safety Coalition and an online CALM training for Emergency Medical Services; extending loss survivor supports statewide through support groups with expansion of groups to fourteen by the end of the grant period and numerous advocacy networks, International Survivor Of Suicide (ISOS) teleconference events, and active involvement of loss survivors in the suicide prevention conference, the NAMI NH WALK and the presence of TEAM SOS (Survivors of Suicide Loss) throughout NH; efforts to reach out to specialized high risk populations by training Connect trainers in the Bhutanese Refugee Community to deliver the Connect Training in Nepalese and in the Deaf and Hard of Hearing Community to conduct the Connect Suicide Prevention Training in sign language.

The grant helped to support the annual suicide prevention conference which each year was filled to capacity with a diverse cross section of participants.  Workshops and plenaries covered a wide variety of topics ranging from Zero Suicide to safe messaging, postvention, substance misuse and suicide, ethics and suicide, and wellness.

Overall infrastructure has been strengthened as noted by the many communities and schools who now consult with each other to implement best practices with guidance from GLS staff (vs. relying on GLS staff) , the strengthened network of loss survivors, trainers and regions who are prepared to take initiative around advocacy and education and/or respond at the time of a crisis in an appropriate and coordinated manner. Further evidence that a culture of best practices has been established has been noted by a fairly consistent way that media has been responsible in reporting on suicide and utilized some of the best practice approaches in their reporting styles as well as consultation with GLS staff and other suicide prevention experts in NH.

Specialized projects such as the NH Gun Shop Project have received national attention through articles in the US News and World Report and CNN: http://www.cnn.com/interactive/2014/12/us/cnn-guns-project/gun-shop-owner.html.  Many states have joined in to replicate or otherwise utilize the project across the U.S.

Connect Garrett Lee Smith (CGLS) strives to reduce suicide incidents by supporting the NH Suicide Prevention Council (SPC) to implement the State Plan and increase capacity on the individual, community and systems level for suicide prevention and postvention. CGLS improves access to mental health care through early intervention and referral, builds caring communities, clarifies service provider roles and responsibilities, changes attitudes and behaviors, and enhances skills.

Goal #1: Promote implementation of the State Plan by providing technical assistance and consultation to the SPC. CGLS will partner with SPC to: strengthen relationships across systems, educate policy leaders, and enhance awareness of cultural needs.
Goal #2: Establish a statewide environment that improves the understanding and response capacity of systems to high risk youth by educating, training, and reducing stigma related to mental health/substance use disorders. CGLS will train key service providers to address target populations including survivors, veterans/military, GLBT, Indians, substance-involved youth, foster care and attempt survivors by training 600 statewide leaders annually for a total of 1,800, utilizing the Best Practice programs of Connect, AMSR and CALM. CGLS will disseminate 7,000 media products annually for a total of 21,000 promoting help-seeking behavior and the National Suicide Prevention Lifeline.
Goal #3: Strengthen the ability of regional coalitions and key stakeholders to recognize youth at risk, provide an integrated culturally-competent response, and connect them to appropriate resources by implementing the Connect National Best Practice suicide prevention, early intervention and postvention program. The northernmost NH region is rural, isolated, economically depressed, with substance use and suicide rates that greatly exceed both the state and national averages. Working with regional coalitions and service providers to strengthen relationships to address the target populations, CGLS will train 600 participants annually for a total of 1,800 in the Connect model.
Goal #4: Improve the quality of NH’s suicide prevention, intervention and postvention activities by conducting local and cross site evaluation and enhancing the capacity of existing statewide data surveillance systems. CGLS will work with the SPC Data Committee to improve data collection, data analysis and reporting between systems so key decision makers can allocate resources based on objective information. Local and cross-site data will be used strategically to inform and improve project performance.
Goal #5: Promote sustainability of suicide prevention, intervention and postvention efforts in NH by implementing the NH State Plan. CGLS will: a) develop an educated leadership, b) strengthen public/private partnerships, c) expand help-seeking efforts through public education d) improve data monitoring and surveillance activities and e) improve public policy and statewide financial support. Evaluation guides all CGLS activities.

Nevada has continually had one of the ten highest youth suicide rates in the nation. A System of Care for Youth Suicide Prevention in Nevada supports, enhances and expands suicide prevention efforts with youth ages 10-24 in three regions of Nevada (Clark County, Washoe County and the Rural Counties) by implementing goals of the Nevada Suicide Prevention Plan and building on successes of current youth suicide prevention programs in Southern Nevada.

For 15 to 24 year old Nevadans, suicide is the second leading cause of death and the third leading cause of death for youth ages 10-14. The focus of this project, which is administered through the Nevada Office of Suicide Prevention, is to incorporate several existing suicide prevention efforts targeting the mental health issues of teens and their families into a comprehensive and collaborative system of care approach. The intention is to implement and expand the pilot project in Clark County into a more comprehensive and sustainable system of suicide prevention, disseminate information from the pilot project statewide, and implement a utilization-focused evaluation system to inform decision making and bring this public health crisis under control.

Nevada’s Youth Suicide Prevention Program utilizes the management and leadership of the following important groups: an Administrative Committee consisting of representatives from the Nevada Office of Suicide Prevention, various State agencies, the Statewide Behavior Health Consortium; and three locally driven and very active children’s mental health consortia consisting of parents, child welfare services, mental health professionals, school personnel and sub grantees. The Office of Suicide Prevention and local consortia will work together to build upon existing infrastructure where suicide prevention is a key component to achieve the following:

Goal I. Nevada will strengthen its comprehensive statewide Suicide Prevention Plan using a quality improvement process derived from lessons learned in prior suicide prevention efforts and continue to accomplish youth-focused goals that increase awareness that suicide is preventable and decrease suicidal behaviors.

Goal II. Nevada will improve local suicide prevention planning/services in its largest community (Clark County) while developing and implementing a local suicide prevention plan in its second largest community (Washoe County). In addition to Gatekeeper Training and screening, text messaging will be implemented as a unique method of increasing youth awareness and encouraging help-seeking behavior.

Goal III. Nevada will support stakeholders in at least two of Nevada’s rural communities and partner to develop, implement and evaluate local suicide prevention plans.

Goal IV. Nevada will continue to evaluate youth suicide prevention plan and programs to improve training, policy, and community collaboration.

The purpose of the Nebraska Youth Suicide Prevention Project is to prevent suicides and reduce the number of suicide attempts for youth ages 10-24. We will serve youth across the entire state of Nebraska with two populations of focus: Youth in K-12 Schools (ages 10-21) and Youth at high risk for behavioral health disorders (ages 10-24). The project promotes use of evidence based practices in suicide prevention for schools, clinical settings, and communities and will support web-based or in-person training for 28,055 gatekeepers and clinicians (5,611 annually); suicide risk screening for 5,706 at risk youth (1145 annually); postvention for 500 suicide survivors and attempters (100 annually); and outreach/awareness touching 1.4 million Nebraskans. System change will be promoted by working through Nebraska Department of Health and Human Services and Regional Behavioral Health Authorities to ensure youth suicide prevention becomes an expected component of service delivery and data collection. The State Suicide Prevention Coalition and Project Everlast (youth council) serve as advisory bodies to ensure activities are culturally appropriate for youth and Nebraska communities. The NDHHS, Division of Behavioral Health manages the award and coordinates outreach and awareness activities; the University of Nebraska Public Policy Center assists with program coordination and conducts the evaluation.

Goal #1. Prevent youth suicides in Nebraska

• 50% of licensed Nebraska clinicians are trained to assess, manage and treat youth at risk
• Increase # of at risk youth identified & referred who receive services
• Reduce the youth suicide rate by 50% in five years

Goal #2. Standardized screening protocols are in place for youth at risk for suicide in child serving systems

• 100% of K-12 public school personnel receive youth suicide prevention training
• Screening protocols are implemented by regional network providers serving youth with behavioral disorders
• Screening protocols are adopted by post-secondary settings (campuses, workforce development agencies, specialty services/schools)

Goal #3. Nebraska communities implement culturally appropriate suicide prevention strategies

• 75% of adults in Nebraska report general awareness of signs of suicide and the National Hotline
• Culturally appropriate suicide prevention strategies are supported in each of the six behavioral health regions in Nebraska
• LOSS postvention teams are available in each of the six behavioral health regions in Nebraska

Nebraska’s suicide rate for youth ages 10-24 exceeds the national rate and is the second leading cause of death for Nebraskans ages 15-19. The Nebraska Suicide Prevention Project will reduce youth suicide by promoting culturally appropriate, evidence based prevention practices statewide, focusing on youth at high risk for suicide: youth involved in multiple systems, minority youth and youth in transition to adulthood, including young returning veterans.

The Nebraska Department of Health and Human Services Division of Behavioral Health provides oversight for the grant. The University of Nebraska Public Policy Center and Interchurch Ministries of Nebraska and the Nebraska State Suicide Prevention Coalition are collaborating partners charged with carrying out grant activities and evaluating the project’s progress.

The project aims to increase general awareness of suicide as a preventable public health issue and to produce measurable decreases in Nebraska’s youth suicide rates through the provision of seed grants for local suicide prevention activities; training gatekeepers and clinicians to screen, recognize and act on signs of suicide; implementing screening for suicide with high risk youth; working with communities to support young returning veterans and military families in Nebraska; assisting the state’s trauma centers to implement means restriction protocols; and strengthening Nebraska’s public/private state suicide prevention coalition. Project activities are designed to support local, regional and state suicide prevention efforts to ensure suicide prevention is sustained in urban, rural and frontier areas of the state. The public/private State Suicide Prevention Coalition will serve as an advisory body for the grant’s project management team as it monitors progress toward reaching grant goals.