Grantee Types: Garrett Lee Smith State

Community Health Network Zero Suicides for Indiana Youth will prevent suicide attempts and deaths of Indiana youth ages 10-24. Healthcare and youth serving organizations will be trained to identify and refer at-risk youth. Crisis, telepsychiatry and intensive care coordination services will support over 600 primary care physicians, 11 emergency departments and 13 hospitals. Over 5,000 youth per year will receive evidence-based assessments and treatments.

The Indiana Division of Mental Health and Addiction designated Community Health Network as the lead entity because it has the most comprehensive youth services in the state and it was already working to become the 1st large health system in the country to fully implement the Zero Suicides model. The Zero Suicides for Indiana Youth project will leverage the best practice toolkit developed by the National Action Alliance for Suicide Prevention. Youth, families, survivors, youth serving organizations, policy makers, emergency departments, medical-surgical units, primary care, general medical providers, behavioral health entities and crisis services will:

• Promote systems-level change among youth-serving agencies and health care providers
• Improve the preparedness of youth-serving organizations (schools, foster care systems and juvenile justice programs) to identify risk and provide timely intervention and referrals
• Improve the preparedness of clinical service providers (primary and behavioral) to assess, manage, and treat youth at risk for suicide and provide timely intervention and referrals, while adopting an institution-wide cultural adoption of the Zero Suicides in Healthcare model
• Improve access to timely care for youth in suicidal crisis
• Strengthen care coordination and continuity of care for youth at risk of suicide
• Evaluate the impact of the project, disseminate lessons learned, and replicate the model

Zero Suicides for Indiana Youth is aligned with the 2012 National Strategy for Suicide Prevention. Suicide prevention resources will be provided to increase the number of persons in youth-serving organizations throughout the state trained to identify/refer youth at risk for suicide and to advertise the National Suicide Prevention Lifeline. It will increase the number of clinical service providers trained to assess, manage, and treat youth at risk for suicide. Continuity of care and follow-up of youth identified at risk for suicide discharged from emergency departments and inpatient psychiatric units will be improved. Outreach will engage youth at higher risk such as individuals who are homeless, ethnic minorities, in foster care, in the juvenile justice system and LGBTQ. Suicide is the second leading cause of death among 15-34 year olds and the third among 10-14 year olds. The CDCs 2011 Youth Risk Behavior Survey revealed that the percentage of Indiana students actually attempting suicide was the 2nd highest among the 43 states surveyed, demonstrating the critical need for Zero Suicides for Indiana Youth.

The Illinois Youth Suicide Prevention Project (IYSPP) supports the advancement of the Illinois Suicide Prevention Strategic Plan by building on the momentum of activities already occurring, improving cross-systems linkages to services and enhancing relationships to build networks of caring communities. The purposes of IYSPP are to:

• Enhance primary suicide prevention;
• Support local entities in the implementation of evidence based prevention;
• Increase linkage to prevention and treatment services for youth ages 10 to 24;
• Decrease risk factors for high school students;
• Increase protective factors for high school students; and
• Increase the degree of statewide support among specific stakeholder groups for sustained suicide prevention activities.

The statewide activities of the IYSPP are designed to increase the capacity to make system-wide changes.

Two strategic communication processes will be held to identify opportunities for system-wide changes:

First, a consensus process will be designed with the many systems that serve adolescents and youth. This cross-systems series of meetings will:

• Share what is known about the scope of youth suicide in Illinois,
• Identify strengths and gaps of current policies and practices,
• Solicit and integrate recommendations for system improvements, and
• Create linkages to strengthen the continuum of care

Second, a higher education system strategy process will be initiated to help college and university campuses build on the initiatives made by the Campus Security Task Force. This task force was organized after a shooting involving suicide, ended the lives of multiple people at Northern Illinois University in 2008. The goal is to duplicate the system strategy meeting format with other systems of care during years two and three of the grant.

The majority of the program funds will be utilized to implement an evidence-based program and to enhance linkages to services by providing awareness, evidence-based training and interventions, referrals and promotion of the National Suicide Prevention Lifeline. Approximately eight qualifying agencies will be chosen through a Request for Applications process. Priority will be given to agencies that successfully demonstrate they can implement these strategies within systems of care, focus high-risk populations and/or assist in linking centers to the National Suicide Prevention Lifeline Network.

Data and evaluation from each of the project activities will be utilized to build awareness and to further inform the implementation of the comprehensive Illinois Suicide Prevention Strategic Plan.

The goal of the Idaho Awareness to Action Youth Suicide Prevention Early Intervention Project (AAYSP) is to reduce suicides among Idaho youth ages 10-24 by implementing objectives from Idaho’s Suicide Prevention Plan. The goals include information dissemination, collaboration with prevention stakeholders, gatekeeper training, and data collection/evaluation. The Governor’s Council on Suicide Prevention provides input the project. Awareness to Action Academies help stakeholders learn how to put knowledge of suicide prevention in use.
Goal 1: Disseminate Evidence-Informed Practices, including an awareness campaign toolkit, Signs of Suicide (SOS) program, QPR and culturally appropriate practices.
Goal 2: Conduct Gatekeeper Training using Idaho’s nationally recognized gatekeeper training, Better Todayâ€‖s/Better Tomorrows, with trainees recruited from adult caregivers representing high risk groups, emergency services personnel and first responders, Indian tribes, Hispanics, Asian/Pacific Islanders, and Alaska Natives as well as LGBT groups, attempters, survivors, child welfare/foster care workers, juvenile justice, law enforcement, childcare, parents/grandparents, college campuses, and faculty/staff of Idaho’s 114 school districts.
Goal 3: Collaborate with the Governor’s Council on Suicide Prevention for guidance, input, and evaluation of project progress. Consult independently with specific cultural, high risk, and racial/ethnic groups not represented on the Council. Work with SPAN Idaho and others on evidence informed materials relevant to crisis workers, medical response and first responders, juvenile justice, childcare, foster care, sexual orientation, and previous attempters.
Goal 4: Conduct Awareness to Action Academy for a variety of stakeholders including general and mental health professionals suicide assessment and advocacy skills to lead Idaho from awareness of to a state where advocates and health professionals are leaders for action.
Goal 5: Participate in the cross-site evaluation and conduct local evaluations including quantitative and qualitative input from program participants, public, private, tribal, and family stakeholders to assess achieving project goals, objectives, outcomes, and processes. The local evaluation includes suicide risk and protective factors identification and model building
Project activities will result in sustainable products and services, such as supporting sustainable SOS activities in Idaho’s 114 school districts, creating a cadre of QPR trainers statewide, distributing a college workbook for suicide prevention among resident assistant housing staff, and developing suicide assessment and advocacy skills through assures consistency with state priorities and supports implementation through evidence-based practices.

In Hawaii there were 43 suicides among children aged 10 to 19 years from 2004 to 2008, making suicide the 2nd leading cause of death for this age group, after car crashes.  Hawaii, through the Hawaii State Department of Health (DOH), Injury Prevention and Control Program (IPCP), is using funds from the $1.5 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to train people who have direct contact with youth –gatekeepers – to recognize the signs of suicide and to intervene. The goal is to reduce suicides and suicide attempts among youth.

Hawaii’s project – called the Hawaii Gatekeeper Training Initiative (HGTI) – focuses on suicide intervention training for people in three agencies that already impact significant numbers of youth ages 10-24 years in both school and community settings. These agencies and their programs are the Department of Education (PEER Education Program and School-based Behavioral Health), the Department of Health (Alcohol and Drug Abuse Division – agencies contracted to provide drug and alcohol treatment services for youth), and the Honolulu Police Department (Emergency Psychological Services/Jail Diversion Program).

HGTI is accomplishing these goals using three training curricula: Applied Suicide Intervention Skills Training (ASIST) with adult populations, SafeTALK with police officers, and Signs of Suicide (SOS) with youth populations. Implementing suicide intervention training using these curricula and focusing on these target populations will allow HGTI to enhance state level infrastructure for youth suicide prevention efforts and enhance youth suicide prevention efforts.

Hawaii’s Caring Communities Initiative

Under the Hawaii’s Caring Communities Initiative, Hawaii will implement two strategic projects entitled “Mobilizing Communities At Risk” and “Enhancing the Statewide Trauma Network”, using the rubric of the evidence-based Communities that Care. With the goal of preventing youth suicide and increasing early intervention, these projects will positively impact at-risk communities, as well as the statewide suicide crisis infrastructure in Hawaii. Research indicates that at-risk communities in Hawaii include Native Hawaiian communities and rural communities. This Initiative will have a ripple effect on communities throughout Hawaii as public awareness on suicide prevention will be enhanced, more at-risk youth will be identified and referred, and more families will be empowered to prevent future attempts. This Initiative aligns with the State strategic goals for suicide prevention and builds upon previous efforts of the Hawaii Gatekeeper Training Initiative.

• Communities that Care is a universal, community-wide, evidence-based prevention system. It employs a public health model of preventing poor outcomes by helping communities set the foundation for introducing interventions, and by reducing risk factors and increasing protective factors. It has been proven to make a difference in promoting positive youth development by effectively addressing issues that youth in a specific community face, thereby increasing the effectiveness of selected interventions.
• Mobilizing Communities At Risk – A local pilot project using a youth and community mobilization model to engage youth in suicide prevention advocacy demonstrated promising results. Hawaii will expand on this strategy through youth-serving organizations by linking the Connect Suicide Prevention Program endorsed by the National Registry of Best Practices, with community mobilization. This project will increase public awareness and community-based support for youth suicide prevention, and expand gatekeeper training in at-risk communities. Thirty youth leaders per year will receive advocacy training and work with their peers and community partners to conduct public awareness campaigns and promote the suicide hotline, reaching 18,000 community members each year, including youth and their families.
• Enhancing the Statewide Trauma Network – Community emergency departments in the Statewide Trauma System provide a new avenue for training gatekeepers who have far too frequent contact with youth who are suicidal or have made suicide attempts. This project focuses on improving access to care and reducing mental health disparities in rural communities by training every emergency department manager in Connect who would then train 500 other healthcare professionals in their respective facilities to provide intervention for 100 youth per year as well as consult with parents and family members to better support youth who are at risk for suicide and to prevent future attempts.

Suicide is the 5th leading cause of death on Guam; an approximate one suicide death every two weeks occurring predominantly among males, who outnumber suicide deaths among females with a ratio of 9:1.  Suicide deaths disaggregated by age predominate among youth and young adults aged 10-29 on Guam.   Cumulatively in the past eleven years (from 2000 to 2010), 20% of suicide deaths occurred in those aged 10-19, and 38% of deaths happened among those aged 20-29 years.  Altogether, close to 60% of all suicide deaths on Guam from 2000-2010 occurred in those younger than age 30.  

In October 2008, Guam was awarded a GLSMA Youth Suicide Prevention grant targeting individuals primarily between the ages of 10-24 years. Guam’s Focus on Life accomplishments to date include:
a) an improved surveillance and centralized monitoring and reporting system for capturing data on suicide attempts and deaths, as well as other intentional self-harming;
b) stronger public, private and community-based partnerships in the development of culturally relevant suicide prevention resources, training, early intervention, post-vention and referrals for treatment services that are responsive to the community’s identified needs;
c) expansion of Guam’s 24-Hour Crisis Hotline services to include a Youth Helpline component managed by trained youth volunteers;
d) established pool of locally-based ASIST (Applied Suicide Intervention Skills Training) and safeTALK trainers who advocate for effective, evidence-based suicide prevention policies, programs, and practices among Guam’s key stakeholders; and

e) a Program Evaluation Logic Model that makes sense for evaluating program effectiveness in reducing suicide rates and attempts on Guam, resulting in healthier, resilient community members.

Governor of Guam Edward J.B. Calvo and Lt. Governor Raymond S. Tenorio issued Executive Order No. 2011-03, demonstrating their commitment to sustain PEACE and Focus on Life initiatives that strengthen Guams capacity to create a healthier island community.  Following a strategic prevention framework process, culturally relevant, evidence-based programs, practices and policies that are data-driven and build upon the strengths and resources of the people of Guam will be implemented. Appointed members of the Governors PEACE Council and Guams SEOW will actively facilitate the accomplishments of identified policy and program goals and objectives to ensure that targeted priorities are based on current data and that evidence of effectiveness is collected and used in decision-making processes.The Council and SEOW represent children, youth and family services agencies.

Guam endures a disturbingly high rate of suicide among its youth and adult population; close to 60% of all suicide deaths on Guam occur among those 30 years and younger. Cumulatively from 2000 to 2010, 21% of suicide deaths occurred in those aged 10-19, and 38% of deaths happened among those aged 20-29 years. Suicide is the fifth leading cause of death on Guam with approximately one suicide death every two weeks. Guams Focus on Life-Suicide Prevention and Early Intervention State Plan has been endorsed by Governor Calvo. Utilizing SAMHSA Strategic Prevention Framework 5-steps process and lessons learned from the PEACE (Prevention Education and Community Empowerment) Project experience. Data-driven, community-based approaches were utilized to ensure that youths, their families and communities at risk for suicide were served, particularly in the area of community outreach and education, and skills training among youth, parents, educators and youth services providers to identify and make the necessary referrals for treatment.

Guam Focus on Life will not only be to strengthen what has been accomplished within the recent three years, but to take action to build and expand suicide prevention and early intervention services that are aligned with the goals of this State/Tribal Youth Suicide Prevention Cooperative Agreement. Guam State Strategic Prevention Plan for prevention and training follows a public health approach that focuses on identifying the patterns of behaviors of a group of population and aims at changing the environment to increase protective factors and reduce risks. Several measures have been taken in this regard: Establishing a surveillance system, identifying risk and protective factors, implementing prevention and early intervention programs and services that are effective on Guam, and evaluating what works and/or could be improved upon

The Georgia Youth Suicide Prevention Project is building upon existing state suicide prevention efforts to extend suicide prevention/early intervention services to at-risk youth and their families. The project blends statewide prevention awareness and gatekeeper training, coalition support, peer leadership development, enhanced gatekeeper training in middle and high schools and advanced training for crisis workers, hospital staff and diverse youth-serving agencies in five target counties.

To build and expand existing statewide capacity, the project is conducting basic youth suicide prevention training among youth-serving agencies, organizations and professional groups, establishing an active youth subcommittee within the Suicide Prevention Coalition of Georgia, and developing a statewide strategy for youth suicide prevention.

The project is working in five target counties to support local suicide prevention coalition development and expand or enhance linkages among a network of mental health, substance abuse, juvenile justice and youth serving agencies and educators. It is working with local communities to implement an enhanced gatekeeper training tested in Cobb County Schools that combines Question, Persuade and Refer (QPR) training for adult school staff and the Sources of Strength program to develop peer leaders that reflect a school’s diversity and encourage positive relationships between youth and trusted adults. We are offering training in Counseling on Access to Lethal Means (CALM), Assessing and Managing Suicide Risk (AMSR) for clinical professionals and Working With Those Bereaved by Suicide in the Professional Setting: Postvention Strategies. Trainings are being focused on the five target counties but open to professionals from communities throughout the state.

The project is conducting QPR gatekeeper training for state and local youth-serving agencies and professional organizations to (1) raise awareness and build support for youth suicide prevention; (2) provide support for the school-based enhanced gatekeeper training program; and (3) ensure that those who regularly come into contact with youth (i.e., those in education, child welfare/foster care, juvenile justice, law enforcement, etc.) are properly trained to effectively identify, respond and facilitate linkages for youth who are at-risk for suicide.

We are assisting Emory University in its efforts to collect campus-wide data on at-risk students in its undergraduate and graduate programs. We participated in the state-wide Suicide Prevention College Conference where suicide prevention teams from 29 of Georgia’s institutions of higher education gathered to share information about their suicide prevention efforts and hear recommendations from experts in the field. We are also adding five colleges to our group of programs with Sources of Strength teams.