Zero Suicide in Texas BHC Panel, Sept 2015 Jenna Heise, MA, NCC, - - PowerPoint PPT Presentation

Zero Suicide in Texas BHC Panel, Sept 2015

Jenna Heise, MA, NCC, MC-DMT (DSHS) Erica Shapiro, Ph.D.TIEMH, University of Texas Tammy Weppelman, LPC-S (Denton Co MHMR) Brian Hoppe, LPC-S (Tarrant Co MHMR) Holly Borell (Tropical Texas BH Center)

Texas Suicide Safe Care: Zero Suicides in Texas (ZEST)

Creating a statewide comprehensive suicide safe care system

• 45% of people who died by suicide had contact with

primary care providers in the month before death. Among older adults, it’s 78%.

• 19% of people who died by suicide had contact with

mental health services in the month before death.

• South Carolina: 10% of people who died by suicide

were seen in an emergency department in the two months before death.

Why Zero Suicide? Suicide and Health Care Settings

Source: http://www.ncbi.nlm.nih.gov/pubmed/12042175

• Ohio: Between 2007-2011, 20.2% of people who died

from suicide were seen in the public behavioral health system within 2 years of death.

• New York: In 2012 there were 226 suicide deaths among

consumers of public mental health services, accounting for 13% of all suicide deaths in the state.

• Vermont: In 2013, 20.4% of the people who died from

suicide had at least one service from state-funded mental health or substance abuse treatment agencies within 1 year of death.

• Texas: In 2013 there were 248 suicide deaths among

consumers of public mental health services, accounting for 8.1% of all suicides in Texas.

Suicide and Public Mental Health Settings

2012 National Strategy for Suicide Prevention:

GOALS AND OBJECTIVES FOR ACTION

A report of the U.S. Surgeon General

and of the National Action Alliance for Suicide Prevention GOAL 8: Promote suicide prevention as a core component

• f health care services.

GOAL 9: Promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors.

Goals of Zero Suicide in Texas

• Goal 1: Reduce suicides among those aged 10-24
• Goal 2: Focus on enhancements to the public

mental health system to improve service delivery to those with serious emotional disturbances and persistent mental illness

Leadership & Survivors Suicide Safe Care Centers

• Create a leadership driven, safety-
• riented culture committed to

dramatically reducing suicide among people under care.

• Includes suicide attempt and loss

survivors as part of their leadership and planning:

• Survivor Panel of People with Lived Experiences at Zero

Suicide Implementation Training

• Inclusion of Suicide Loss and Attempt survivors in Policy

Making at state & local level

• Support Groups for Survivors of Suicide Attempts

What is Zero Suicide in Texas?

• Zero Suicide is a commitment to suicide prevention

in health and behavioral health care systems. It is a leadership-driven, safety-oriented culture that commits to dramatically reducing suicide among people under care.

Essentials of Zero Suicide Texas

Suicide Safer Care

Assessment

Pathway to Care

Evidence Based Care Follow Up

WITHOUT IMPROVED SUICIDE CARE, PEOPLE SLIP THROUGH GAPS

THE TOOLS OF ZERO SUICIDE FILL THE GAPS

Zero Suicide Texas: Suicide Safe Care Sites

• Best practices model including prevention, assessment, treatment,

and postvention guidelines.

• Goal of having agencies statewide adhere to this model.

Texas Suicide Safe Care Model

Suicide Safe Care Center State:

• Coordinated state leadership
• Guiding state strategic plan
• Statewide public awareness
• Statewide technical assistance

Community:

• Local coalitions
• Regional summits
• Gatekeeper training
• Coordinated care and referral

Behavioral Health System:

• Zero Suicide culture
• Evidence-based screening

and assessment

• Pathways to care
• Competent workforce
• Effective interventions
• Supportive policies

ZEST Toolkit for Suicide Safe Care Centers

Workforce Development Strategies

• Fidelity, training with experts, “Train the Trainer”

model, web-based and in person training

• Coaching calls with national experts for

participating sites about zero suicide strategies

• C-SSRS, Safety Planning, CAMS, ASIST/SafeTALK, CALM, CBT-SP
• ZS Tools for Workforce:
• ZS Brochure
• Toolkit
• Newsletter
• Apps
• Endorsement Process
• Logic Model
• ZS Academy/ Suicide Safe Care Implementation Training
• Learning Collaborative Calls

Workforce Survey Results

• “I have the support/supervision I need to engage and

assist those with suicidal desire and/or intent.”

• Resulted in a statistically significant increase in those that

agreed with this statement following ASIST training.

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% Agree Don't Know Disagree 2012 2014

Workforce Survey Results

• “I have received the training I need to engage and

assist those with suicidal desire and/or intent”

• Resulted in a statistically significant increase in those that

agreed with this statement following ASIST training.

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% Agree Don't Know Disagree 2012 2014

Workforce Training

FACE to FACE TRAINING

# Trained

# of Trainings Collaborative Assessment Management of Suicidality CAMS 219 complete 374 enrolled 9 centers ASK TOT 70 3 summer 2015 ASIST Train the Trainer 120 6 since 2012 CSSR-S (Only Denton reporting) 42 1 CALM 99 2 summer 2015 Safety Planning Training 42 1 Spring 2015

INTERNET TRAINING

K-12 Higher Ed

Kognito-At Risk Total Trained 14993 821

Learning Collaborative Interactive Webinars

• Held on a monthly basis with 11 participating sites
• Expanded to 22 sites total for FY 2016
• Focus on a specific zero suicide topic (e.g., risk

assessment, safety planning, six month check in)

• Tends to correspond with specific toolkit chapter
• Sites get to share success and challenges with each
• ther
• Lessons learned
• Problem solving
• Troubleshooting

Achievements

• Leadership & Organization: Many have created

leadership teams focused on suicide prevention

• Workforce Competency: Trainings in ASIST, Safety

Planning Intervention (SPI),CAMS, ASK TOT, CALM, SafeTALK TOT, ASIST TOT Summer 2015

• Suicide Screening: Many have implemented the C-

SSRS into their organizations

• Some working to imbed this measure into their electronic medical record
• Safety Planning: Many attended training with

expert, Dr. Barbara Stanley and are implementing this best practice intervention organization wide

• Improved Continuity of Care Transitions with

partners like Eds, hospitals & other providers

ZEST Accomplishments

• Conducted two regional summits
• Created a learning community with 11 mental health agencies

and our early adopter (Denton County MHMR)

• Developed a Texas Zero Suicide toolkit
• Developed a website and monthly newsletter
• Provided Train-the-Trainer workshops on best practices:
• ASK about Suicide to Save a Life
• ASIST and SafeTALK
• Safety Planning Intervention
• Counseling on Access to Lethal Means (with first responders)
• National Breakthrough Series on Zero Suicide
• Completed initial crosswalk of Vital Statistics and DSHS data
• Conducted in person workshop supporting learning community
• Completed Year Two of 3 year SAMHSA funded Youth Suicide

Prevention grant: First in the nation to focus on Zero Suicide

Zero Suicide: National Outcomes Centerstone

Zero Suicide: National Outcomes Centerstone

Zero Suicide Texas: Outcomes

• Data driven quality improvement

Implementati

• n Team

Employ Tool (Workforce Survey) Review Data (We need to train staff) System Intervention (Train 100% staff) Re Test (It worked! Skill Increase, better care

Priorities for Next Year

• Expansion of learning collaborative – 12 new
• rganizations
• Continued support and development of initial
• rganizations
• Efforts to embed changes in state and local policy
• Training in CBT for Suicide Prevention
• Strengthening data and QI efforts
• Expanding partnerships in communities
• Develop Endorsement Process
• CANS/ ANSA C-SSRS screener statewide

Follow Us: #ZeroSuicide @StopTXSuicides #txsp15

Resource: Zero Suicide

• Zero Suicide Toolkit https:/sites.utexas.edu/zest
• Website: www.zerosuicide.com

Lead Pilot Site ZEST Cohort 1 ZEST Cohort 2

Cohort 1 Austin Travis County Integral Care Bluebonnet Trails Community Center Border Region MHMR Coastal Plains MHMR Denton County MHMR Hill Country Community Center MHMRA of Harris County MHMR of Tarrant County Spindletop Center Tri-County Services Tropical Texas Behavioral Health Cohort 2 Andrews Center Behavioral Health Center of Nueces Betty Hardwick Center Center for Life Resources Gulf Bend Center Heart of Texas Region MHMR Helen Farabee Center MHMRA of Brazos Valley Texas Panhandle Centers Pecan Valley Centers StarCare Lubbock Texana Center

Progress Towards a Zero Suicide State

Zero Suicide Denton County MHMR

Tammy Weppelman, LPC-S Administrator of Crisis Services

Why ZS in Denton?

• How important is it?
• We joined the effort 2 years ago after hearing the statement, “if zero isn’t

the right number what is?”

• We believe that having the training and the best practices in place

Center wide help us to better serve our highest risk clients and our community.

• Since making ASIST available to all employees in 2012, we have had many

staff previously not formally trained in suicide safe care tell us they have intervened in the lives of loved ones or community members because of the training they have received.

Zero Suicides in Denton Co MHMR

• What have you

accomplished?

• CSSRS, CASE approach and

Barbara Stanley Safety Plan for every risk of harm assessment

• CAMS implemented for crisis

treatment during LOC 5

• CSSRS training and CAMS

training for case managers in LOC 1-4. Implementation to come.

• CALM training for all mental

health providers

• Implementation of attempt

survivors group

• Signed suicide safe care policy
• How did you

implement it?

• First key implementation piece

is having leadership on board.

• We implemented the majority
• f the best practices first in the

crisis setting then rolled them

• ut to our regular services once

crisis was able to figure them

• ut.
• We focused on one best

practice at a time, getting it imbedded in our system before moving on to another piece.

Zero Suicide Texas Outcomes: Denton County

• 548 screening were completed using the CSSR-S in 2014
• 47.4% Female
• Mean age 19
• 61.3% 18 and over

CSSR-S 27%- Active Suicidal Ideation with Specific Plan and Intent 51.5% - Suicidal thoughts with intent to act in past 30 days 31.6% - Had at least one suicidal behavior present over the past 90 days.

Zero Suicide Texas Outcomes: Denton County

10 20 30 40 50 60 70 80 90 100 2009 2010 2011 2012 2013 2014

Deaths by Suicide Denton County 2009-2014

Grant began

10 20 30 40 50 60 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14

Cumulative Total of Deaths by Suicide: 2014 in Denton County

County Served by LMHA w/in 12 mos

Denton Next Steps

• In FY 2016 we will be implementing a LOSS team to

strengthen our postvention efforts .

• We will be implementing more of the best practices

fully into our loc 1-4.

• We will be completing the training for our debriefing

teams and making sure they are fully implemented.

Zero Suicide Tropical Texas Behavioral Health Center

Holly Borel Chief Operating Officer

Why ZS for Tropical Texas BH Center?

• How important is it?
• Even the loss of one life by suicide is too many

with the resources and services available today

• Why did you apply, why continue?
• Aligns with our Mission
• Closely aligned with existing activities & efforts
• Increase in suicide deaths in the Valley
• Staff are passionate about the project
• If the LMHA doesn’t make it a priority, who will?

Zero Suicides

• What have you

accomplished?

• 100% of staff trained in ASIST
• Mental Health Officers trained

in ASIST

• More than 800 educators and

community members trained in Mental Health First Aid

• Integrated the Columbia

Suicide Rating Scale into Crisis Screening forms in EHR

• LPHAs trained in (Counseling on

Access to Lethal Means) CALM

• Safety Plans completed with all

clients

• Participation in suicide

awareness events such as Out

• f the Darkness walk
• How did you

implement it?

• Project team established
• Team lead identified
• Regular meetings of project

team

• Regular conference calls

with ZEST partners

• Barriers overcome?
• Lack of time in our

schedules

• Need to keep paperwork

and assessment process streamlined

Tropical

• Development of Local Outreach to Suicide Survivors

(LOSS) Team

• Gaining access to suicide data for catchment area

& tracking over time

• Educating schools on effective postvention
• Integrate Columbia Suicide Severity into intake

process/forms

• Consideration of a suicide high risk level of care or

specialized caseloads

Zero Suicide Tarrant County MHMR

Brian Hoppe, LPC-S, Clinical Director Crisis Services and Mark Ware, Director of Crisis Services

Why ZS for Tarrant County MHMR?

• How important is it?

As a community we need to become more proactive rather than reactive to suicides and mental health. Using best practice models will help mental health professionals better understand their assessments and how to help their clients.

• Why did you apply, why continue?

We applied to learn more about ZS and to implement this practice in our agency. The progress that we have made with the C-SSRS has helped staff clearly define when a client is suicidal and at risk. We still have more work to do and data to track to help serve our clients to the best of

• ur ability.

Tarrant County MHMR Breakthrough Series

• National Pilot with National Council, SPRC, DSHS
• Opportunity to work with international experts and

partner with 6 states on pilot series

• Trained in best practices and evidence based

methods

• Accountability provided through data metrics.

Tarrant County

• Next Steps/ Goals for this year
• Implement CAMS as treatment modality
• Extend ZS practices to all aspects of Crisis Services
• During the next year implement ZS agency wide
• Increase in Lethality Assessments after implementing of

C-SSRS

• June 17 Lethality Assessments
• July 46 Lethality Assessments
• August 68 Lethality Assessments
• AFSP Grant application

Q & A

• Thank you! Jenna, Erica, Tammy, Holly, Brian, Marc