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
Why Zero Suicide? Suicide and Health Care Settings 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. Source: http://www.ncbi.nlm.nih.gov/pubmed/12042175
Suicide and Public Mental Health Settings 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.
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 of 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- oriented culture committed to dramatically reducing suicide among people under care. • Includes suicide attempt and loss survivors as part of their leadership and planning: o Survivor Panel of People with Lived Experiences at Zero Suicide Implementation Training o Inclusion of Suicide Loss and Attempt survivors in Policy Making at state & local level o 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 Assessmen t Suicide Pathway to Safer Follow Up Care Care Evidence Based Care
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 State: • Coordinated state leadership • Guiding state strategic plan • Statewide public awareness • Statewide technical assistance Community: • Local coalitions • Regional summits Suicide • Gatekeeper training Safe Care • Coordinated care and referral Center 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 o • ZS Tools for Workforce: ZS Brochure o Toolkit o Newsletter o Apps o Endorsement Process o Logic Model o ZS Academy/ Suicide Safe Care Implementation Training o Learning Collaborative Calls o
Workforce Survey Results “I have the support/supervision I need to engage and • assist those with suicidal desire and/or intent.” 100.00% 80.00% 60.00% 2012 40.00% 2014 20.00% 0.00% Agree Don't Know Disagree Resulted in a statistically significant increase in those that • agreed with this statement following ASIST training.
Workforce Survey Results “I have received the training I need to engage and • assist those with suicidal desire and/or intent” 100.00% 80.00% 60.00% 2012 2014 40.00% 20.00% 0.00% Agree Don't Know Disagree Resulted in a statistically significant increase in those that • agreed with this statement following ASIST training.
Workforce Training # Trained # of Trainings FACE to FACE TRAINING Collaborative Assessment 219 complete Management of Suicidality CAMS 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 K-12 Higher Ed INTERNET TRAINING 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 o • Sites get to share success and challenges with each other Lessons learned o Problem solving o Troubleshooting o
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 o • 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 o ASIST and SafeTALK o Safety Planning Intervention o Counseling on Access to Lethal Means (with first responders) o 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 on Team Re Test Employ Tool (It worked! (Workforce Skill Increase, Survey) better care System Review Data Intervention (We need to (Train 100% train staff) staff )
Priorities for Next Year • Expansion of learning collaborative – 12 new organizations • Continued support and development of initial organizations • 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
Progress Towards a Zero Suicide State Cohort 1 Austin Travis County Integral Care Lead Pilot Site Bluebonnet Trails Community Center Border Region MHMR Coastal Plains MHMR ZEST Cohort 1 Denton County MHMR Hill Country Community Center ZEST Cohort 2 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
Zero Suicide Denton County MHMR Tammy Weppelman, LPC-S Administrator of Crisis Services
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