1. Zero Suicide in Texas (ZEST) Zero Suicide in Texas (ZEST) Collaborative Call: May 2016 DSHS: DSHS: Jenna Heise TIEMH: TIEMH: Molly Lopez Erica Shapiro

2. REMINDERS  CBT-SP Training Next Week in Dallas!  If your attendees have not completed the pre-conference survey, please have them do so  CAMS Online Training  If you have not yet submitted your list of learners for your organization, please send to me as soon as possible  Statewide Suicide Symposium  August 2-4, 2016 in San Marcos, Texas  Safety Planning Intervention  Save the date: September 22, 2016 in Austin, TX

3. LESSONS FROM CAMS  69% of respondents report using no-harm contracts, which is not considered best practice.

4. PATHWAY TO CARE Goal: Individuals assessed to be at risk will receive care in accordance with the Suicide Safe Care Pathway. Agencies will use quality management tools to monitor adherence to the Suicide Safe Care Pathway guidelines.

5. RATIONALE Support shared decision making between providers and individuals in care Support shared decision making between providers and individuals in care Promotes best practices during high-risk periods Promotes best practices during high-risk periods Individuals on the Suicide Safe Care Pathway deserve a level of care/monitoring reflective of the importance of individual safety to the health care system Individuals on the Suicide Safe Care Pathway deserve a level of care/monitoring reflective of the importance of individual safety to the health care system Intended to describe best practices for individuals at risk for suicide who will be monitored or treated in a community setting.

6. ORGANIZATION OF THE PATHWAY Presented as two flowcharts: Presented as two flowcharts: One targets individuals identified at risk who are not yet engaged in community-based care One targets individuals identified at risk who are not yet engaged in community-based care One targets those individuals within care who are identified at-risk. One targets those individuals within care who are identified at-risk. Reflect standards for continued monitoring, on-going safety planning, treatment planning, and frequency of contact Reflect standards for continued monitoring, on-going safety planning, treatment planning, and frequency of contact

7. SUICIDE RISK IDENTIFIED AT CRISIS CONTACT OR INTAKE Risk Assessment Conducted Safety Plan Developed (same day) Counseling on Access to Lethal Means (with Family/consumer check-in on same day) Reassess with C-SSRS at every contact 2 C-SSRS at low risk Engaged in Care through Community (3 visits or more) Eligible for LMHA Services? Referral to Community Face-to-face or phone contact every 3 days Review safety plan at every contact Consider referral for peer support Serve through SP 0 Intake appointment within 24 hours Serve through SP 5 Consider referral for CAMS Caring Follow-Up Contacts YES OR EXIT THE SUICIDE SAFE CARE PATHWAY ENTER THE SUICIDE SAFE CARE PATHWAY Psychiatric assessment within 7 days Consider the following service/support referrals: Peer support; Attempt survivor group CAMS; CBT-SP; ACT; Wraparound Refer to Engaged in Care Pathway AND Elevated Screen

8. Suicide Risk Identified at While Engaged in Care Risk Assessment Conducted Safety Plan Developed (same day) Counseling on Access to Lethal Means (with Family/consumer check-in on same day) Reassess with C-SSRS at every contact Fewer than 2 crisis contacts in last 2 months 2 consecutive C-SSRS at low risk Moderate: Face-to- face contact every 7 days Review safety plan at every contact (consider limiting medications) EXIT THE SUICIDE SAFE CARE PATHWAY ENTER THE SUICIDE SAFE CARE PATHWAY Consider the following treatment referrals: CAMS CBT-SP DBT AND Consider the following care management referrals: ACT Wraparound Consider the following support referrals: Peer support Attempt survivor group No recent hospital discharge in last 3 months AND High: Face-to-face contact every 3 days Missed Appointment: Same day contact; enact protocol if unable to assure safety Elevated Screen

9. EDUCATION ABOUT THE SUICIDE SAFE CARE PATHWAY Individuals (and caring others) should be educated about the Suicide Safe Care Pathway when they are placed on it Should be informed that providers will want to stay in regular contact with the individual If they miss an appointment unexpectedly, the provider will try to reach them that day Individuals should be encouraged to check in with the provider proactively if they will miss an appointment Providers should gather several emergency contacts who are likely to know where the individual is if the provider is unable to contact the individual directly

10. QUALITY MANAGEMENT Measuring “fidelity” to the pathway Measuring “fidelity” to the pathway Staff supervisors and program managers monitor Staff supervisors and program managers monitor Consider reasons for lack of adherence Consider reasons for lack of adherence Knowledge Knowledge Time Time Programmatic support Programmatic support Productivity standards Productivity standards

11. Examples of Quality Management Indicators Possible Indicators: Percent of individuals correctly identified for Pathway (unless electronic) Percent of individuals with same day safety plan at Pathway entry Percent of individuals receiving counseling on access to lethal means on same day as Pathway entry Percent of contacts with documented C-SSRS Percent of contacts with review of safety plan Percent of individuals in Crisis Services with contact every 3 days Percent of individuals maintained on Pathway until engaged in care (3 visits) or assessed at low risk For individuals referred to LMHA services, percentage of times initial appointment is within 24 hours of referral For moderate risk, percent of individuals with contact every 7 days For high risk, percent of individuals with contact every 3 days Hours to contact after missed appointment Percent of individuals re-engaged in care after missed appointment

12. ZEST GROUPS & MEETING DATES Wednesdays, 2pm CST Fridays, 9am CST Pecan ValleyAndrews Center Gulf Bend CenterHeart of Texas Center for Life Resources Nueces County Texana CenterTri-County Services Betty Hardwick CenterHarris County participants Helen Farabee Center Brazos Valley Star Care Lubbock Month Wednesdays, 2pm CST Fridays, 9am CST November Nov 18 h Nov 20 th December No Call January (2016) Jan 27 th Jan 29 th February Feb 24 th Feb 26 th March Mar 23 rd Mar 25 th April Apr 27 th Apr 29 th May May 25 th May 27 th June Jun 22 nd Jun 24 th July Jul 27 th Jul 29 th August Aug 24 th Aug 26 th