1. Instituting Zero Suicide through DBHDD’s Garrett Lee Smith Youth Suicide Prevention Project Part 1
Tiffany Chen
Nakia Valentine
Office of Behavioral Health Prevention
Division of Behavioral Health
Georgia Department Of Behavioral Health and Developmental Disabilities
Georgia School of Addiction Studies Conference
August 28, 2017

2. OBHP Suicide Prevention Team
Tiffany Chen
Suicide Prevention Specialist
Sally Vander Straeten
Suicide Prevention Coordinator
Nakia Valentine
Garrett Lee Smith Grant Director

3. Part 1: Presentation (10:45 a.m.-noon)
Agenda
Part 1: Presentation (10:45 a.m.-noon)
Data
Zero Suicide
Garrett Lee Smith (GLS) Youth Suicide Prevention Grant
Zero Suicide & System of Care in GLS Implementation
Part 2: Panel (3:15-4:30p.m.)
Trainings
System of Care (Peer Specialists, Collaborations, Coalitions)
Expansion
Exercise: Applying Zero Suicide

4. Suicide Data: Georgia Youth & Young Adults, Ages 10-24
Sources:
National Violent Death Reporting System (NVDRS)
2. CDC WISQARS
3. Georgia Online Analytical Statistical Information System (OASIS)
4. Georgia Student Health Survey II

5. Suicide Deaths by Age All ages Youth, ages 10-24 Youth, ages 10-17
12.2% of all suicide deaths
Youth, ages 10-17
102 deaths,
23.0% of youth ages 10-24
2.8% of all suicide deaths
Youth, ages 18-24
342 deaths,
77.0% of youth ages 10-24
9.4% of all suicide deaths
Potential suicide deaths ages 0-9 suppressed, as children may not be able to understand or express suicidal intent & consequences
Source: NVDRS, Georgia,

6. Suicide as a Leading Cause of Death: 2012-2014, Age Breakdown
Source: CDC WISQARS, Georgia,

7. Suicide Deaths & Breakdown by Sex
Ages 10-17
102 deaths, 2012 to 2014
29 deaths in 2012
41 deaths in 2013
32 deaths in 2014
Sex, 2012 to 2014
80 Male (78.4%)
22 Female (21.6%)
Ages 18-24
342 deaths, 2012 to 2014
97 deaths in 2012
123 deaths in 2013
122 deaths in 2014
293 Male (85.7%)
49 Female (14.3%)
Source: NVDRS, Georgia,

8. Suicide Deaths by Race * <10 individuals
Source: NVDRS, Georgia,
* <10 individuals

9. Suicide Deaths by Method/Means
Firearms
Firearms
“Studies that compare states with high and low gun ownership levels find that where there are more guns, there are more suicides.”
Though high gun ownership states (WY, SD, AK, WV, MT, AR, MS, ID, ND, AL, KY, WI, LA TN, UT) don’t include Georgia, Georgia is typically more pro-gun than the low gun ownership states (HI, MA, RI, NJ, CT, NY)
Correlation between more guns and more suicides
Firearms used in youth suicide usually belong to a parent
90% of attempters who survive do NOT go on to die by suicide later
Crisis triggering suicide attempts  little planning, but the more lethal the means, the more likely the a suicide death
5-17
Nationally
0.89 per 100,000 used firearms
2.27 per 100,000 all mechanisms
0.89 / 2.27 = 39.2%
Georgia
0.85 per 100,000 used firearms
1.69 per 100,000 all mechanisms
0.85 / 1.69 = 50.3%
Source: NVDRS, Georgia,
* <10 individuals

10. Suicide Deaths vs. Death Rates, Ages 10-17 by County 2013-2015
Source: Georgia Department of Public Health OASIS,

11. Suicide Deaths v. Death Rates, Ages 18-24 by County 2013-2015
Source: Georgia Department of Public Health OASIS,

12. Georgia Student Health Survey II 2015-2016
Anonymous, self-reported responses from youth grades 6-12, collected annually
57,677 students reported seriously considering attempting suicide during the past 12 months, representing 8.7% of all students who responded
27,014 students reported attempting suicide at least once in the past 12 months, representing 4.1% of all students who responded
4,731 students reported attempting suicide more than 5 times in the past 12 months, representing 0.7% of all students who responded
146,889 students reported that they disagreed with the statement “I know an adult at school that I can talk with if I need help,” representing 22.1% of all students who responded
Grades 6-12 = ages 10-18
Breakdown by grade (both thoughts & attempts) – peaks at 8th grade through 10th grade
GASPS data warehouse data visualization
Breakdown by # of attempts – 17.5% of those who attempted suicide at all attempted more than 5 times
Source: Georgia Student Health Survey II:

13. Georgia Youth Grades 6-12, 2013-2016
Measures
587,043
629,648
2015-
2016
663,797 # %
Seriously considered attempting suicide during past 12 months
54,859
9.3%
58,372
57,677
8.7%
Attempting suicide at least once in past 12 months
31,346
5.3%
27,985
4.4%
27,014
4.1%
Attempting suicide more than 5 times in past 12 months --
4,905
0.8%
4,731
0.7%
Disagreed with statement, “I know an adult at school that I can talk with if I need help.”
152,820
26.0%
149,597
23.8%
146,889
22.1%
Increase in # students answering survey (more students at schools?)
Note change in survey from 2014 school year to 2015 school year – different questions
Decrease in average % of measures across the state
Self-reported, only in-school youth (no dropouts)
Source: Georgia Student Health Survey II,

14. 2. A specific set of strategies and tools
Zero Suicide Suicide deaths for people under care are preventable: a bold goal & an aspirational challenge
A commitment to suicide prevention in health & behavioral health care systems
2. A specific set of strategies and tools
zerosuicide.sprc.org

15. Zero Suicide System-wide Approach
Broader community engagement
Suicide attempt survivors
Family members
Policymakers
Researchers
Clinicians
Preventing suicidal individuals from falling through the cracks

16. Henry Ford Health System, Michigan
Quality improvement for issues like inpatient falls & medication errors
Applied to mental & behavioral health care
Perfect Depression Care Model with suicide prevention as explicit goal
80% reduction in suicide rate among health plan members

17. Essential Elements of Suicide Care
Lead
Train
Identify
Engage
Treat
Transition
Improve
Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include survivors of suicide attempts and suicide loss in leadership and planning roles.
Develop a competent, confident, and caring workforce.
Systematically identify & assess suicide risk among people receiving care.
Ensure that every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means.
Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors.
Provide continuous contact & support, especially after acute care.
Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.

18. Setting Big Goals
“It is critically important to design for zero even when it may not be theoretically possible. When you design for zero, you surface different ideas and approaches that if you’re only designing for 90 percent may not materialize. It’s about purposefully aiming for a higher level of performance.” --Thomas Priselac, President & CEO of Cedars-Sinai Medical Center

19. Garrett Lee Smith Youth Suicide Prevention Grant
Substance Abuse and Mental Health Services Administration (SAMHSA)
5-year Federal grant supporting suicide prevention work with youth ages in campus, state, or tribal communities
Cohort X:
September 1, 2015 –
September 29, 2020

20. GLS Goals
Develop, implement, and monitor effective programs that promote wellness and prevent suicide related behaviors
Provide training to 3,500 community and clinical service providers on prevention of suicide and related behaviors
Promote suicide prevention as a core component of health-related behaviors
Promote and implement effective clinical and professional practices for assessing and treating 1,500 youth identified as being at risk for suicidal behaviors
Provide care and support to individuals affected by suicide deaths and attempts to promote healing and implement community strategies to help prevent further suicides

21. GLS Outcomes DECREASE Among youth ages 10-24, GLS aims to:
# suicide deaths
Rate of suicide deaths
# non-fatal suicide attempts
Rate of non-fatal suicide attempts
Among youth ages 10-24, GLS aims to:

22. “Georgia Suicide Safer Communities for Youth”
Focuses on youth ages years old living in Bartow, Newton, and Oconee counties in Georgia
Community Service Boards
Colleges & Universities
Builds infrastructure and increases the suicide-specific continuum of care through training, outreach, and implementation of evidence-based practices
Aims to serve 5,000 youth and their families over the life of the 5-year project

23. Georgia College & University Suicide Prevention Coalition & Conference
30+ institutions of higher education, including technical, public, and private colleges & universities
1 of 5 college & university coalitions in the U.S.
Jacqueline Awe, College Coalition Chairperson
Conference
Annual
September 18-20, 2017
Offers additional training opportunities, assessment, data collection, and evaluation for the college coalition

24. GLS Trainings Dialectical Behavior Therapy (DBT) Training
Didi Hirsch Suicide Attempter’s Survivor’s Group Train the Trainer
Attachment Based Family Therapy (ABFT) Training
Question, Persuade, Refer (QPR)
Cognitive Behavioral Therapy- Suicide Prevention (CBT-SP)
Collaborative Assessment and Management of Suicidology (CAMS)
Counseling on Access to Lethal Means (CALM)

25. GLS Zero Suicide Academies
June 15-16: Highland Rivers Health
July 19-20: ViewPoint Health
August 22-23: Advantage Behavioral Health
Training for health & behavioral health care organizations in using the Zero Suicide framework to reduce suicide among their consumers
Participants learn how to incorporate best & promising practices in improving processes, care, and safety for patients at risk
Interactive presentations, small group sessions, organization-specific action planning

26. Suicide Prevention Coalitions
Highland Rivers Health
Gordon Co. Suicide Prevention Coalition
Bartow Co. Coalition in the planning stages
Advantage Behavioral Health
Oconee Co. Coalition in the planning stages now
View Point Health
Newton/Rockdale Suicide Prevention Coalition
Gwinnett Co. Suicide Prevention Coalition

27. GLS Expansion
Since the grant was written, the number of youth suicides have decreased in the 3 original counties that were identified
The youth suicide numbers in the counties surrounding the 3 original counties have increased
Due to the increase in numbers, GLS has decided to expand into the surrounding counties, which the 3 GLS agencies also cover
The expansion will begin in October 2017, Year 3 of the grant

28. Family GLS and System of Care Schools Child Welfare Juvenile Justice
Primary Care
Emergency Care
Public Behavioral Health Providers
Private Behavioral Health Providers

29. Logic Model RESOURCES Community Transition to Suicide Care
SHORT TERM GOALS
System of Care
ACTIVITIES
LONG TERM GOALS
1. Increase in suicide prevention
activities within the community
and within the organizations
who make up the community
system of care. P
Schools and
Colleges
Outreach
Child Welfare
ALL YOUTH who are
at-risk for suicide have
access to care and are
able to have their
treatment needs met
in their community.
Coalition
Building
Increase in individuals in the
community and community system
of care who understand that help is
available in the community and how
to access that care.
Juvenile Justice/ Jails F A M I L Y F A M I L Y
Primary Care
Suicide Prevention Activities
Emergency Care
Increase in identification
and referral systems within
organizations in the community
system of care.
Public Behavioral Health Provider
Gatekeeper
Training
4. Increase number of youth ages 10 to
24 referred to GLS behavioral health
care site (Advantage, HR, VP)
Private Behavioral Health Providers
Identification
And Referral
Systems
Care Transition to Community Behavioral Health Provider

30. Logic Model SUICIDE CARE in Behavioral Health Providers Recovery Focus
All youth and family receive and use Safety Plan
Interv.
(SPI)
SUICIDE CARE
Peer Support
Strength Based Activities
CAMS Framework
CBT for Suicide
DBT
Suicide Attempters Group
Safety Plan Intervention
Suicide
Risk
Formulation
AMSR
All youth
Receive
ANSA/CANS
Further
Assess As
Indicated
All youth screened using C-SSRS
Treatment
Plan with
Suicide Care
Services on Continuum of Care
Monitoring and Follow-up D
Short-Term Goal
Short-Term Goal
Youth receive suicide care as needed
Long-Term Goal
Decrease in suicide ideation and behavior in youth
DBHDD Policy gets at-risk youth securely into care
Long-Term Goal
Increase in youth who receive full course of treatment
meeting their treatment needs

31. Logic Model
Care Transitions for Youth in Crisis and Hospitalized Youth
High-Risk Crisis Transition
ACTIVITIES
Short-Term Goals
Long-Term Goals
Increase in youth
identified as high-risk
for suicide in high-risk
transition situations
Emergency Department
Identification of high-risk youth
Decrease in suicide
ideation and behavior
In youth who have been
in high-risk transition
BHL/Crisis Teams
DJJ Locked
Warm handoff to
GLS Team
Increase in youth and
families in high risk transition
who have behavioral health
support for at least 4 months
after the transition
Alcohol/Drug Inpatient
Increase in family
feelings of competence
and support while
dealing with youth in
high-risk transition
Screening, Assessment and Suicide Care
Jails
Increase in youth who are
treated in behavioral health
after high risk crisis transition
BH Hospitals and CSUs
Care Transition to Community Behavioral Health Provider
Build Community Integration and Sources of Strength
Increase in community
connections, coping skills
and sources of strength for
youth and families
Care Transition to Community System of Care

32. Resources
Suicide Prevention Resource Center (SPRC)
GLS Grantees
Georgia Crisis and Access Line (GCAL)

33. Panel: Garrett Lee Smith Supervisors on Implementing Zero Suicide Part 2
Olive Aneno
Noelle Beard
Larry Evans Jr.
Office of Behavioral Health Prevention
Division of Behavioral Health
Georgia Department Of Behavioral Health and Developmental Disabilities
Georgia School of Addiction Studies
August 28, 2017

34. Zero Suicide Coordinators
Olive Aneno
Advantage Behavioral Health (Oconee)
Noelle Beard
Highland Rivers Health (Bartow)
Larry Evans, Jr.
ViewPoint Health (Newton)
They are responsible for training staff and community in QPR and educating about Zero Suicide and what GLS is doing. They are responsible for screening youth who may need suicide care. They are responsible for linking the youth, if screened positive to suicide care. Other things include trainings, work with their coalitions, work with their colleges and universities in their area, and promote wellness.

35. Experiences with GLS Trainings
Dialectical Behavior Therapy (DBT)
Didi Hirsch Suicide Attempter’s Survivor’s Group Train the Trainer
Attachment-Based Family Therapy (ABFT)
Question, Persuade, Refer (QPR)
Cognitive Behavioral Therapy - Suicide Prevention (CBT-SP)
Collaborative Assessment and Management of Suicidology (CAMS)
Counseling on Access to Lethal Means (CALM)

36. Experiences with Zero Suicide Academy
Highland Rivers (Noelle Beard)
June 15-16
ViewPoint Health (Larry Evans, Jr.)
July 19-20
Advantage Behavioral Health (Olive Aneno)
August 22-23

37. How does System of Care apply to your work?
Zero Suicide
Broader community engagement
Suicide attempt survivors
Family members
Policymakers
Researchers
Clinicians
Family
Schools
Child Welfare
Juvenile Justice
Primary Care
Emergency Care
Public Behavioral Health Providers
Private Behavioral Health Providers

38. Peer Specialists
Integrates the voice of lived experience into ongoing suicide prevention efforts
Andrea loveless, highland rivers health (bartow)
Cheronne Moore, Advantage behavioral health (Oconee)
Tbd, viewpoint health (newton)

39. Newton: Project AWARE, Sources of Strength Georgia Highlands College
Collaborations
Newton: Project AWARE, Sources of Strength
Oconee:
Apex, EPIC
Bartow:
Georgia Highlands College

40. Suicide Prevention Coalitions
Highland Rivers Health
Gordon Co. Suicide Prevention Coalition
Bartow Co. Coalition in the planning stages
Advantage Behavioral Health
Oconee Co. Coalition in the planning stages now
View Point Health
Newton/Rockdale Suicide Prevention Coalition
Gwinnett Co. Suicide Prevention Coalition

41. GLS Expansion
Process
Preparation
Expectations

42. Brainstorm using the 7 essential elements of suicide care
Exercise:
How can Zero Suicide be applied in your organizations or communities to prevent suicide?
Brainstorm using the 7 essential elements of suicide care

43. Recap: Essential Elements of Suicide Care
Lead
Train
Identify
Engage
Treat
Transition
Improve
Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include survivors of suicide attempts and suicide loss in leadership and planning roles.
Develop a competent, confident, and caring workforce.
Systematically identify & assess suicide risk among people receiving care.
Ensure that every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means.
Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors.
Provide continuous contact & support, especially after acute care.
Apply a data-driven quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.

44. Next Steps
Zero Suicide Toolkit online for more knowledge and understanding
Create a 5-10 member Zero Suicide Implementation Team to lead the initiative
Zero Suicide Organizational Self-Study sheets
Zero Suicide Work Plan Template sheets

45. Resources
Suicide Prevention Resource Center (SPRC)
GLS Grantees
Georgia Crisis and Access Line (GCAL)