Community Change Project:Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent County, MichiganFerris State UniversityNURS 340 Community Nursing

Mariah LabBrandi MillerMaia NovakKimberly ReedBrandon Zolynsky

Problem Overview

In the United States, 38,364 people died from suicide in 2010 Suicide deaths outnumbered the 33,687 deaths caused by

motor vehicle crashes Suicide rates among middle-aged people are rising Suicide is the 10th leading cause of death An estimated 11 attempted suicides occur per every suicide

death Suicide is preventable

CDC, 2013NIH, n.d.

Statistics

2004-2008 2009 45-64 yr olds 2004-2008

45-64 yr olds 2009

0

5

10

15

20

25

Kent CountyMichigan

(Rate is per 100,000 population)

Kent County Working Together for a Healthier Tomorrow, 2011

Use of the Ecological Model to Classify the Factors Contributing to Suicide

Macrocultural

• Stigma• Ethnic factors• Religious

factors

Exosystem

• Socioeconomic status

• Economy• Legal problems• Feeling

unaccepted• Media

coverage of suicide

Microsystem

• Family history of suicide

• Divorce• Losing custody

of child(ren)• Loved one

being victimized

• Bullying• Access to guns

Ontogenic

• Depression• Other mental

disorders• Age• Unemployed• Personal loss• Victim• Previous

suicide attempt

Kent County Working Together for a Healthier Tomorrow, 2011Caruso, n.d.American Foundation for Suicide Prevention, 2013

Affected Population Kent county residents (including all ages, sex, and race)

*Most at-risk individuals include men and women ages 45-64 years*

Weaknesses of affected group Unemployed Mentally ill and in a lower socioeconomic class Stigmatized Ethnic and religious factors

Strengths of the affected group Community resources and community improvement focus groups

Network 180 Goals and interventions to assist at-risk individuals

Kent County Working Together for a Healthier Tomorrow, 2011

Barriers to Change Lack of resources Lack of accessibility to health care Lack of support Negative association with mental illness High public school drop-out rates

Grand Rapids Public Schools, 2011Kelly, Jorm, & Wright, 2007Kent County Working Together for a Healthier Tomorrow, 2011Rickwood, Deane, Wilson, & Ciarrochi, 2005

Community Resources

Pine Rest, 2013Network 180, 2013

Pine Rest Treats all aspects of a person’s well-being Provides a number of different services and programs

Prevention Groups, Community Living Support, Crisis Residential Placements, In-Home Services, Multi-Systemic Therapy, Respite Care, Residential Care, Outpatient Therapy, Psychiatric Hospitalization, Trauma Focused Cognitive Behavioral Therapy

Network 180 Coordinates the community mental health response, including:

Assertive Community Treatment, Case Management, Community Living Supports, Community Placement, Consumer-Run Services, Crisis Intervention, Crisis Residential Services, Enhanced Mental Health Services, Housing Assistance, Kent County Correctional Facility, Nursing Facility Mental Health Monitoring, Outpatient Services, Recovery Academy

Community Nursing DiagnosisRisk of suicide among residents of Kent County, Michigan, related to untreated or undertreated: Depression Other mental health disorders Co-occurring health problems

As demonstrated by the following indicators: More than 90% of the people who die by suicide in Kent County have one of

these risk factors Increasing suicide rate Almost 8% of students report they have attempted suicide during the past 12

months Prevalence of mental health disorders

Kent County Working Together for a Healthier Tomorrow, 2011Muecke, 1984

Intervention Options

Cincinnati Children’s Hospital Medical Center, 2013Magellan of Arizona, 2013

Arizona Programmatic Suicide Deterrent System Oversees system of care for more than 20,000 people Partnered with the Arizona Department of Health Services Division of

Behavioral Health Services Comprehensive national model

Surviving the Teens Provides information, resources, and support Division of Psychiatry at Cincinnati Children’s Hospital Medical Center

ASIST Overview Applied Suicide Intervention Skills Training (ASIST) Two-day workshop designed to help community members become more

willing, ready and able to help persons at risk for suicide Objectives based on five learning sections:

Preparing

Connecting

Understanding

Assisting

Networking

Participants receive several learning tools

Lang, Ramsay, Tanney, & Kinzel, 2010

Social Support Behavior Change Model

Instrumental Assistance Providing transportation to mental health appointments

Providing a safe environment for problem solving

Informational Support Teaching about mental health and community resources

Emotional Support Calling and checking-in on at-risk individuals

Sponsoring individuals in substance abuse programs

Appraising Support Providing an unbiased view of perceived problems and available solutions

Harkness & DeMarco, 2012

Implementation TeamWhat community resources will be needed? Trainers, organizers, facilities, equipment and materials Human resources needed:

• Health department staff, regional trainers, and logistic personnel

• Trainers will attend a five-day training course • Training cost: $2,750 per person plus travel expenses

• Class size: 24 individuals per 2 trainers

What community human resources are available? Volunteers and health department staff

Lang, Ramsay, Tanney, & Kinzel, 2010

Needed ResourcesFacilities Health department, hospitals, public schools, colleges and universities

Equipment Multimedia projection system and screen DVD player Chalkboard Flip chart

Materials Program materials Incidental materials

Lang, Ramsay, Tanney, & Kinzel, 2010

Community Relevance

Top Strategic Issues from the Kent County Community Needs Assessment: Equal access to high quality, affordable

health care A coordinated system of care that is

local, preventative, holistic, and patient-centered

An environment that supports healthy living for all

Kent County Working Together for a Healthier Tomorrow, 2011

Direct Outcomes

Reduce the suicide rate in Kent County to be at or below the level in Michigan (from 12 to 11.7) by 2018

Reduce the suicide rate among 45-64 year olds in Kent County to be at or below the level in Michigan (from 21.2 to 17.2) by 2018

Reduce the suicide rate in Kent County to 10.2 by 2020 in accordance with the Healthy People 2020 objectives

HHS, 2013Kent County Working Together for a Healthier Tomorrow, 2011

(Rates are per 100,000 population)

Indirect Outcomes

HealingAnd

Working!!!

Kent County Working Together for a Healthier Tomorrow, 2011

Lowered rates of substance abuse Reduced rates of other mental health disorders Decreased unemployment Better grades

Process OutcomesASIST Process Outcomes Participant Satisfaction

Good use of time High quality Long-lasting effects

Knowledge and Attitude Increased knowledge about suicide,

prevention, warning signs, and intervention methods

Skills Improved intervention skills

Behavior Change Increased intervention behavior

Outcome Measures Seminar Evaluations

At seminar completion

One year following seminar completion

Monitor Attendance and Seminar Utilization

Coordinate with Network 180

Rodgers, 2010

Structural Outcomes Structural outcomes are geared toward measuring accessibility and utilization

of resources

Eventual Desired Outcomes Integration of ASIST program into major health care systems Sustainability of the ASIST program within Kent County Two additional inpatient treatment facilities in Kent County Subsidiary of Network 180 devoted to suicide prevention

Measures Suicide rate trends Utilization of treatment facilities Number of ASIST training attendees

Conclusion

Suicide is 100% Preventable

Kent County Working Together for a Healthier Tomorrow, 2011Lang, Ramsay, Tanney, & Kinzel, 2010

ReferencesAmerican Foundation for Suicide Prevention. (2013). Risk factors and warning signs. Retrieved from http://www.afsp.org/understanding-suicide/risk-

factors-and-warning-signs Caruso, K. (n.d.). Suicide.org. Retrieved from http://www.suicide.org/ Centers for Disease Control and Prevention [CDC]. (2013). CDC finds suicide rates among middle-aged adults increased from 1999-2010. Retrieved from

http://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html Cincinnati Children’s Hospital Medical Center. (2013). Surviving the teens/suicide prevention. Retrieved from

http://www.cincinnatichildrens.org/service/s/surviving-teens/default/ Evans, R. E., & Price, S. (2013). Exploring organisational influences on the implementation of gatekeeper training: a qualitative study of the Applied

Suicide Intervention Skills Training (ASIST) programme in Wales. Critical Public Health, 23, 213-224. doi:10.1080/09581596.2012.752069 Forest View Hospital. (n.d.). Mental health care with compassion and respect. Retrieved from http://www.forestviewhospital.com/ Grand Rapids Public Schools. (2011). Strategic plan 2011. Retrieved from http://www.grps.org/images/about%20grps/pdfs/grpsStrategicPlan.pdf Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins. Isaac, M., Elias, B., Katz, L. Y., Belik, S., Deane, F. P., Enns, M. W., …, & The Swampy Cree Suicide Prevention Team (12 members). (2009). Gatekeeper

training as a preventative intervention for suicide: a systematic review. Canadian Journal of Psychiatry, 54, 260-268.

ReferencesKelly, C. M., Jorm, A. F., & Wright, A. (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Medical Journal

of Australia, 187(7), S26-S30. Kent County Working Together for a Healthier Tomorrow. (2011). Kent County 2011 community health needs assessment and health profile. Retrieved from

http://www.kentcountychna.org/ Klimes-Dougan, B., Klingbeil, D. A., & Meller, S. J. (2013). The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of

youths. Crisis, 34, 82-97. doi: 10.1027/0227-5910/a000178 Lang, W. A., Ramsay, R. F., Tanney, B. L, & Kinzel, T. (2010). ASIST organizer guide. Fayetteville, NC: LivingWorks. Magellan of Arizona. (2013). Suicide prevention. Retrieved from http://magellanofaz.com/programs/suicide-prevention.aspx Mental Health Foundation of West Michigan. (n.d.). Education. Retrieved from http://www.themhf.org/education/education_links Muecke, M. A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1, 23-25. National Institutes of Health [NIH]. (n.d.). Suicide in the U.S.: statistics and prevention. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-

in-the-us-statistics-and-prevention/index.shtml Network 180. (2013). Services. Retrieved from http://network180.org/en/mental-illness/programs Pine Rest. (2013). Our services. Retrieved from http://www.pinerest.org/philosphy-care#sthash.2j728dbp.dpuf

Rickwood, D., Deane, F. P., Wilson, C. J., Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Advances in Mental Health, 4, 218-251. doi: 10.5172/jamh.4.3.218