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

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

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 o C-SSRS, Safety Planning, CAMS, ASIST/SafeTALK, CALM, CBT-SP

• ZS Tools for Workforce: o 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

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) o Tends to correspond with specific toolkit chapter

• Sites get to share success and challenges with each

other o Lessons learned

o Problem solving

o 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 o 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: o 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)

• 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

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

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

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?

o We joined the effort 2 years ago after hearing the statement, “if zero isn’t

the right number what is?”

o 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.

o 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? o CSSRS, CASE approach and

Barbara Stanley Safety Plan for every risk of harm assessment

o CAMS implemented for crisis treatment during LOC 5

o CSSRS training and CAMS training for case managers in LOC 1-4. Implementation to come.

o CALM training for all mental health providers

o Implementation of attempt survivors group

o Signed suicide safe care policy

• How did you

implement it? o First key implementation piece

is having leadership on board.

o We implemented the majority

of the best practices first in the

crisis setting then rolled them

out to our regular services once

crisis was able to figure them

out.

o 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

0

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

0

10

20

30

40

50

60

Jan

-14

Feb

-14

Mar

-14

Ap

r-14

May

-14

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

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? o Even the loss of one life by suicide is too many

with the resources and services available today

• Why did you apply, why continue? o Aligns with our Mission

o Closely aligned with existing activities & efforts

o Increase in suicide deaths in the Valley

o Staff are passionate about the project

o If the LMHA doesn’t make it a priority, who will?

Zero Suicides • What have you

accomplished? o 100% of staff trained in ASIST

o Mental Health Officers trained in ASIST

o More than 800 educators and community members trained in Mental Health First Aid

o Integrated the Columbia Suicide Rating Scale into Crisis Screening forms in EHR

o LPHAs trained in (Counseling on Access to Lethal Means) CALM

o Safety Plans completed with all clients

o Participation in suicide awareness events such as Out of the Darkness walk

• How did you implement it? o Project team established

o Team lead identified

o Regular meetings of project team

o Regular conference calls with ZEST partners

• Barriers overcome? o Lack of time in our

schedules

o 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 our 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