A SUMMARY OF SAMHSA (SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION) SUICIDE PREVENTION GRANT OUTCOMES: PA s Projected Contributions and

Transcription

1 A SUMMARY OF SAMHSA (SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION) SUICIDE PREVENTION GRANT OUTCOMES: PA s Projected Contributions and Products

2 Objectives At the conclusion of this session, participants should be able to: 1. Discuss the key components of a comprehensive school suicide prevention program. 2. Describe the aims of Pennsylvania s current SAMHSA grant focusing on schools and suicide prevention efforts. 3. Identify and locate resources for schools and communities affiliated with SAMHSA grants.

3 Suicide Prevention in USA: A Brief History 1999 Surgeon General declares suicide a public health threat Each state charged with formulating a comprehensive across the life span plan 2011 National Prevention Strategy outlined nation s plan for promoting health & wellness 2012 National Action Strategy for Suicide Prevention released four strategic directions joint efforts of Surgeon General & National Action Alliance for Suicide Prevention

4 Four Strategic Directions for Suicide Prevention: 1. Create supportive environments 2. Enhance clinical and community preventative services 3. Promote availability of treatment and supportive services in a timely manner 4. Improve suicide prevention surveillance collection, research and evaluation

5 2014 Action Alliance Released Safe and Effective Suicide Messaging Guidelines : Strategy Who is the audience? What is the intended outcome? How will it be measured? Safety Does content and delivery follow best practice guidelines Positive Narrative Are hope, recovery and resources/support emphasized? Reporting on suicide research and best practice guidelines at 5

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7 Background: Garrett Lee Smith (GLS) Grants GLS Memorial Act was signed into law in 2004 allotting 27 million dollars to grantees funded by SAMHSA since 2005 Funding made available to states, tribes, and college campuses to implement youth suicide prevention activities targeting ages Since 2014 over 180 grants have been issued to 49 states and over 48 tribal communities; Over 140 campus grants have been issues but they were not included in the GLS evaluation studies looking at the impact of GLS activities on the impact of suicide mortality and attempts

8 Background: Garrett Lee Smith (GLS) Grants cont. GLS program activities have included (Garraza et al., 2015): education and mental health awareness programs gatekeeper training screening enhanced partnerships and linkages to services programs for survivors of suicide crisis hotlines GLS programs are intended to be comprehensive and multifaceted

9 FIGURE 1 Model of the comprehensive, community-based Garrett Lee Smith Memorial Suicide Prevention Program (Walrath et al., 2015).

10 SPRC (Suicide Prevention Resource Center) Offers Technical Support to GLS Grantees:

11 SUMMARY OF GLS YOUTH SUICIDE PREVENTION PROGRAMS: THEIR IMPACT ON SUICIDE MORTALITY AND SUICIDE ATTEMPTS American Journal of Public Health. 2015; 105 (5): JAMA Psychiatry. 2015; 72 (11):

12 Findings and Limitations: Lower mortality rates were associated with more gatekeepers trained; effects were more significant for mortality in the age range than Decreased attempt rates were reported in range; no data available for younger range. For both suicide deaths and suicide attempters the impact of the GLS prevention program did not appear to last a year after implementation of the program. Speaks to the need for sustained and diverse suicide prevention efforts and measures other than self-reports for suicide attempters.

13 REFER TO PREVENTING SUICIDE : A TOOLKIT FOR HIGH SCHOOLS Download your free copy at :

14 SPRC AND RESOURCES FOR COLLEGES AND UNIVERSITIES 14

15 Six Steps to Comprehensive Suicide Prevention in Schools Identification & Response Protocols Staff Education & Specialized Training & Response Postvention Student Education & Advocacy Parent Education Screening SAMHSA, 2012

16 Six Steps to Comprehensive Suicide Prevention in Schools (SAMHSA) 1. Protocols for helping students at risk of suicide, including:»»a protocol for helping students who may be at risk of suicide»»a protocol for responding to students who attempt suicide at school»»agreements with community providers to provide behavioral health services to students

17 Working with Students At-Risk for Suicide Immediate evaluation Every PA County must have a emergency services system. Call 211 Parents are notified and asked to come and take the child to evaluation If student refuses, parent can do a 201 If parent and student refuses and child is in imminent danger, conduct a 302 Work with solicitor for best practice on transporting students to hospital or on a case by case basis

18 Six Steps to Comprehensive Suicide Prevention in Schools 2. Protocols for responding to suicide death (Postvention), including:»»steps to take after the suicide of a student or other member of the school community»»staff responsible for taking these steps»»agreements with community partners to help in the event of a suicide

19 Readiness & Postvention Checklists Maine Youth Suicide Prevention Guide, pages 4-10 and 47: w%20discl.pdf STAR Center Postvention Manual pages

20 Six Steps to Comprehensive Suicide Prevention in Schools 3. Staff education and training, including:»»information about the importance of suicide prevention for all staff»»training, for all staff, on recognizing and responding to students who may be at risk of suicide.»»training, for appropriate staff, on assessing, referring, and following up with students identified as at risk of suicide.

21 Free Examples of Teacher Training AFSP (American Foundation Suicide Prevention) More Than Sad 2 hours Society for Prevention of Teen Suicide Making Educators Partners in Suicide Prevention: ACT on FACTS - SOS (Signs of Suicide) - 1 ½ hours QPR (Question Persuade Refer) 21

22 NREPP: prevention, screening, gatekeeper education, postvention

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24 HOW 2 TALK WITH UR KID/STUDENT: SUGGESTIONS FROM TEENS 24

25 Six Steps to Comprehensive Suicide Prevention in Schools 4. Parent education, including:»» Information for parents about suicide and related behavioral health issues Refer to Washington GLS grant - on_final_low.pdf» Strategies to engage parents in suicide prevention programs

26 Student Education & Prevention Programs Suicide Prevention Resource Center -Best Practice Registry Free student curriculums through PDE s Act 71 page. Tailored from Wisconsin GLS grant. Integration of suicide prevention into other behavioral health and emotional wellness curriculum/activities PAYSPI sponsors PSA awareness campaigns through print and multi-media. Visit

27 Who Should Do Suicide Prevention Curricula with Students?

28 Comprehensive Suicide Prevention Includes Policy and procedures to govern suicide prevention, intervention and postvention efforts Training of specialized staff to respond to identified youth who may be at risk or in imminent danger Gatekeeper training of personnel regarding identification, referral and resources for at-risk youth Parent education on referral resources and prevention strategies including enhancing protective factors Youth education around peer referral Screening for behavioral health issues Postvention procedures to address a death by suicide 28

29 ELEMENTS OF A COMPREHENSIVE SUICIDE PREVENTION PROGRAM FOR COLLEGES AND UNIVERSITIES 29

30 HIGHLIGHTING PA S GLS GRANT EFFORTS: Past and Current

31 PA s GLS Grant for Screening in Primary Care First grant focused on rural counties that had suicide rates, from , as high as more urban areas but had far fewer resources Luzerne, Lackawanna and Schyhill identified Second grant expanded focus to other counties willing to partner Allegheny, Westmoreland, Berks, Bucks, Philadelphia, Delaware and Montgomery At the time PA was only state whose grant focused on screening in primary care

32 GLS-1 Primary Care Grant Objectives Objective 1: Create a task force of a broad range of stakeholders Objective 2: Provide a youth suicide gatekeeper training program Refer to gatekeeper guidelines at dationsgatekeepertraining.pdf Objective 3: Provide medical practitioners in the 3 counties free access to a web-based self-report suicide screening tool Objective 4: Increase the integration of behavioral health services with medical services Objective 5: Enhancing clinical services for suicidal youth

33 GLS-1 Successes Broad range of stakeholders involved Task forces in each county 10 primary care practices participating Over 400 youth screened 48 youth identified as at risk for suicide 13% identification rate Created an archive of training materials for medical professionals visit

34 GLS-2 Primary Care Grant Overview The goal of this project was to increase identification of youth (ages years) at risk for suicide and to improve their access to MH services. Implementation of an early identification system within primary care and related health settings. We achieved our goals through: Providing educational materials and training that improved providers' ability to identify and refer youth at risk for suicide. Providing medical practitioners free access to a web-based, patient self-report screening tool to assess for suicide and related risk factors. Increasing the integration of BH services with medical services to decrease access barriers, reduce delays in assessment and treatment, and provide necessary BH support to providers and their patients.

35 GLS-2 Outcomes OUTCOME GRANT GOAL ACTUAL TOTAL No. of Adolescents Screened Through Grant No. of Positive Screens Identified No. of Referrals % of Individuals receiving MH or related services after referral No. of individuals trained in prevention or MH promotion No. of individuals exposed to MH awareness messages No. of people in the MH and related workforce trained in MH related practices/activities 33% 40%

36 Suicide Prevention in Pennsylvania Schools and Colleges Initiative: Current GLS Grant Awarded to the Office of Mental Health and Substance Abuse Services (OMHSAS) at the Department of Human Services (DHS) OMHSAS received > $3.5 million to implement programming in schools and colleges over 5 years Partnering with universities (Drexel University, University of Pittsburgh, Thomas Jefferson University) and the Pennsylvania Network for Student Assistance Services (PNSAS) Targeting 100 districts/schools and 18 colleges throughout PA by the end of the grant (estimated 212,000 youth)

37 Youth Suicide in Pennsylvania 2 nd leading cause of death in high school students ages in PA (CDC, 2014) 3 rd leading cause of death in year-olds in PA in 2014, but was the LEADING cause of death in year-olds in PA in 2013 (37% of all deaths) Survey Item In the past 12 months Youth Risk Behavior Survey (2013) Pennsylvania Youth Survey (2013) Considered suicide 13.0% 15.6% Had a suicide plan 11.7% 11.6% Attempted suicide 10.0% 7.6% Needed medical treatment for 3.2% 1.7% suicide attempt Felt very sad or hopeless for at least 2 weeks 29.6% 23.4% (Youth Risk Behavior Survey, 2013) (Pennsylvania Youth Survey, 2013)

38 How Schools Can Help Prevent Suicide Protocols for helping students at risk of suicide Screening Student Education Protocols for responding to suicide death Staff education training Parent Education (SAMHSA, 2012)

39 Project Goals Increase the number of staff in schools, colleges, and universities trained to identify/refer youth at risk for suicide youth screened and referred for treatment clinical service providers trained to assess, manage, and treat youth at risk for suicide Increase awareness about youth suicide prevention among youth, families, educators, and community members Implement sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicidal ideation, attempts, and deaths Promoting state-wide, systems-level change to advance suicide prevention efforts

40 Project Activities Support for schools to develop policies and procedures for youth suicide prevention, intervention, and postvention Gatekeeper and specialized training for school staff and SAP liaisons Awareness activities for students, families, and community members Validated and standardized screening tool for SAP liaisons Clinical trainings in evidence-based treatment for community mental health providers

41 School Readiness Survey SAP & Crisis Baseline Data SAP DATA 619 total SAP referrals (range = ) Of these students, 4% (N = 23) were referred for concerns regarding suicidal gesture or attempt Of the total number of students referred to SAP, 47% (range = 0 102) were referred for screening by a SAP liaison CRISIS DATA 50% of schools (N = 4) presently track crisis response data Across all schools (N = 8), there were an estimated 85 crisis situations during the school year (mean = 10.6) 85% (N = 72) of these crises involved potential harm to self

42 School Readiness Survey Suicide Prevention Policy Needs Percent of Schools/Districts Have Need Prevention Intervention Reentry/reintegration after an attempt School-wide Policies and Procedures Postvention

43 School Readiness Survey Suicide Prevention Programs & Needs 100 Have Need 100 Percent of Schools/Districts Gatekeeper Training/Awareness for Staff Specialized Training for SAP Curricula/Programming for Students Parent/Guardian Education and Outreach Suicide Prevention Program Component School-wide Awareness Campaigns Support for SAP to Use a Validated Screening Tool

44 School Readiness Survey Specialized Training Needs Safety Planning/Interventions for At-Risk Students 100 Family Engagement 100 Trauma/Substance Abuse/Mental Health/Other Related 88 Data/Documentation 75 Suicide Risk Assessment 75 Team Building 63 General Mental Health Assessment Percent of Schools/Districts

45 School Readiness Survey Identified Barriers Funding for training/release time/programs/materials 38 Time/scheduling constraints for staff training 38 Sustainability Time/scheduling constraints for planning and development of a suicide prevention program Integrating a suicide prevention program within existing structures and programs Liability concerns Percent of Schools/Districts

46 Implementation of Training and Screening Training Screening Training and screening

47 Suicide Prevention Training in Pennsylvania Suicide risk assessment Safety Planning Postvention Family Engagement Myths Risk and protective factors Warning Signs How to respond to youth who may be suicidal Specialized Clinical Gatekeeper Cognitive-behavioral therapy for suicide prevention (CBT-SP) Attachment-based family therapy (ABFT)

48 Act 71 of 2014 Beginning with the school year, each school entity shall: Adopt suicide prevention policies and procedures Develop a professional development plan to provide 4 hours of suicide awareness and prevention training every 5 years Beginning with the school year, each school entity may: Incorporate suicide prevention curriculum/programming for students

49 Why necessary? Act 71 of 2014 Many schools not doing anything related to suicide prevention Generic crisis plan does not address specific nuances of suicide prevention, intervention, and postvention GLS grant efforts support free archive of Act 71 resources. Visit

50 PDE s Priority Teacher Training Topics 1. Debunking Myths 2. School-Related Epidemiology 3. Risk Factors vs Warning Signs 4. Risk and Protective Factors 5. Warning Signs 6. Review District s Policies and Procedures 7. How Educators Can Respond to Youth about Whom They are Concerned 8. Safe Messaging 9. Postvention

51 Gatekeeper and Specialized Trainings Specialized Training 51% Gatekeeper Training 49% 2/3 of gatekeeper trainings were Act 71 trainings for schools

52 Training Participants Non-mental health (e.g., educators, administrator, community members) 80% Mental health or related workforce 20% Nearly 50% received online training

53 Breakdown of Trainings by Setting Primary Health Care 3% Mental Health 4% Higher Education 5% Other 15% K-12 Education 73%

54 Module Name Online Gatekeeper Trainings Module Pre/Post Assessment Number of Participants Pre-Assessment Average Post-Assessment Average Average Difference Myths % 96% +21% Epidemiology % 96% +61% Definitions % 98% +24% Risk Factors vs. Warning Signs How to Respond % 96% +69% % 98% +15%

55 Online Gatekeeper Trainings: Increased Knowledge 98% of participants agree or strongly agree Closing Survey Increased Comfort 95% of participants agree or strongly agree Plan to Apply Information Learned 99% of participants agree or strongly agree

56 Screening for Students at Risk The GLS grant team is promoting the use of the following tools: Behavioral Health Screen (BHS), developed by Diamond et al. (2010) ASK Suicide-Screening Questionnaire (ASQ), developed by Horowitz et al. (2012) Additional tools available include the following: Patient Health Questionnaire (PHQ-9) Columbia Suicide Severity Rating Scale (CSSR-S) Child and Adolescent Needs and Strengths (CANS) Beck Depression Inventory (BDI) Suicide Behaviors Questionnaire (SBQ-R) Other screening tools (e.g., locally developed tools, etc.)

57 Screening Settings (N=13) Percent of Screens by Setting (N = 1949) 23% 37% 77% 63% SAP AGENCIES COLLEGES/UNIVERSITIES SAP AGENCIES COLLEGES/UNIVERSITIES

58 100 PERCENT OF SCREENS POSITIVE FOR SUICIDE AND RISK FACTORS % WITHIN SETTING SUICIDE DEPRESSION ANXIETY TRAUMA EATING DISORDER RISK FACTOR SAP AGENCIES COLLEGES/UNIVERSITIES SUBSTANCE ABUSE

59 SUICIDAL IDEATION: LIFETIME VS CURRENT % WITHIN SETTING LIFETIME SAP AGENCIES CURRENT COLLEGES/UNIVERSITIES

60 Higher Education Suicide Prevention Coalition Collaborative of key individuals on campuses across PA who have a role in caring for the emotional and mental health of students First Annual Conference March 7 th and 8 th, 2016 in Philadelphia 215 total attendees representing: 70 Different Schools 5 different states (with speakers-9 different states) 19 Different Organizations 30 Student Mental Health Ambassadors 19 Student Journalists 144 Campus Faculty/Staff

61 HESPC Campus Participation

62 Annual youth suicide prevention PSA Contest for high school students Recognition of PSA Contest winners: Suicide Prevention Night at the Ballpark Capitol Day in Harrisburg If it is not already there, pull out your phone and enter TALK (8255) Awareness Events

63 Upcoming Grant Activities Online gatekeeper training modules in partnership with IU25 Train-the-trainer (QPR) and facilitator guides for online modules Clinical trainings in cognitive-behavioral therapy (CBT) and attachment-based family therapy (ABFT) SAP Regional Conferences developed in partnership with SAP regional coordinators and local stakeholders Youth and family components

64 How to Get Involved: For additional information about the GLS grant or to discuss participation, please contact: Perri Rosen, Ph.D. Project Director, GLS Youth Suicide Prevention Grant Department of Human Services OMHSAS Bureau of Children s Behavioral Health (717) phone (717) mobile c-prosen@pa.gov

65 Youth Suicide Prevention Resources Pennsylvania Youth Suicide Prevention Initiative (PAYSPI): PSA Contest Act 71 Resources Higher Education Suicide Prevention Coalition (HESPC) Youth Suicide Warning Signs: Student Assistance Program: STAR Center:

66 Youth Suicide Prevention Resources cont. SAMHSA High School Toolkit: American Foundation for Suicide Prevention: National Suicide Prevention Lifeline: TALK Crisis Text Line:

67 We acknowledge with gratitude the Pennsylvania Legislature for its support of STAR-Center and our outreach efforts. This presentation was developed by Services for Teens At Risk in conjunction with the GLS 2015 grant for suicide prevention in schools and may not be reproduced without written permission from: STAR-Center Outreach, Western Psychiatric Institute and Clinic, 3811 O Hara Street, Pgh., PA (412) All Rights Reserved,