Zero Suicide in Texas (ZEST) Collaborative Call: January 2015 DSHS: Jenna Heise TIEMH: Dr Molly Lopez Bonnie Evans
WORKFORCE SURVEY: REMINDER https://edc.co1.qualtrics.com/se/?sid=sv_6ybr65dumalrbnf. AIM: ALL Staff to complete (takes approximately 10 minutes) ZEST Sites to complete 2014 workforce survey: Spindletop Tri County (26 responses ) Harris (3 responses ) Border Region (222 responses ) ATCIC (199 responses ) Please email Bonnie if you need help in reaching a higher response rate bonnie.evans@austin.utexas.edu
WORKFORCE COMPETENCY: REMINDER Goal 1: All staff need to be trained in suicide-specific gatekeeper and treatment interventions. Staff should have the opportunity via the agency or greater community to pursue these trainings. Gatekeepers ASIST SafeTalk Direct Care Staff CAMS AMSR Therapists CBT DBT CAMS: Specific treatment of suicidality (i.e. delivered by clinicians) Q: Who from your site could attend CAMS training? Please email names & details to Bonnie: bonnie.evans@austin.utexas.edu
SAFETY PLANNING TRAINING: REMINDER When? Safety Planning Training Safety Planning Train-the-trainer Thursday February 26 th 12.30pm- 4.30pm Friday February 27 th 9am- 12.30pm Who? Please email Bonnie: names, title, contact details of 2-3 people from your site you wish to attend training. What to bring? Please bring a copy of your agencies safety planning template & any written policies on safety planning. *More information about training will be sent via email in the next coming weeks. **Please email if you have any Questions
SHARE A SUCCESS OR CHALLENGE! ASK A PEER!
RISK ASSESSMENT Goal: All children and adults within the public mental health system who are identified as potentially at risk during a suicide screening will receive an evidence-informed suicide risk assessment. This suicide risk assessment should include all of the core components of an effective risk assessment.
CASE APPROACH Real Suicide Intent = Stated Intent + Reflected Intent + Withheld Intent Raising the topic of suicide normalization and shame attenuation You know, when my clients are feeling as stressed out and depressed as you have been feeling, they sometimes have thoughts about killing themselves. I wonder if you have been having thoughts like that. Considering all of the pain that you have been experiencing, I am wondering if you have had any thoughts about killing yourself? Have you had any fleeting thoughts about suicide, even for a moment or two? Shea, 2009
CASE APPROACH Real Suicide Intent = Stated Intent + Reflected Intent + Withheld Intent Behavioral Incident asking factual questions Tell me what happened next. Gentle assumption frame the question as an assumption of the positive What other ways have you thought about killing yourself? Denial of the specific following a general question with specifics Have you thought about shooting yourself? Have you thought about overdosing? Have you thought about hanging yourself? Amplification of symptoms suggesting an amount at the upper limits When your thoughts of suicide are most intense, what percentage of the day are you thinking about suicide 70%, 80%, 90%? Shea, 2009
RISK ASSESSMENT CORE COMPONENTS OF A RISK ASSESSMENT Suicide Inquiry - Current and previous suicidal thoughts, plans, behavior, and intent Warning signs characteristics that are temporally related to the acute onset of suicidal behaviors (hours to a few days) Risk factors characteristics that statistically put an individual at increased risk Protective factors characteristics that statistically indicate lower risk
CORE COMPONENTS OF A RISK ASSESSMENT CONT. Determine risk level develop appropriate treatment plan to address risk in least restrictive environment Risk Level Risk/Protective Factors Suicidality High One or more risk factors may be present; extra concern for psychiatric Suicidal thoughts with intent to act in past 30 days (C-SSRS Item 4) diagnoses with severe symptoms; lack of family and/or social support; lack of Ideation with plan and intent in past 30 days (C- SSRS Item 5) engagement in care; intent with lethal means Any suicide behavior in past 90 days (C-SSRS Item 6) Moderate Absence or presence of risk and protective factors may play stronger Suicidal thoughts with method in past 30 days (but no plan or intent) role in overall risk Suicidal thoughts with intent to act (but no plan) at worst ever (C-SSRS Item 4) Suicidal thoughts with specific plan and intent at worst ever (C-SSRS Item 5) Any suicide behavior at worst ever (C-SSRS Item 6) Low Modifiable risk factors, strong protective factors Wish to be dead in past 30 days (C-SSRS Item 1) General thoughts of killing self without thoughts of methods (C-SSRS Item 2) Documentation - document risk level, rationale, treatment plan, and follow-up
WHERE WILL YOU DOCUMENT RISK LEVEL? How does risk level get communicated to all staff?
ZEST GROUPS & MEETING DATES Wednesdays, 2pm CST Border Region Coastal Plains Hill Country ATCIC Tarrant *Denton Fridays, 9am CST Tropical Harris Bluebonnet Spindletop Tri County *Denton Month Wednesdays, 2pm CST Fridays, 9am CST October (2014) ALL GROUPS: Weds 2pm, Oct ALL GROUPS: Weds 2pm, Oct 29 th 29 th November Nov 19 th Nov 21 st December Dec 17 th Dec 19 th January (2015) Jan 28 th Jan 30 th February PLEASE NOTE WE ARE NOT HAVING GROUP CALLS DUE TO THE SAFETY PLANNING TRAINING FEBRUARY 26 & 27 March Mar 25 th Mar 27 th April Apr 22 nd Apr 24 th May May 27 th May 29 th June Jun 24 th Jun 26 th July Jul 29 th Jul 31 st August Aug 26 th Aug 28 th September Sep 23 rd Sep 25 th