Building Strategies to Address

Youth Suicide- Louisiana and the

National Child Safety Learning

Collaborative

Louisiana School-Based Health Alliance23rd Annual ConferenceApril 9th, 2019

Presenters: Faith Boudreaux, MEd and Ryann Martinek, MPH

Louisiana Youth and Suicide

• Louisiana suicide rates have been increasing– Especially among youth ages 15-19

• Louisiana suicide rate among youth exceeded the US rate (7.8 vs. 7.2 per 100,000) in 2017 for youth 10-19 years old

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Louisiana Suicide Rate Per 100,000Ages 10-19

Source: Vital Records, 2007-2017

Louisiana Youth Suicide

• In 2017, 17.8% of Louisiana’s high school students taking the Youth Risk Behavior Survey (YRBS) seriously considered attempting suicide

– 16.8% attempted suicide

– Nationally, 7.4% of US high school students reported attempting suicide

Source: Centers for Disease Control and Prevention (CDC). 1991-2017 High School Youth Risk Behavior Survey Data.Available at http://nccd.cdc.gov/youthonline/.

• Between 2007 and 2017, 375 Louisiana youth (10-19) died of suicide

– 56% from firearms

– 35% from suffocation

– 5% from self poisoning

Suicide Mechanism

Source: Vital Records, 2007-2017

• Between 2007 and 2017, the majority of violent deaths (suicide, homicide, accidental firearm) among children 10-14 years old in Louisiana were due to suicide

– 57% by firearms

– 34% from suffocation

Suicide Mechanism

Louisiana State Child Death Review and

Suicide Prevention

• Nationally, Child Death Review (CDR) began in 1978

• CDR was established in 1992 in Louisiana with the aim of identifying the causes of unexpected child death and methods for prevention

• Legislatively mandated: Louisiana Revised Statute 40:2019

• 28 member panel of agency directors or Governor appointees

CDR Case Definition:Unexpected deaths of children ages 0-14

An unexpected death is defined within CDR legislation:

“…death which is a result of undiagnosed disease, or trauma in which the surrounding circumstances are suspicious, obscure, or otherwise unexplained, or other death the circumstances of which are suspicious, obscure, or otherwise unexplained. A clinical diagnosis of death due to Sudden Infant Death Syndrome (SIDS) shall be deemed an unexpected death.”

CDR Program Activities

• Identification of cases using state vital records

Bureau of Family Health

• Identification of additional cases through news sources (e.g.. obituaries, newspaper articles, etc.)

• Validation of Cases

• Data abstraction

• Case Review Team (CRT) Meetings

• Community Advisory & Action Team (CAAT) Meetings

Regional

• State CDR Meeting

• Annual Report

• Statewide Preventive Measures (practice changes, programs, system improvements, policies, or state laws)

State

State CDR Suicide Case Review

Recommendations (June 2018)

– Strengthen/identify opportunities to build capacity in:• Suicide prevention programs for children• School-based bullying prevention programs• Support schools in effectively implementing suicide prevention

tools and, should a death occur, support schools in responding to the loss

– Determine if anticipatory guidance in healthcare exists when providers suspect a child is suicidal

– Support follow up care efforts after emergency visits for suicide attempts

– Enforce suicide safety intervention plans as a standard of care for suicidal children

Child Safety Learning Collaborative

Purpose Of CSLC

Focus states on a common agenda for child safety

Actively engage states in collaborative learning and sharing

Increase states’ knowledge and implementation of evidence-based strategies and programs

Enable states to create and use a structured improvement process to achieve child safety results

Demonstrate change over five years

The CSLC will:

Priority Injury Topics

Bullying PreventionMotor Vehicle Traffic

Safety Poisoning Prevention

Sudden Unexpected Infant Death Prevention

Suicide and Self-Harm Prevention

Participating States And Jurisdictions

What Is A Learning Collaborative?

Shared Aims

Application of Quality

Improvement Methods to Inform

and Accelerate Implementation of

Effective Strategies

Effective Strategies and

Measures

Collaborative Data Sharing

Peer Learning

Organizational Level

Collaboration and Targeted Technical

Assistance for Change

Collective National Impact

Suicide and Self-Harm Prevention (SSHP) Common Aim

By April 2023, states and jurisdictions will decrease suicide and self-harm related fatalities, hospitalizations, and emergency department visits by 4% from the November 2018 baselines for children and adolescents ages 10 through 19, through the implementation and spread of evidence-based suicide and self-harm prevention strategies and programs.

Child Safety Network Framework For Quality Improvements And Innovation In Child Safety

Suicide and Self-Harm Topic Teams

17

Suicide and Self-Harm Prevention

• Indiana

•Louisiana

•Tennessee

•Texas

•South Carolina

•Vermont

•Wyoming

Benefits of Participation

• Access to national experts and resources and toolkits

• Ability to set individual goals and strategies related to topic and stakeholder interest

• Cross-State Collaboration among Topic Teams

• Contribution to national efforts and a cost-benefit analysis of using evidence-based strategies.

18

Change Packages

• Focus on evidence-based and evidence-informed strategies

• Targets the organizational level to increase capacity for implementation and spread

• Informed by Maternal Child Health Bureau state action plans and selected national

performance measures

• Designed to enable Topic Teams to have significant overlap of strategies and

measures

• Informed by the CS CoIIN

• Constantly being tested for effectiveness and potential improvement

19

Suicide and Self-Harm Change Packages

20

20

Louisiana Pilot Community- Region 4

• Lafayette’s strong foundation with suicide coalition organized by local stakeholders

• Evidence-based screening in select schools

• Commitment from local stakeholders to the Learning Collaborative

• Region 4 includes the parishes of Evangeline, St. Landry, Acadia, Lafayette, St. Martin, Vermillion and Iberia

• Over the past 3 years the rate of suicide for Region 4 has been increasing for children 10 through 19 years of age. In 2017 the rate per 100,000 was 11 compared to the states rate of 8

Louisiana’s SSHP Team

Pilot is focused in the seven parishes in Region 4 with the goal to spread slowly and deliberately across Louisiana

• Participating Organizations:

• OPH Region 4 Public Health Office

• Louisiana Office of Behavioral Health

• Louisiana Department of Education

• Louisiana Office of Public Health – BFH – Adolescent School Health Program

Child Death Review Team

National Violent Death Reporting System

• Acadian Area Human Services Authority

• The Family Tree

– Suicide Prevention Coordinator

• St. Martin School-Based Health Centers

Louisiana Learning Collaborative Time Frame

Cohort 1 through April 2020

(Regions 4 Pilot)

Cohort 2 through October 2021

(Replication)

Cohort 3 through April 2023

(Replication)

23

Thank you!

For more information , please contact:

Faith BoudreauxFaith.Boudreaux@la.gov

Acknowledgments:

Lafayette Area Partners• Dr. Tina Stefanski, Debra Perna, Marie Collins, Brad Farmer, Brittney Williams,

Adrienne HuvalLouisiana Office of Behavioral Health:• Danita LeBlancLouisiana Department of Education:• Janice ZubeLouisiana Office of Public Health - Bureau of Family Health• Norah Friar, Jane Herwehe, Amanda Perry, Jia Benno, Rosaria Trichilo,, Ryann

Martinek, Cara McCarthy