Nebraska State Suicide Prevention Coalition Activity Plan Modification 2013

Prepared by Denise Bulling, PhD, LIPC

University of Nebraska Public Policy Center dbulling@nebraska.edu

April 2013

1 NSSPC

April 2013

Background The NSSPC supports the Nebraska State Suicide Prevention Plan. Nebraska’s overarching desire is to decrease rates of suicide. Three goals were set to move the state closer to this achievement:

Goal 1: Nebraskans will view suicide as a preventable public health problem Goal 2: Empirically supported suicide prevention programs are implemented across Nebraska Goal 3: Data is collected and reported across systems to evaluate effectiveness and cost efficiency of suicide prevention efforts in Nebraska

NSSPC delineated activities related to these goals for 2011-2012 with the intent of reviewing and updating them annually. (See Appendix A for the current Nebraska plan and 2011-2012 NSSPC Activity Plan.)

Two contextual changes influenced NSSPC members as they engaged in this review. First, the state of Nebraska completed a grant funded project addressing youth suicide which decreased resources available to NSSPC to carry out activities. Second, the 2012 National strategy for suicide prevention embraced a model of organizing goals and objectives that the NSSPC wished to emulate as much as possible to be consistent with national goals and objectives. The new strategy organizes activities into four interconnected directions:

1. Healthy and empowered individuals, families and communities2. Clinical and community preventive services3. Treatment and support services4. Surveillance, research and evaluation

The Nebraska State Suicide Prevention Coalition (NSSPC) engaged the University of Nebraska Public Policy Center to administer on on-line survey to regular attendees of NSSPC meetings and interested stakeholders as a way to gauge relevancy of the Coalition’s action plan. The survey results were then used to guide discussion at the March 22, 2013 meeting of NSSPC related to aligning the Coalition’s action plan with the 2012 National Strategy for Suicide Prevention (US Department of Health and Human Services, 2012).i The survey was accessed 23 times with varying levels of completion. The number of respondents did not reflect the entire membership of the Coalition. Survey results are detailed in Appendix B.

2 NSSPC

April 2013

Priority Activities NSSPC members prioritized the following items for action in 2013-2015:

• Disseminate suicide prevention information & resources• Promote regional suicide prevention programs & events• Support law enforcement training academy, CIT training and BETA by providing

resources• Promote QPR to local coalitions as a gatekeeper training model• Encourage schools to adopt empirically supported suicide prevention practices• Enhance clinical competencies by promoting AMSR• Collect evaluation data from grantees funded via the NSSPC

Previously, these actions were grouped into Awareness, Methodology and Intervention categories to correspond with National framework. The new framework assumes many of the activities overlap in four interconnected strategic directions. The priority actions for the NSSPC align with the 2012 National Strategy in each of the strategic directions.

Healthy and empowered individuals, families and communities

Disseminate suicide

prevention information & resources

Promote regional suicide

prevention programs &

events

Clinical and community preventive services

Support law enforcement

training academy, CIT training and BETA by pro

viding resources

Promote QPR to local coalitions as a gatekeeper training model

Encourage schools to adopt

empirically supported

suicide prevention practices

Treatment & Support Services

Enhance clinical competencies by promoting

AMSR

Surveillance, research and evaluation Collect evaluation data from grantees funded via the NSSPC

3 NSSPC

April 2013

Other activities The Coalition identified a number of activities that were important but not feasible right now. These activities could be reconsidered for priority action if resources become available:

Healthy and empowered individuals, families and communities

Clinical and community preventive services

Treatment and support services

Surveillance, research and evaluation

• Distribute suicideawarenessmaterials toprimary caresettings

• Promote suicideprevention duringsuicideprevention month

• Promoteawareness ofmilitary efforts toprevent suicide

• Disseminateeducationalmaterials on risk,depression andsuicideprevention to 55+age range

• Promote 1-8 0 0 -273 TALK hotline

• Provide resourcesto the LOSSdevelopmentgroup

• Promotedepressionscreening inprimary caresettingsemphasizingyouth andVeterans

• Track the numberof schools thatinclude someform of suicidepreventionactivity

Survey respondents offered suggestions for additional activities in a text format on the survey. Their full comments are included in Appendix B. Generally, respondents encouraged the NSSPC to work closely with local coalitions, the state and other groups to minimize duplication of efforts and to strengthen/work within existing networks for prevention.

Respondents were also asked what NSSPC could do to encourage attendance at meetings. Several indicated that schedule conflicts keep them from meetings. Appreciation for video conference linking to meetings was also noted as an effective way to engage coalitions and individuals outside the Lincoln area.

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April 2013

This report was created by the University of Nebraska Public Policy Center.

The University of Nebraska Public Policy Center provides assistance to policymakers in all three branches of government and researchers on a wide range of public policy issues. The mission of the PPC is to actively inform public policy by facilitating, developing, and making available objective research and analyses of issues for elected and appointed officials; state and local agency staff; the public at large; and others who represent policy interests.

215 Centennial Mall South, Suite 401, Lincoln, NE 68588-0228 Ph: 402-472-5678 | Fax: 402-472-5679 www.ppc.nebraska.edu

The University of Nebraska does not discriminate based on gender, age, disability, race, color, religion, marital status, veteran’s status, national or ethnic origin, or sexual orientation.

i U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. Washington, DC: HHS, September 2012.

December 2010 1

2011-2015 Nebraska State Suicide Prevention Goals

Nebraska’s State Suicide Prevention Goals are drawn from multiple sources including a statewide summit and a strategic planning process led by the Nebraska State Suicide Prevention Coalition (NSSPC). The NSSPC is an all-volunteer coalition with an open membership policy that is recognized as the group with primary responsibility for development of recommendations related to suicide prevention for the Nebraska Department of Health and Human Services. The NSSPC works throughout the year to promote suicide prevention activities statewide via local coalitions and other grassroots initiatives. More information about the NSSPC can be found on its website at http://www.suicideprevention.nebraska.edu.

Decreasing the rates of suicide in Nebraska will signal success for the state’s suicide prevention efforts

Three goals are identified for suicide prevention in Nebraska during 2011-2015:

Goal 1: Nebraskans will view suicide as a preventable public health problem

Goal 2: Empirically supported suicide prevention programs are implemented across Nebraska.

Goal 3: Data is collected and reported across systems to evaluate effectiveness and cost efficiency of suicide prevention efforts in Nebraska.

These goals are augmented by specific objectives for the period of 2011-2012. The objectives are intended to guide and inform NSSPC activities; youth suicide prevention work associated with implementation of a federal youth suicide prevention grant award directed by the Division of Behavioral Health (http://www.youthsuicideprevention.nebraska.edu ); and surveillance activities directed by the Division of Public Health. The objectives are reviewed and updated annually or as they are achieved.

Vision The Nebraska public behavioral health system promotes wellness, recovery, resilience and self determination in a coordinated, accessible consumer and family-driven system

Appendix A Nebraska State Suicide Prevention Plan 2013

December 2010 2

Goal 1: Nebraskans will view suicide as a preventable public health problem

Objective Outcome Measure By 2012 Public health districts will incorporate suicide awareness benchmarks in regular reports

# Health Depts reporting awareness measures

By 2012 Suicide awareness materials will be distributed to all primary care settings in Nebraska

# and location of material distribution

By 2012 Means Restriction information will be available in all Emergency Departments in Nebraska

# Emergency Rooms incorporating material

By 2012 a public awareness campaign will be completed # materials distributed; market estimates for media outlets; website statistics

Goal 2: Empirically supported suicide prevention programs are implemented across Nebraska.

Objective Outcome Measure By 2012 25% of Licensed Behavioral Health Clinicians will receive training in assessment and management of suicide

# of Clinicians trained

By 2012 25% of schools in Nebraska will include some form of empirically supported suicide prevention activity

# schools and type of program

By 2012 600 gatekeepers will receive empirically supported gatekeeper training

# Gatekeepers trained

By 2012 3 LOSS postvention programs will be functioning in Nebraska

# and location of LOSS programs

Goal 3: Data is used to evaluate effectiveness of suicide prevention in Nebraska.

Objective Outcome Measure By 2011 a group will be convened to identify cross system measures related to suicide prevention

Slate of measures

By 2012 a report on suicide prevention measures will be issued by the Department of Health and Human Services

Report issued

Appendix A Nebraska State Suicide Prevention Plan 2013

Attachment A Nebraska State Suicide Prevention Coalition Activity Plan 2011-2012

December 2010 3

The Statewide Suicide Prevention Coalition is a group of interested citizens, government and private representatives who work together to promote suicide prevention in Nebraska. The Statewide Coalition will work together to implement these activities and build a work plan to support each one. More information about the Coalition and its activities is available on its website: http://www.suicideprevention.nebraska.edu/index.htm. A list of abbreviations and acronyms is available at the end of this document.

The following activities have been identified by the Nebraska State Suicide Prevention Coalition in support of the State Suicide Prevention Plan (2011-2015):

Nebraskans will view suicide as a preventable public health problem Activities Resources

Publ

ic A

war

enes

s

Disseminate suicide prevention information and resources to faith based groups; service clubs; non-profit groups; and corporations

Website NSSPC Brochure LOSS Conference NSSPC speakers

Suicide awareness materials will be distributed to all primary care settings in Nebraska

Primary care toolkit SPRC

Disseminate educational materials on suicide risk, depression and suicide prevention to Nebraskans in the 55+ age range via groups that serve them

Website Educational material Local Coalitions

Promote suicide prevention during suicide prevention month PSA’s Press Releases Brochure distribution

Promote Regional programs and community events related to suicide prevention

Website Email lists Newsletter

Engage youth by having at least one youth organization present at each NSSPC meeting

Website Email lists NSSPC members

Promote access to treatment resources statewide

Website Partner websites Depression screening Primary care brochure

Promote awareness of military efforts to prevent suicide Website Partner websites Military rep on NSSPC

Engage post secondary education representatives in NSPCC activities

Partner with GLS grant Brochure

Distribute Public Ad Council’s campaign on suicide prevention during mental illness awareness week, suicide prevention month and mental health month

PSA’s

Support the Law Enforcement Training Academy, CIT training and BETA (Behavioral Health Threat Assessment) by providing resources pertinent to suicide prevention and law enforcement

Brochures Educational material Means Restriction material

Provide means restriction material to emergency rooms for distribution to networks of support for people with self inflicted injuries

Means Restriction material Partner Websites Website

Appendix A Nebraska State Suicide Prevention Plan 2013

Attachment A Nebraska State Suicide Prevention Coalition Activity Plan 2011-2012

December 2010 4

Activities Resources

Inte

rven

tion

Promote QPR to local coalitions as a gatekeeper training model Partner with GLS grant QPR trainers

Promote 1-800-273-TALK hotline Website & Brochures

Partner with national groups to incorporate empirically supported means restriction activities in protocols promoted by emergency response entities across the state

Website Means Restriction material SPRC resources National Org material

Encourage schools to adopt empirically supported suicide prevention practices (e.g., SOS, school prevention specialist training, etc)

SPRC website AAS website Kim Foundation GLS grant

Enhance clinical competencies through promotion of AMSR training (assessing and managing suicide risk) or similar empirically supported education (primary care training)

GLS grant SPRC material AAS & AFSP material AMSR trainers

Provide resources to the LOSS development group to assist in establishing 2 additional LOSS teams in Nebraska (total of 3)

LOSS website GLS grant LOSS conference & training

Encourage AAS certification of crisis centers in Nebraska AAS material Partner with BH Regions & DHHS

Promote depression screening in primary care settings with an emphasis on youth and veterans

Screening tools Website Partner with medical community

Convene a group to explore development of a suicide specialist certification

National certifications SPRC AAS & AFSP DHHS University partners

Data is used to evaluate effectiveness of suicide prevention in Nebraska. Activities Resources

Met

hodo

logy

Convene a group to identify cross system measures related to suicide prevention

Coalition partners DHHS Strategic Plans

Support data collection and evaluation of QPR training GLS grant QPR trainers Local coalitions

Support data collection and evaluation of AMSR training GLS grant AMSR trainers DHHS partners

Track the number of schools in Nebraska that include some form of empirically supported suicide prevention activity

Dept of Ed partner GLS grant

Collect evaluation data from grantees funded via the NSSPC

Grantees Kim Foundation University Partners Website

Promote evaluation of promising practices such as the YRTCGreenline program

University Partners GLS grant Kim Foundation SPRC

Appendix A Nebraska State Suicide Prevention Plan 2013

Empirically supported suicide prevention programs are implemented across Nebraska.

Attachment A Nebraska State Suicide Prevention Coalition

Activity Plan 2011-2012

December 2010 5

Abbreviations and Acronyms used in this Document

AAS American Association of Suicidology

AFSP American Foundation for Suicide Prevention

AMSR Assessing and Managing Suicide Risk (Training tool from SPRC)

BH Behavioral Health

DHHS Department of Health and Human Services

GLS Garrett Lee Smith (Grant Act Title)

LOSS Local Outreach to Suicide Survivors (Outreach Teams)

NSSPC Nebraska State Suicide Prevention Coalition

PSA Public Service Announcement

QPR Question, Persuade, Refer (Suicide Prevention Training Tool)

SPRC Suicide Prevention Resource Center (National)

YRTC Youth Rehabilitation and Treatment Center (Kearney, NE)

Appendix A Nebraska State Suicide Prevention Plan 2013

Appendix B – Survey Report 2013 2013

Survey Report – Nebraska State Suicide Prevention Coalition

April 30, 2013

Appendix B – Survey Report 2013 2013

1. Click on each item and drag it to the category you believe it belongs in. You can drag and drop the items in each box to reflect how important each item is with the most important item in the number one spot, then next most important in the number two spot etc. You do

not need to rank items in the discontinuation box.

# Answer Absolutely continue these

activities

These activities are important BUT Resources are not

sufficient to ensure NSSPC can

do it well

Discontinue these activities

1 Disseminate suicide prevention information & resources 13 3 0

2 Distribute suicide awareness materials to primary care settings

8 5 2

3 Promote suicide prevention during suic. prev. month 10 4 1

4 Promote regional suic. prev. programs & events 12 3 0

5 Engage youth by having youth at NSSPC meetings 8 4 3

6 Promote access to treatment resources statewide 11 4 1

7 Promote awareness of military efforts to prevent suicide 10 6 0

8 Engage post secondary representatives in NSSPC 6 8 1

Appendix B – Survey Report 2013 2013

activities

9 Distribute Public Ad Council's campaign on suicide prevention 4 5 6

10 Support law enforcement training academy, CIT training and BETA by providing resources

8 7 1

11 Provide means restriction material to ER's 9 6 2

12 Disseminate educational materials on risk, depression and suic. prev. to 55+ age range

5 10 0

Answer

Absolutely continue

these activities - Mean Rank

These activities are important BUT Resources

are not sufficient to ensure NSSPC can do it

well - Mean Rank

Discontinue these activities - Mean

Rank

Disseminate suicide prevention information & resources 2.69 4.33 0.00

Distribute suicide awareness materials to primary care settings 4.38 3.00 2.00

Promote suicide prevention during suic. prev. month 4.00 2.75 2.00

Promote regional suic. prev. programs & events 3.33 3.33 0.00

Engage youth by having youth at NSSPC meetings 5.38 2.25 2.33

Promote access to treatment resources statewide 3.36 3.00 4.00

Promote awareness of military efforts to prevent suicide 4.30 2.83 0.00

Engage post secondary representatives in NSSPC activities 7.50 3.13 3.00

Distribute Public Ad Council's campaign on suicide prevention 4.00 2.00 1.67

Support law enforcement training academy, CIT training and BETA by providing resources

4.88 1.86 2.00

Provide means restriction material to ER's 4.33 4.17 1.00

Disseminate educational materials on risk, depression and suic. prev. to 55+ age range

4.40 2.70 0.00

Appendix B – Survey Report 2013 2013

2. Click on each item and drag it to the category you believe it belongs in. You can drag and drop the items in each box to reflect how important each item is with the most important item in the number one spot, then next most important in the number two spot etc. You do not need to rank items in the discontinuation box.

# Answer Absolutely continue these

activities

These activities are

important BUT

Resources

Discontinue these

activities

1 Promote QPR to local coalitions as a gatekeeper training model 14 1 0

2 Promote 1-800-273 TALK hotline 13 3 0

3 Partner with national groups to incorporate means restriction activities in emergency protocols

6 10 1

4 Encourage schools to adopt empirically supported suic. prev. practices 14 2 0

5 Enhance clinical competencies by promoting AMSR 9 5 3

6 Provide resources to the LOSS development group 10 5 1

7 Encourage AAS certification of crisis centers 4 5 5

8 Promote depression screening in primary care settings emphasizing youth and Veterans

10 7 0

9 Convene a group to explore development of a suicide specialist certification 2 7 6

Appendix B – Survey Report 2013 2013

Answer Absolutely continue these

activities - Mean Rank

These activities are important BUT

Resources are not sufficient to ensure

NSSPC can do it well - Mean Rank

Discontinue these activities - Mean Rank

Promote QPR to local coalitions as a gatekeeper training model 2.43 2.00 0.00

Promote 1-800-273 TALK hotline 3.08 2.00 0.00

Partner with national groups to incorporate means restriction activities in emergency protocols

3.17 2.20 1.00

Encourage schools to adopt empirically supported suic. prev. practices

3.29 2.00 0.00

Enhance clinical competencies by promoting AMSR 4.00 2.60 1.33

Provide resources to the LOSS development group 3.60 2.00 2.00

Encourage AAS certification of crisis centers 3.75 2.20 2.00

Promote depression screening in primary care settings emphasizing youth and Veterans

2.80 1.86 0.00

Convene a group to explore development of a suicide specialist certification

5.50 2.57 1.33

Appendix B – Survey Report 2013 2013

3. Click on each item and drag it to the category you believe it belongs in. You can drag and drop the items in each box to reflect how important each item is with the most important item in the number one spot, then next most important in the number two spot etc. You do not need to rank items in the discontinuation box.

# Answer Absolutely continue these

activities

These activities are important BUT Resources are not

sufficient to ensure NSSPC can

do it well

Discontinue these activities

1 Convene a group to identify cross system measures related to suicide prevention

7 7 2

2 Support data collection and evaluation of QPR training 7 6 1

3 Support data collection and evaluation of AMSR training 7 5 2

4 Track the number of schools that include some form of suicide prevention activity

10 6 1

5 Collect evaluation data from grantees funded via the NSSPC 11 2 2

6 Promote evaluation of promising practices such as the YRTC Greenline program

6 7 3

Appendix B – Survey Report 2013 2013

Answer Absolutely continue these

activities - Mean Rank

These activities are important BUT

Resources are not sufficient to ensure

NSSPC can do it well - Mean Rank

Discontinue these activities - Mean

Rank

Convene a group to identify cross system measures related to suicide prevention

2.43 1.57 2.00

Support data collection and evaluation of QPR training 2.43 2.00 2.00

Support data collection and evaluation of AMSR training 3.14 1.80 1.00

Track the number of schools that include some form of suicide prevention activity

2.00 1.50 2.00

Collect evaluation data from grantees funded via the NSSPC 1.82 2.50 1.50

Promote evaluation of promising practices such as the YRTC Greenline program

2.67 1.86 2.00

4. Please check each of the statements below that best reflect your perception.

# Answer

Response %

1 The NSSPC should narrow their focus and take on fewer activities over the next year

1 7%

2 The NSSPC should take a broad view of suicide prevention and take on many activities

2 13%

3 The NSSPC should prioritize activities and take on one at a time no matter how many activities they identify

4 27%

4 The NSSPC should only take on activities that can be completed in one year

1 7%

5 The NSSPC should make an activity plan for multiple years rather than one year

7 47%

Total 15 100%

Appendix B – Survey Report 2013 2013

Statistic Value

Min Value 1

Max Value 5

Mean 3.73

Variance 1.92

Standard Deviation 1.39

Total Responses 15

5. Please share any ideas or activities that you believe the NSSPC should consider as they begin their planning on March 22.

Text Response

The NSSPC should consider adding a goal aimed at looking for addiitonal funding to support suicide prevention in our state. The Outreach Coordinator has been instrumental in helping the NSSPC reach out statewide and helping other communities. The model we have in place with the seed grants has been very successful. The NSSPC should pull together a grant review/funding committee to keep focus on finding additional funds for the Coalition.

There already is a strategic plan thru 2015. Strategies should be established that support those already identified goals. In addition, healthcare reform and the DHHS Division of Behavioral Health strategic plan should be considered.

While I placed certain things in various areas of importance, I think they are all important and I am not sure of your available resources so it's hard to determine this is more important than that. I personally think you could narrow your focus by delegating some education efforts elsewhere, if other people are already working on that focus area, but know sometimes that is not the case. I guess what I'm saying is don't recreate the wheel if someone else is focusing on it, or collaborate to get it done. If there is a need however that you see that involves suicide prevention, and you have the resources to fill it, it seems it would be w/in your focus area.

The coalition should think smart about using existing networks, media, and channels to disseminate awareness, knowledge, and skills building in the area of suicide prevention. It's not so much "many activities" as many partners and perhaps three key messages disseminated via many channels.

The NSSPC should support the local coalitions so that they can promote suicide prevention locally. Local public health is an infrastructure across the state and can bring partners together at the local level. NSSPC should focus system wide state systems and supporting the local coalitions to get the information and awareness out at the ground level.

where is the greatest need at this time for suicide awareness and prevention? Military? Schools? Identify and form partnerships with others seen as stakeholders in this need to strengthen our impact

I would encourage working with multiple entities, so duplication of services is minimized.

Statistic Value

Total Responses 7

Appendix B – Survey Report 2013 2013

6. Please tell us a little bit about you. How many times have you attended the NSSPC over the last year?

# Answer

Response %

1 Once

2 13%

2 two or three times

3 20%

3 More than three times

8 53%

4 Didn't make it to any meetings during 2012

2 13%

Total 15 100% 7. Please tell us what the NSSPC could do to make it more likely that you could or would attend meetings?

Text Response

Consistency in meeting time and notices is appreciated.

My work load has changed and that makes it more difficult to attend regularly. I have recruited a member of my team who can make more regular attendance. I am a certified QPR trainer, and I would like to look to the coalition for opportunities to deliver training.

As I am employed outside of the Health care industry, it is difficult to attend meetings on Friday am. An evening or occasional weekend day would help me attend more meetings.

We are active in our local suicide prevention coalition. We are geographically over 400 miles away from the NSSPC meetings. Teleconference is the only way that is feasible to join in the meeting.

I have always just attended through the telehealth system. Seems to work well. sometimes emails are just as good as an actual meeting. Less time spent. We are all so busy with our schedules.

they are conveniently located.....I appreciate the food offerings......sometimes it is a personal matter of being over-scheduled that keeps me from attending. The meetings are of value to NE

I think it might be valuable to include all in assisting with strategies. We all have things in our areas, but if we are a part of the larger unit and have a part in the activity - more buy in with the programming.

Other than schedule conflicts I would definitely be there!

I have wanted to attend but have had conflicts with my schedule.

personally invite individuals to attend, send out multiplr email reminders, have a presence within the unicameral

Statistic Value

Total Responses 10