Success Stories from the Best Practices Registry for Suicide Prevention: Identifying Promising and Effective Suicide Prevention Programs Bridging the Divide Conference Colorado State University, Ft. Collins, CO M 20, May 20 2011 Philip Rodgers, Ph.D. Evaluation Scientist

Acknowledgements U.S. Department of Health & Human Services Substance Abuse and Mental Health Services Agency Howard Sudak, MD AFSP Katrina Bledsoe,, Ph.D. SPRC

This project is supported by a grant (1 U79SM0598945 01) from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). No official endorsement by y SAMHSA or DHHS for the information in this p presentation is intended or should be inferred.

What is the Best Practices Registry for S i id P ti (BPR)? Suicide Prevention The BPR is an online registry of “best best practices practices” in suicide prevention – Over 80 programs are currently listed in the BPR

The purpose of the BPR is to identify, review, and disseminate information about best practices that address specific objectives of the National Strategy for Suicide Prevention – “P “Practices” ti ” is i d defined fi d b broadly, dl iincluding l di programs, policies, protocols, awareness materials, etc.

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Presentation objectives At the conclusion of this presentation, participants will ill b be able bl tto: 1. Define what “makes” a program effective. 2 Describe the importance of targeting risk and 2. protective factors in suicide prevention. 3. Discuss how the Best Practices Registry g y contributes to suicide prevention and how to access the BPR. 4. Understand the importance of program adaptation. 5. List several aspects of successful suicide prevention programs.

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What Makes a Program Effective?

An effective program achieves its goals

Implement Suicide Prevention Program

Decrease S icide Suicide Deaths

But, in our field, it may not be quite that simple

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Why is it difficult to measure suicide deaths?

Knox, K. L., Litts, D. A., Talcott, G. W., Feig, J. C., and Caine, E. D. (2003). Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: Cohort study. BMJ, 327, 1376.

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Why are large numbers needed? Small numbers are unreliable. Suicide Rates for US & Vermont 15-19-year-olds y US

Vermont

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Rate pe er 100,000

10 8 6 4 2 0 1999

2000

2001

2002

2003

2004

2005

Year

Source: CDC for 2006.

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Logic Model Example: Gatekeeper Training Generic Gatekeeper Model

Training

Potential I t Intercessor (Gatekeeper)

Exposure to Population

Gatekeeper

Identification

Population

Intervention & Referral

“At-Risk” I di id l Individual

Mental H lth Healthcare Provider

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Itt iss important po ta t to dete determine ep program og a logic og c Generic Gatekeeper Training Logic Model Process

Outcomes

Inputs

Activities

Outputs

Funds Trainers Materials Trainees

Gatekeeper Training

Ï People trained Ï Satisfaction with training Ï Fidelity Fidelit of training

Sh t t Short-term

I t Intermediate di t

L Long-term t

a. Ï Knowledge b. Ï Attitudes c. Ï Skills

c. Ï Identification of those at risk d. Ï Referral

f. Ï Treatment g. Ð Suicide deaths

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Why are Risk and Protective Factors Important to Suicide Prevention?

Suicide has multiple contributing factors Biological Factors

Predisposing Factors

Familial Risk

Major Mental Disorders

Proximal Factors

Immediate gg Triggers

Hopelessness

Public Humiliation Shame

Intoxication

Access T A To Weapons

Serotonergic S t i Function

Substance Use/Abuse

Neurochemical Regulators

Personality Profile

Impulsiveness Aggressiveness gg

Severe Defeat

Demographics

Abuse Syndromes

Negative Expectancy

Major Loss

Pathophysiology

Severe Medical/ S M di l/ Neurological Illness

Severe Chronic Pain

Worsening Prognosis

SUICIDE RISK ASSESSMENT WORKSHOP, University of Michigan David J. Knesper, M.D. Available at www.med.umich.edu/depression/suicide_assessment/

However, we often seek simple answers…

Source: MSNBC.com August 17, 2010

But, in regards to prevention, it’s important t look to l k att the th whole h l story… t Biological Factors

Father F th Died by Suicide

Predisposing Factors

Proximal Factors

Major D Depression i Intoxicated Loss of Job

Substance Abuse Impulsive Male

Immediate Trigger

Childhood Abuse

Death by Suicide

A basic prevention approach is to... 1. Identify risk and protective factors that are related to suicide for a g given p population p 2. Select and implement a program that targets positive cchange a ge in tthose ose risk s a and dp protective otect e factors acto s

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How Does the BPR Contribute to Suicide Prevention?

How does the BPR help to prevent suicide? The Best Practices Registry provides a list of programs that: 1. Target specific risk and protective factors related to suicide, and 2. Have been reviewed by experts using criteria related to effectiveness, or quality and safety of content.

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Best practices or better practices? Usually, the term “best” denotes “the best thing t do” to d ” This would be a misnomer in regards to the BPR More accurate to refer to BPR as “better practices registry” because… – Th There are many practices ti that th t can address dd suicide i id risk – And these practices occur in a variety of settings with a variety of persons with a variety of needs and resources – Therefore, Th f there th is i rarely l a universal i l “b “best” t” amongstt prevention programs 18

How to Access the BPR

How is the BPR organized? SPRC Home Page (sprc.org) BPR Landing Page

Section I

Section II

Section III

Evidence-based E id b d programs

Expertt and E d consensus statements

Adherence tto Adh standards

• NREPP

Sections do not represent levels of effectiveness

BPR Landing Page

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BPR Search Engine Screen Shot

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Each BPR program has a fact sheet

What If there isn’t a BPR Program for a Specific Need?

Programs can be adapted (changed) for ifi needs… d specific The BPR does not provide an exhaustive list of good/effective suicide prevention programs Some BPR p programs g may y be adapted p for use in settings other than those for which they were created – Example of the White Mountain Apache Tribe’s suicide prevention efforts

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Program may need to be changed “adapted” ffor llocall use It is important to consider how programs can be adapted for local use What changes g need to be made to a program to meet local considerations? Can these changes g be made without changing critical elements of the program? See Linda Langford’s GLS Presentation http://www.sprc.org/grantees/statetribe/2010/4B%20Langford.pdf

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Example #1 of program adaption ER Intervention for Adolescent Females

Evidence-based program for use in emergency rooms for adolescent females who survived a suicide attempt Adapted by White Mountain Apace tribe and their partners t att Johns J h H Hopkins ki university i it for f use in i th the homes of male and female suicide attempt survivors

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Example #2 of program adaption American Indian Life Skills Development program

Evidence-based program for use classroom settings in schools with all students Adapted by White Mountain Apace tribe and their partners at Johns Hopkins university for use in homes with suicide attempt p survivors 29

What are some examples of Successful Community-Based Programs and What M k them Makes th S Successful? f l?

Attributes of successful community programs The relationship between program goals and suicide risk can be demonstrated Each p program g component p is thoughtfully g y considered Program g materials are easily y understood When appropriate, programs address multiple levels When appropriate, programs provide multiple helping resources 31

Additional important aspects of programs Are supported by evaluation results Seek higher-hanging fruit Are collaborative Are multi-faceted

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Questions? Philip Rodgers Rodgers, Ph.D. Ph D 802-446-2446 [email protected] d @ f

Remember to find out more about the BPR visit www www.sprc.org sprc org

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