Zero Suicide in Texas (ZEST) Collaborative Call: February 2016 DSHS: Jenna Heise TIEMH: Dr Molly Lopez Dr. Erica Shapiro

SAFETY PLANNING Goal : All children and adults with moderate or high risk for suicide will work collaboratively with a trained provider to develop an effective, individualized safety plan.

WHY Safety PLAN? Rationale: It is not uncommon for at-risk individuals to have poor follow-through with outpatient referrals or leave treatment within first three months Essential to engage in brief interventions during contacts to reduce risk   Support: Has been identified as best practice (Level 3) by the Suicide Prevention Resource Council Implemented throughout the Veteran’s Administration Draws from cognitive therapy interventions that utilize distraction and active coping to manage suicidal thoughts. Notably different from “no suicide contract” which does not identify how an individual and their family should respond if the individual becomes suicidal. Minimal support for “no suicide contracts” and concerns have been raised that they may impede open communication with clinicians and clients about true suicidal intent.

SAFETY PLANNING INTERVENTION A brief, 20 to 45 minute intervention that provides an individual with a set of steps that can be used progressively to attempt to reduce risk and maintain safety when suicidal thoughts emerge. Includes the following core components: Recognizing warning signs of an imminent suicidal crisis (e.g., changes in mood, thoughts, behaviors) Utilizing internal coping skills that can help reduce distress Using people in individual’s support network as a means of distraction Reaching out to family or friends to help manage the crisis Contacting mental health professionals or emergency contacts (e.g., hotline) Reducing access to potentially lethal means SPI should follow a comprehensive risk assessment Safety plans should be developed within a collaborative process among a provider, the individual at risk, and his close family or friends. Can be a stand alone intervention, utilized during crisis contacts or as a part of an ongoing treatment relationship

safety planning intervention training Who should participate in training? All individuals who will conduct safety planning with individuals at risk should be trained and competent in the intervention. Several resources are available to support staff training. An introductory training on SPI, lasting about 30 minutes, can be found on the Zero Suicide website. The Department of State Health Services has also supported the development of in-state trainers. A list of regional trainers is available through Jenna. Workshop: will hopefully be held this summer. It is 4 hours in length and consists of both didactic learning and role playing of safety planning steps to provide additional opportunities for practice and feedback. Follow-up coaching is recommended to assist providers learning the model to receive feedback on skills development and have the opportunity to bring questions and challenges to the trainer or colleagues. http://www.suicidesafetyplan.com/Training.html SPI Training:

resources Manuals: http://www.suicidesafetyplan.com/Page_8.html Templates: http://www.sprc.org/sites/sprc.org/files/SafetyPlanTemplate.pdf Mobile Apps: Two mobile applications have been developed to support SPI. Individuals can utilize one of these applications to keep their safety plan in a convenient location readily available for consultation if suicidal thoughts occur. Both applications can be downloaded for free from iTunes or GooglePlay.

SPI FIdelity To ensure that SPI is being implemented with fidelity to the model A fidelity instrument has been developed by the intervention developers. The Texas Institute for Excellence in Mental Health has supported the training of a team of raters for SPI fidelity. Centers may submit a sample of audio or videotapes of safety planning interventions for review by fidelity raters. Following the rating, a feedback report will be provided to individuals who have submitted. Analysis of SPI fidelity will be one component of the review for designation as a Suicide Safe Care Center

Implementation of SPI

Counseling on Lethal means restriction Core Component of Safety Planning Access to lethal means – Counseling those at-risk and their loved ones is an effective prevention strategy Counseling on Access to Lethal Means (CALM)– Developed by Elaine Frank and Mark Ciocca. Considered a best practice and provider learns how to ask individuals about their access to lethal means and develop a plan to reduce access. Free, web-based training-http://training.sprc.org/course/description.php-course3. Training requires approximately two hours to complete and includes didactic information and video-based examples of counseling interventions. All staff responsible for safety planning should complete this training.

Moving Beyond: Community Expansion Agency can provide leadership within the community by extending the use of SPI to other health care providers within the community Emergency departments First responders Behavioral health providers Your organization may also provide leadership by partnering with community organizations and/or coalitions to provide education around reducing access to lethal means Providing gun locks at local events Collaborating with gun dealers to display/disseminate suicide prevention materials Supporting placement of barriers at high risk locations (e.g., bridges, overpasses) http://www.hsph.harvard.edu/means-matter/

ZEST Groups & Meeting dates Month Wednesdays, 2pm CST Fridays, 9am CST November Nov 18h Nov 20th December No Call January        (2016) Jan 27th Jan 29th February Feb 24th Feb 26th March Mar 23rd Mar 25th April Apr 27th Apr 29th May May 25th May 27th June Jun 22nd Jun 24th July Jul 27th Jul 29th August Aug 24th Aug 26th Wednesdays, 2pm CST Fridays, 9am CST Pecan Valley Andrews Center Gulf Bend Center Heart of Texas Center for Life Resources Nueces County Texana Center Tri-County Services Betty Hardwick Center Harris County participants Helen Farabee Center Brazos Valley Star Care Lubbock