1. Florida Children and Youth Cabinet Statewide Suicide Task group Florida Children and Youth Cabinet Statewide Suicide Task group June 14, 2016 Prepared by: Heather A. Flynn, PhD Director, Center for Integrated Healthcare FSU College of Medicine & Kim Gryglewicz, PhD, MSW School of Social Work University of Central Florida

2. Review of Importance of the Problem Compared to the national average, Florida’s suicide rate is higher (13.8 vs. 12.93 per 100,000; CDC, 2014), making it one of the leading causes of death among all Floridians. Over the last ten years, the overall number of suicides in the state has been on the rise, an increase of 24% (FL DOH, 2016). Suicide is the 3 rd leading cause of death among youth (ages 10-24) 2 nd leading cause of death among young adults (ages 25-34) 4 th and 5 th leading cause of death among middle-age adults (ages 35-44 and ages 45-54, respectively)

3. Youth, in particular, continue to be at- risk 4,752 Emergency Department visits for suicide attempts 1,909 hospitalizations for suicide attempts 246 suicide deaths (280 deaths in 2014) One child/youth dies by suicide every 32 hours

4. Suicide also has significant human capital and economic costs for the state Number of deaths lost to suicide reflect a total of 49,282 years of potential life lost before age 65 Economic cost of suicide reflects over 2.84 billion in combined lifetime medical and work losses (AFSP, 2016)

5. How can Florida address this? One way to make inroads in the prevention of suicidal behaviors (suicide ideation, suicide attempts and deaths) is to improve state level data surveillance. Florida partners must work together to determine the best ways to gather information that is usable and actionable towards the common goal of finding out who is suffering and dying in Florida.

6. Why is this important? We must find out 1) the extent of the problem and 2) the impact of interventions in order to target resources effectively and efficiently Preventative and intervention services/programs can be greatly informed by data and surveillance. The collection, monitoring, and sharing of such data increases the ability to: Understand the problem, locate “hot spots” Assess the impact of existing services Identify gaps/barriers in existing systems/areas (geographical locations) Identify systems, populations, and locations to target (current and future) efforts Effectively target local, state, and federal funding to invest in services/programs that have an impact

7. The Children’s Cabinet Suicide Task Group The overall goal is to investigate ways that state-level systems/local agencies are collecting, monitoring, and sharing data on suicide attempts and deaths and to recommend needed enhancements or new systems. What are specific goals of the task group? The Task Group may wish to devise 3-10 Key Questions that we need to answer in order to guide where to look for and find the data What do we need in order to accomplish the goals? Nomination of key stakeholder representatives; funding / staffing?

8. Suggested specific goals: 1.Identify existing systems/agencies/entities collecting suicide-related data and how they are using the data (goal: create an integrated system where all data is pooled) 2.Integrate existing sources of data? Challenge of disparate methods and definitions 3.Examine models that have been successful in making an impact in other states and how those may or may not be applicable to Florida 4.Models from other statewide data surveillance systems in Florida (such as infections disease –DOH) 5.Explore data sharing agreements between systems/agencies/entities (goal: create agreements between systems) 6.Examine existing metrics used to define suicidal behaviors (goal: create a universal process) 7.Explore other gaps/barriers that hinder data collection processes 8.Identify state-level partners that could apply for future federal funding to enhance the state’s existing data surveillance system (relating to behavioral health indicators, especially the collection of suicide attempts and deaths) 9.Advocate for an improved data surveillance system which pools multiple sources together so that local and state-level systems can use reliable information to guide prevention and intervention efforts (this is a primary goal for SAMHSA)

9. Model elements from other states: Oregon By law, Oregon hospitals are required to report adolescent suicide attempts to the Oregon Public Health Division. Purpose Estimate the magnitude of suicide attempts among Oregon adolescents and monitor possible increases, decreases and trends. Understand factors associated with suicide and suicide attempts among adolescents. Increase public awareness and develop programs that support suicide prevention.

10. Oregon: Continued Takes a primary prevention approach- data helps to: Estimate the frequency of suicidal behavior among Oregon adolescents; Monitor possible increases, decreases and trends; Monitor factors associated with suicidal behavior; Increase public awareness; and Develop programs that promote health and reduce suicide

11. What they learned and recommendations Firearm and hanging are most common mechanism Mental health problems, Interpersonal problems, and school problems are most common associated factors (Implications for prevention)

12. Recommendations based on data systems For healthcare community: Improve follow up and outreach to attempters Refer for follow up care! Improve access to affordable behavioral healthcare For Communities Crisis services and response teams Reduce behavioral healthcare stigma (Integrated behavioral health) Reduce access to lethal means For schools Strong links to community resources Protocols for all staff Identification of behavioral health needs

13. National Violent Death Reporting System (NVDRS) Created in 2002 by CDC, NVDRS is a surveillance system that pulls together data on violent deaths in 32 states (see map below), including information about homicides, such as homicides perpetrated by a intimate partner (e.g., boyfriend, girlfriend, wife, husband), child maltreatment (or child abuse) homicides, suicides, and deaths where individuals are killed by law enforcement in the line of duty. The system also collects data on unintentional firearm injury deaths and deaths of undetermined intent. Provides states and communities with a clearer understanding of violent deaths to guide local decisions about efforts to prevent violence and track progress over time. NVDRS is the only state-based surveillance (reporting) system that pools data on violent deaths from multiple sources into a usable, anonymous database. These sources include state and local medical examiner, coroner, law enforcement, crime lab, and vital statistics records.

14. Attempts to combine related data to get a clearer, more useful picture NVDRS collects facts from four major sources about the same incident, and pools information into a usable, anonymous database. An incident can include one victim or multiple victims. The four major data sources are: Death certificates; Coroner/medical examiner reports; Law enforcement reports; and Crime laboratories. The facts that are collected about violent deaths include: Circumstances related to suicide such as depression and major life stresses like relationship or financial problems; The relationship between the perpetrator and the victim – for example, if they know each other; Other crimes, such as robbery, committed along with homicide; Multiple homicides, or homicide followed by suicide.

15. Summary of next steps: Devise key questions and refine specific goals of task group Continue exploration of other state models Pursue CDC cooperative agreement for NVDRS? As goals become clearer, who and what else is needed to do the job? Involvement of researchers Timeline? Work plan? Possibly create working groups for smaller aims Deliverables? Dissemination to community

16. Phased goals and timeline? Phase I: Existing data source discovery, aggregation, analyses; pursue NVDRS Phase II: Develop strategy to improve data surveillance, reporting and use Phase II: Develop recommendations and prevention strategies based on data