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

2. 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.

3. 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.

4. 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

5. 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.
SPI Training:

6. resources Manuals: http://www.suicidesafetyplan.com/Page_8.html
Templates:
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.

7. 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

8. Implementation of SPI

9. 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-
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.

10. 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)

11. 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