1. ZERO SUICIDE INITIATIVE The Hope and Health Phone Follow-Up Services (STRUCTURED FOLLOW UP PROGRAM) Jessica C. Pirro, LMSW Chief Executive Officer Crisis Services- Buffalo, NY

2. Planning and Implementation
Numerous calls and meetings with NYS OMH, Crisis Services, Erie County Medical Center Corporation.
Buffalo Psychiatric Center was initially to be involved but already had established follow up process.
We considered referrals from CPEP but the volume was to large for the resources allocated to us on the grant. Projected referrals a week- that is what we see in a month from outpatient.

3. Planning and Implementation
Collaboration on paperwork development,
referral process and communication structure
MOU developed
Crisis Services already contracted with ECMC for other services - existing relationship made this process more efficient

4. Program Process
Crisis Services receives referral by fax from ECMC Inpatient Psychiatric Department Discharge Planners.
Information Provided:
Referral to Structured Follow up Program
Structured Follow Up Consent/Confidentiality Form
Contact Information/Emergency Contacts
Safety Plan
First Outpatient Appointment

5. Profile created in i-Carol system First call is attempted 24-48 hours
Call information and call outcome documented
Outcome
Unsuccessful- Did not speak with Client
Outcome Successful- Reached and spoke to Client

6. Reiterate goal of Hope and Health/Structured Follow up Program
Successful Contact
Reiterate goal of Hope and Health/Structured Follow up Program
C-SSRS Completed
Check in with Client
Discuss any use of Safety Plan and/or review for updates
1st Outpatient Appointment Confirmed
2nd Structure follow up call scheduled after First Outpatient appt.
Supportive Counseling

7. 2nd Structure follow up call – Made after first Outpatient Appt.
Lethality Assessed
Safety Plan Reviewed
3rd Structure Follow Up Scheduled after 2nd Outpatient Appointment
Supportive Counseling

8. 3nd Structure follow up call – Made after seconded Outpatient Appt.
Lethality Assessed
Safety Plan Reviewed
Supportive Counseling
If patient is stable and on-going Outpatient is confirmed case is closed
On selective occasions a 4th Structured Follow up call is scheduled for after the 3rd Outpatient appointment either through client request or if Crisis Counselor feels it is warranted

9. Unsuccessful Call
Staff leave a voic (with prior consent) indicating our attempt to reach them
Staff inform Client that Staff will be attempting to reach out again but if Client is in an emergency, unsafe or having thoughts of suicide to utilize the Crisis Services 24 hour hotline or 911
If Client is not contacted, Staff will reach out to the Emergency Contact and/or Staff schedule a 3rd attempt the following business day

10. Unsuccessful Call If Emergency Contact is reached
Staff inquire with Emergency Contact if they have had contact with Client
Staff inquire on Client’s appearance, behaviors and status on how they are doing and explains that Staff will attempt contact again
Review the services the Mobile Outreach Team at Crisis Services
If staff reaches out 3 times and each call is unsuccessful, Staff will leave a final voic indicating that the Client’s case will be closed, reminding them of the 24 hours hotline as resource to call anytime for assistance.

11. Data – January- July 2016

12. Data- Ages 25- 64 (Grant Criteria)

13. Data – Ages 18-24/65+

14. Challenges Fax Machine Contact rate of clients referred I-Carol
Adding encrypted system in 2017
Contact rate of clients referred
Crisis Services provides Mobile Outreach Services- could this have an impact?
Program Name Change  
At discharge patients are given a lot of program information and paper work to sign
I-Carol
Does not have user friendly outgoing call tracking capabilities
Have a multiple systems to track stats

15. Lessons Learned
Having a data system that would be more efficient in gathering statistics. 
Operational changes to help address several staff working on program. 
Track the non- grant ages and monitor any differences with ages in response to the program.

16. Triumphs
“I appreciate the support” and readily disclose if they have experienced suicidal ideations and/or have utilized their safety plan or not.
“I was having strong thoughts of suicide today”, states that they were "grateful for the call"  and that “it was very kind to check up on them". 
Education on Crisis Services and the various levels of services provided.

17. Jessica C. Pirro, LMSW Chief Executive Officer Crisis Services- Buffalo, NY