1. Participant Code: 9406634 INSTRUCTIONS FOR MODERATOR: Scripting below.
Open the webinar room and upload the slides at 1030
In the chat field type “Thank you for joining Dialogue with DSPO! For audio, use the *** Toll Free Number:
Participant Code:
We will begin at 1100 ET.”
As participants enter the “room” welcome them through the chat box and encourage them to introduce themselves.
2. Open the conference line at 1045 –
The operator will place speakers and participants on mute.
3. When you are ready to begin, the webinar
Webinar: *** do NOT record this episode (April 2019) ***
Katherine:
Welcome back! And thank you for joining us for our four episode of season three.
We started Dialogue with DSPO in January 2017 with about 30 participants and have grown our community of practice throughout the years to an average of 150 suicide prevention professionals dialing and logging in each month to discuss topics that are relevant and timely to the work we all do.
Today, we are going to discuss Zero Suicide Systems Approach: a USAF Pilot Study with Dr. Adam Walsh!
Before we get started today … as always, I’ll offer up a few reminders for our discussion-
This is a DIALOGUE! You are welcomed and ENCOURAGED to share information and questions both through the chat box and through the conference line. Please keep your phone lines on MUTE when and where available.
*** This episode is NOT recorded. ****
*** Add a comment on how we tried to do video… but was freezing up today***
*** Add an apology that we had to delay this from last month***
< Marina: next slide >

2. For more information visit:
Katherine: Before we get started, I wanted to provide a quick update for you about the upcoming VA/DoD Suicide Prevention Conference. With much awaited anticipation, I am happy to announce that (drum roll please) the conference will take place in Nashville, TN at the Gaylord Opryland Resort and Conference and registration will be opening soon. For more information visit

3. Director, Research & Program Evaluation, DSPO
Progress of Zero Suicide Federally Funded Efforts: Preliminary Findings from a pilot study with 5 United States Air Force Military Treatment Facilities American Association of Suicidology Conference
April 25, 2019
INSTRUCTIONS FOR MODERATOR: Scripting below.
Open the webinar room and upload the slides at 1030
In the chat field type “Thank you for joining Dialogue with DSPO! For audio, use the *** Toll Free Number:
Participant Code:
We will begin at 1100 ET.”
As participants enter the “room” welcome them through the chat box and encourage them to introduce themselves.
2. Open the conference line at 1045 –
The operator will place speakers and participants on mute.
3. When you are ready to begin, the webinar
Webinar: *** do NOT record this episode (April 2019) ***
Katherine:
Welcome back! And thank you for joining us for our four episode of season three.
We started Dialogue with DSPO in January 2017 with about 30 participants and have grown our community of practice throughout the years to an average of 150 suicide prevention professionals dialing and logging in each month to discuss topics that are relevant and timely to the work we all do.
Today, we are going to discuss Zero Suicide Systems Approach: a USAF Pilot Study with Dr. Adam Walsh!
Before we get started today … as always, I’ll offer up a few reminders for our discussion-
This is a DIALOGUE! You are welcomed and ENCOURAGED to share information and questions both through the chat box and through the conference line. Please keep your phone lines on MUTE when and where available.
*** This episode is NOT recorded. ****
*** Add a comment on how we tried to do video… but was freezing up today***
*** Add an apology that we had to delay this from last month***
< Marina: next slide >
Adam Walsh, Ph.D.
Director, Research & Program Evaluation, DSPO

4. Overview Zero Suicide Systems Approach (ZSSA)
Framework for safer suicide care in healthcare systems
Shown to reduce suicide deaths in civilian healthcare settings
Why pilot ZSSA in the United States Air Force (USAF)
Military Treatment Facilities (MTFs) have different access and care delivery structures than civilian healthcare settings
Research has shown that 30% of Service members had accessed behavioral healthcare at an MTF within 90 days of death by suicide
Defense Suicide Prevention Office (DSPO) oversees the Defense Strategy for Suicide Prevention (DSSP)
Aligns with DSSP Goal 1, which integrates and coordinates suicide prevention into DoD programs and activities
Methodological Notes
OPA uses well-established, scientific procedures to randomly select a sample representing the military population based on combinations of demographic characteristics
Demographic groups with lower response rates are oversampled
Weighted response rate was 23 percent
Data are weighted using an industry standard process to produce survey estimates representative of their respective populations
Results can be generalized to full military population
OPA and DSPO collaborated on development of suicide prevention items; example topics include:
Suicidal thoughts and attempts
Awareness and perceived effectiveness of training and outreach
Resiliency
Help seeking
Barriers to care

5. United States Air Force (USAF) Pilot Study
DSPO sponsored a U.S. Air Force (USAF) pilot of the Zero Suicide Systems Approach (ZSSA) at military treatment facilities (MTFs) in five Air Combat Command (ACC) installations in FY16
The pilot examined the impact of ZSSA within selected MTFs compared to control MTFs (no program)
DSPO supported pilot study by providing:
Oversight and Technical Support
Subject Matter Expertise
Monthly Interim Progress Reviews (IPRs)
Pilot goal to reduce suicide among USAF MTF patients by:
Instilling safety-oriented suicide prevention at MTFs
Training all MTF staff to increase competence and confidence in their respective suicide prevention roles
Improving assessment of suicide risk of all patients

6. Pilot Screening and Training Results

7. Results of Columbia Suicide (C-SSRS) Screening and Assessment Protocol
Methodological Notes
OPA uses well-established, scientific procedures to randomly select a sample representing the military population based on combinations of demographic characteristics
Demographic groups with lower response rates are oversampled
Weighted response rate was 23 percent
Data are weighted using an industry standard process to produce survey estimates representative of their respective populations
Results can be generalized to full military population
OPA and DSPO collaborated on development of suicide prevention items; example topics include:
Suicidal thoughts and attempts
Awareness and perceived effectiveness of training and outreach
Resiliency
Help seeking
Barriers to care
Staff reported (on a scale of 1-5) high confidence in their likelihood to use, and the ability to administer, the C-SSRS screening and assessment protocols
Staff reported high confidence in the instruments ability to identify at risk patients and to contribute to their risk formulations
USAF Instruction was given to replace the Suicide Status Form (SF) with the C-SSRS protocol Service-wide

8. Results of Safety Planning Tool (SPT) Training and Protocol
Methodological Notes
OPA uses well-established, scientific procedures to randomly select a sample representing the military population based on combinations of demographic characteristics
Demographic groups with lower response rates are oversampled
Weighted response rate was 23 percent
Data are weighted using an industry standard process to produce survey estimates representative of their respective populations
Results can be generalized to full military population
OPA and DSPO collaborated on development of suicide prevention items; example topics include:
Suicidal thoughts and attempts
Awareness and perceived effectiveness of training and outreach
Resiliency
Help seeking
Barriers to care
Providers reported that they were significantly more confident in using the SPT protocol (on a scale of 1-5) when compared to their previous method of safety planning
Technicians reported that they were significantly more confident in using the SPT protocol (on a scale of 1-5) when compared to their previous method of safety planning

9. Results of Time-Motion Observation Study for Mental Health (MH) Providers
Methodological Notes
OPA uses well-established, scientific procedures to randomly select a sample representing the military population based on combinations of demographic characteristics
Demographic groups with lower response rates are oversampled
Weighted response rate was 23 percent
Data are weighted using an industry standard process to produce survey estimates representative of their respective populations
Results can be generalized to full military population
OPA and DSPO collaborated on development of suicide prevention items; example topics include:
Suicidal thoughts and attempts
Awareness and perceived effectiveness of training and outreach
Resiliency
Help seeking
Barriers to care
MH providers stated in previous interviews that much of their time is used for record documentation. This was supported by the time-motion study: Time spent on patient care was nearly identical to time spent on record documentation
Results supported efforts to revise existing intake and follow-up note templates to achieve efficiency and reduce time spent

10. Tracking the Rate of Suicide Attempts during the Pilot at 5 USAF MTFs
Suicide attempt trends pre to post ZSSA implementation:
Rates for the pilot bases are consistently lower than comparison bases and are continuing on a declining trend

11. Tracking the Rate of Psychiatric Hospitalization during the Pilot at 5 USAF MTFs
Psychiatric hospitalization trends pre to post ZSSA implementation:
Rates for the pilot bases are consistently lower than comparison bases and are continuing on a lower trend

12. Primary Care C-SSRS Screening during the Pilot at 5 USAF MTFs
Primary Care Screening Fidelity Data:
The proportion of total encounters in Primary Care Clinics with documented C-SSRS results has increased substantially over the course of the pilot.
*Note: This proportion only represents the total number of encounters with C-SSRS results documented in the TSWF-specific template during that encounter. However, it has recently been identified that PCMs have been using alternative methods for documenting C-SSRS results within the patient record. As a result, the actual proportion of encounters where screening is taking place is likely much higher. Clinics have been re- directed to only use the TSWF-specific template to document C-SSRS results for all encounters in their clinics.

13. ZSSA Pilot Outcome Metrics
Primary Care Screening Outcome Data:
As the rate of screening increased, the proportion of total screeners that resulted in an intermediate or high-risk designation decreased
By July 2018, less than 2.55% of total screenings conducted resulted in intermediate risk & less than 1/10th of a percent resulted in high- risk
Out of the total of 451 recorded intermediate or high-risk screenings, only 57 (12%) had a follow-up with BHOP and/or MH
That is 57 in 17,623 encounters for a rate of .003%

14. Next Steps
USAF will possibly use pilot findings on outcomes and effectiveness to translate the system to a wider USAF audience
USAF is planning a Randomized Control Trial (RCT) informed by findings of Pilot Study
Depending on results of RCT, consider policy changes to address use of ZSSA in the Services
Findings to inform plan for broader potential rollout to larger Air Force
Findings to inform plan for potential rollout to other military Services

15. Questions?
Adam Walsh, Ph.D.

16. < Marina: hold this slide throughout >
LET’s HAVE SLIDE MATCH WHAT EVERY WE USE EARLIER
Katherine:
Let’s turn back to questions we received from the DWD Community.
Q. Has DSPO initiated any DOD Best Practices for Suicide Prevention within each service?
DSPO works closely with the academic community and leads research efforts focusing on promising and emerging practices to initiate evidence-based practices for suicide prevention within each Service.
Air Force, Zero Suicide:
DSPO funded a pilot on the Zero Suicide Systems Approach with the Air Force, who trained medical personnel at all Air Force Treatment Facilities, integrating suicide risk assessment, safety planning, and means safety education for all health facility staff.
Navy, REPS training:
DSPO funded a pilot of teaching Rational Thinking, Emotion Regulation, and Problem-Solving skills to Navy recruits in the A Schools, as well as teaching Navy chaplains cognitive behavioral strategies for suicide prevention.
Marine Corps, C-SSRS:
DSPO also helped facilitate an evaluation of the Columbia Suicide Severity Rating Scale with JAG officers in the.
Army, social media training:
The Army, along with the other Services, assisted with the development of a DSPO-funded training, how to identify suicide-related thoughts and behaviors on social media and how to respond effectively.
National Guard, SOFS-R:
Finally, DSPO worked with the National Guard to incorporate suicide prevention questions on the Status of Forces Survey Reserve.
Q. Are there any communications between from DSPO to Army Resilience Directorate for Suicide Prevention Programs initiatives and future planned workshops?
A. DSPO and ARD have participated in the program evaluation planning where DSPO has shared its Department-wide program evaluation framework and logic model for ARD review and feedback. ARD has offered their logic model and program evaluation activities. DSPO and ARD agree that our program evaluation efforts are complementary and opportunities for collaboration are possible. DSPO and ARD participate in the standing STARRS working group that includes discussions on how to translate STARRS-LS research findings into new DoD and Army suicide prevention guidance and proximal measures that can inform the logic models DSPO and ARD have.
Katherine: < additional questions, time permitting >
1. What are some of the things you have focused on in your first few months in this role? – IF DIDN’T ASK BEFORE
2. What do you like to do in your down time?

17. Questions? LET’s HAVE SLIDE MATCH WHAT EVERY WE USE EARLIER Katherine:
Let’s turn back to questions we received from the DWD Community.
Q. Has DSPO initiated any DOD Best Practices for Suicide Prevention within each service?
DSPO works closely with the academic community and leads research efforts focusing on promising and emerging practices to initiate evidence-based practices for suicide prevention within each Service.
Air Force, Zero Suicide:
DSPO funded a pilot on the Zero Suicide Systems Approach with the Air Force, who trained medical personnel at all Air Force Treatment Facilities, integrating suicide risk assessment, safety planning, and means safety education for all health facility staff.
Navy, REPS training:
DSPO funded a pilot of teaching Rational Thinking, Emotion Regulation, and Problem-Solving skills to Navy recruits in the A Schools, as well as teaching Navy chaplains cognitive behavioral strategies for suicide prevention.
Marine Corps, C-SSRS:
DSPO also helped facilitate an evaluation of the Columbia Suicide Severity Rating Scale with JAG officers in the.
Army, social media training:
The Army, along with the other Services, assisted with the development of a DSPO-funded training, how to identify suicide-related thoughts and behaviors on social media and how to respond effectively.
National Guard, SOFS-R:
Finally, DSPO worked with the National Guard to incorporate suicide prevention questions on the Status of Forces Survey Reserve.
Q. Are there any communications between from DSPO to Army Resilience Directorate for Suicide Prevention Programs initiatives and future planned workshops?
A. DSPO and ARD have participated in the program evaluation planning where DSPO has shared its Department-wide program evaluation framework and logic model for ARD review and feedback. ARD has offered their logic model and program evaluation activities. DSPO and ARD agree that our program evaluation efforts are complementary and opportunities for collaboration are possible. DSPO and ARD participate in the standing STARRS working group that includes discussions on how to translate STARRS-LS research findings into new DoD and Army suicide prevention guidance and proximal measures that can inform the logic models DSPO and ARD have.
Katherine: < additional questions, time permitting >
1. What are some of the things you have focused on in your first few months in this role? – IF DIDN’T ASK BEFORE
What do you like to do in your down time?

18. Follow DSPO on Social Media
Defense Suicide Prevention Office
@DSPOmil
Katherine: < Wrap Up >
Transition to wrap up.
Pausing in May. Join us again in June (Wed 12 June) at 1100 ET.
INSTRUCTIONS FOR PLANNER
Receive audio count from operator
@DSPOmil
Defense Suicide Prevention Office