1. Primary Prevention Initiative: Suicide Prevention Module

2. Objectives Upon completion of this module, learner will be able to: –Define levels of prevention –Describe how to select relevant topic, locate data, and identify an appropriate intervention 2

3. The Levels of Prevention PRIMARY Prevention SECONDARY Prevention TERTIARY Prevention DefinitionAn intervention implemented before there is evidence of a disease or injury An intervention implemented after a disease has begun, but before it is symptomatic. An intervention implemented after a disease or injury is established IntentReduce or eliminate causative risk factors (risk reduction) Early identification (through screening) and treatment Prevent sequelae (stop bad things from getting worse) ExampleEncourage exercise and healthy eating to prevent individuals from becoming overweight. Check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese. Help obese individuals lose weight to prevent progression to more severe consequences. Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3); 001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm 3

4. Primary Prevention Initiative (PPI) Established by Dr. Dreyzehner in 2012 Goal is to focus the Department’s energy on primary prevention—eliminating risk factors for later problems Intent is for all TDH employees to engage in primary prevention efforts in their community Statewide Roll- out January, 2013

5. PPI Process –All counties participating in Primary Prevention Initiatives –County forms PPI Team –PPI Team meets to determine focus areas –Counties may utilize Community Health Assessments to determine priority topics –PPI Team submits PPI Proposal –PPI Team submits reports on each Activity –Process continues 5

6. Team Work Your county may have multiple teams working on different community activities Teams will spend 5% of their time working on PPI –Approximately ½ day every other week 6

7. PPI Teams Team members will be: –Catalysts –Encouragers –Resource providers –Data keepers/providers Team members are not sole workers –Teams will engage community partners to accomplish activities 7

8. PPI Teams Team size will vary –Teams of 3, 5, or 7 depending on health department size Team composition: –Include community members –Teams should be multidisciplinary (clerical, nursing, clinical, administrative) –Include Regional office staff i.e. Health Promotion Coordinator and/or Community Health Council Coordinator, county staff such as Health Educator, Health Care Provider, and administrative staff 8

9. Topics for PPI Activities –Tobacco –Obesity –Teen Pregnancy –Infant Mortality –Substance Use and Abuse –Immunizations –Suicide Prevention –Occupational Safety –Healthcare Associated Infections 9

10. Selecting a Topic There are so many things you could choose to work on—but time and resources are limited! You will need to prioritize your efforts based on the specific need(s) in your community Needs (and therefore, projects) will likely vary across the State 10

11. Selecting a Topic What can you use to help you prioritize? –Community Health Assessment Tools –County Health Council Priorities –Needs Assessments –Strategic Plans –Ranking/Report Card findings 11

12. Locating Data Once you’ve selected the topic on which you plan to focus, you will need to locate data that is relevant to the topic Data can help you: –Confirm “suspicions” or “hunches” –Sharpen your focus on a particular aspect of the topic –Identify baseline for measuring improvement 12

13. Locating Data Some Potential Data Sources: –Birth/death certificates –Hospital Discharge data –Health Information Tennessee (HIT) website –Behavioral Risk Factor Surveillance System (BRFSS) –Youth Risk Behavior Survey (YRBS) –Pregnancy Risk Assessment Monitoring Survey (PRAMS) –Data from community health assessments 13

14. Identifying An Intervention Once you’ve selected your topic and gathered appropriate data, it’s time to decide what you’re actually going to do There is no need to “re-invent the wheel” Explore what others have done, what has been tested, and what has been shown to work 14

15. Identifying An Intervention Some Sources for Identifying an Intervention: –Guide to Community Preventive Service http://www.thecommunityguide.org/index.html –Healthy People 2020, Community Interventions http://www.healthypeople.gov/2020/topicsobjectives2020/ebr. aspx?topicid=33#interhttp://www.healthypeople.gov/2020/topicsobjectives2020/ebr. aspx?topicid=33#inter –Institute of Medicine http://www.iom.edu/~/media/Files/Report%20Files/2012/APO P/APOP_insert.pdfhttp://www.iom.edu/~/media/Files/Report%20Files/2012/APO P/APOP_insert.pdf –Tennessee State Plan on Nutrition, Physical Activity and Obesity http://www.eatwellplaymoretn.org/assets/files/plan.pdf 15

16. PPI Proposal Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link: http://www.surveygizmo.com/s3/1537642/PPI-Proposal 16

17. PPI Proposal cont ains County Topic Objective Activities Team members Primary contact Community partners Estimated Start Date Estimated Completion Date 17

18. PPI Activity Reporting As the PPI Team completes each activity, report in PPI Activity Reporting Survey Gizmo link: http://www.surveygizmo.com/s3/1458250/PPI-V3-0 18

19. PPI Activity Reporting Contains County name Division/Office Topic Objective Activity description Key Partners/Contributions Start date of activity Facilitating factors of success Barriers encountered Plans to overcome barriers Unanticipated outcomes Impact measures- numbers served Stage of Change Success Stories 19

20. Applying Primary Prevention Principles to Suicide Prevention

21. Tennessee Data: Suicide Prevention 956 reported suicide deaths in 2012 Suicide rate at 14.8 per 100,000—up slightly from previous years, still elevated National suicide rate for 2010: 12.1 per 100,000 In 2010, Tennessee’s suicide rate ranked 17 th in the nation Increase in suicides appears driven by adults, mostly middle-aged (45-54 y.o.) males Data Source: Division of Health Statistics, Office of Policy, Planning and Assessment, Tennessee Department of Health. 2/16/14. CDC. National Center for Health Statistics. Stats of the State of Tennessee, 2010. Available at http://www.cdc.gov/nchs/pressroom/states/TN_2014.pdfhttp://www.cdc.gov/nchs/pressroom/states/TN_2014.pdf

22. National and State Data: Suicide Prevention Trends Division of Health Statistics, Office of Policy, Planning and Assessment, Tennessee Department of Health. 2/26/14 CDC. Web-based Injury Statistics Query and Reporting System (WISQARS): fatal injury data. Available at http://www.cdc.gov/injury/wisqars/fatal.htmlhttp://www.cdc.gov/injury/wisqars/fatal.html National Vital Statistics. Deaths: Preliminary Data for 2011. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf Accessed on 2/26/14.http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf

23. Tennessee Counties with the Highest Suicide Rates, 2012 Data Source: Tennessee Department of Health, Vital Statistics Resident Summary Data 2012. Available at: http://health.tn.gov/statistics/PdfFiles/VS_Rate_Sheets_2012/Suicide2012.pdf County Rate per 100,000 population Actual number of deaths Smith41.98 Cheatham35.614 Giles31.09 Grainger30.97 Stewart30.14 Cannon28.94 Cumberland28.116 Humphreys27.45 Marshall25.98 Claiborne25.28

24. Proven Primary Prevention Strategies Strategy 1—Promote National Suicide Prevention Lifeline (1-800-273-TALK) Objective: Promote Lifeline and TSPN.org website as statewide resources for suicide prevention Activity: –Get local media to promote the Lifeline number & TSPN website –Distribute resources that include the number (especially TSPN pamphlets and resource directories) –Encourage churches and civic groups to promote the Lifeline and TSPN website –Add Lifeline and TSPN websites to appropriate websites

25. Proven Primary Prevention Strategies Strategy 2—Promote Gun Safety Project Objective: Help firearm dealers and firing range owners spot and engage troubled/suicidal customers Activity: –Share guidelines with gun store/firing range owners about how to avoid selling or renting a firearm to a suicidal customer –Encourage gun stores and firing ranges to display and distribute project materials –Educate public about safe firearm use and storage, including temporary removal of guns from premises if someone there may be suicidal

26. Proven Primary Prevention Strategies Strategy 3—Promotion of suicide prevention curricula in schools Objective: Implement means for educating students and staff about suicide prevention Activity: –Promote mental health programs like Mental Health 101 and I.C. Hope –Promote suicide prevention programs like the Jason Foundation’s “Promise for Tomorrow” program –Promote adoption of anti-bullying programs with a suicide prevention component

27. Proven Primary Prevention Strategies Strategy 4—Promote suicide prevention training and assessment Objective: Train general public in suicide prevention, with an emphasis on potential gatekeepers Activity: –Promotion of evidence-based training programs like QPR to schools and community groups –Promotion of appropriate training programs (e.g., ASIST) to mental health and medical professionals –Inclusion of information about suicide prevention training in directories, pamphlets, etc.

28. Proven Primary Prevention Strategies Strategy 5— Promote support to the survivors of suicide Objective: Connect survivors to sources of support throughout the state Activity: –Promotion awareness of and attendance in the survivors of suicide support groups –Promotion the development of new survivor of suicide groups. –Inclusion of information about support groups in directories, pamphlets, online, etc.

29. Additional Resources Tennessee Suicide Prevention Network - www.tspn.orgwww.tspn.org Suicide Prevention Resource Center - www.sprc.orgwww.sprc.org CDC Suicide Prevention Briefs - http://www.cdc.gov/features/suicidebriefshttp://www.cdc.gov/features/suicidebriefs National Suicide Prevention Lifeline -http://www.suicidepreventionlifeline.org/http://www.suicidepreventionlifeline.org/

30. Technical Assistance Resources Rachel Heitmann - Injury Prevention and Detection Director - 615-741-0368 Terry Love - Injury Prevention Manager - 615-532-7778 Abhilash Philipose - CDC Public Health Associate - 615-532-7768