Success Stories from the Best Practices Registry for Suicide Prevention: Identifying Promising andfor Suicide Prevention: Identifying Promising and

Effective Suicide Prevention Programs

Bridging the Divide ConferenceColorado State University, Ft. Collins, CO

M 20 2011May 20, 2011

Philip Rodgers, Ph.D.Evaluation Scientist

AcknowledgementsAcknowledgementsU.S. Department of Health & Human Services

Substance Abuse and Mental Health Services AgencySubstance Abuse and Mental Health Services Agency

Howard Sudak, MDAFSPAFSP

Katrina Bledsoe, Ph.D.,SPRC

This project is supported by a grant (1 U79SM0598945 01) from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (DHHS). No official endorsement by SAMHSA or DHHS for the information in this presentation is intended or should be inferred.y p

What is the Best Practices Registry for S i id P ti (BPR)?Suicide Prevention (BPR)?

The BPR is an online registry of “best practices”The BPR is an online registry of best practices in suicide prevention – Over 80 programs are currently listed in the BPR

The purpose of the BPR is to identify, review, and disseminate information about best practices that address specific objectives of the National Strategy for Suicide Prevention

“P ti ” i d fi d b dl i l di– “Practices” is defined broadly, including programs, policies, protocols, awareness materials, etc.

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Presentation objectivesPresentation objectives

At the conclusion of this presentation, participants ill b bl twill be able to:1. Define what “makes” a program effective.2 Describe the importance of targeting risk and2. Describe the importance of targeting risk and

protective factors in suicide prevention.3. Discuss how the Best Practices Registry contributes g y

to suicide prevention and how to access the BPR.4. Understand the importance of program adaptation.5. List several aspects of successful suicide prevention

programs.

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What Makes a Program Effective?

An effective program achieves its goalsAn effective program achieves its goals

Decrease S icide

Implement Suicide

Suicide Deaths

Prevention Program

But, in our field, it may not be quite that simple

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Why is it difficult to measure suicide deaths?Why is it difficult to measure suicide deaths?

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Knox, K. L., Litts, D. A., Talcott, G. W., Feig, J. C., and Caine, E. D. (2003). Risk of suicide and related adverse outcomes after exposure to a suicide prevention programme in the US Air Force: Cohort study. BMJ, 327, 1376.

Why are large numbers needed?Why are large numbers needed?Small numbers are unreliable.

Suicide Rates for US & Vermont 15-19-year-oldsy

10

12US Vermont

6

8

er 1

00,0

00

2

4

Rat

e pe

01999 2000 2001 2002 2003 2004 2005

Year

88Source: CDC for 2006.

Year

Logic Model Example: Gatekeeper TrainingLogic Model Example: Gatekeeper Training

Generic Gatekeeper Model

TrainingIntervention &

ReferralIdentificationExposure to Population

Potential I t

Gatekeeper Population “At-Risk” I di id l

Mental H lthIntercessor

(Gatekeeper)Individual Healthcare

Provider

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It is important to determine program logict s po ta t to dete e p og a og cGeneric Gatekeeper Training Logic Model

Inputs Activities Outputs

Outcomes Process

Sh t t I t di t L tInputs Activities OutputsFunds

TrainersMaterials

GatekeeperTraining

People trainedSatisfaction

with trainingFidelit of

Short-terma.

Knowledgeb.

Intermediatec.

Identification of those at risk

Long-termf.

Treatmentg.

Trainees Fidelity of training Attitudes

c.Skills

d.Referral

Suicide deaths

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Why are Risk and Protective Factors Important to Suicide Prevention?Important to Suicide Prevention?

Suicide has multiple contributing factorsSuicide has multiple contributing factors

BiologicalFactors

ProximalFactors

PredisposingFactors

ImmediateTriggersFactors

FamilialRisk

S t i

HopelessnessMajor MentalDisorders

Substance

gg

A T

Public HumiliationShame

SerotonergicFunction

NeurochemicalRegulators

Intoxication

ImpulsivenessAggressiveness

SubstanceUse/Abuse

PersonalityProfile

Access To Weapons

SevereDefeatRegulators

Demographics

gg

NegativeExpectancy

Severe

AbuseSyndromes

S M di l/

MajorLoss

PathophysiologySevere

Chronic PainSevere Medical/

Neurological IllnessWorseningPrognosis

SUICIDE RISK ASSESSMENT WORKSHOP, University of MichiganDavid J. Knesper, M.D. Available at www.med.umich.edu/depression/suicide_assessment/

However, we often seek simple answers…

Source: MSNBC.com August 17, 2010

But, in regards to prevention, it’s important t l k t th h l t

Biological Predisposing Proximal Immediate

to look at the whole story…

F thMajor

D i

Factors Factors Factors Trigger

Death byLoss of

Intoxicated

Father Died by Suicide

Depression

Death by Suicide

Loss of Job

Impulsive

Substance Abuse

Male Childhood Abuse

A basic prevention approach is to...A basic prevention approach is to...

1.1.Identify risk and protective factors that are related to

suicide for a given populationg p p

22.Select and implement a program that targets positive

change in those risk and protective factorsc a ge t ose s a d p otect e acto s

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How Does the BPR Contribute to Suicide Prevention?Suicide Prevention?

How does the BPR help to prevent suicide?How does the BPR help to prevent suicide?

The Best Practices Registry provides a list ofThe Best Practices Registry provides a list of programs that:

1. Target specific risk and protective factors related to suicide, and

2. Have been reviewed by experts using criteria related to effectiveness, or quality and safety of content.

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Best practices or better practices?Best practices or better practices?

Usually, the term “best” denotes “the best thing t d ”to do”This would be a misnomer in regards to the BPRMore accurate to refer to BPR as “better practices registry” because…

Th ti th t dd i id– There are many practices that can address suicide risk

– And these practices occur in a variety of settings withAnd these practices occur in a variety of settings with a variety of persons with a variety of needs and resourcesTh f th i l i l “b t” t– Therefore, there is rarely a universal “best” amongst prevention programs

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How to Access the BPR

How is the BPR organized?SPRC Home Page (sprc.org)

How is the BPR organized?

BPR Landing Page

Section IE id b d

Section IIE t d

Section IIIAdh tEvidence-based

programs• NREPP

Expert and consensus statements

Adherence to standards

Sections do not represent levels of effectivenessSections do not represent levels of effectiveness

BPR Landing Page

2222

BPR SearchSearch Engine Screen

ShotShot

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Each BPR program has a fact sheetEach BPR program has a fact sheet

What If there isn’t a BPR Program for a Specific Need?Specific Need?

Programs can be adapted (changed) for ifi dspecific needs…

The BPR does not provide an exhaustive list ofThe BPR does not provide an exhaustive list of good/effective suicide prevention programsSome BPR programs may be adapted for use in p g y psettings other than those for which they were created – Example of the White Mountain Apache Tribe’s

suicide prevention efforts

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Program may need to be changed “adapted” f l lfor local use

It is important to consider how programsIt is important to consider how programs can be adapted for local useWhat changes need to be made to a gprogram to meet local considerations?Can these changes be made without gchanging critical elements of the program?See Linda Langford’s GLS Presentation

http://www.sprc.org/grantees/statetribe/2010/4B%20Langford.pdf

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Example #1 of program adaptionExample #1 of program adaption

ER Intervention for Adolescent FemalesER Intervention for Adolescent Females

Evidence-based program for use in emergency rooms for adolescent females who survived a suicide attempt

Adapted by White Mountain Apace tribe and their t t J h H ki i it f i thpartners at Johns Hopkins university for use in the

homes of male and female suicide attempt survivors

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Example #2 of program adaptionExample #2 of program adaption

American Indian Life Skills Development programAmerican Indian Life Skills Development program

Evidence-based program for use classroom settings in schools with all students

Adapted by White Mountain Apace tribe and theirAdapted by White Mountain Apace tribe and their partners at Johns Hopkins university for use in homes

with suicide attempt survivors

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p

What are some examples of SuccessfulWhat are some examples of Successful Community-Based Programs and What

M k th S f l?Makes them Successful?

Attributes of successful community programsAttributes of successful community programs

The relationship between program goals andThe relationship between program goals and suicide risk can be demonstratedEach program component is thoughtfully p g p g yconsideredProgram materials are easily understoodg yWhen appropriate, programs address multiple levelsWhen appropriate, programs provide multiple helping resources

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Additional important aspects of programsAdditional important aspects of programs

Are supported by evaluation resultsAre supported by evaluation resultsSeek higher-hanging fruitAre collaborativeAre collaborativeAre multi-faceted

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Questions?

Philip Rodgers Ph DPhilip Rodgers, Ph.D.802-446-2446d @ fprodgers@afsp.org

Remember to find out more about the BPRvisit www sprc orgvisit www.sprc.org

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