Download Steps Along the Pathway - New York State Coalition for Children`s

Steps Along the Pathway –
Creating Excellence in Suicide Prevention at Hillside Family of Agencies
Disclosures and
acknowledgments
The author and speaker for this presentation does not
have any potential conflicts of interest and is not
receiving any financial support beyond salary to disclose
content contained here.
Agenda
-
Who is Hillside?
Where we started – 2011
Why we transformed our services
What shaped our efforts
How we transformed our services
What we do now
What have we learned?
Who is Hillside?
- Founded 1837
- Orphanage transformed into a multi-system, multiservice provider
- Over 110 different services and over 40 locations
- 15,000 individuals served annually
- Major funders
- OASAS, OCFS, OMH, OPWDD, State Ed,
Department of Health
- Located across Central and Western NY, Prince George’s
County MD, Washington DC
Where we started – 2011
- “Home-grown” risk assessment tool
- Compassion-focused education for employees
- Inconsistent pathway for response and care regarding
suicidal ideation/behavior
- Behavioral focus for chronic suicidal ideation
- Unclear plan for how to handle a suicide death
- No plan for how to support employee distress
- Clinician/RN-centric model, ED-focused model for
community programs
Why we transformed our services
- Garrett Lee Smith Grant – NYS sub-awardee
- Agency focus of “translating research into effective
practice solutions that create value”
- Limited history of deaths by suicide among individuals
receiving services, and employees providing supports
- Active community partner
What shaped our efforts
-
Recommended best practices for NYS grant proposal
2012 National Strategy for Suicide Prevention
Suicide Care in Systems Framework
Zero Suicide Initiative
Focus on “Culture Change”
What shaped our efforts
Recommended Best Practices
- Universal Gatekeeper Skills – safeTALK, QPR, ASIST
- Risk Assessment – Columbia Suicide Severity Rating
Scale (C-SSRS)
- Safety Planning – Safety Planning Brief Intervention
Tool
- Postvention – NAMI NH CONNECT Program, Lifelines
What shaped our efforts
2012 National Strategy for Suicide Prevention
The NSSP features 13 goals and 60 objectives with the themes that
suicide prevention should:
- Foster positive dialogue - counter shame, prejudice, and silence
- Address the needs of vulnerable groups - tailored to the cultural and
situational contexts and eliminate disparities
- Be coordinated and integrated - addressing health and behavioral health,
ensure continuity of care
- Promote changes policies and environments - support and
facilitate the prevention of suicide
- Apply the most up-to-date knowledge base for suicide
prevention
http://actionallianceforsuicideprevention.org/national-strategy-suicide-prevention-0
What shaped our efforts
Suicide Care in Systems Framework
Core Values: Beliefs and Attitudes
- Leadership leading to cultural transformation – make suicide a “never event.”
- Continuity of Care and Shared Service Responsibility – suicide risk must be
addressed directly, not merely as a symptom of an underlying disease.
- Immediate Access to Care for All Persons in Suicidal Crisis – continuous
access to individuals trained in assessment, counseling, and intervention.
- Productive Interactions between Persons at Risk and Persons
Providing Care – Positive health and behavioral health outcomes are dependent on positive,
functional, and supportive relationships.
- Evaluate Performance and Use for Quality Improvement – Set a goal of
zero suicides, manage system of care performance, and use untoward events as opportunities to
improve capacity to save lives at risk.
http://actionallianceforsuicideprevention.org/sites/actionalliance
forsuicideprevention.org/files/taskforces/Clinical Care Intervention
Report.pdf
What shaped our efforts
Zero Suicide – 7 Essential Elements
- Lead – Create a leadership-driven, safety-oriented culture
- Train – Develop a competent, confident, and caring
workforce
- Identify – Systematically identify and assess suicide risk
- Engage – Ensure every individual has a pathway to care
- Treat – Use effective, evidence-based treatments
- Transition – Provide continuous contact and support
- Improve – Apply a data-driven quality improvement
approach
http://zerosuicide.sprc.org/
What shaped our efforts
Culture Change
Desire to move to a culture where:
- Suicide is approached head-on, and treated
- Suicide is not seen as a “disruption” to treatment,
but a part of treatment
- All employees of the agency have an active role in
suicide prevention – not the purview of a
small group of “experts”.
How we transformed our services
- Dedicated employee role
- Implementation Team
- Postvention Work Group
What we do now
- Offer gatekeeper courses for all employees
- “Universal” Screening
- Best Practice Tools
-
- C-SSRS
-
- Safety Planning Brief Intervention Tool
-
Suicide Intervention Pathways
Emergency Department Diversion
Postvention
Employee Psychological Distress protocol
What we do now
Offer gatekeeper courses for all employees
- QPR for non-service employees. 1.5 hour
presentation
- safeTALK for service employees who do not take
ASIST. 3 hour presentation
- ASIST for employees performing risk assessment
and safety planning, as well as any other
employee interested in being able to provide
“suicide first aid”, in order to create “safetyfor-now” with the person at risk.
What we do now
“Universal” Screening
- The “Clinical Risk Screen” is a multi-topic tool
which incorporates questions to identify a
number of clinical needs for treatment in the
individual being admitted for services.
- Questions regarding suicidal ideation and
behavior are incorporated into this tool,
drawn from C-SSRS Screener tool
What we do now
Best Practice Tools
C-SSRS
- International recognized best-practice tool for
determining risk of suicide. Can be implemented by
a wide variety of individuals, which expands
assessment opportunities.
Safety Planning Brief Intervention Tool
- Widely recognized best practice tool, providing a
“brief intervention”, and equipping the person at
risk with a self-directed safety plan for addressing
future ideation/behavior.
http://cssrs.columbia.edu/
http://www.suicidesafetyplan.com/
What we do now
Suicide Intervention Pathways
- Provides clear guidance across programs and funder
systems on how to move through all aspects of care
needs of a person experiencing suicidal
ideation/behavior
- Aligns with Zero Suicide Care Pathway
- Addresses “atypical” situations such as:
- alternate motivation
- lack of engagement in treatment
- lack of congruence with external providers
What we do now
Suicide Intervention Pathways
Initial Ideation of Suicidal Risk
1. Preserve Safety
2. Risk Assessment
3. Planning for Safety from Suicide
4. Risk Formulation/Action Plan
5. Treatment
6. Reframing Thinking and Developing Skills
7. On-going Gatekeeper Skills
8. Regular Direct Inquiry
9. Safety Plan Review
What we do now
Suicide Intervention Pathways
Suicidal Crisis
10. Emergency Management Procedures
11. Physical Health Needs
12. Emotional/Behavioral Health Needs
Steps #1 - 9
Atypical Situations
A. / B. Alternate Motivations
- Attention, Revenge, Reaction
C. Not Participating in Treatment
D. / E. Provider or Parent/Guardian Do Not
Agree With the Need For Care
What we do now
Emergency Department Diversion
- Movement from an ED-dependent model for communitybased programs to internal assessment, where
relationships have already been established.
- Better experience for the person at risk, especially those
who have had prior (negative) experience with ED
assessment.
What we do now
Postvention
- Agency Postvention Plan merges Critical Incident
Management protocols with Postvention Best
Practice activities.
- 4 domains of activity
- Critical Incident Management Response to the Incident
- Healing and Recovery
- Risk Review and Assessment of the Incident
- Pre-emptive Education and Prevention
- 5 timeframes for postvention activity
- immediately, initial hours after the event, within 24 – 72
hours, on-going after the event
What we do now
Employee Psychological Distress protocol
- Steps for Employees to follow:
- Sense changes in your peers.
- Assess ability to talk with the peer.
- Talk with the peer employee about what has been noticed.
- Act to promote safety.
- Follow up if the relationship allows.
- Steps for Supervisors to follow:
- Respond to concerns you identify, or that are conveyed to you by other
employees.
- Inquire about supports and resources.
- Assess what should happen next.
- Leverage needed resources and supports.
- Act to address performance concerns.
- Follow up as long as needed.
What have we learned?
- Change is hard – especially regarding death/suicide
- You cannot over-communicate
- Important to reframe concept of “Risk”
- “Lean In” to the idea of fear – figure it out, and address it.
- Leverage those with passion
- There is always another level of detail to define for
employees
- It always takes longer than you want to make lasting
change
- Spread the ownership
- It takes a whole agency to change what the agency
believes and does
Special Thanks to:
- New York State Office of Mental Health
- Suicide Prevention Center of NY
- Pat Breux
- Garra Lloyd Lester
- Gary O’Brien
Special Regards and In Memoriam of Fred Meservey
Q&A
THANK YOU!
Tony Hess
Manager, Organization Development and Learning
Hillside Family of Agencies
1 Mustard Street
Rochester, NY 14609
[email protected]
585 654-1328