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Community Change Project: Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent Co

Community Change Project: Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent County, Michigan. Ferris State University NURS 340 Community Nursing Mariah Lab Brandi Miller Maia Novak Kimberly Reed Brandon Zolynsky. Problem Overview.

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Community Change Project: Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent Co

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  1. Community Change Project:Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent County, Michigan Ferris State University NURS 340 Community Nursing Mariah Lab Brandi Miller Maia Novak Kimberly Reed Brandon Zolynsky

  2. Problem Overview • In the United States, 38,364 people died from suicide in 2010 • Suicide deaths outnumbered the 33,687 deaths caused by motor vehicle crashes • Suicide rates among middle-aged people are rising • Suicide is the 10th leading cause of death • An estimated 11 attempted suicides occur per every suicide death • Suicide is preventable CDC, 2013 NIH, n.d.

  3. Statistics (Rate is per 100,000 population) Kent County Working Together for a Healthier Tomorrow, 2011

  4. Use of the Ecological Model to Classify the Factors Contributing to Suicide Kent County Working Together for a Healthier Tomorrow, 2011 Caruso, n.d. American Foundation for Suicide Prevention, 2013

  5. Affected Population Kent county residents (including all ages, sex, and race) *Most at-risk individuals include men and women ages 45-64 years* Weaknesses of affected group • Unemployed • Mentally ill and in a lower socioeconomic class • Stigmatized • Ethnic and religious factors Strengths of the affected group • Community resources and community improvement focus groups • Network 180 • Goals and interventions to assist at-risk individuals Kent County Working Together for a Healthier Tomorrow, 2011

  6. Barriers to Change • Lack of resources • Lack of accessibility to health care • Lack of support • Negative association with mental illness • High public school drop-out rates Grand Rapids Public Schools, 2011 Kelly, Jorm, & Wright, 2007 Kent County Working Together for a Healthier Tomorrow, 2011 Rickwood, Deane, Wilson, & Ciarrochi, 2005

  7. Community Resources Pine Rest • Treats all aspects of a person’s well-being • Provides a number of different services and programs • Prevention Groups, Community Living Support, Crisis Residential Placements, In-Home Services, Multi-Systemic Therapy, Respite Care, Residential Care, Outpatient Therapy, Psychiatric Hospitalization, Trauma Focused Cognitive Behavioral Therapy Network 180 • Coordinates the community mental health response, including: • Assertive Community Treatment, Case Management, Community Living Supports, Community Placement, Consumer-Run Services, Crisis Intervention, Crisis Residential Services, Enhanced Mental Health Services, Housing Assistance, Kent County Correctional Facility, Nursing Facility Mental Health Monitoring, Outpatient Services, Recovery Academy Pine Rest, 2013 Network 180, 2013

  8. Community Nursing Diagnosis Risk of suicide among residents of Kent County, Michigan, related to untreated or undertreated: • Depression • Other mental health disorders • Co-occurring health problems As demonstrated by the following indicators: • More than 90% of the people who die by suicide in Kent County have one of these risk factors • Increasing suicide rate • Almost 8% of students report they have attempted suicide during the past 12 months • Prevalence of mental health disorders Kent County Working Together for a Healthier Tomorrow, 2011 Muecke, 1984

  9. Intervention Options Arizona Programmatic Suicide Deterrent System • Oversees system of care for more than 20,000 people • Partnered with the Arizona Department of Health Services Division of Behavioral Health Services • Comprehensive national model Surviving the Teens • Provides information, resources, and support • Division of Psychiatry at Cincinnati Children’s Hospital Medical Center Cincinnati Children’s Hospital Medical Center, 2013 Magellan of Arizona, 2013

  10. ASIST Overview • Applied Suicide Intervention Skills Training (ASIST) • Two-day workshop designed to help community members become more willing, ready and able to help persons at risk for suicide • Objectives based on five learning sections: • Preparing • Connecting • Understanding • Assisting • Networking • Participants receive several learning tools Lang, Ramsay, Tanney, & Kinzel, 2010

  11. Social Support Behavior Change Model • Instrumental Assistance • Providing transportation to mental health appointments • Providing a safe environment for problem solving • Informational Support • Teaching about mental health and community resources • Emotional Support • Calling and checking-in on at-risk individuals • Sponsoring individuals in substance abuse programs • Appraising Support • Providing an unbiased view of perceived problems and available solutions Harkness& DeMarco, 2012

  12. Implementation Team What community resources will be needed? • Trainers, organizers, facilities, equipment and materials • Human resources needed: • Health department staff, regional trainers, and logistic personnel • Trainers will attend a five-day training course • Training cost: $2,750 per person plus travel expenses • Class size: 24 individuals per 2 trainers What community human resources are available? • Volunteers and health department staff Lang, Ramsay, Tanney, & Kinzel, 2010

  13. Needed Resources Facilities • Health department, hospitals, public schools, colleges and universities Equipment • Multimedia projection systemand screen • DVD player • Chalkboard • Flip chart Materials • Program materials • Incidental materials Lang, Ramsay, Tanney, & Kinzel, 2010

  14. Community Relevance Top Strategic Issues from the Kent County Community Needs Assessment: • Equal access to high quality, affordable health care • A coordinated system of care that is local, preventative, holistic, and patient-centered • An environment that supports healthy living for all Kent County Working Together for a Healthier Tomorrow, 2011

  15. Direct Outcomes • Reduce the suicide rate in Kent County to be at or below the level in Michigan (from 12 to 11.7) by 2018 • Reduce the suicide rate among 45-64 year olds in Kent County to be at or below the level in Michigan (from 21.2 to 17.2) by 2018 • Reduce the suicide rate in Kent County to 10.2 by 2020 in accordance with the Healthy People 2020 objectives (Rates are per 100,000 population) HHS, 2013 Kent County Working Together for a Healthier Tomorrow, 2011

  16. Indirect Outcomes • Lowered rates of substance abuse • Reduced rates of other mental health disorders • Decreased unemployment • Better grades Healing And Working!!! Kent County Working Together for a Healthier Tomorrow, 2011

  17. Process Outcomes ASIST Process Outcomes • Participant Satisfaction • Good use of time • High quality • Long-lasting effects • Knowledge and Attitude • Increased knowledge about suicide, prevention, warning signs, and intervention methods • Skills • Improved intervention skills • Behavior Change • Increased intervention behavior Outcome Measures • Seminar Evaluations • At seminar completion • One year following seminar completion • Monitor Attendance and Seminar Utilization • Coordinate with Network 180 Rodgers, 2010

  18. Structural Outcomes • Structural outcomes are geared toward measuring accessibility and utilization of resources Eventual Desired Outcomes • Integration of ASIST program into major health care systems • Sustainability of the ASIST program within Kent County • Two additional inpatient treatment facilities in Kent County • Subsidiary of Network 180 devoted to suicide prevention Measures • Suicide rate trends • Utilization of treatment facilities • Number of ASIST training attendees

  19. Conclusion Suicide is 100% Preventable Kent County Working Together for a Healthier Tomorrow, 2011 Lang, Ramsay, Tanney, & Kinzel, 2010

  20. References American Foundation for Suicide Prevention. (2013). Risk factors and warning signs. Retrieved from http://www.afsp.org/understanding-suicide/risk-factors-and-warning-signs Caruso, K. (n.d.). Suicide.org. Retrieved from http://www.suicide.org/ Centers for Disease Control and Prevention [CDC]. (2013). CDC finds suicide rates among middle-aged adults increased from 1999-2010. Retrieved from http://www.cdc.gov/media/releases/2013/p0502-suicide-rates.html Cincinnati Children’s Hospital Medical Center. (2013). Surviving the teens/suicide prevention. Retrieved from http://www.cincinnatichildrens.org/service/s/surviving-teens/default/ Evans, R. E., & Price, S. (2013). Exploring organisational influences on the implementation of gatekeeper training: a qualitative study of the Applied Suicide Intervention Skills Training (ASIST) programme in Wales. Critical Public Health, 23, 213-224. doi:10.1080/09581596.2012.752069 Forest View Hospital. (n.d.). Mental health care with compassion and respect. Retrieved from http://www.forestviewhospital.com/ Grand Rapids Public Schools. (2011). Strategic plan 2011. Retrieved from http://www.grps.org/images/about%20grps/pdfs/grpsStrategicPlan.pdf Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins. Isaac, M., Elias, B., Katz, L. Y., Belik, S., Deane, F. P., Enns, M. W., …, & The Swampy Cree Suicide Prevention Team (12 members). (2009). Gatekeeper training as a preventative intervention for suicide: a systematic review. Canadian Journal of Psychiatry, 54, 260-268.

  21. References Kelly, C. M., Jorm, A. F., & Wright, A. (2007). Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Medical Journal of Australia, 187(7), S26-S30. Kent County Working Together for a Healthier Tomorrow. (2011). Kent County 2011 community health needs assessment and health profile. Retrieved from http://www.kentcountychna.org/ Klimes-Dougan, B., Klingbeil, D. A., & Meller, S. J. (2013). The impact of universal suicide-prevention programs on the help-seeking attitudes and behaviors of youths. Crisis, 34, 82-97. doi: 10.1027/0227-5910/a000178 Lang, W. A., Ramsay, R. F., Tanney, B. L, & Kinzel, T. (2010). ASIST organizer guide. Fayetteville, NC: LivingWorks. Magellan of Arizona. (2013). Suicide prevention. Retrieved from http://magellanofaz.com/programs/suicide-prevention.aspx Mental Health Foundation of West Michigan. (n.d.). Education. Retrieved from http://www.themhf.org/education/education_links Muecke, M. A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1, 23-25. National Institutes of Health [NIH]. (n.d.). Suicide in the U.S.: statistics and prevention. Retrieved from http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml Network 180. (2013). Services. Retrieved from http://network180.org/en/mental-illness/programs Pine Rest. (2013). Our services. Retrieved from http://www.pinerest.org/philosphy-care#sthash.2j728dbp.dpuf Rickwood, D., Deane, F. P., Wilson, C. J., Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Advances in Mental Health, 4, 218-251. doi: 10.5172/jamh.4.3.218

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