NORTHWEST

PORTLAND

AREA

INDIAN

HEALTH

BOARD

Burns –Paiute Tribe

Chehalis Tribe

Coeur d’Alene Tribe

Colville Tribe

Coos, Suislaw &

Lower Umpqua Tribe

Coquille Tribe

Cow Creek Tribe

Cowlitz Tribe

Grand Ronde Tribe

Hoh Tribe

Jamestown S’Klallam Tribe

Kalispel Tribe

Klamath Tribe

Kootenai Tribe

Lower Elwha Tribe

Lummi Tribe

Makah Tribe

Muckleshoot Tribe

Nez Perce Tribe

Nisqually Tribe

Nooksack Tribe

NW Band of Shoshoni Tribe

Port Gamble S’Klallam Tribe

Puyallup Tribe

Quileute Tribe

Quinault Tribe

Samish Indian Nation

Sauk-Suiattle Tribe

Shoalwater Bay Tribe

Shoshone-Bannock Tribe

Siletz Tribe

Skokomish Tribe

Snoqualmie Tribe

Spokane Tribe

Squaxin Island Tribe

Stillaguamish Tribe

Suquamish Tribe

Swinomish Tribe

Tulalip Tribe

Umatilla Tribe

Upper Skagit Tribe

Warm Springs Tribe

Yakama Nation

2121 SW Broadway

Suite 300

Portland, OR 97201

Phone: (503) 228-4185

Fax: (503) 228-8182

www.npaihb.org

December 1, 2015

Zero Suicide Model Training for NW IHS/Tribal Clinics

The Northwest Portland Area Indian Health Board’s THRIVE project (Tribal

Health: Reaching out InVolves Everyone) works to improve the capacity of tribal

health programs to track, prevent, and treat suicide.

In support of this goal, THRIVE is recruiting three IHS/Tribal Clinics to support

their implementation of the Zero Suicide (ZS) Model. NW IHS/Tribal Clinics

can request a 1-2 day Zero Suicide Model (ZS) training to be organized by

THRIVE, which will take place at the Tribes’ clinic in 2016 (January – July).

These trainings will be funded by the Methamphetamine and Suicide Prevention

Initiative (MSPI – grant no. BH16IHS0016-01-00) from the Indian Health Service

(IHS).

ZS is a promising practice recognized by the 2012 National Strategy for Suicide

Prevention (NSSP), which helps communities create systems-wide change to

improve the identification of those at risk of suicide, and the quality of treatment

services. Being versed in ZS can help clinics build the tools and support needed to

adopt approaches that can dramatically reduce suicide among those served by the

clinic. This is a model that helps coordinate care across the care continuum, from

a phone call or referral to the actual appointment where the patient is seen.

Coordinated care keeps suicidal persons from falling through the cracks in the

healthcare system. The attached ZS document contains more information about

the ZS Model.

Tribes and tribal organizations who request this training will need to meet several

eligibility requirements before submitting the Training Request Form. The

trainings will be fulfilled on a first come, first served basis, as long as the

eligibility requirements are met.

Eligibility

Tribes or tribal organizations with existing Meth and Suicide Prevention

Initiative (MSPI), SAMHSA suicide prevention grants, or who are already

implementing the ZS Model are not eligible to apply.

Timeframe

The clinic’s scope of work should be completed within 12 months of the 1-2

day ZS Training.

Before submitting the Training Request Form:

Review the ZS toolkit online: http://zerosuicide.sprc.org/toolkit

Watch the recorded webinar - The Emerging Zero Suicide Paradigm:

http://zerosuicide.sprc.org/about

Obtain written approval from the Tribal Health Director and the Behavioral Health Director.

Select a primary contact person who will schedule the ZS training, facilitate a local

implementation team, and participate in monthly technical assistance calls with THRIVE

staff for 12 months following the ZS training.

To support implementation of the Zero Suicide Model, THRIVE will provide:

A free 1-2 day training at your clinic with a certified trainer (Dr. Ursula Whiteside).

Implementation team planning tools and templates.

Analysis and compilation of a local Workforce Survey Report.

Monthly technical assistance (or as requested by the clinic).

One follow-up conference call with THRIVE and Dr. Whiteside approximately 1-3 months

following the training.

$2,000 per site to host a ZS community kickoff event.

To support implementation, the IHS/Tribal Clinic will:

Complete the enclosed Organizational Self-Study with at least 3 clinic staff who would be

leaders in the ZS effort, including clinic decision-makers.

Circulate and return the enclosed Workforce Survey. The survey must be completed by at

least 75% of the medical and behavioral health workforce, including janitorial staff, medical

records, finance staff, etc. This step must be completed before the ZS Training can take

place.

Select dates (1-2 days) and a location for the ZS training. (Unfortunately, THRIVE’s grant

dollars cannot pay for meals, just light refreshments.) Ensure at least 15 clinic staff attend

the 1-2 day training. Decision-makers are important to the implementation process, and

should be present at the training if possible.

Create a local ZS Implementation Plan at the first implementation team meeting after the ZS

training. A template will be provided by THRIVE staff.

Host a ZS community kickoff event to get your community (and partnering programs)

excited about the ZS model and your clinic’s services. The implementation team will be

encouraged to announce the ZS initiative in their tribal paper.

Review and/or update the clinic’s current crisis response protocol, particularly surrounding

suicide and suicide attempts.

Agree to implement the ZS Model for at least one full year, through an active implementation

team that meets at least once a month. This will require using your clinic’s EHR and quality

improvement initiatives to achieve system-wide change.

Distribute THRIVE’s social marketing campaign: We Are Connected. We Need You Here.

Participate in 2 regional Tribal Zero Suicide virtual meetings or conference calls, to support

cross-site sharing and learning.

Optional: Host at least one additional suicide prevention training (i.e. QPR, ASIST,

safeTALK, etc.) for clinic staff and community members. THRIVE can support the cost of

QPR or ASIST participant booklets, and can facilitate the training if scheduled in advance.

(Unfortunately THRIVE cannot cover the cost of outside trainers.)

Please contact the THRIVE project manager, Colbie Caughlan, at ccaughlan@npaihb.org or

503.416.3284 if you plan to submit a request for the ZS Training or if you have any questions

about the application process.

Applications must be completed and submitted to the project manager by fax

(503.228.4801) or email (ccaughlan@npaihb.org) by January 22, 2016. We will continually

take applications until the three clinics have been identified. Please contact Colbie if you

would like to turn in your request after the January 22 due date.

Respectfully,

Colbie Caughlan, Stephanie Craig Rushing, Celena McCray

THRIVE Staff

THRIVE - Zero Suicide Model Training Request

Tribe:

Primary Contact:

Address, City, State, & Zip:

Email:

Phone Number:

Alternate contact name, number, and email:

Please answer the following questions. (All three must be NO to be eligible to apply)

Does your Tribe or IHS/Tribal Clinic currently having funding through the Meth & Suicide Prevention Initiative or a SAMHSA suicide prevention grant?

Circle one: Yes No

Has your Tribe or IHS/Tribal Clinic staff ever attended a Zero Suicide Academy?

Circle one: Yes No

Is your Tribe or IHS/Tribal Clinic currently implementing the Zero Suicide Model?

Circle one: Yes No

Please check those steps that your clinic has completed:

Reviewed the ZS toolkit online: http://zerosuicide.sprc.org/toolkit

Watched the recorded webinar - The Emerging Zero Suicide Paradigm:

http://zerosuicide.sprc.org/about

Obtained written approval from the Tribal Health Director and the Behavioral Health Director.

Selected a primary contact person who will schedule the ZS training, facilitate a local

implementation team, and participate in monthly technical assistance calls with THRIVE staff for 12

months following the 1-2 day ZS training.

Check this box to indicate that you agree to fulfill the following activities:

Complete the enclosed Organizational Self-Study with at least 3 clinic staff who would be

leaders in the ZS effort, including clinic decision-makers.

Circulate and return the enclosed Workforce Survey. This survey must be completed by at least

75% of the medical and behavioral workforce, including janitorial staff, medical records, finance

staff, etc. This step must be completed before the ZS Training can take place.

Select dates (1-2 days) and a location for the ZS training. (Unfortunately, THRIVE’s grant dollars

cannot pay for meals, just light refreshments.) Ensure at least 15 clinic staff attend the 1-2 day

training. Decision-makers are important to the implementation process, and should be present

at the training if at all possible.

Host a ZS community kickoff event to get your community excited about the program and your

clinic’s services. The implementation team will be encouraged to announce the ZS initiative in

their tribal paper.

Create a local ZS Implementation Plan at the first implementation team meeting after the ZS

training. A template will be provided by THRIVE staff.

Review and/or update the clinic’s current crisis response protocol, particularly surrounding

suicide and suicide attempts.

Agree to implement the ZS Model for at least one full year, through an active implementation

team that meets at least once a month. This will require using your clinic’s EHR and quality

improvement initiatives to achieve system-wide change.

Distribute THRIVE’s social marketing campaign: We Are Connected. We Need You Here.

Participate in 2 regional Tribal Zero Suicide virtual meetings or conference calls, to support

cross-site sharing and learning.

Optional - Host at least one additional suicide prevention training (i.e. QPR, ASIST, safeTALK,

etc.) for staff and community members by September 29, 2016.

Why does your clinic want to take on the Zero Suicide Model?

Briefly describe what changes your crisis response protocols/policies will need in the upcoming year, and how your ZS implementation team will be poised to achieve them.

Please have the Tribal Health Director and/or Behavioral Health Director (or equivalent) sign in the box and submit with your application. This signature indicates that your Tribe and IHS/Tribal Clinic are in support of the ZS implementation process and are committed to the time and energy that are needed to put this model into action. This process can be time intensive, and can ebb and flow based on the local plan and workforce implementing it. THRIVE staff will provide as much technical assistance as we can. This also indicates your understanding that the funds provided will only cover the costs of the ZS training and trainer; it will not cover your staff’s time.

In exchange for this subcontract, (Tribal Clinic Name) _______________________________ agrees to implement the Zero Suicide Model for at least one year following the provided training. The preferred month for the training is: ____________________ 2016. Primary Contact’s Signature: _____________________________________________________________ Printed Name & Date: __________________________________________________________________ Tribal Health Director Signature: _________________________________________________________ Printed Name & Date: __________________________________________________________________ Behavioral Health Director Signature (optional but preferred):___________________________________ Printed Name & Date: __________________________________________________________________

Requests must be completed and submitted to the project manager by fax (503.228.4801) or email (ccaughlan@npaihb.org) by January 22, 2016

Its core propositions are that suicide deaths for people under care are preventable,

and that the bold goal of zero suicides among persons receiving care is an aspirational

challenge that health systems should accept. The Zero Suicide approach aims to improve

care and outcomes for individuals at risk of suicide in health care systems. It represents

a commitment to patient safety—the most fundamental responsibility of health care—

and also to the safety and support of clinical staff, who do the demanding work of

treating and supporting suicidal patients.

The challenge of Zero Suicide is not one to be borne solely by those providing clinical

care. Zero Suicide relies on a system-wide approach to improve outcomes and close

gaps rather than on the heroic efforts of individual practitioners. This initiative in health

care systems also requires the engagement of the broader community, especially suicide

attempt survivors, family members, policymakers, and researchers. Thus, Zero Suicide

is a call to relentlessly pursue a reduction in suicide for those who come to us for care.

The programmatic approach of Zero Suicide is based on the realization that suicidal

individuals often fall through multiple cracks in a fragmented and sometimes distracted

health care system, and on the premise that a systematic approach to quality improvement

is necessary. The approach builds on work done in several health care organizations,

including the Henry Ford Health System (HFHS) in Michigan. Like other leading health

care systems, HFHS applied a rigorous quality improvement process to problems

such as inpatient falls and medication errors. HFHS realized that mental and behavioral

health care could be similarly improved. This insight led to the development of HFHS’s

Perfect Depression Care model, a comprehensive approach that includes suicide

prevention as an explicit goal. The approach incorporates both best and promising

practices in quality improvement and evidence-based care and has demonstrated stunning

results—an 80 percent reduction in the suicide rate among health plan members.

www.zerosuicide.com

2.10.15

Education Development Center, Inc. ©2015 All Rights Reserved.Suicide Prevention Resource CenterSPRC

WHAT IS ZERO SUICIDE?Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems, and also a specific set of tools and strategies. It is both a concept and a practice.

TRAIN

LEAD

IDENTIFY

ENGAGE

TREAT

TRANSITION

IMPROVE

Using these successful approaches as the basis for its

recommendations, the Clinical Care and Intervention

Task Force of the National Action Alliance for Suicide

Prevention identified essential elements of suicide

prevention for health care systems (i.e., health care

plans or care organizations serving a defined population

of consumers, such as behavioral health programs,

integrated delivery systems, and comprehensive primary

care programs). These elements include:

1 LEAD Create a leadership-driven, safety-oriented

culture committed to dramatically reducing suicide

among people under care. Include suicide attempt

and loss survivors in leadership and planning roles.

2 TRAIN Develop a competent, confident, and

caring workforce.

3 IDENTIFY Systematically identify and assess suicide

risk among people receiving care.

4 ENGAGE Ensure every person has a suicide care

management plan, or pathway to care, that is both

timely and adequate to meet his or her needs. Include

collaborative safety planning and restriction of lethal means.

5 TREAT Use effective, evidence-based treatments that

directly target suicidality.

6 TRANSITION Provide continuous contact and

support, especially after acute care.

7 IMPROVE Apply a data-driven quality improvement

approach to inform system changes that will lead to

improved patient outcomes and better care for those

at risk.

If we do not set big goals, we will never achieve them. In the

words of Thomas Priselac, president and CEO of Cedars-

Sinai Medical Center:

“It is critically important to design for zero even when

it may not be theoretically possible. When you design

for zero, you surface different ideas and approaches

that if you’re only designing for 90 percent may not

materialize. It’s about purposefully aiming for a higher

level of performance.”

Better performance and accountability for suicide prevention

and care should be core expectations of health care programs

and systems. While we do not yet have proof that suicide can

be eliminated in health systems, we do have strong evidence

that system-wide approaches are more effective.

To assist health and behavioral health plans and organizations,

the Suicide Prevention Resource Center (SPRC) offers an

evolving online toolkit that includes modules and resources

to address each of the elements listed above. SPRC also

provides technical assistance for organizations actively

implementing this approach.

Learn more at www.zerosuicide.com.

www.zerosuicide.com

FOR MORE INFORMATION, PLEASE CONTACT:

Julie Goldstein Grumet, PhD

Director of Prevention and Practice

Suicide Prevention Resource Center

Education Development Center, Inc.

1025 Thomas Jefferson Street, NW

Suite 700W

Washington, DC 20007

Phone: 202.572.3721

Email: jgoldstein@edc.org