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Learning Module 2: Describing the Problem

and its Context

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Learning CollaborativeStrategic Planning for Suicide Prevention

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e!

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my holder text.

Anara Guard

Sandra Black, MSW

Sandra Black has worked in suicide prevention in California since

2007. Until 2011 she m

anaged the California Office of Suicide

Prevention, which included com

pletion and implem

entation of the California Strategic Plan on Suicide Prevention. In 2011 she joined the Know

the Signs suicide prevention social marketing

campaign as a consultant, and has since also joined the Each

Mind M

atters mental health m

ovement team

. She provides technical assistance to counties and com

munity-based

organizations around mental health prom

otion and suicide prevention. She holds an M

SW from

the University of California,

Berkeley and a BS from Cornell U

niversity.

Anara Guard has w

orked in suicide and injury prevention since 1993. For the past eight years, she has been a subject m

atter expert advising Know the Signs and other suicide prevention projects. Previously, she w

as deputy director at the national Suicide Prevention Resource Center w

here, among other duties, she led the

development of annual grantee m

eetings for SAMHSA’s suicide prevention grantees and oversaw

technical assistance. She has presented num

erous workshops and trainings for journalists, com

munity m

embers, and

the field of suicide prevention at large on how best to com

municate about suicide prevention. Her

publications include peer-reviewed articles and m

anuals on alcohol screening and brief intervention, rural suicide postvention, consum

er protection approaches to firearm safety, child hypertherm

ia, violence and teen pregnancy, and m

ore. Ms. Guard earned a m

aster’s degree in library and information science and a

certificate in maternal and child health.

Anara Guard

Sandra Black, MSW

Rosio Pedroso

Stan Collins, has worked in the field of suicide prevention for nearly 20

years. Currently he is working as a consultant, focusing on technical

assistance in creation and implem

entation of suicide prevention curricula and strategies. Stan is a m

ember of the Am

erican Association of Suicidology’s Com

munication team

and in this role supports local agencies in their com

munications and m

edia relations related to suicide. In addition, he is specialized in suicide prevention strategies for youth and in law

enforcem

ent and primary care settings. Since 2016 he has been

supporting school districts with AB 2246 policy planning and as w

ell as postvention planning and crisis support after a suicide loss or attem

pt.Stan Collins

Jana Sczersputowski, M

PH

Rosio Pedrosohas over 20 years of research and evaluation experience focusing on

unserved and underserved comm

unities. She has over six years of experience conducting train the trainer curriculum

and materials for com

munity engagem

ent and statew

ide campaigns including suicide prevention and child abuse and neglect

awareness.

Jana Sczersputowskiapplies her public health background to deliver com

munity-driven and

behavior change oriented comm

unication solutions in the areas of mental health, suicide

prevention, child abuse prevention and other public health matters. She is specialized in

strategic planning, putting planning into action, and evaluating outcomes. M

ost of all she is passionate about listening to youth, stakeholders and com

munity m

embers and ensuring

their voice is at the forefront of public health decision making im

pacting their comm

unities.

5

Strategic Planning Learning Collaborative Overview

Webinar 2: Describe the

Problem and its Context

•Tuesday Decem

ber 4 10:30am-12p

•W

ebinar 1: Strategic Planning Framew

ork•

Novem

ber 6th 10:30am-12pm

•Recording Link: https://attendee.gotow

ebinar.com/recording/2093205551616896003

•W

ebinar 3: Building and sustaining a coalition•

January 15th 10:30am-12pm

•W

ebinar 4: Putting planning into action: Selecting interventions and using logic m

odels•

February 5th 10:30am-12pm

•W

ebinar 5: Evaluating and sustaining your efforts•

March 12th 10:30am

-12pm

What sources of data

are available to help describe the problem

of suicide?

What story does your

data tell you?

0 2 4 6 8 10 12 14 16 18

20072008200920102011201220132014201520162017

Number of Deaths

Female Suicide Deaths

Male Suicide Deaths

How are you using and

sharing the data?

•Provide context to local issue of suicide•Dispel m

isconceptions•Focus effort w

here the problem is m

ost severe

•Identify risk and protective factors to select interventions

•Persuade funders, policy and decision m

akers•Evaluation and m

easuring change over tim

e

Why use

Data?

•Mortality

•Morbidity

•Co-morbidity

•Risk and protective factors•Help seeking •Q

ualitative data•

Comm

unity strengths and gaps•

Existing resources and programs

Telling a story about suicide and

suicide prevention

SourcesW

hat it tells you

CoronerW

ho dies by suicideM

eans of suicideRisk factors

EpiCenter(CA DPH)State and countyN

umbers, rates, m

eansAll ages &

demographics

Can create queries

Death Review Team

sDem

ographics and means

Warning signs

Risk factors and context

CDPH County Health Status Profiles

State and countyRates, 3-year averages, percentagesRanked and com

pared to national Healthy People 2020 objectivesAll ages &

demographics

Data grouped into annual reports

Mortality

deaths that were

confirmed to be

suicide.

Learning CollaborativeTom

Tamura, Contra Costa Crisis Center

Nam

e, Kings County

SourcesW

hat it tells you

Local hospitalsEpiCenter(CA DPH)

Non-fatal self injuries treated in hospitals and

emergency room

s State and countyN

on-fatal & fatal injuries by m

ethodAll ages &

demographics

Can create queries

CDC WISQ

ARSN

on-fatal self injuries treated in hospitals and em

ergency rooms

State and countyN

on-fatal self-inflicted injuries & m

ethodAll ages and dem

ographicsCost of injury reportsCan create queries

CDC Behavioral Risk Factor Surveillance System

(BRFSS)Phone surveysAdults 18+Associated risk factors such as substance use, m

ental health conditions

Morbidity

non-fatal, intentional self

injuries, or suicide attem

pts. They exclude accidental

self injury.

Co-Morbidity

risk factors that are related to the suicidal behavior.

SourcesW

hat it tells you

CDC Youth Risk Behavior Surveillance

National and state

Suicidal ideationSuicide attem

pts9

th-12thgrade students

CA Healthy Kids SurveyM

odular survey (administered at schools)

California, biannualStudents age 10 and upM

ental health and resiliencyRisk and protective factors

SAMHSA N

ational Survey on Drug U

se & Health

Interviews

Youth ages 12-17, Adults 18+N

ational and stateSuicidal ideation, suicide attem

ptsSubstance use M

ental illnessCA Health Interview

SurveyBiannual phone surveyState, regional, countySuicide Ideation (adults only)Adults 18+, adolescents (12-17), child (0-11)

Suicidal Thoughts

(self reported)

SourcesW

hat it tells you

National Violent Death

Reporting SystemCalifornia Violent Death Reporting System

(EpiCenter)

All ages and demographics

State, countyRange of factors and circum

stances surrounding deaths

Coroner/Medical

Examiner Reports

Details surrounding the circumstances of

individual deaths based on investigation

Local stakeholder Interview

s, Surveys and Assessm

ents

Perceived problem of suicide in the

comm

unityAvailable and m

issing programs and services

Risk and Protective

Factors

54%.

More than half of

people who died by

suicide did not have a know

n mental

health condition.

20

California Healthy Kids Survey (calschls.org)

Type of DataSources

What it tells you

Help SeekingN

ational Suicide Prevention Lifeline

Num

ber of calls that originated in your countyCalls to Spanish HotlineCalls to Veteran Hotline

Local hotline dataW

arm line data

Friendship LineTrevor ProjectPoison Control SystemBehavioral Health Dept

Num

ber and demographics of people

callingService usage

TrainingsLocal providers

Num

ber of trainings providedN

umber of people trained

Help Seeking System

Mapping

Local partnersHow

are people connected to help in various settings (school, prim

ary care, law

enforcement, other)

Help Seeking &

Prevention

0 10 20 30 40 50 60 70 80 90

January.2013March.2013

May.2013July.2013

September.2013November.2013


May.2014July.2014



May.2015July.2015



May.2016July.2016



May.2017July.2017



May.2018

2013-June 2018

General

Veterans

Spanish

0 10 20 30 40 50 60 70 80 90

July 2017-June 2018

General

Veterans

Spanish

Continuous, systematic collection, analysis and interpretation

of health-related data needed for the planning, im

plementation, and evaluation of public health practice.

Surveillance can:•serve as an early w

arning system for im

pending public health em

ergencies;•docum

ent the impact of an intervention, or track

progresstowards specified goals;

•monitor and clarify the epidem

iology of health problem

s, to allow priorities to be set and to inform

public health policy and strategies.

Public Health Surveillance

Surveillance

•Identify data sources at m

ultiple levels•

Establish partnerships with those

agencies/systems/organizations to ensure regular

access•

Establish a process for how the data w

ill be regularly review

ed, and how it w

ill be incorporated into planning and evaluation

•Com

pile data into reports or presentations that can be shared w

ith stakeholders and others as needed

Setting up a Surveillance System

Data Analysis

Prese

ntatio

n

Data Analysis

State Data

County Data

AnalysisDetailed Reports

Annual Trends

Ad Hoc Reports

Descriptive statistics using

Excel and SPSS, Geospatial

analysis with ArcGIS

Updating annual surveillance records for internal planning

Releasing detailed reports on status of problem

every 3-5 years

Further analysis created by request by m

anagement,

stakeholders, or program

s

Office of Statewide Health Planning

and Development

(OSHPD)

EDD/PDD

California Dept. of Public Health

Death Statistical M

aster File (DSMF)

Sheriff-Coroner Report

Data Analysis

Primarily, surveillance data

arrives from the California

Department of Public

Health.

All local governments in CA

can request the data, following the instructions here:

Deaths (CDPH DSMF):

https://www.cdph.ca.gov/Program

s/CHSI/Pages/Data-Applications.aspx*

Emergency Departm

ent Visits and Hospitalizations (O

SHPD EDD/PDD):https://oshpd.ca.gov/data-and-reports/request-data/for-hospitals-health-dept/

REQUESTIN

GD

ATA

*Births and death data now available from the CDPH online California Integrated Vital Records System

https://casadm.calivrs.org/cas-server/login?service=https%

3A%2F%

2Fvrbis.calivrs.org%2Fvrbis-web-static%

2Flogin%2Fcas

Data Analysis

Geography:Location inform

ation can be exact as an address, ZIP code

or more broad, such as county

of residence

Diagnosis, Injury, Disease,

Cause of Death:Usually in ICD-9-CM

or ICD-10-CM

form

Demographics:

Gender, Race/Ethnicity, Age and som

etimes

other variables like nationality, prim

ary language, education, etc.

Depending on the data source, other variables are available such as payer/insurance, additional diagnoses

and procedure codes, place of injury, etc.

Information Available

Data Analysis

PROC

ON

Sheriff-Coroner

OSHPD Data

>M

ost detailed case data for morbidity

>Based on Em

ergency Department

Encounters (EDD) and Hospitalizations (PDD) Data

>Includes som

e important co-variables, like age and

race

>Location only specific to zip code level

>Socio-econom

ic variables not included >

Reporting lag up to 1.5 years

>Detailed text to explain cause of death

>Less lag-tim

e in reporting>

Not uniform

ly coded/more difficult to analyze with

syntax or on large scale

DSMF Data

>M

ore detailed demographics com

pared to OSHPD

>Cause of death coded as ICD-9 or 10-CM

>Location specific to address of residence

>M

ore specific socio-economic variables not included

>Reporting lag up to nearly 1.5 years

Data Analysis

When you identify interesting

trends, you can investigate further, identifying key dem

ographics or other covariates of interest

Sharing findings helps to generate ideas about

what other factors may be

involved behind trends

703

660

680

658

689

717

836

931

886

8790.0

50.0

100.0

150.0

200.0

250.0

300.0

0

200

400

600

800

1000

1200

20072008

20092010

20112012

20132014

20152016

Rate per 100,000

Number

Teen Self-Harm Injuries, O

range CountyN

umber of ED

Visits

Rate of ED Visits

476443

458439

461504

624694

650647

227217

221219

228213

212237

236232

0

100

200

300

400

500

600

700

800

20072008

20092010

20112012

20132014

20152016

Teen Self-Harm Injuries, O

range CountyFem

ale # of ED Visits

Male # of ED Visits

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,00020102011

20122013

20142015

2016

Total Medi-Cal Enrollm

ent, Orange County

Data Analysis

AN

ALYZIN

G DA

TA BY

GEO

GRA

PHY helps to visualize data and com

municate where

resources should be targeted.

GEOGRAPHIC

ANALYSIS

USINGARCM

AP

Data Analysis

SUICIDE

(and

pub

lic he

alth)

Surveillance2.SPECIFY what data sources you

will use

3. DESIGN your case selection criteria

and analysis syntax

1. DEVELOP a plan for surveillance

4. ANALYZE your data

5. ADJUST your analysis, bring in other data sources as needed

6. SHARE and APPLY your findings

In Summ

ary

Thank You

Child Death Review Team

s

ICAN N

ational Center on Child Fatality Review

In 2001, a multi-disciplinary sub-group of the ICAN

Child Death Review

Team, the Child and Adolescent

Suicide Review Team

(CASRT) was form

ed. The Team

reviews child and adolescent suicides, analyzes trends

and makes recom

mendations aim

ed at the recognition and prevention of suicide and suicidal behaviors.

.

Child and Adolescent Suicide Review Team

(CASRT)

In 1996, ICAN Associates, Inc. received a grant from

the U.S.

Department of Justice, O

ffice of Juvenile Justice and Delinquency

Prevention, to establish the ICAN N

ational Center on Child Fatality

Review (N

CFR). The mission of N

CFR is to develop and promote a

nationwide system

of Child Fatality Review Team

s to improve the

health, safety and well being of children and reduce preventable

child fatalities and severe injuries

ICANInter-Agency Public Private Partnership

In 1977, the Los Angeles County Board of Supervisors designated the Inter-Agency Council on Child Abuse and

Neglect (ICAN

) as the official LA County agent to coordinate services for the prevention and treatm

ent of child abuse and neglect.

.

Mental health services should be available and

delivered to all students regardless of income

and Medi-Cal eligibility. If this is not feasible,

assistance should be provided to help them locate

appropriate mental health resources

School districts are encouraged to develop policies and procedures that utilize Em

ployee Assistance Program

resources to support school em

ployees after the death of a student.

School suicide prevention resources should be available to students

throughout the year including non-schooldays and during sum

mer and

holiday breaks.

Recomm

endations made by

ICAN based on the 2016 report.

Qualitative Data

What is the role of stakeholders

in describing the problem of

suicide and its context?Help understand com

munity perception of

the problem

Secure buy-in and engagement

Identify cultural perceptions, needs, and cultural “fit”

Help learn about risk and protective factors populations at risk

Qualitative

Data

Type of DataSources

What it tells you

Comm

unity Strengths and Gaps

Stakeholder interview

s, focus groups, surveys and assessm

ents

More context:

Perceived problem of suicide in the

comm

unityAvailable and m

issing, or underutilized, resources and program

s for populations at riskRisk factors and protective factors for specific populations at riskPotential partners to aid in solutions to problem

Learning CollaborativeN

estor Veloz-PassalacquaSan Luis O

bispo County

www.slocounty.ca.gov

PREVENTIO

N AN

D EARLY INTERVEN

TION

Student Assistance ProgramO

riginal MHSA W

ork Plan to build w

ellness and resiliency, reduce risk factors and increase protective factors for m

iddle schoolers.

•Som

e middle school needed continued

support and assistance.•

Designed to have an wrap-around

model: PEI Student Counselor, Fam

ily Advocate, and Friday N

ight Live Coordinator.

Conduct pre/post surveys on a quarterly basis:

•229 unique total contacts

•46%

engaged in intensive case m

anagement services

•86%

managed cases show

ed progress in attendance and behavior.

LGBTQ

Needs Assessm

ent (NA)

•County had not current data on the needs/concerns of the com

munity

•County received M

HSA Stakeholder approval for a one-tim

e expense on the N

A•

County partnered with Cal Poly to

complete the one-year long N

A•

NA is conducted county-w

ide to get a larger sam

ple size and employs tw

o phases:

•O

nline English/Spanish survey: Over

450 comm

unity mem

bers completed

the online survey•

Focus groups have been scheduled for the next few

months

•Findings to be available in June.

SLO -Prevention and Early Intervention

System M

apping

System

Mapping

•Identify resources and processes that are currently in place to identify and support those at risk of suicide.

•The goalof system m

apping to provide a clearer picture of all supports in the process, the roles that other entities play, and the gaps that need to be addressed.

SPRC Approach to Suicide PreventionLevels of System

Mapping

•In addition to creation of an overview

document connecting various

systems, for system

mapping to be m

ost effective, it should also occur at the individual organization level.

•For exam

ple, a school will w

ant to map out the school specific

process for identifying and responding to youth at risk.

•Ideally your system

map w

ill demonstrate all of the points from

early identification to crisis response, intervention, and postvention.

SPRC Approach to Suicide PreventionM

apping out your crisis response system

SPRC Approach to Suicide PreventionM

apping

https://ww

w.sdchip.org/initiatives/suicide-

prevention-council/reports-resources/

HANDO

UT

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