Zero Suicide in Texas ZEST Collaborative Call May

Zero Suicide in Texas (ZEST) Collaborative Call: May 2016 DSHS: Jenna Heise TIEMH: Molly Lopez Erica Shapiro

REMINDERS CBT-SP Training Next Week in Dallas! CAMS Online Training If you have not yet submitted your list of learners for your organization, please send to me as soon as possible Statewide Suicide Symposium If your attendees have not completed the pre-conference survey, please have them do so August 2 -4, 2016 in San Marcos, Texas Safety Planning Intervention Save the date: September 22, 2016 in Austin, TX

LESSONS FROM CAMS 69% of respondents report using no-harm contracts, which is not considered best practice. How often during a typical month have you used no-suicide/no-harm contracts with patients at risk for suicide? 19% 31% Never 1 to 2 3 to 5 More than 5

PATHWAY TO CARE Goal: Individuals assessed to be at risk will receive care in accordance with the Suicide Safe Care Pathway. Agencies will use quality management tools to monitor adherence to the Suicide Safe Care Pathway guidelines.

RATIONALE Intended to describe best practices for individuals at risk for suicide who will be monitored or treated in a community setting. • Support shared decision making between providers and individuals in care • Promotes best practices during high-risk periods • Individuals on the Suicide Safe Care Pathway deserve a level of care/monitoring reflective of the importance of individual safety to the health care system

ORGANIZATION OF THE PATHWAY • Presented as two flowcharts: • One targets individuals identified at risk who are not yet engaged in community-based care • One targets those individuals within care who are identified at-risk. • Reflect standards for continued monitoring, on-going safety planning, treatment planning, and frequency of contact

Elevated Screen SUICIDE RISK IDENTIFIED AT CRISIS CONTACT OR INTAKE Risk Assessment Conducted ENTER THE SUICIDE SAFE CARE PATHWAY Counseling on Access to Lethal Means (with Family/consumer check-in on same day) Safety Plan Developed (same day) Eligible for LMHA Services? OR Referral to Community Serve through SP 0 Serve through SP 5 Reassess with C-SSRS at every contact Face-to-face or phone contact every 3 days Consider referral for CAMS Review safety plan at every contact Consider referral for peer support EXIT THE SUICIDE SAFE CARE PATHWAY Engaged in Care through Community (3 visits or more) AND Caring Follow-Up Contacts 2 C-SSRS at low risk YES Intake appointment within 24 hours Psychiatric assessment within 7 days Consider the following service/support referrals: • Peer support; • Attempt survivor group • CAMS; • CBT-SP; • ACT; • Wraparound Refer to Engaged in Care Pathway

Suicide Risk Identified at While Engaged in Care Risk Assessment Conducted Elevated Screen ENTER THE SUICIDE SAFE CARE PATHWAY Counseling on Access to Lethal Means (with Family/consumer check-in on same day) Safety Plan Developed (same day) Consider the following treatment referrals: • CAMS • CBT-SP • DBT Consider the following care management referrals: • ACT • Wraparound Consider the following support referrals: • Peer support • Attempt survivor group Reassess with C-SSRS at every contact High: Face-to-face contact every 3 days Missed Appointment: Same day contact; enact protocol if unable to assure safety Review safety plan at every contact (consider limiting medications) Moderate: Face-to-face contact every 7 days EXIT THE SUICIDE SAFE CARE PATHWAY 2 consecutive C-SSRS at low risk AND Fewer than 2 crisis contacts in last 2 months AND No recent hospital discharge in last 3 months

EDUCATION ABOUT THE SUICIDE SAFE CARE PATHWAY • Individuals (and caring others) should be educated about the Suicide Safe Care Pathway when they are placed on it • Should be informed that providers will want to stay in regular contact with the individual • If they miss an appointment unexpectedly, the provider will try to reach them that day • Individuals should be encouraged to check in with the provider proactively if they will miss an appointment • Providers should gather several emergency contacts who are likely to know where the individual is if the provider is unable to contact the individual directly

QUALITY MANAGEMENT • • • Measuring “fidelity” to the pathway Staff supervisors and program managers monitor Consider reasons for lack of adherence • Knowledge • Time • Programmatic support • Productivity standards

Examples of Quality Management Indicators Possible Indicators: • Percent of individuals correctly identified for Pathway (unless electronic) • Percent of individuals with same day safety plan at Pathway entry • Percent of individuals receiving counseling on access to lethal means on same day as Pathway entry • Percent of contacts with documented C-SSRS • Percent of contacts with review of safety plan • Percent of individuals in Crisis Services with contact every 3 days • Percent of individuals maintained on Pathway until engaged in care (3 visits) or assessed at low risk • For individuals referred to LMHA services, percentage of times initial appointment is within 24 hours of referral • For moderate risk, percent of individuals with contact every 7 days • For high risk, percent of individuals with contact every 3 days • Hours to contact after missed appointment • Percent of individuals re-engaged in care after missed appointment

ZEST GROUPS & MEETING DATES Month Wednesdays, 2 pm CST Fridays, 9 am CST November Nov 18 h Nov 20 th December No Call January (2016) Jan 27 th Jan 29 th February Feb 24 th Feb 26 th March Mar 23 rd Mar 25 th Wednesdays, 2 pm CST Fridays, 9 am CST Pecan Valley Andrews Center Gulf Bend Center Heart of Texas Center for Life Resources Texana Center Nueces County Tri-County Services April Apr 27 th Apr 29 th Betty Hardwick Center Harris County participants May 25 th May 27 th Helen Farabee Center Brazos Valley June Jun 22 nd Jun 24 th July Jul 27 th Jul 29 th August Aug 24 th Aug 26 th Star Care Lubbock