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
Community Change Project:Implementing Applied Suicide Intervention Skills Training (ASIST) to Reduce Suicide in Kent County, MichiganFerris State UniversityNURS 340 Community Nursing
Mariah LabBrandi MillerMaia NovakKimberly ReedBrandon Zolynsky
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, 2013NIH, n.d.
Statistics
2004-2008 2009 45-64 yr olds 2004-2008
45-64 yr olds 2009
0
5
10
15
20
25
Kent CountyMichigan
(Rate is per 100,000 population)
Kent County Working Together for a Healthier Tomorrow, 2011
Use of the Ecological Model to Classify the Factors Contributing to Suicide
Macrocultural
• Stigma• Ethnic factors• Religious
factors
Exosystem
• Socioeconomic status
• Economy• Legal problems• Feeling
unaccepted• Media
coverage of suicide
Microsystem
• Family history of suicide
• Divorce• Losing custody
of child(ren)• Loved one
being victimized
• Bullying• Access to guns
Ontogenic
• Depression• Other mental
disorders• Age• Unemployed• Personal loss• Victim• Previous
suicide attempt
Kent County Working Together for a Healthier Tomorrow, 2011Caruso, n.d.American Foundation for Suicide Prevention, 2013
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
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, 2011Kelly, Jorm, & Wright, 2007Kent County Working Together for a Healthier Tomorrow, 2011Rickwood, Deane, Wilson, & Ciarrochi, 2005
Community Resources
Pine Rest, 2013Network 180, 2013
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
Community Nursing DiagnosisRisk 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, 2011Muecke, 1984
Intervention Options
Cincinnati Children’s Hospital Medical Center, 2013Magellan of Arizona, 2013
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
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
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
Implementation TeamWhat 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
Needed ResourcesFacilities Health department, hospitals, public schools, colleges and universities
Equipment Multimedia projection system and screen DVD player Chalkboard Flip chart
Materials Program materials Incidental materials
Lang, Ramsay, Tanney, & Kinzel, 2010
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
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
HHS, 2013Kent County Working Together for a Healthier Tomorrow, 2011
(Rates are per 100,000 population)
Indirect Outcomes
HealingAnd
Working!!!
Kent County Working Together for a Healthier Tomorrow, 2011
Lowered rates of substance abuse Reduced rates of other mental health disorders Decreased unemployment Better grades
Process OutcomesASIST 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
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
Conclusion
Suicide is 100% Preventable
Kent County Working Together for a Healthier Tomorrow, 2011Lang, Ramsay, Tanney, & Kinzel, 2010
ReferencesAmerican 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.
ReferencesKelly, 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