Primary Prevention Initiative: Suicide Prevention Module
Primary Prevention Initiative: Suicide Prevention Module
Objectives
• Upon completion of this module, learner will be able to:– Define levels of prevention– Describe how to select relevant topic, locate
data, and identify an appropriate intervention
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The Levels of Prevention
PRIMARYPrevention
SECONDARYPrevention
TERTIARYPrevention
Definition An intervention implemented before there is evidence of a disease or injury
An intervention implemented after a disease has begun, but before it is symptomatic.
An intervention implemented after a disease or injury is established
Intent Reduce or eliminate causative risk factors (risk reduction)
Early identification (through screening) and treatment
Prevent sequelae (stop bad things from getting worse)
Example Encourage exercise and healthy eating to prevent individuals from becoming overweight.
Check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese.
Help obese individuals lose weight to prevent progression to more severe consequences.
Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3); 001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm
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Primary Prevention Initiative (PPI)
• Established by Dr. Dreyzehner in 2012• Goal is to focus the Department’s energy
on primary prevention—eliminating risk factors for later problems
• Intent is for all TDH employees to engage in primary prevention efforts in their community
• Statewide Roll- out January, 2013
PPI Process– All counties participating in Primary
Prevention Initiatives– County forms PPI Team – PPI Team meets to determine focus areas– Counties may utilize Community Health
Assessments to determine priority topics– PPI Team submits PPI Proposal– PPI Team submits reports on each Activity– Process continues
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Team Work• Your county may have multiple teams working
on different community activities• Teams will spend 5% of their time working on
PPI– Approximately ½ day every other week
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PPI Teams
• Team members will be:– Catalysts– Encouragers– Resource providers– Data keepers/providers
• Team members are not sole workers– Teams will engage community partners to
accomplish activities
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PPI Teams
• Team size will vary– Teams of 3, 5, or 7 depending on health
department size• Team composition:
– Include community members– Teams should be multidisciplinary (clerical,
nursing, clinical, administrative)– Include Regional office staff
• i.e. Health Promotion Coordinator and/or Community Health Council Coordinator, county staff such as Health Educator, Health Care Provider, and administrative staff
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Topics for PPI Activities
– Tobacco – Obesity– Teen Pregnancy– Infant Mortality– Substance Use and Abuse– Immunizations– Suicide Prevention– Occupational Safety– Healthcare Associated Infections
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Selecting a Topic
• There are so many things you could choose to work on—but time and resources are limited!
• You will need to prioritize your efforts based on the specific need(s) in your community
• Needs (and therefore, projects) will likely vary across the State
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Selecting a Topic
• What can you use to help you prioritize?– Community Health Assessment Tools– County Health Council Priorities– Needs Assessments– Strategic Plans– Ranking/Report Card findings
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Locating Data
• Once you’ve selected the topic on which you plan to focus, you will need to locate data that is relevant to the topic
• Data can help you:– Confirm “suspicions” or “hunches”– Sharpen your focus on a particular aspect of
the topic– Identify baseline for measuring improvement
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Locating Data
• Some Potential Data Sources:– Birth/death certificates– Hospital Discharge data– Health Information Tennessee (HIT) website– Behavioral Risk Factor Surveillance System
(BRFSS)– Youth Risk Behavior Survey (YRBS)– Pregnancy Risk Assessment Monitoring
Survey (PRAMS)– Data from community health assessments
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Identifying An Intervention
• Once you’ve selected your topic and gathered appropriate data, it’s time to decide what you’re actually going to do
• There is no need to “re-invent the wheel”• Explore what others have done, what has
been tested, and what has been shown to work
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Identifying An Intervention
• Some Sources for Identifying an Intervention:– Guide to Community Preventive Service
• http://www.thecommunityguide.org/index.html
– Healthy People 2020, Community Interventions• http://www.healthypeople.gov/2020/topicsobjectives2020/ebr.
aspx?topicid=33#inter
– Institute of Medicine• http://www.iom.edu/~/media/Files/Report%20Files/2012/APO
P/APOP_insert.pdf
– Tennessee State Plan on Nutrition, Physical Activity and Obesity
• http://www.eatwellplaymoretn.org/assets/files/plan.pdf 15
PPI Proposal
• Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link:
http://www.surveygizmo.com/s3/1537642/PPI-Proposal
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PPI Proposal contains
• County • Topic• Objective• Activities• Team members• Primary contact• Community partners• Estimated Start Date• Estimated Completion Date
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PPI Activity Reporting
• As the PPI Team completes each activity, report in PPI Activity Reporting Survey Gizmo link:
• http://www.surveygizmo.com/s3/1458250/PPI-V3-0
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PPI Activity Reporting Contains
• County name• Division/Office• Topic• Objective• Activity description• Key Partners/Contributions• Start date of activity• Facilitating factors of success• Barriers encountered• Plans to overcome barriers• Unanticipated outcomes• Impact measures- numbers served• Stage of Change• Success Stories 19
ApplyingPrimary Prevention Principles to Suicide
Prevention
Tennessee Data:Suicide Prevention
• 956 reported suicide deaths in 2012• Suicide rate at 14.8 per 100,000—up slightly
from previous years, still elevated• National suicide rate for 2010: 12.1 per 100,000• In 2010, Tennessee’s suicide rate ranked 17th in
the nation• Increase in suicides appears driven by adults,
mostly middle-aged (45-54 y.o.) males
Data Source: Division of Health Statistics, Office of Policy, Planning and Assessment, Tennessee Department of Health. 2/16/14.CDC. National Center for Health Statistics. Stats of the State of Tennessee, 2010. Available at http://www.cdc.gov/nchs/pressroom/states/TN_2014.pdf
National and State Data:Suicide Prevention Trends
Division of Health Statistics, Office of Policy, Planning and Assessment, Tennessee Department of Health. 2/26/14CDC. Web-based Injury Statistics Query and Reporting System (WISQARS): fatal injury data. Available at http://www.cdc.gov/injury/wisqars/fatal.html National Vital Statistics. Deaths: Preliminary Data for 2011. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf Accessed on 2/26/14.
2006 2007 2008 2009 2010 20115
10
15
20
14.313.3
15.214.7 14.6
14.1
11.0 11.3 11.6 11.8 12.1 12.0
Tennessee and National Suicide Rates 2006-2011Tennessee National
Age-
Adju
sted
Rat
e pe
r 100
,000
Tennessee Counties with the Highest Suicide Rates, 2012
Data Source: Tennessee Department of Health, Vital Statistics Resident Summary Data 2012. Available at: http://health.tn.gov/statistics/PdfFiles/VS_Rate_Sheets_2012/Suicide2012.pdf
CountyRate per 100,000
population
Actual number of deaths
Smith 41.9 8
Cheatham 35.6 14
Giles 31.0 9
Grainger 30.9 7
Stewart 30.1 4
Cannon 28.9 4
Cumberland 28.1 16
Humphreys 27.4 5
Marshall 25.9 8
Claiborne 25.2 8
Proven Primary Prevention Strategies
• Strategy 1—Promote National Suicide Prevention Lifeline (1-800-273-TALK)
• Objective: Promote Lifeline and TSPN.org website as statewide resources for suicide prevention
• Activity: – Get local media to promote the Lifeline number & TSPN website– Distribute resources that include the number (especially TSPN
pamphlets and resource directories)– Encourage churches and civic groups to promote the Lifeline
and TSPN website– Add Lifeline and TSPN websites to appropriate websites
Proven Primary Prevention Strategies
• Strategy 2—Promote Gun Safety Project• Objective: Help firearm dealers and firing range owners
spot and engage troubled/suicidal customers• Activity:
– Share guidelines with gun store/firing range owners about how to avoid selling or renting a firearm to a suicidal customer
– Encourage gun stores and firing ranges to display and distribute project materials
– Educate public about safe firearm use and storage, including temporary removal of guns from premises if someone there may be suicidal
Proven Primary Prevention Strategies
• Strategy 3—Promotion of suicide prevention curricula in schools
• Objective: Implement means for educating students and staff about suicide prevention
• Activity:– Promote mental health programs like Mental Health
101 and I.C. Hope– Promote suicide prevention programs like the Jason
Foundation’s “Promise for Tomorrow” program– Promote adoption of anti-bullying programs with a
suicide prevention component
Proven Primary Prevention Strategies
• Strategy 4—Promote suicide prevention training and assessment
• Objective: Train general public in suicide prevention, with an emphasis on potential gatekeepers
• Activity:– Promotion of evidence-based training programs like
QPR to schools and community groups– Promotion of appropriate training programs (e.g.,
ASIST) to mental health and medical professionals– Inclusion of information about suicide prevention
training in directories, pamphlets, etc.
Proven Primary Prevention Strategies
• Strategy 5— Promote support to the survivors of suicide
• Objective: Connect survivors to sources of support throughout the state
• Activity:– Promotion awareness of and attendance in the
survivors of suicide support groups– Promotion the development of new survivor of suicide
groups.– Inclusion of information about support groups in
directories, pamphlets, online, etc.
Additional Resources
• Tennessee Suicide Prevention Network
- www.tspn.org
• Suicide Prevention Resource Center
- www.sprc.org
• CDC Suicide Prevention Briefs
- http://www.cdc.gov/features/suicidebriefs
• National Suicide Prevention Lifeline- http://www.suicidepreventionlifeline.org/
Technical Assistance Resources
• Rachel Heitmann
- Injury Prevention and Detection Director
- 615-741-0368• Terry Love
- Injury Prevention Manager
- 615-532-7778• Abhilash Philipose
- CDC Public Health Associate
- 615-532-7768