The North Carolina Collaborative Learning Institute: Building Community Capacity to Prevent Suicide and Adverse Childhood Experiences Using Systems Thinking Tools

What did North Carolina do?

North Carolina Core State Injury Prevention Program (Core SIPP) developed a new program named Adverse Childhood Experiences (ACEs) and Suicide Prevention in a Remote Environment (ASPIRE). The ASPIRE program included: 1) a six-month Collaborative Learning Institute (CLI) training program on using systems thinking approaches for ACEs and suicide prevention planning and 2) two toolkits designed to improve learning and demonstrate best practices for ACEs and suicide prevention.

Partners who conducted the program were the North Carolina Injury and Violence Prevention Branch, University of North Carolina (UNC) Injury Prevention Research Center, UNC Gillings School of Global Public Health, and the Rural Opportunities Institute. North Carolina Core SIPP collects and analyzes data after each CLI round to improve the structure and delivery of the program and tools in the next round. There have been a total of five CLI cohorts since 2020.

How did North Carolina use systems thinking approaches to improve suicide and ACEs prevention?

The CLI program combined systems thinking approaches with an understanding of ACEs- and suicide-related risk and protective factors to inform prevention. The program included virtual learning with supportive resource materials, recorded sessions for review and additional learning, skill-building exercises, and ongoing feedback and support from coaches.

One of the first tasks for suicide prevention was to add to the outcomes and various types of shared risks and protective factors found in CDC's Connecting the Dots: An Overview of the Links Among Multiple Forms of Violence. North Carolina Core SIPP recruited specifically for teams working in suicide prevention, in addition to teams working in ACEs prevention, in the first round of the CLI. The year one webinar co-hosted by the Safe States Alliance highlighted CLI outcomes from that team. This webinar description is archived on the Safe States website.

Evaluation data collected through focus groups with CLI teams, post-webinar surveys, and pre- and post-test surveys before and after each CLI session and for the overall program, revealed several program strengths. Participants stated an appreciation for the dedicated time to work together as a team on ACEs strategic planning alongside a coach. One participant wrote, "I really like that each group has a CLI rep to help guide us when we have questions or are confused." Several participants noted a change in perspective that helped their team approach ACEs in a new way. One participant noted, "This institute gave us the lens that we needed to reframe our work in a meaningful and clear way." North Carolina Core SIPP plans to complete follow-up surveys and/or interviews with previous CLI participants to learn more about outcomes they experienced after participating in CLI. Questions for the participants will include: Are they still functioning as a team? Has their collaboration strengthened because of CLI? Have they implemented a new strategy or developed a new policy based on participation? Do they have new partners? Were there changes within organizations that participated? Has the overall ACEs prevention system changed in their community?

Why did North Carolina create the ASPIRE program?

ACEs and suicide have related risk factors. Communities in North Carolina aim to prevent both suicide and ACEs by creating programs and strategies. However, most of these efforts do not use a systems thinking approach when creating their programs and strategies. Systems thinking could improve their communication about how their programs interact to prevent counter-productive outcomes or duplicated efforts. A systems thinking approach ensures programs and strategies meet the needs of children and families and are created with collaboration, aligned with other community efforts, and have enough resources to support them. There are more than 40 ACEs task forces across the state that can integrate systems thinking into their programs and strategies. Organizations that are a part of these task forces include local public health and social services, child advocacy centers, and other family support services agencies. Increasing the use of systems thinking in planning and establishing ACEs programs requires an improvement in skills, resources, and knowledge through training and technical assistance.