Comprehensive Suicide Prevention: Success Stories

2023 story

Leveraging CDC Resources to Promote Suicide Prevention Awareness in Rural Communities

California's Injury and Violence Prevention Branch selected 13 counties to participate in California's Comprehensive Suicide Prevention Program (CSP). Each year, the CA CSP team gathers and releases a county profile report that includes surveillance data. Profiles compare county and state suicide rates and emergency department visits for self-harm. Counties use the profile data to inform their decision-making and program planning efforts.

Amador County, a rural county in Northern California, had the state's second highest suicide rate and highest rate of emergency department visits for self-harm from years 2018 to 2020. Amador County Behavioral Health Department used its profile to apply data-driven strategies that mobilized the community to focus on new and existing partnerships with at-risk groups by promoting suicide protective factors. The Amador County Behavioral Health Department and the Amador Suicide Prevention Education Awareness Knowledge Support (SPEAKS) Suicide Prevention Coalition led recurring meetings events and workshops, such as suicide prevention gatekeeper training and crisis intervention. County partners distributed evidence-based resources to reduce stigma associated with help-seeking and mental illness.

The SPEAKS Suicide Prevention Coalition presented the county profiles and their accomplishments to the county board of supervisors. The county-specific data helped them understand the importance of suicide prevention awareness in their community which will help improve the overall well-being of their residents. Since 2022, the Amador County board of supervisors proclaimed September as Suicide Prevention Month to support awareness and support for suicide prevention.

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Leveraging CDC Suicide Prevention Resources to Expand Suicide Prevention Efforts Statewide

Suicide is a prevalent problem in California with statewide impact. In 2020, there were 4,140 suicide deaths among California residents. Many California counties have residents who are at increased risk for suicide, including counties that are rural and those where firearm ownership is common. The state also experienced a 65.5% increase in handgun ownership compared to the previous year.[1] Data consistently show that firearms are the most common mechanism for suicide, and research has established a link between firearm ownership and increased risk for suicide1. Additionally, poisoning is a common method of suicide in California, especially for females. To address these issues, the Injury and Violence Prevention Branch (IVPB) within the California Department of Public Health is providing support to 13 counties that participate in the CDC-funded California Violent Death Reporting System and have higher suicide and self-harm injury rates than the state average.

California is using CSP funds to track suicide and self-harm emergency department visits and sharing these findings to help build awareness for the need to prevent suicide statewide, and to use data to inform prevention efforts. California shared data with members of the legislature in hearings and with partners across multiple sectors through webinars, presentations, data briefs, and fact sheets.

Sharing these data helped facilitate an allocation of $2.78 million in state funding to establish the Office of Suicide Prevention (OSP), which is intended to be an overarching convener and coordinator of statewide suicide prevention efforts. The CSP program is planning to leverage OSP funding to expand its strategy of reducing access to lethal means among people at risk by purchasing lock boxes to safely store firearms and medications. Lock boxes will be provided to the CSP counties interested in promoting safe storage.

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Colorado Uses Comprehensive Suicide Prevention Funds to Support LGBTQ+ Suicide Prevention Efforts

Colorado prioritizes six counties with high rates and counts of suicide to implement comprehensive suicide prevention strategies for individuals who identify as LGBTQ+. Each of the six counties implemented strategies to reach LGBTQ+ populations focusing on connectedness to increase opportunities for belonging, safe spaces, inclusive community events, and meaningful social interaction.

Colorado's CSP-funded counties implemented the following LGBTQ+ specific activities:

• Hosting community round tables
• Promoting and supporting gay-straight alliances in schools
• Meeting with schools to discuss how gender identity and sexual orientation inclusion in anti-discrimination policies can protect all students
• Delivering Local Outreach for Suicide Survivors (LOSS), a training with emphasis on equity issues for BIPOC and LGBTQ+ communities
• Delivering locally created “ABCs of LGBTQ” trainings for community members, parents, and schools
• Delivering locally created “How to Be a Trusted Adult” trainings for community members, parents, and schools
• Meeting with schools to discuss how gender identity and sexual orientation inclusion in anti-discrimination policies can protect all students
• Creating safe spaces for LGBTQ+ youth activities like an LGBTQ+ youth dance, PRIDE activities, and teen self-care events. Also, Trans Day of Remembrance events, LGBTQ+ outreach with storytelling & resources, an LGBTQ+ mental health podcast, and an LGBTQ+ poetry workshop.

In 2022, four of the six CSP-funded counties confirmed the following:

• 100% of partner schools had written anti-discrimination policies that outlined protections for transgender students
• 18% of local CSP-supported participants who responded to the 2023 annual local partner survey belong to the LGBTQ+ identity
• Local CSP-supported entities held 93 community events to increase opportunities for safe spaces and inclusive communities

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Colorado-National Collaborative Partner Spotlight: Community Health Partnership Prevention Efforts in El Paso County

The Colorado-National Collaborative (CNC) identifies, promotes, and implements successful state- and community-based comprehensive strategies for suicide prevention. The Office of Suicide Prevention funds local organizations in six Colorado counties to coordinate full-scale, community-based comprehensive suicide prevention efforts. The CNC coordinator organizes and facilitates monthly meetings with local partners from nearly 40 different organizations.

El Paso County has participated in the CNC project since 2019. CNC is considered a critical learning community for the county to exchange suicide prevention information with others across the state. In El Paso County, CSP funds support the Community Health Partnership (CHP), a community health and wellness organization that participates in the CNC. The CHP coordinates and implements local suicide prevention efforts in El Paso through projects aligned with the CDC Suicide Prevention Resource for Action. The CHP successfully established a suicide prevention coalition, The Suicide Prevention Collaborative of El Paso County, to serve as the advisory and action planning committee for the project.

The CHP created a community postvention response plan and postvention issue brief, which includes best practices around implementing a plan for suicide loss survivors. Postvention plans focus on mitigating negative effects from exposure to suicide and promoting healing. The CHP also created the Manager's Guide to Suicide Postvention toolkit to support workplace suicide prevention efforts. The brief gained media attention throughout the county, garnering the support of the Colorado Attorney General, Southern Colorado Business Partnership, and the local Chamber of Commerce. The team produced and promoted videos of individuals with lived experience and created a 40-hour training, Local Outreach for Suicide Survivors (LOSS), which incorporates equity by focusing on specific populations with high rates of suicide, including Black, indigenous, people of color (BIPOC), LGBTQ+, and military communities.

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Connecticut’s CSP Program Shares Data with Local Partners to Inform Suicide Prevention

Prior to CSP funding, local health departments and districts (LHDs) in Connecticut did not have access to near real-time data from emergency departments (EDs) on suspected suicide ideation and suicide attempts. Instead, the state department of public health typically provided ED and hospital discharge data that was up to 18 months old, and only upon request. Connecticut’s CSP Team partnered with LHDs to improve access to near real-time ED data on suicide ideation and attempts.

Near real-time data, or syndromic surveillance, provides public health officials with a timely system for detecting, understanding, and monitoring health events such as suicidal ideation and suicidal attempts. Syndromic surveillance is important to improve awareness of suicide risks in jurisdictions. As a result of CSP funding, since late 2021, LHDs have been able to access syndromic data on suicide ideation and suicide attempts in emergency departments and urgent care centers within a day of occurrence. LHDs can now track counts and rates of suicide ideation and attempts as they occur—rather than waiting over a year for the data—so that they can more quickly address these issues and increase targeted awareness. LHDs can directly access the Connecticut Department of Public Health’s (DPH’s) EpiCenter syndromic surveillance system, which comprises 100% of Connecticut’s EDs and about 40 health system-affiliated urgent care centers.

Connecticut’s CSP program collaborated with three priority LHDs and trained them on the use of the suicide ideation and suicide attempt case definitions, and how to use the data dashboards in the EpiCenter system. LHDs can access aggregate data from 2019–2022 on the state-, county-, region-, LHD-, and zip code-levels, by home and facility location. They can also access line-level data for their jurisdictions’ residents, which include age, date of birth, zip code of residence, sex, race, ethnicity, facility, chief complaint, diagnosis codes, and triage notes. These data can be compared to the state and to other towns and regions in Connecticut, and data can also be compared across time periods. The dashboard is interactive and can be changed to suit the needs of the LHDs.

LHDs can use suicide-related syndromic data to identify populations at increased risk for suicide, connect and outreach to them, and target selected CSP strategies and interventions. LHDs can put data into action by using syndromic surveillance data to target their evidence-based approaches and reach at-risk people.

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Leveraging Comprehensive Suicide Prevention Funds to Share and Expand Data in Florida

Florida's CSP team used partner feedback to expand available suicide data in Florida Health CHARTS (Community Health Assessment Resource Tool Set). CHARTS provides easy access to health indicator data at the community and state levels.

Partners were specifically interested in veteran suicide fatality data. The CSP team used this feedback to expand the CHARTS with a Suicide and Behavioral Health profile, which includes provisional monthly veteran suicide fatality data. Additionally, Firewatch, a veteran serving community organization, adapted the CHARTS data set to create their own public dashboard.

Expanding on the CHARTS data empowers partners to make informed policy and prevention decisions. The CSP continues to educate partners on the data available and plans to add risk and protective factors to each county profile.

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Georgia Comprehensive Suicide Prevention Team Address Gaps in Care among First Responders

In Georgia's 159 counties there are more than 125,000 first responders and nearly 700,000 military veterans. Currently there are no state-level or national standards or systems to collect suicide data in first-responder populations.

Georgia's Comprehensive Suicide Prevention (GA CSP) team partners with the Advancement of Military and Emergency Services (AMES) Research Center at Kennesaw State University (KSU) to create and implement a comprehensive approach to suicide prevention for people who served in the military including the reserves and those in first responder professions. GA CSP and KSU surveyed first responders to assess their health and access to suicide prevention resources. Data were gathered between September 2022 and August 2023, from 20 first-responder organizations, 932 first responders, and 4,433 military personnel, veterans, and family members across 151 counties in Georgia.

Using the information provided by the 5,365 veterans and first responders who completed health assessments, educational training and informative materials were designed to raise awareness of risk and protective factors related to suicidal ideation for veterans and first responders, families, and their broader communities. Resources developed include Mental Health 101, Optimizing Sleep Health, Substance Use Versus Misuse, Mental Health First Aid, Effective Communication and Conflict Styles, Financial Resilience Preparedness, and Trauma and the Body.

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Expanding CDC Investments to Develop a Suicide Community Alert Network

The Louisiana Department of Health (LDH) developed the Suicide Community Alert Network (SCAN) as part of CDC's near real-time surveillance program. Powered by their new knowledge of syndromic surveillance, the LDH leveraged Comprehensive Suicide Prevention (CSP) funds to create an email alert system. The system generates alerts when there is an increase in the emergency department visits involving young ages 10–19 for suicide ideation and attempt in their area (region and/or parish level). School-based mental health professionals and the Office of Public Health regional medical director receive the email alerts.

Participating SCAN partners also receive suggested responses to the alert and a list of resources. Louisiana's CSP team trains individuals interested in participating in SCAN. The training course includes the following:

• Introduction to syndromic surveillance methods
• Overview of syndromic data caveats
• Explanation of the email-based alert sequence
• Information about responsibly sharing the alerts with recipients' school health networks
• Recommendations for action and resources

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Maine Uses Comprehensive Suicide Prevention Funds to Boost Postvention Efforts Across the State

Maine's Comprehensive Suicide Prevention (CSP) team developed infrastructure to support adults who experienced a suicide loss, also known as postvention. Prior to receiving CSP funding, the Maine Suicide Prevention Program provided postvention responses only in schools following the loss of a student or staff member. Expanding statewide postvention services improves the wellbeing of loss survivors and communities by destigmatizing suicide and reducing risk at the individual and population levels.

Maine's CSP developed the Suicide Loss Survivor Survey and conducted focus groups with suicide loss survivors to assess gaps in services and support. The survey showed that many participants did not have access to support following their experience of suicide loss. Results indicate access to therapists who were specifically trained in suicide loss (76%) and peer support from other survivors (60%) would be helpful.

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A Suicide Prevention Marketing Campaign for At-Risk Men in Massachusetts

The Massachusetts Department of Public Health's Suicide Prevention Program developed the MassMen Project to promote wellness and empower working-aged men with low-to-moderate income across the state. Massachusetts used Comprehensive Suicide Prevention (CSP) funding to promote their screener tool, which helps men self-identify their emotional, physical, and spiritual needs and gain confidence in seeking support. The screener tool provides mental health suggestions and resources based on responses to prompts. Paid advertisements for the tool were displayed through Facebook and Instagram from November 1–December 24, 2022. The campaign received 8,315,217 impressions and over 20,000 total clicks. The campaign made a significant impact on screener use with an average of 63% more responses throughout the campaign.

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Building Partnerships with Lawrence Public Schools to Prevent Suicide Among Latinx Youth

The Massachusetts Department of Violence and Injury Prevention's Comprehensive Suicide Prevention (CSP) program implements upstream prevention strategies that include training elementary, trade/vocational, and high school personnel in teaching coping and problem-solving skills in youth, as well as supporting, assessing, and managing suicidality among Latinx youth. Massachusetts's CSP program focuses on Latinx individuals and specifically Latinx males, a priority population that experiences significant health disparities related to mental health and lack of access to care.

According to data from the CDC-funded Massachusetts Violent Death Reporting System (MVDRS), suicides among Latinx males rose 33% between 2018 and 2019. While youth suicide rates have been declining since 2016, suicide is still the 2nd leading cause of death among youth aged 10–24 years in both Massachusetts and the country overall as of 2020. Additionally, between 2017–2019, according to the MA Youth Risk Behavior Survey, Hispanic students were significantly more likely to report attempting suicide compared to White, non-Hispanic students.

With the Lawrence community's participation as well as the LPS officials' participation and partnership in this project, Massachusetts' CSP Program will deliver trainings that are culturally appropriate and will advance staff's capacity and knowledge in promoting help-seeking behaviors and reducing the risk for suicide among their Latinx students and residents.

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Michigan Men Share Their Stories of Hope and Resilience

In the state, men are three times more likely to die by suicide than women. Michigan used Comprehensive Suicide Prevention (CSP) program funds to create a media campaign to reach men ages 25 and older. Michigan CSP produced testimonial videos featuring three men with suicide lived experience. The men helped plan and write the scripts for the videos to ensure authenticity. The team created a 60- and 30-second versions featuring all three men, and three 15-sec versions—one for each participant. The videos encouraged men to speak up about suicide prevention. The videos ads ran on social media in June 2022 for Men's Health Month and again in September 2022 for Suicide Prevention Week. The ads have 8,189,751 impressions and continue to be shared by partners in the state.

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Creating a Diverse Multi-Sectoral Partnership to Reduce Suicide Among Michigan Men

A key component of comprehensive suicide prevention is establishing a multi-sectoral partnership to help address suicide. Michigan's Comprehensive Suicide Prevention (CSP) program, Preventing Suicide in Michigan Men (PRiSMM), brings together key individuals, organizations, and stakeholders to form the PRiSMM Partnership, which works to prevent suicide in Michigan men, a population that is at disproportionate risk for suicide. PRiSMM includes organizations in the construction, automotive, farming, and television and media industries, as well as the faith community. It includes individuals invested in reducing male suicides but who may not work in the suicide prevention field, as well as individuals working in agriculture, automotive, and construction industries who are able to inform the PRiSMM Partnership of gaps and barriers in suicide messaging. Many of the individuals involved in PRisMM interact with adult men and provide the perspective of Michigan men to help further the work of the overall project.

One of PRiSMM's non-traditional partners oversees Michigan's largest construction company. As a result of their participation in PRiSMM, this company plans to implement strategies to improve mental health and suicide prevention among its employees. This partner has also been able to provide insight on how PRiSMM's suicide prevention messaging can reach Michigan men who work in construction.

PRiSMM shares data and information across a wide network. PRiSMM created a suicide prevention social media guide, a risk factors and warning signs guide, and data presentations to disseminate and inform the PRiSMM Partnership about suicide data and suicide prevention efforts that could be and are implemented in Michigan. PRiSMM also creates and disseminates a quarterly newsletter to keep the Partnership informed of data trends and prevention efforts. The PRiSMM Partnership has pushed a community-driven approach to implementation of suicide prevention efforts, and this approach is critical to the success of suicide prevention among Michigan men.

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Research Foundation for Mental Hygiene's (New York) CSP Team Builds Partnerships with Area School Districts

New York's Comprehensive Suicide Prevention (CSP) team forged new connections with the Board of Cooperative Educational Services (BOCES). BOCES are responsible for the administration and management of curricular, financial, and student support services. Partnerships with the Capital Region, Questar III, and Washington-Saratoga-Warren-Hamilton-Essex BOCES have allowed the CSP staff to efficiently reach the 40 individual school districts in the Capital Connect jurisdiction.

This partnership allowed the CSP to offer two virtual sessions introducing evidence-based programs for schools to use to reduce suicide risk and improve protective factors. Attendees included school administration, principals, directors, social workers, and school counselors. The sessions raised awareness, generated enthusiasm, and fostered initial buy-in from the school districts. The CSP also held two Creating Suicide Safety in Schools (CS3) workshops as the next steps for interested school districts. The CS3 workshop is an evidence-based gatekeeper training to improve school suicide prevention, response, and postvention activities. It is also one of the featured programs in CDC's Suicide Prevention: Resource for Action. The CS3 workshop exit survey showed that 100% of the 42 participants said they would recommend the program and found it useful.

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North Carolina Comprehensive Suicide Prevention Trains Faith Leaders to Combat Mental Health Provider Shortages in Rural Areas

The North Carolina Comprehensive Suicide Prevention (CSP) team implemented Faith Leaders for Life (FLFL) training. This is a statewide suicide prevention initiative aimed at reducing mental health provider shortages in rural areas. The CSP partnered with LivingWorks Education USA to deliver their faith gatekeeper training. A CSP team member was also trained to administer the training with a North Carolina context to address concerns unique to rural North Carolina faith leaders.

After two cohorts, FLFL trained 43 clergy and other faith leaders reaching an estimated 24,000 congregants in North Carolina communities. The training uses LivingWorks Start, an online comprehensive suicide prevention course. Participants in the FLFL program receive 10 Living Works Start licenses to share with other faith leaders to build the capacity and network of care in each faith community to prevent suicide. On average for every faith leader trained, five additional licenses were used in their community. The CSP checks on trained faith leaders quarterly, keeping up to date with their contact information and asking about their use of gatekeeper skills over the last three months.

The CSP also offers the Applied Suicide Intervention Skills Training (ASIST), a 2-day program that teaches participants how to properly assist people at risk for suicide. The training is offered to faith leaders and Black, indigenous, and people of color (BIPOC) individuals in rural communities to expand access to suicide care amid provider shortages. Using ASIST skills allows participants to create safety plans and provide interventions for someone who is at risk for suicide.

2022 story

Expanding CALM Training Capacity Across North Carolina

North Carolina’s Comprehensive Suicide Prevention (CSP) team is supporting and promoting Counseling on Access to Lethal Means (CALM) training statewide. This training is an evidence-based, effective suicide prevention strategy. Initially, there was no central registry or tracking of CALM trainers in the state, and only two people in the entire state could be identified as CALM trainers. The CSP team partnered with the existing two trainers to conduct three CALM Train-the-Trainer (T4T) events: two in the Fall of 2021 and one in the Fall of 2022. The first two trainings trained 18 additional trainers. A few weeks after the first T4T, the CSP team received feedback from a new trainer concerning a session with a young client:

“Could you please pass on my appreciation for this training? I was able to apply what I learned in training during a session and believe it made a considerable difference in safety.”

After the team announced to partners that there is a team of CALM trainers ready and available, they’ve received requests from multiple parties requesting CALM trainings in their communities. North Carolina’s CSP team checks in with the trainers quarterly, keeping their contact information and availability up to date, and collecting data on how many trainings they have done, numbers of participants, and more. Of the 100 counties in North Carolina, 15 are currently in the coverage area of a CALM trainer. The CSP team anticipates both the number of trainers and how much of North Carolina is covered will increase after the Fall 2022 CALM Train-the-Trainer event.

2023 story

North Dakota HOPE Uses Comprehensive Suicide Prevention Funds to Promote First-of-Its-Kind Suicide Fatality Review

The North Dakota Healthcare, Opportunity, Prevention, and Education in Suicide Prevention (ND HOPES) team established a statewide Suicide Fatality Review (SFR) commission – the first in the nation. ND passed a bill establishing the statewide suicide fatality review commission in 2023. This commission will be integral in identifying the risk factors and protective factors involved in each case of suicide, recommending policies and programs to improve suicide prevention efforts, and providing consultation and support to agencies involved in suicide investigation or prevention.

The ND HOPES team is also working with the North Dakota Department of Health and Human Services (ND DHHS) to increase awareness of SFR committees across counties in the state. ND HOPES's goal is to work with local SFR committees to improve the availability of data on suicide risk and protective factors. One way to improve data on suicide and related context is through increased use of the Suicide Consolidated Risk Assessment Profile (SCRAP), which is a data collection tool available to coroners when investigating a suspected suicide. The SCRAP form is a brief supplement to standard data collected at death scenes and provides more detailed suicide mortality risk data specific to localities within North Dakota. The SCRAP data helps inform SFR committee work by providing suicide-related data that are comprehensive, local, and actionable.

The SCRAP form is available for use by county coroners, and ND DHHS plans to incorporate the form into a new online death investigation platform so the questions are included alongside all other standard fields coroners complete for the death certificate. The innovative efforts in North Dakota were showcased at the SAMHSA Service Members, Veterans, and their Families Technical Assistance Center Innovations conference in May 2023 in Washington, D.C., as a model for other states.

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LGBTQ+ Suicide Prevention in North Dakota

Members of the North Dakota Healthcare, Opportunity, Prevention, and Education in Suicide Prevention (ND HOPES) team presented at the North Dakota LGBTQIA2S+ Summit and Professional Development Day in October 2022. The professional development presentation included education on suicide prevention statistics, advocacy, resources, and a safety planning workshop designed to help medical and behavioral health professionals better assist the LGBTQ+ community. The summit presentation included suicide prevention strategies and information on the ND HOPES project.

For example, a parent who attended the LGBTQIA2S+ Summit wanted to support their child in learning more about their identity. The child recently identified as non-binary and was affected by a fellow youth's suicide. The parent reached out to ND HOPES leadership after the summit to ask for affirming resources that could help them and their child navigate the loss of a friend. ND HOPES provided the contact information for the local LGBTQ+ peer support group in their hometown. The parent followed-up via email and confirmed they connected with their local LGBTQ+ support group. ND HOPES was able to make this connection because of partnerships established with community organizations.

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The Northwest Pennsylvania Veteran Suicide Prevention Program Implements Gatekeeper Training to Help Prevent Suicide Among Veterans

PERU CSP also launched a military culture training series in March 2023. Thirteen people attended the introduction to Military Culture session and 14 attended the introduction to Military Sexual Trauma.

The University of Pittsburgh Program Evaluation and Research Unit (PERU) expanded their gatekeeper trainings using CDC funding. The PERU Comprehensive Suicide Prevention (CSP) team planned 31 virtual and seven in-person Question. Persuade. Refer. (QPR) trainings for professionals and lay people. Participants learned the warning signs of a suicide crisis and best practices for responses. In-person trainings took place throughout Northwestern Pennsylvania in a variety of locations, including gun shops, American Legion halls, college campuses, and community centers. There were a total of 712 virtual and 81 in-person participants. Trainings included: Applied Suicide Interventional Skills Training (ASIST), Counseling on Access to Lethal Means (CALM), and QPR Instructor Certification. All training participants attained QPR suicide prevention trainer certification.

PERU launched a social media campaign to spread awareness about the importance of these trainings. Individual training dates and registration information were posted on the program's website, shared on social media channels, and distributed through professional networks. As a result of this outreach, 73 people participated in ASIST, 115 in CALM, and 31 received QPR trainer certification.

PERU CSP also launched a 3-part military culture training series in March 2023. The trainings include:

• Military Culture

• Military Sexual Trauma

• Moral Injury

94 crises service workers, 45 psychiatric hospital staff, 21 social work students, 18 Pennsylvania Department of Correction workers, and 11 workers from sexual assault survivor centers participated in PERU CSP's Military Culture training series. 95% of participants agreed or strongly agreed that the trainer was knowledgeable, the delivery was appropriate, and the content will help inform their work.

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Tennessee Department of Health Uses Suicide Surveillance Data to Increase Partner Engagement

TDS CSP is strengthening efforts to use ED data to increase partner engagement and improve decision making. This data helps identify contributing factors for suicidal behavior. Weekly surveillance alerts about suicidal behaviors and injuries increase staff to support syndromic surveillance activities in order to ensure data is used for action.

The TDH analyzes statewide data from emergency department visits to monitor trends for suicidal ideation, injuries related to self-harm, or suicide attempts collected through Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE). An above-average number of suicide-related emergency department visits activates an ESSENCE alert for a county and age group and prompts TDH to share a weekly alert data bulletin to community partners in those identified areas. This weekly alert data bulletin notifies community partners about the increase in suicide-related behavior in their area, any trends in demographics that were noticed, and the risk factors noted during reported visits. Responses also refer community persons to prevention support, guidelines, resources, and trainings.

The TDH launched an online portal that allows those interested in suicide prevention to sign up to receive weekly ESSENCE alerts for the counties where they work or live. Between January 2021 and February 2024, more than 446 people from across the state subscribed to the weekly alerts.

Using CSP funds, the TDH created a new position and hired an ESSENCE Director. This person will educate hospitals, emergency departments, and community partners on how to use ESSENCE to monitor for suicide-related behaviors, work to improve prevention responses to ESSENCE weekly alerts in rural areas and increase suicide prevention activities in high-risk counties and large workforce organizations.

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Suicide Prevention Improvements in 100% of Vermont Emergency Departments

Vermont used CSP funding to create the Vermont Emergency Department Suicide Prevention Quality Improvement Initiative. This initiative focused on improving screening, assessment, and safety planning to reduce access to lethal means and improve follow-up care for individuals at-risk for suicide. Vermont averages over 5,000 visits to hospital emergency departments for self-harm and suicidal ideation each year.

In March 2022, the Vermont Program for Quality in Health Care (VPQHC) began an initiative with all 14 of the state's acute care hospitals to improve the quality of care for individuals coming to emergency departments with suicidal ideation. All hospitals completed an organizational assessment to identify the current state of their suicide prevention practices in relation to evidence-based best practices. Hospitals also received tailored comparative data reports, coaching and consultation from national subject matter experts and the VPQHC team, and access to quarterly networking meetings.

The Vermont CSP team successfully implemented the project with 100% participation from Vermont's emergency departments. All hospitals completed a Zero Suicide Organizational Self Study resulting in the following:

• 86% participated in a survey focused on improving suicide care

• 93% demonstrated increases in their quality improvement goals

• over 300 hospital staff members completed Counseling on Access to Lethal Means training