Vote For Your Favorite Costume! B C A D E F "Dog Parade" by editrixie is licensed under CC BY-ND 2.0 and annulla 1
Day 2 October 17, 2019 Learning Session 2
Welcome and Recap of Day 1 Jennifer Leonardo, PhD, MSW, LCSW Children’s Safety Network, Director 3
Technical Tips Download resources in the Call (866) 835-7973 to File Share pod (above the listen and be heard slides) Mute yourself when you’re This session is being not talking (use phone’s recorded mute button or press *#) * Use the chat (bottom left) This webinar is subject to to ask questions at any the CSLC data agreement time 4
CSLC Cohort 1 Highlights So Far 5
All Teach/All Learn Questions for Peers Quality Successes to Improvement Share Questions All Teac ach All ll Learn 6
Day 2 Welcome and Recap of Day 1 Jennifer Leonardo, Director Review homework highlights Erin Ficker, CSLC Co-Manager Team Present storyboard LA Suicide and Self-Harm Prevention Using Data Effectively Maria Katradis, CSLC Co-Manager & Data Manager Team Present storyboard IA Poisoning Prevention Team Present storyboard WA Motor Vehicle Traffic Safety Closing Remarks and Next Steps Jenny Stern-Carusone, Associate Director 7
Review Homework Highlights Erin Ficker CSLC Co-Manager 8
Homework Reflection Questions Where are you in your improvement journey? Develop? Test? Implement? Spread? 9
Homework Reflection Questions 1. 1. How did y did you appr approach u usin sing t the c checklist? 2. 2. What at did y did you lear arn ab about y your pr project? 3. 3. What at w was t as the mo most c chal allenging par part o of goin ing t through t the Checklist ist? 4. 4. After g r going t throu ough t h the Improvement Che hecklist, a are re y you ou in the he s stage of of im impr provement y you in init itially t thought y you were? 5. 5. Bas Based o on wh what at y you lear arned, wh what at’s n next f for your w work o on this st strategy? 10
Improvement Checklist 11
Improvement Checklist 12
Improvement Checklist 13
Improvement Checklist 14
Improvement Checklist 15
Questions? Please enter your questions in the chat pod 16
Suicide and Self-Harm Prevention Storyboard Presentation Jane Herwehe, LA Facilitator: Maria Katradis, Debra Perna, LA SSHP Topic Lead Rosaria Trichilo, LA 17
Louisiana: Suicide and Self Harm Prevention Presenters: Jane Herwehe he, M , MPH Debra P a Perna, a, R RN Rosar osaria Trichil ilo, M , MPH Bureau o of f Family H Health h – OPH PH – Louisiana D Dep ept. t. o of Hea ealth th 18
Project Rationale The P Probl oblem: • Data from multiple sources demonstrate a need for suicide prevention programs in schools and increased focus on children’s mental and emotional health • Legislation has recognized unexpected deaths of children as a significant public health concern warranting review and action • National Violent Death Reporting System (NVDRS) • In 2017, we began to gather critical data on homicide, suicide and unintentional firearm fatalities using NVDRS • NVDRS helps state and local officials understand the circumstances contributing to violent deaths by linking data from multiple sources including o Medical Examiner, Coroner, law enforcement, toxicology, and vital statistics records • NVDRS data show that among children 10-14 years old: • 22% of fatal injuries are from suicide • Suicides exceed homicides 19
Louisiana Youth Suicide Louis isian ana Su a Suic icid ide Rat ate P Per 100,000 Ages 10 10-19 19 Louisiana suicide rates have been 9.0 .0 increasing 8.0 .0 • Especially among youth 7.0 .0 ages 15-19 6.0 .0 5.0 .0 Louisiana suicide rate in 2017 for 4.0 .0 youth 10-19 years old exceeded 3.0 .0 the US rate 2.0 .0 • 7.8 vs. 7.2 per 100,000 1.0 .0 0.0 .0 2007 20 07 2008 20 08 20 2009 09 2010 20 10 20 2011 11 20 2012 12 20 2013 13 20 2014 14 2015 20 15 2016 20 16 20 2017 17 Source: Vital Records, 2007-2017
Louisiana Youth Suicide • Among Louisiana High School students who took the 2017 Youth Risk Behavior Survey (YRBS) ◦ 17.8% seriously considered attempting suicide ◦ 16.8% attempted suicide • Nationally, 7.4% of US high school students reported attempting suicide Source: Centers for Disease Control and Prevention (CDC). 1991-2017 High School Youth Risk Behavior Survey Data. Available at http://nccd.cdc.gov/youthonline/.
Suicide Mechanism Between 2007 and 2017, 375 Louisiana youth age 10-19 died of suicide • 56% from firearms • 35% from suffocation • 5% from self poisoning Source: Vital Records, 2007-2017
Louisiana State Child Death Review (CDR) and Suicide Prevention Recommendations Established in 1992, CDR aims to identify the causes of unexpected child death and methods for prevention CDR wor orks t to: o: Strengthen/identify opportunities to build capacity in: • Suicide prevention programs for children • School-based bullying prevention programs • Support for schools in effectively implementing suicide prevention tools and, should a • death occur, support schools in responding to the loss Determine if anticipatory guidance in healthcare exists when providers suspect a child is • suicidal Support follow up care efforts after emergency visits for suicide attempts • Enforce suicide safety intervention plans as a standard of care for suicidal children •
AIM Statement Increase by a minimum of 1 the number of emergency departments in LDH Region 4 that are implementing universal screening for suicide risk with valid screening tools among children 10-19 years old.
Project Approach 25
Team Member Roles CoLeads Local Partners •Data Team Lead, BFH •Suicide Prevention Coordinator, Family Tree Lafayette •Office of Behavioral Health Suicide •St. Martin Parish School System Prevention Manager •Regional Medical Director, OPH •NVDRS Coordinator, BFH •Regional MCH Coordinator, OPH •Department of Education, Program •Local Emergency Department Manager Physician and Pediatric Director •Acadiana Area Human Services, •ACES Coordinator, BFH Director •School Based Health Team, BFH •Mortality Epidemiologist •EMS for Children Manager •Statewide Surveillance Manager 26
Team Photos 27
Impact Story • Feedback from the local community has resulted in shift in AIM • Still in the 0 minus 90 day period • Feedback from the targeted health providers has resulted in research into practices, tools and clinical pathways • Team participants are more familiar with the principles of CQI, but there has not been the chance to practice these just yet given progress. • Embarking on this work has elevated the awareness of child suicide within the Bureau of Family Health Title V program and garnered increased interest in success of this collaborative. 28
Louisiana Pilot Community – Region 4 • Lafayette, LA has a strong foundation • Suicide coalition organized by local stakeholders • Evidence-based screening in select schools • Commitment from local stakeholders, including ED healthcare personnel, to the Learning Collaborative • Region 4 includes the parishes of Evangeline, St. Landry, Acadia, Lafayette, St. Martin, Vermilion and Iberia • Over the past 3 years the rate of suicide for Region 4 has been increasing for children 10 through 19 years of age • In 2017 the rate per 100,000 was 11 compared to the state’s rate of 8 29
Progress: Affectionately known as our “0 minus 90-Day” AIM Statement... where we are now... CSLC P Progre ogress S Scale ale 30
Clinical Pathways Map • Team and local partners got together to outline the process flow when youth report suicidal ideation From school or from home Identified ED as a key referral location by schools and parents Began to map possible clinical pathway for EDs to use in conjunction with universal screening • See next slide 31
Screeners to consider: Screen • ASQ (suicide) • PHQ-9 modified (suicide+depression) • C-SSRS • QPR (suicide+depression) • Add screener to EMR Screen positive - Yes Who to screen? • Universal vs targeted (“red flags” ) • What ages if universal screening? i.e 8/10 and older • 8/10 + pediatric psychiatric ED patients (refer to Feb 2017 Prev Sci article) Evaluate • Role of CART • Role of Hospital Social Worker • Suicide Guide to ED Evaluation and Triage Suicide. ( Suicide Prevention Lifeline ) Admit Discharge Home • Confirm that no Primary Care consent needed. • Have conversation Provider with parent while in Involvement ED, let them know Parental Post d/c that you are after d/c. Safety Plan notifying the PMD . Education Case Management • Medicaid Case Management? • Safety Planning Guide : • Warning Signs (how to access, what is their A quick guide for • Hotline Info role, warm handoff. Will they clinicians. (WICHE) • Established safety Plan, in writing and develop check in with family? • Look for other, simpler with ED staff. • Private insurance (BCBS and guides for ED staff to • School Involvement United HC) Same questions. use with • F/U plan: appointments, case management, etc. parents/children while • General Info for parents: in ER. NASP Preventing Youth Suicide, Tips for Parents and Educators
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