Centerstone's Zero Suicide Initiative (ZSI) - The Zero Suicide Initiative (ZSI) will enhance/expand suicide prevention and intervention programs designed to raise awareness of suicide, establish referral processes, and improve care and outcomes for adults ages 25+ within Centerstone’s Health System (i.e., Florida, Illinois, Indiana, and Tennessee). ZSI will serve an unduplicated total of 47,285 adult Health System clients (Yr 1: 7,465; Yrs. 2-5: 9,955 annually). ZSI’s focus population is expected to mirror those of the Health System’s client population, with 43% male, 57% female, 72% white, 10% African American, 3% Hispanic/Latino, and 0.4% American Indian/Alaska Native individuals. Focus population clinical characteristics (e.g., 35% have SUD; 42%, a depressive disorder, etc.) are risk factors for suicide attempt/death. The focus area suicide rate (23.4/100,000) exceeds the U.S. rate (14.5). ZSI will screen/assess clients’ risk level using the Patient Health Questionnaire-9, Columbia-Suicide Severity Rating Scale, and the Interpersonal Needs Questionnaire. Those at high risk will be placed on a Suicide Prevention Pathway and treated according to a Suicide Care Management Plan comprising of safety planning, reduced access to lethal means crisis intervention, continuous contact/monitoring, and rapid follow-up. Integrated screenings will assure attention to preventing suicide among Health System clients receiving services for serious mental illness (SMI). Staff will provide added contact/support to engage and intervene with Veterans at risk for suicide but not currently receiving Veterans Affairs (VA) services. ZSI’s suicide-specific evidence-based practices include RELATE; the Interpersonal Theory of Suicide (ITS); Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP); Suicide-Prevention Focused Narrative Exposure Therapy (S-NET); Dialectical Behavioral Therapy-Skills Treatment (DBT-ST); Attempted Suicide Short Intervention Program (ASSIP); and Counseling on Access to Lethal Means (CALM). ZSI will accomplish the following goals: 1) Expand a leadership-driven, safety-oriented culture committed to reducing suicide; 2) Develop a competent, confident, and caring workforce, 3) Systematically identify/assess client suicide risk; 4) Ensure timely needs-based pathways to care, including safety planning and lethal means restriction; 5) Use evidence-based treatments that directly target suicidal thoughts/behaviors; 6) Provide continuous contact/support, especially after acute care; and 7) Apply a data-driven, quality improvement approach leading to improved patient outcomes and better care for those at risk. ZSI will achieve the following measurable objectives: Provide suicide risk screenings for 262,680 Health System clients; Provide comprehensive assessment for 47,285 at-risk clients; Provide Suicide Prevention Pathway services for 2,840 clients; Provide care transition for 2,130 Pathway participants; Refer/connect 47,285 clients to mental health/related services; Follow-up with 2,840 Pathway participants; and Provide workforce training in evidence-based practices and protocols/processes for 2,500 clinical staff. ZSI has secured commitments from partners dedicated to the project’s success, including Veteran-serving organizations.
