North Dakota (ND) had the second-highest state increase in suicide rates between 2000 and 2018. Complicating this problem is the limited crisis support and resources that exist in remote and tribal communities in ND. In response, the North Dakota Rural and Tribal Suicide Care Project (RT-SC), serving youth ages 10-24, will provide suicide prevention and intervention supports for 12 counties located in the north-central and parts of the northeastern regions of ND. The RT-SC project will serve multiple communities, health and behavioral health care providers, schools, and organizations to implement a culturally appropriate suicide prevention strategy by leveraging existing services in under-resourced communities. The project will support upstream prevention, integrates evidence-based practices, and evaluates outcomes. These efforts include community-wide engagement, critical stakeholder partnerships, and data gathering processes.
RT-SC will provide clinical screenings for over 500 youth per year and upstream intervention to 2,000 youth per year for a total of 12,500 youth served across the five years of the project. RT-SC will provide education, training, and technical assistance to over 360 people a year for a total of 1,804 people served. Project goals and objectives are 1) To develop, test, and disseminate a model of suicide care for youth ages 10-24 in critical access hospitals and community clinics to elevate the ND standard of care. The SBIRT-Suicide Care (SBIRT-SC) protocol will be adopted for rural and tribal communities. Training on brief intervention, safety planning, lethal means counseling, and follow-up/monitoring will be provided. A community-based referral network serving critical access hospitals and crisis response teams will be developed and technical assistance will be provided supporting future implementation across the region. Pre-service training on suicide prevention and screening tools will be offered. 2) To provide suicide prevention, early intervention, and treatment services in school and community settings for youth 10-18 years old. Training will be offered to school counselors, educators, and staff in the region on suicide prevention and intervention including the adoption of Suicide Safety Training and Sources of Strength. A partner health care center will pilot an upstream prevention program in two remote communities. Skills Training (ASIST) and Question, Persuade and Refer (QPR) training will be provided to foster care and juvenile justice staff. QPR training will also be provided to pre-service teachers. Training on evidence-based crisis responses will be offered to schools and the rural and tribal communities. 3) To develop and implement a post-incident response system to provide support to families and others after a suicide attempt or death. Two toolkits, one for FQHCs and critical access hospitals and another for foster parents, will be developed to provide content on post-incident interventions. The foster parent tool kit will also enhance their ability to recognize signs and risks of suicide. 4) To develop and implement a community-based lethal means reduction campaign in partnership with gun shops, sportsmen’s clubs, game and fish, and the gun-owning community. This includes a media campaign for the gun shops, sportsmen’s clubs, and the gun-owning community in the region regarding the dangers of access to lethal means along with QPR training. 5) To evaluate the impact of clinical and community suicide prevention project activities on changes in suicide risk identification, clinical service delivery, and lethal and non-lethal suicide attempts. This project will track the amount of training, screenings, risk assessments, safety plans, suicide-specific interventions, follow-up phone calls/texts, and non-demand caring contact texts. It will conduct an outcome evaluation on project impact with an anticipated 20% reduction in suicides and suicide attempts among youth 10-24 across NCND.