Tribal Health – Reaching out InVolves Everyone (THRIVE)

Funded by the Indian Health Service (IHS) and Substance Abuse and Mental Health Services Administration (SAMHSA)

Project activities are funded by the Substance Abuse and Suicide Prevention (SASP) grant awarded by the IHS, Division of Behavioral Health in September 2015 and SAMHSA’s Garrett Lee Smith youth suicide prevention grant awarded in June 2019. THRIVE does not currently have funding for Tribal Cooperative Grants but please check back every couple of months to see if there is an update. If you need assistance with honoraria, incentives, training materials, etc. please contact Colbie Caughlan (ccaughlan@npaihb.org or 503-416-3284) to ask if THRIVE can help provide smaller materials for your event(s). Thank you!

Suicide is a sensitive issue, but one that is of great concern to many American Indian and Alaska Native (AI/AN) communities. Data suggest that suicide is a significant problem throughout Indian Country, particularly among Native youth, males, veterans, and elders. From 2002-2006, the average suicide death rate was highest among AI/AN aged 10-24 years at 27.72 cases per 100,000. In the Northwest (ID, OR, and WA), suicide is the 8th leading cause of death for AI/AN people and the 2nd leading cause of death for AI/ANs ages 15-24 years (this is the same for AI/AN youth throughout the U.S.).

The Portland Area has one of the higher suicide death rates for AI/AN among the IHS service areas.  The IHS reported that, from 1996-1998, the age-adjusted suicide death rate for the Portland Area was 22.0 per 100,000, a rate that was exceeded only by Aberdeen, Alaska, Bemidji, and Tucson.

At the state level, annual suicide rates for AI/AN tend to fluctuate widely because the actual number of deaths each year is relatively small.  For example, an average of 20 AI/AN suicides occur in Washington each year, 6 in Oregon, and 4 in Idaho. While males typically complete suicide more often than women, studies suggest that women actually attempt suicide more frequently than men. This pattern is also present among AI/ANs in the Pacific Northwest.

Data on suicide risk factors and attempts, as opposed to mortality, are available from a variety of sources, including the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) and the Youth Risk Behavior Survey (YRBS).  Data from these sources and other studies have found that several factors can put a person at higher risk for attempting suicide, including: – Previous suicide attempt(s) – History of depression – Alcohol or drug abuse – Family history of suicide or violence – Physical illness – Feeling alone. Additional research is needed to identify and explore the culturally unique factors that affect AI/ANs.

There are also protective factors against suicide attempts among AI/ANs. They include:

• Connectedness to family and/or friends
• Connectedness to culture and/or spirituality
• Good emotional and physical health
• Positive Communication with family or friends
• Restricted access to lethal means
• Access to mental health care
• Problem solving skills
• Engagement in positive activities i.e. extracurricular sports, clubs, community center groups, cultural activities, etc.

Sources:

• Suicide Epidemiologic Profile compiled by Dr. Thomas Weiser
• Injury Mortality Among American Indian and Alaska Native Children and Youth- United States, 1989-1998
• Centers for Disease Control and Prevention (CDC) – violence prevention including suicide statistics
• Leading Causes of Death by Age Group, American Indian or Alaska Native Males- United States, 2004
• Injuries among Native Americans: Fact Sheet
• 10 Leading Causes of Death – American Indian and Alaskan Native (Both Sexes, Males or Females) 1995-97
• Indian Health Service (IHS) – Methods of Suicide Among Persons Aged 10-19 Years- United States, 1992-2001

Data Collection Tools:

Oregon Native Youth Risk Survey. The Oregon Native Youth Survey (ONYS) is based upon the Oregon Healthy Teen survey (which is made up of the Youth Risk Behavior Survey and the Student Drug Use Survey), the Communities That Care (CTC) survey (developed by Hawkins and Catalano at UW Seattle), and the Voices of Indian Teens survey (Dr. Spero Manson, PI). Native American Rehabilitation Association (NARA), which has been using the survey tool, added a peer suicide knowledge section from the Lifelines PreTest Questionnaire and additional questions about protective factors based on the concept of resiliency. The survey was also reviewed for cultural appropriateness by a cultural advisory team at NARA-NW. NARA has been granted permission to use parts/all of these surveys and/or they are public domain. The second to last question (#108) is meant to be tailored to the particular Tribe or community it will be implemented in. The ONYS is also designed to be used along with focus groups for a better understanding of how the actual intervention activities are experienced by the youth. Folks are welcome to tweak and perfect (and share their tweaking with us, please!). Please contact Tamara Perkins, of NPC Research, with any questions. NPC Research would be most interested in contracting with interested communities to work on implementation and analysis. Tamara Perkins – perkins@npcresearch.com – http://www.npcresearch.com

Native Youth Survey. Washington State 2008 Healthy Youth Survey Sixth, eighth, tenth, and twelfth graders were surveyed. The survey included questions about safety and violence, alcohol, tobacco and other drug use, physical activity and diet, and related risk and protective factors.

Results:

Resource and Patient Management System (RPMS) RPMS is a computerized Health Information System that has been used by most Indian health care programs since the 1980s. RPMS is a comprehensive suite of packages with many outstanding features that are useful for the daily management of patients. Although RPMS has a vast amount of data on the health status of individual patients, a detailed analysis of its usefulness and accuracy for surveillance has not been done. The EpiCenter has recently been invited by the national IHS Epidemiology Program to enter into a contract to do such an analysis. IHS’s suicide surveillance tool and measure, available through the RPMS Information on IHS ‘s Suicide RPMS package

Request a Suicide Prevention Training! If you would like to request a suicide prevention training for your Tribe or Tribal staff in WA, OR, or ID, please contact Lael Tate at ltate@npaihb.org. Three different trainings are available as well as suicide prevention presentations or awareness activities:

• QPR (Question, Persuade, Refer) – This is a 1.5 – 2 hour training for anyone who may come in contact with a person thinking about suicide.
• safeTALK (Suicide Awareness for Everyone) – This is a 3 – 3.5 hour training that is similar to QPR in that it is for anyone who may come in contact with a person thinking about suicide. For QPR & safeTALK, participants become suicide prevention gatekeepers and learn what the signs of suicide may be and how to link a person to proper resources or to a person with intervention skills training.
• ASIST (Applied Suicide Intervention Skills Training) – This is a full two day workshop that focuses on teaching participants intervention skills that they may need to be a caregiver of someone thinking about suicide. This is not a counseling treatment model but can be a wonderful supplement to skills that counselors and mental health professionals already possess. It is also a very effective workshop for those who may already understand the signs of suicide but who would like a little bit more training on how to really review a person’s risk of suicide and how to help them get more help.o QPR (Question, Persuade, Refer) – This is a 1.5 – 2 hour training for anyone who may come in contact with a person thinking about suicide.  o safeTALK (Suicide Awareness for Everyone) – This is a 3 – 3.5 hour training that is similar to QPR in that it is for anyone who may come in contact with a person thinking about suicide. For QPR & safeTALK, participants become suicide prevention gatekeepers and learn what the signs of suicide may be and how to link a person to proper resources or to a person with intervention skills training.

Recorded 1/8/2020 Introduction to Zero Suicide & Examples from Indian Country: Recently the THRIVE team hosted a webinar to introduce the Zero Suicide model to new staff at the clinics we are assisting with Zero Suicide implementation. Feel free to check this webinar out and learn about the model!

• Link to webinar agenda -Agenda Intro to ZS Webinar (PDF)
• Link to webinar Slides -ZS Faculty Slides (PDF)
• Link to Webinar “Intro to ZS & Examples in Indian Country”

Online Suicide Prevention Trainings and Courses:

• Mental Health First Aid training
  
• Center for Substance Abuse Prevention (CSAP) Prevention Courses – can be used for CEUs
• Living Works ASIST training
• Question Persuade and Refer (QPR) Online Training
• SPRC free online trainings – can be used for CEUs
• SPRC Trainings and Events Calendar
• YSPP calendar of free webinars and fee for training – can be used for CEUs
• SPRC Training Website

Local links
NARA
Crisis Contact List
List of Suicide Prevention Trainers in WA, OR, and ID
Native American Youth Family Center (NAYA)
National Indian Child Welfare Association (NICWA)

State links
Oregon DHS, Public Health Division – Youth Suicide Prevention Program
Oregon Partnership: Crisis Line
Youth Suicide Prevention Program (YSPP) – website for Washington State youth
Washington State: Youth Suicide Prevention
Idaho State University- Institute of Rural Health
Suicide Prevention Action Network of Idaho
Idaho State: Suicide Prevention
The Teenline offers a crisis line between 8AM and 10PM at 206-722-4222 or 1-877-345-8336

National links
Mental Health and Suicide Prevention Resources
IHS Division of Behavioral Health
WeRNative
Suicide Prevention Resource Center (SPRC)
SPRC AI/AN Suicide Prevention
National Suicide Prevention Lifeline
Trevor Helpline for LGBTQ youth
Yellow Ribbon Suicide Prevention Program
Reachout.com
Lethal Means & Suicide Prevention: A Guide for Community & Industry Leaders 

When someone dies by suicide, many others are deeply affected. It can begin with family and those closest to the person who took their life and then the impact spreads outward to others such as friends, witnesses, first responders, treatment providers, and colleagues. According to the National Alliance on Mental Illness (NAMI), postvention is activities which reduce risk and promote healing after a suicide death. Although postvention is done after a suicide it is important that we prepare for postvention before a suicide.

The list of resources below include information appropriate for particular settings:

• Safe and Effective Messaging for Suicide Prevention –this document can help develop effective messages surrounding a suicide. It includes the do’s and don’ts of reporting for suicides. http://www.sprc.org/sites/sprc.org/files/library/SafeMessagingrevised.pdf
• At-a-Glance – Safe Reporting on Suicide – what reporters should report after a suicide  https://dphhs.mt.gov/Portals/85/suicideprevention/MediaGuidelines.pdf
• Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines – http://www.sprc.org/sites/sprc.org/files/library/RespondingAfterSuicideNationalGuidelines.pdf
• Suicide Postvention – http://www.csus.edu/indiv/b/brocks/Workshops/NASP/Suicide%20Postvention%20Paper.pdf
• Lifeline Online Postvention Manual– http://www.sprc.org/sites/sprc.org/files/library/LifelineOnlinePostventionManual.pdf
• International Association for Suicide Prevention (IASP) – Resources: Postvention (Suicide Bereavement) – Survivor Guides – http://www.iasp.info/resources/Postvention/Guides/
• Hope and Healing: A Practical Guide for Survivors of Suicide – http://www.health.gov.bc.ca/library/publications/year/2007/HopeandHealing.pdf
• The Journey Toward Hope and Healing – https://store.samhsa.gov/product/A-Journey-Toward-Health-and-Hope-Your-Handbook-for-Recovery-After-a-Suicide-Attempt/SMA15-4419
• After An Attempt – https://store.samhsa.gov/product/A-Guide-for-Taking-Care-of-Yourself-After-Your-Treatment-in-the-Emergency-Department/SMA18-4355ENG

The following postvention resources all discuss demoralization:

• The Suicide Prevention Resource Center’s “After a Suicide: A Toolkit for Schools (Second Edition)” is quite comprehensive and includes immediate post-suicide action steps for schools in the “Crisis Response” section (pages 8-12) that might be informative. The toolkit also includes information on memorials and long-term postvention strategies. See pages 16, 25-30, and page 31 for a specific decision-making tool schools can use to direct next steps.
• SAMHSA’s “Preventing Suicide: A Toolkit For High Schools” includes information on memorials and long-term strategies, in addition to specific tools and checklists schools can use to inform next steps (pages 105 and 109 might be most relevant).
• Although this resource was developed for college campuses, the Higher Education Mental Health Alliance’s “Postvention: A Guide For Response To Suicide On College Campuses” also provides some helpful information about postvention that k-12 schools could also consider, including information on memorials/anniversaries (page 23-25).
• The National Association of School Psychologists (NASP) offers several pieces of guidance related to “Memorials” (this is a PDF link, which includes a list of DOs and DONTs) “Addressing Grief,” and “Anniversaries of Traumatic Events: Guidance for Educators.” Please note that some of these NASP resources are not specific to suicide deaths, but taken on the whole, they all provide some pretty detailed guidance for schools.
• The University of Southern California’s National Center for School Crisis and Bereavement offers “Guidelines For Schools Responding To A Death By Suicide.” That guidance directly addresses some staff notification considerations, memorials, and handling of student belongings. You might also pass along the “Guidelines For Responding To The Death Of A Student Or School Staff” (these two resources are very similar to one another, but they do offer some interesting different bits of information).