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Current Research and Implementation Projects

Suicide Prevention in Schools and Colleges

The Suicide Prevention in Schools and Colleges initiative will implement suicide prevention and early intervention strategies for youth ages 10-25 across Pennsylvania. The grant will provide gatekeeper training, suicide risk management training, standardized screening, and training in empirically supported treatments. The project will raise awareness, increase identification of at risk youth, facilitate referrals to treatment and improve treatment outcomes. The problem addressed by our proposal is that suicide risk is being under identified in Pennsylvania’s schools, community colleges and universities. There is no systematic training for professionals or standardized screening procedures to identify youth at risk. Therefore, too many young people are not identified and too many of those who are high risk are not being adequately screened, and not receiving treatment and support.

There are 500 school districts and 181 community colleges and universities in Pennsylvania. In the general state population, there are 2,570,000 individuals age 10-15 representing a wide range of cultures and demographic diversity. The majority is white, but there are also Black, Hispanic, Asian and American Indian students. We will focus on racial and ethnic, rural and urban cultural differences as well as the needs of the Veteran and the lesbian, gay, bisexual, and transgender populations. Building on the Student Assistance Program in Pennsylvania schools, we will provide gatekeeper training and state of the art screening tools to appropriate school personnel and the behavioral health systems that serve these schools.

Building on the work of past Campus Grants, we will organize a coalition of community college and university representatives to develop model suicide prevention plans and processes for higher education throughout the Commonwealth. Project goals and measurable objectives include: a) increasing the number of persons in schools, colleges, and universities, trained to identify and refer youth at risk for suicide, b) increasing the number of clinical service providers (including those working in schools, mental health, and substance abuse) trained to assess, manage and treat youth at risk for suicide, c) increasing awareness about youth suicide prevention, specifically including the promotion and utilization of the National Suicide Prevention Lifeline, d) comprehensively implementing applicable sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicidal ideation, suicide attempts and suicide deaths in their communities, and e) promoting state systems-level change to advance suicide prevention efforts in our public schools.

With gatekeeper training and awareness campaigns, we plan to reach 186,000 youth over five years. With screening in schools, colleges and primary care practices, we plan to reach approximately 26,000 indicated youth over five years. Thus, our total impact will be felt by nearly 212,000 youth across Pennsylvania.

Screening and Referral of Suicidal Youth in Primary Care

A major challenge in suicide prevention work is locating adolescents before they attempt suicide. Fortunately, over 70 percent of adolescents see a physician at least once a year making primary care a potentially important gatekeeper for adolescent health. We proposed to build a comprehensive identification, screening and triage system within primary care systems to identify adolescents at high risk for suicide. In Year 1, we organized a statewide suicide prevention task force consisting of a wide range of stakeholders from public and private sectors through a participatory action research framework. Bi-monthly meetings were held to identify policy barriers and solutions to better integrating suicide prevention and behavioral health services (mental health and substance abuse treatment systems) into primary care offices. Representatives from 11 diverse counties participated. In Year 1 our goals focused on creating educational resources, technical assistance, policy changes and funding support to help several of these counties implement the new system. Year 2 focused on this implementation.

The proposed program consisted of four components. First, pediatricians, family physicians and nurse practitioners (referred to as medical practitioners) received gatekeeper training in identifying adolescents at risk for suicide. Second, computer-based screening measures were introduced into the medical offices. Third, a system to provide family based, clinical assessment of the adolescent was geographically and administratively integrated into the primary care offices, as needed. Fourth, clinical training for treatment systems (medical and behavioral health) in how to engage and work with suicidal youth and their families was provided. Systemic change at the state and local levels enabled other counties to implement a similar system over the next five years. This project was a state effort (supported by the Departments of Public Welfare, Health and Education) in collaboration with suicide experts at the Children's Hospital of Philadelphia (CHOP), the University of Pennsylvania, Western Psychiatric Institute at the University of Pittsburgh and the Pennsylvania Academy of Pediatrics.

Behavioral Health Screen (BHS) in Emergency Departments

The BHS has been used for many years in several emergency departments. The longest operation is at Children’s Hospital of Philadelphia. Here, BHS is used for all adolescent presenting at the emergency department (ED). CHOP treats 27,000 teens a year and screening about 500 adolescent a month. BHS also operates at the Children’s Crisis Center, the Medicaid Managed Care psychiatric emergency room in the City. This facility treated about 2000 psychiatric pediatric emergency case each year.

Extension of BHS development into the emergency department setting occurred in 2006 with a Health Resources and Services Administration (HRSA) grant (R49CCR 321711-01). After the qualitative studies on acceptability and feasibility of standardized screening in the ED mentioned above, full implementation of the screening began in March 2007 and evaluation of the screen lasted for nine months. All non-critical patients between the ages of 14 and 18 years who presented for something other than a primary psychiatric concern were asked to complete the Behavioral Health Screening-Emergency Department (BHS-ED). In the end, 857 adolescent patients completed the screening tool. Of those screened, 4.3 percent self-reported moderate or severe depressed mood and 3.6 percent reported suicidal ideation in the past week. Results showed that screening increased the identification of youth with behavioral health problems (χ2 = 154.86, p < .001), increased the rate of behavioral health assessment (χ2 = 141.86, p < .001), and increased behavioral health referrals (χ2 = 76.86, p < .001). This screening process was fully incorporated into clinical care for adolescents, and when initiated by the nursing staff achieved a 40 percent penetration rate for eligible patients. Findings from this study can be found at Fein et al, 2010 in our reference list.