|
|
|
Please press CTRL+P to print this page
2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Hennepin County Public Health : Suicide Prevention: Suicide Means Restriction Education in Crisis Care Applicant Name: Dr. Kay S. Pitkin Application Title: Suicide Prevention: Suicide Means Restriction Education in Crisis Care Please enter email addresses you would like your confirmation to be sent to. kay.pitkin@co.hennepin.mn.us Practice Title Suicide Means Restriction Education in Crisis Care Submitting LHD/Agency/Organization Hennepin County, Minnesota Head of LHD/Agency/Organization Todd Monson, Director, Hennepin County Human Services and Public Health Street Address 300 S 6th Street #160 Practice Contact Person Kay S Piktin PhD, LP Title Human Services Program Manager kay.pitkin@co.hennepin.mn.us Submitting LHD/Agency/Organization Web Address (if applicable) http://hennepin.us/ Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice Means Restriction Education in Crisis Care at Hennepin County, Minnesota is a parent education and action oriented intervention offered to caregivers at the time of self-injurious behavior, or suicidal ideation, intent, or attempt by youth. Means restriction education activities may occur in the phone or face-to-face crisis encounters. The method includes stating to the parent that the child is at risk, identifying the reason for concern, and informing that availability of lethal means increases risk of injury or death. The clinician and parent discuss possibilities for decreasing access to lethal means in their household and other locations frequented by the youth. Supplies such as medication lock boxes or gun locks are provided free of charge. Parents have the option of disposing of firearms with their local law enforcement agency. A phone call or visit the next day ensures follow through or addresses barriers to securing the environment. In the first eight months of implementation, 312 Hennepin County parents have been trained in means restriction. Families have accepted 36 medication lock boxes and four gun locks. Thirty-eight metro crisis providers have been trained to use MRE with families in crisis. The MRE method was originally developed by Markus Kruesi, MD from the Medical University of South Carolina (i.e., 1999), as youth seen in the Emergency Department for a suicide attempt were sent home medically stabilized but often had continued access to lethal means for suicide, increasing the likelihood of another attempt. NAMI of Minnesota expanded the use of MRE prior to an emergency room visit by training key partners in health, mental health, and law enforcement. In 2010, the Minnesota chapter of the National Alliance for Mental Illness received a suicide prevention grant from the Minnesota Department of Health to replicate Suicide Means Restriction Education with parents beyond the hospital emergency rooms where it originated and named Hennepin County Child Crisis as the lead agency in bringing MRE to mobile crisis teams in the Minneapolis-St. Paul metropolitan area. Hennepin, the most populous county in Minnesota, had 1,152,425 residents in 2010, including 261,345 youth under 18 (22.7% of the population). The primary target population for Means Restriction Education is the caregivers of Hennepin County youth under 18 reported to have suicidal ideation, gestures, or self Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. injurious behavior. Annually, approximately 500 families calling crisis lines in Hennepin County receive MRE service as part of a crisis intervention.
Subsequent training of metropolitan area county crisis teams (Anoka, Carver, Dakota, Ramsey, Scott, and Washington) added some 1,697,142 additional residents, making a combined population of 2,849,567 for the targeted communities.
• List the goals and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
o End of January 2011 – Suicide Means Restriction Training by Marcus Kruesi MD offered to crisis team members in a train the trainer model. Two crisis staff attended a full day training to become trainers in Means Restriction Education. Electronic and print training material was provided.
o February 2011 – Integration of MRE into standard crisis team practice and report structure. Following the training, trainers, supervisors, and management met to review components of the training and modify existing practice and documentation.
o March 2011 – Means Restriction protocol piloted successfully with crisis clients by the two MRE staff.
o April 2011 – Training of and implementation by all Hennepin Child Crisis staff.
o July 2011 – Metro crisis teams trained on MRE and given training material.
o November 2011 – Children’s Mental Health case managers to be trained in MRE
Objectives were met and planning for expansion of the use of MRE in other crisis and human service settings is underway. Costs of implementation as grant funds covered training and materials needed to implement. Staff costs for training time and planning have been the only real costs at this time. Funding for the training and means restriction supplies have been covered by the Department of Health Grant.
NAMI’s ability to secure grant funding to hire the trainer, engage a broad range of community partners, provide electronic and paper training materials, and supply equipment needed to secure means of suicide ensured initial success. Experienced crisis team staff selected as trainers have successfully integrated MRE into practice and made MRE available to the majority of the population in Minnesota.
Describe the public health issue that this practice addresses. (350 word limit)
Suicide is a serious and preventable public health problem which in 2007 was the tenth leading cause of death in the US (National Institute of Mental Health, 2011). For children aged 5-14, suicide is the sixth most common cause of death; for youth/young adults (15-24), the third leading cause of death (Center for Disease Control, 2008). Suicides account for more than half of all gunshot deaths (National Center for Health 2008; CDC, 2005). Minnesota had more suicides per 100,000 15- to 19-year-olds than the national average, with 8.69 per 100,000 in 2009 and 10.87 in 2010, compared to the national average of 6.87 (CDC 2011). Many deaths could have been prevented by reducing the availability of the most lethal means for suicide (firearms, prescription medication, over the counter medication, vehicles). Instances of youth suicide and suicide pacts in Minnesota (i.e., Sun Newspaper, 2010; ABC News, 2011) have fueled interest in creating a safer environment for youth considering or engaged in self-harm. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) The relevance of suicide as a public health issue in Minnesota has become clear from local and national statistics, community concerns, news media reports, and the direct experience of crisis service providers. In September 2011, the Substance Abuse and Mental Health Service Administration announced release of $52.9 million in grant funding to states and tribes for youth suicide prevention. In announcing the grants, Health and Human Services Secretary Kathleen Sebelius stated “suicide is one of our nation’s most devastating public health problems. It is critical that our nation provides effective suicide prevention services wherever needed…” How does the practice address the issue? Hennepin County provides a 24-7, 365 day mobile mental health crisis service for children, allowing them to remain safely in the community, avoid unnecessary hospitalization, and experience health in their homes, schools, and communities. One third of Hennepin crisis calls request help for youth suicide and self-injury. Crisis services in Hennepin County are typically provided to individuals, but in 2010 and 2011 were also offered to schools for suspected suicide pacts and suicide contagion events.
During a crisis, mental health staff arrive on site to stabilize and rapidly connect youth with psychiatry and other services to avoid harm or more restrictive levels of care. Crisis can be a time which is ripe for intervention and education to increase caregivers’ awareness of the reality of a suicide attempt and offer concrete steps to prevent future attempts. Studies have indicated that injury prevention education for parents plus action to remove the means for suicide are significantly more successful in preventing a subsequent attempt than either practice alone or neither practice (i.e., McManus et al., 1995; Kruesi et al, 1999). MRE can be delivered in a short time frame, congruent with crisis work and simultaneously treats and prevents self-injurious acts including suicide.
Is the practice new to the field of public health? If so, answer the following questions. No What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. How does this practice differ from other approaches used to address the public health issue? Is the practice a creative use of an existing tool or practice? If so, answer the following questions. Yes What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
The Means Restriction Education protocol had previously been used by medical residents in hospital Emergency Departments after a suicide attempt had occurred. Hennepin County’s implementation applied the practice to youth in early stages of suicidal ideation and non-lethal self injury in addition to youth who had attempted. The protocol is delivered by mental health professionals and practitioners in a mobile 24-7 crisis program as part of a service package at no charge to families which includes phone support, stabilization services, and rapid access to psychiatry and other mental health services. What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. NAMI, recipient of the suicide prevention grant, confirmed with the author of the program that MRE had not been used by a mental health crisis program. How does this practice differ from other approaches used to address the public health issue? In the past, the practice has typically taken the form of a safety assessment at an emergency room or therapist’s office, occurred after a suicide attempt, required the family to come to services, did not typically involve concrete solutions, and did not consistently provide for follow up.
Implementation of MRE on the Hennepin crisis team can occur either in the immediate aftermath of a suicide attempt or following the identification of suicidal thought, plans, or self-injury, allowing an opportunity to prevent more serious attempts. Services are free, flexible, accessible, and tailored to the families’ specific circumstances and needs. MRE is delivered on the phone or at a site chosen by the family, is available at all times, and is provided by highly trained, Masters level mental health professionals and practitioners. A parent training model is used to engage and motivate caregivers to secure the home environment or other locations frequented by youth, using locks, lock boxes, or firearms disposal. Expedited access to psychiatry, mental health or other services is available. Effects are immediate and tangible, and may restore a sense of control for parents experiencing a wide range of emotions following a child’s self-harm episode. The intervention includes a next day follow up call to confirm that means for suicide have been removed or to eliminate barriers to their removal. Families may initiate a call for additional support to the team at any time.
This practice is not similar to others in the Model Practices Database. Who were the primary stakeholders in the practice? The Minnesota Department of Health and its Suicide Coordinator Phyllis Brashler awarded a suicide prevention grant to NAMI. NAMI (Sue Abderholden, Suzette Schiele, Donna Fox) identified potential partners in mental health and law enforcement agencies, convened and funded the Suicide Means Restriction “train the trainer” session with Marcus Kruesi, MD, distributed training material and equipment, and monitored progress. Smith and Wesson and other firearms manufacturers provided free or reduced cost locks. Fairview Hospitals and Clinics, Crisis Intervention Team Officers, Omegon Chemical Health Residential Treatment Program, Storefront (an outpatient behavioral health provider), and Crisis Intervention Team officers participated in train the trainer sessions and disseminated Means Restriction practice to their agencies and clients. Families and youth were also stakeholders who were able to shape MRE practice to their circumstances and needs. What is the LHD's role in this practice? Hennepin County participated in a “train the trainer” session, tailored MRE to mobile crisis service, trained metropolitan counties’ crisis teams, and participated in an advisory committee to define the population and design a feasible implementation plan across all participating agencies. Crisis staff participated as trainers, created electronic versions of their training presentation to ensure fidelity of the model in the event of staff turnover on metro crisis teams, provided supplies, and implemented as standard practice the MRE with parents of youth referred for crisis services to prevent or decrease the severity of suicide attempts. Means Restriction practice had the secondary effect of protecting families and communities by securing or removing firearms which could be used in homicides or other harmful acts. What is the role of stakeholders/partners in the planning and implementation of the practice? The Suicide Means Restriction Advisory Committee reviewed the protocol, discussed ways of identifying and engaging partners, and provided staff for the “train the trainer” session. After representatives from the agencies were trained, each partner agency defined the scope and appropriate use of the means restriction protocol in their setting and provided evaluation data to NAMI as the grantee. Planning and implementation within the Hennepin crisis team including designing ways for MRE to be seamlessly integrated into current response to self-injury calls and developing report templates to document progress in implementing MRE. What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. Hennepin has provided training and progress reports to other stakeholders. Insurance carriers and other mental health providers have been informed of the practice and its availability in the community. NAMI has included information about means restriction in informational material intended for youth, families, professionals, and legislators.
Describe lessons learned and barriers to developing collaborations Collaboration in this project has progressed smoothly, with representatives on the advisory committee assuming responsibility for implementing the protocol in each of their systems. NAMI’s stature as a state chapter of a prominent national advocacy group and a convener of diverse partners encouraged participation and enthusiasm in the collaboration. Law enforcement agencies were more difficult to engage as partners as they are numerous and varied in their procedures. More effective engagement of law enforcement could have increased the rate of gun disposal, which is more certain than gun locks in preventing self-harm. Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
1. Means Restriction Education will become a standard practice in Hennepin County children’s crisis work.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
Performance measures – Number of parents trained in MRE
--Staff use of report templates to document MRE work
--Number of means restriction supplies distributed to families
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
Client participation and use of supplies in MRE was included as part of clinical reports and tabulated from that source by administrative staff.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
Staff recording of information in reports and the numbers of families receiving training and supplies suggests that MRE practice is being used consistently in crisis services.
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
NAMI received evaluation results at their request. It was discovered that the practice could be spread very quickly and that related agencies were highly motivated to learn and adopt the strategy.
Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. 2. Metro counties will be trained on use of MRE on their crisis teams.
Performance measures used to evaluate the practice:
--Number of attendees at MRE training
--Number of programs receiving video of training
• Data:
The number of attendees at MRE training was tracked by the crisis team trainers.
• Evaluation results:
Metro counties received information needed to implement MRE in their crisis teams.
Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 3: 3. Families will develop skill in creating a safe home environment for self-injurious youth.
Performance measures used to evaluate the practice:
--Number of parents receiving MRE
--Number of parents accepting supplies to secure lethal means
• Data:
Client participation and use of supplies in MRE was included as part of their clinical reports and tabulated from that source. Clinicians entered the data and administrative staff compiled it.
• Evaluation results:
Data collection is in the early stages, but it is clear that a number of families have been receptive to MRE and have changed home environments as a result.
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? Goal 1: Means Restriction Education will become a standard practice in crisis work.
Objective 1: Learn MRE method
Task 1: Staff - attend MRE training
2: Supervisors, manger - read training material, review with staff trainers to develop consistent method
Objective 2: Integrate MRE method into current clinical practice on crisis team
Task 1: Leadership - review services, reports, and templates used by staff
2: Leadership – define target population for use of MRE
3: Add additional fields related to MRE to all clinical report templates
Objective 3: Train all staff on MRE
Task 1: Discuss MRE progress in team meetings
2: Arrange training at convenient time/location
3: Videotape training, follow up with absentees
Objective 4: Ensure fidelity of practice over time and staff change
Task 1: Make written material easily available to team
2: Train new employees -video, written material, and supervision
3: Reinforce use of MRE in supervision and case consultation
4: Track and give feedback on use of MRE
5: Review training material annually
6: Monitor literature for updates or changes in MRE protocol
Goal 2: Metro counties will be trained on use of MRE on their crisis teams.
Objective 1: Metro county crisis teams will be aware of MRE and motivated to attend training
Task 1: Provide regular communication prior to training
2: Request assistance from grantee and lead agencies in communicating value of MRE
3: Arrange training at a convenient time/location
4: Publicize, repeat announcement of training in written and verbal form
5: Provide training and refreshments
6: Videotape training, follow up with absentees
Goal 3: Families will develop skill in creating a safe home environment for self-injurious youth Objective 1: MRE services will be high quality, accessible, free of charge
Task 1: MRE will be coupled with 24-7 phone and mobile crisis services to promote access and utilization
2: Supplies to increase home safety by reducing access to lethal means will be provided free of charge
3: Provide phone or face to face follow up to all MRE recipients
What was the timeframe for carrying out these tasks? All objectives were scheduled to be completed within 2011. The tasks were approached in a step-wise manner, beginning with training for designated “trainer” staff, planning and infrastructure building to implement on the Hennepin crisis team, testing the practice with families by the trainers, full implementation of the practice with all staff on the Hennepin team, training of the metro counties, and provision of electronic versions of the training and print material to reinforce learning and support the fidelity of the model over time.
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. The Suicide Means Restriction protocol used by the Hennepin County Child Crisis team is sustainable as it has become standard practice with families of youth with suicidal ideation intent, or self-injurious behavior. Means Restriction Education has been well accepted by families and clinicians alike. The practice is included in clinical report templates and routinely applied in clinical practice. Families have expressed appreciation of having clear instructions, rationale, and supplies to create a safer home environment. Expansion of the project to include adult crisis providers and child protection workers in several counties is planned for 2012 and could increase commitment and a wider range of long term resource options. Describe plans to sustain the practice over time and leverage resources. Staff training and inclusion of means restriction activities on crisis report templates ensures that the practice will be sustained. New staff are trained by the original trainers or may review electronic versions of the training and print material. Use of the practice is discussed in case review and supervision. The Department of Health grant which funded the initial training for agencies and supplies for families was recently extended through June 2013, ensuring that gun locks and medication boxes will continue to be available to families at no cost. In the event that the Department of Health Grant is discontinued, other grant opportunities may be pursued or the minimal costs absorbed by existing budgets. Practice Category Choice 1: Practice Category Choice 1, Part 2: Mental Health Practice Category Choice 2: Practice Category Choice 2, Part 2: Injury Prevention (Motor Vehicle Injuries) Practice Category Choice 3: Practice Category Choice 3, Part 2 Primary Care Check all that apply. Colleague in my health department |
|
|