By: Tiffany Thompson, MSW, CSW
tthompson101974@gmail.com
Bio: Tiffany Thompson earned an MSW from Spalding University, Louisville, Kentucky. She is a published author who is passionate about foster care, women’s rights, education, and social justice. Fond of volunteering, she is an educational support tutor for children and youth.
Social workers and other human service professionals recognize the insurmountable challenge of preventing suicides. In 2014, the United States had the most elevated percentage of suicides documented over a thirty-year period (13.8 for every 100,000 people). According to the American Association of Suicidology , 44,193 American lives were lost to suicide in 2015. On September 20, 2016, KVC.org reported that suicide is the 11th primary explanation of mortality in the state of Kentucky. They further disclose that during each 12-hour period, one life succumbs to suicide. Whether considering national or local suicide statistics, one life lost is one too many. For this reason, I attended the fifth annual VA/Community Summit on Suicide Prevention 2017.
The session convened on Friday, August 25th at Hotel Louisville in Louisville, Kentucky. The conference provided two continuing education credits along with a wealth of information about local and national programs to eradicate suicide. The two featured presentations were the “Operation Engage America” initiative by Dr. Howard and Jean Somers and “Implementing Safer Suicide Care with a Focus on Substance Abuse and Chronic Pain” by Beck Stoll, LCSW. The Somers, motivated by the loss of their son to suicide, gave the initial presentation. The second detailed efforts by Becky Stoll and her Centerstone team to improve data-driven programming by pursuing grants to enhance suicide after care with clients in Tennessee.
Operation Engage America was founded by Dr. Howard and Jean Somers after the suicide death of their son, Daniel Somers on June 10, 2013. Jeff and Lisa Naslund, impacted by the loss of their son to suicide, co-founded the organization with the Somers. According to the Somers, Daniel was a CA Army National Guardsman Sergeant (SGT) who endured Gulf War Syndrome, Post Traumatic Stress Disorder, and Traumatic Brain Injury . The Somers mentioned that their son Daniel also experienced trauma due to “moral injury” . According to the U.S. Department of Veterans Affairs, moral injury is a behavior or action, which conflicts with ethical and moral beliefs based on spiritual or religious values, or culture-based, organizational guidelines about equity, humanity, etc. The Somers believe that the lack of treatment and support for these issues contributed to their son’s suicide. The Somers took turns reading an excerpt from their son Daniel’s suicide note. The following is a brief quote from the note in an article titled “Military Suicides Higher than Last Year” by Hannah Mullins: “I’m left in a world with basically nothing. Too trapped in a war to be at peace. Too damaged to be at war.” Furthermore, “Not only am I better off dead, but the world is better off without me in it.”
The philosophical yet macabre words from the letter depicted the torment and hopelessness Daniel felt. The Somers’ goal is to target the various impediments to mental healthcare that their son encountered. Secondly, the Somers wish to prevent future distress while seeking services for veterans and their families. Thirdly, their quest is to involve larger society with veterans and veterans’ issues. Moreover, to connect Veterans with community resources around the nation. To meet this need, the Somers hold awareness campaigns about Veteran transition to civilian life, and access to medical and mental health services. The Somers’ emotional presentation prompted three other veterans to share their personal testimonies about surviving suicide. The Veterans and service providers in attendance greatly appreciated this information.
The second segment, “Implementing Safer Suicide Care with a Focus on Substance Abuse and Chronic Pain” by Beck Stoll, LCSW covered 4 areas: Blue Cross Blue Shield of Tennessee Enhanced Follow Up Project; Use of Technology in Engagement of those at Risk; adopting the Zero Suicide Framework; and Community Collaboration. As the Vice President of Crisis and Disaster Management for Centerstone of Tennessee, Stoll decided to use evidence-based practices to enhance client services. Due to the exhaustive scope of the presentations, I will emphasize important highlights from each one.
The “Blue Cross Blue Shield of Tennessee Enhanced Follow Up Project” was implemented from February 23, 2014 to February 23, 2015 (Stoll, 2017). Ms. Stoll described the goals as after-care assistance augmentation, expanded recommendation connection and participation in assistance, stimulate wellbeing, cut preventable medical visits, and eliminate the number of suicides. To achieve these aims, the initiative included:
• Elevated level of suicidality assessment by community agencies (Centerstone Military Services, Crisis Call Center Staff, 3 Mobile Crisis Teams, and 3 Middle Tennessee Emergency Departments);
• Use of evidence-based evaluation measures by Centerstone Military Services, Crisis Call Center Staff, and Mobile Crisis Staff
• Informed consent from clients
Ms. Stoll shared the resulting data from the project: Total program participants was 199; 50% of clients were connected to assistance, 25% of clients received assistance at the 30 day mark; Rate of emergency room visits was 8% to date; Rate of suicidality for clients was 0. These remarkable outcomes initiated the acquisition of two federal grants to sustain future programming and add children and adults as clients (Stoll, 2017). Ms. Stoll’s report showed the power of evidence-based programming and cooperation with community partners to reduce suicides among their clients.
The second portion, “Use of Technology in Engagement of Those at Risk” detailed a smartphone application called “Lifetiles” (Stoll, 2017). The goal of “Lifetiles” is to provide a user-friendly application across five resource areas: Help, Check-In, Calendar alerts, Resource access in real time, and Project explanation. Ms. Stoll noted that use of the application provided client data comprised of self-surveys, care team alerts, and connectedness. The roll out of this application led to the creation of an EFU Technology Package. Ms. Stoll explained that employment of the EFU would allow:
• EHR Integration-complete client record
• Connectedness: Contacts, iCloud usage, Mobile Iron [https://www.mobileiron.com/] usage, and Tile usage
• Fitbit usage-arrangement with Fitbit to permit information downloads into the software (Stoll, 2017).
The “Lifetiles” application proved to be a valuable component of the after-care service delivery system.
The third section, “Adopting the Zero Suicide Framework” began in August of 2012 (Stoll, 2017). The mission was to cultivate a clinical route for the elimination of suicides using a continuum of evaluation, screening, assessment, treatment, and observation. Ms. Stoll communicated that a committee was formed which involved: the Center for Clinical Excellence at Centerstone, a Charter, Proposal, Administrative endorsement, Administrative buy in, and a Program trial in Tennessee. Next, nationwide partnerships formed between Texas, New York, Arizona, and the Kentucky Departments of Mental Health. This collaboration inspired the development of a Zero Suicide Toolkit .
The initial outcomes were training, culture shift, communication plan, provider survey, and an organizational readiness survey. The Suicide Pathway elements are Electronic Health Records, Evaluation, Rate of Contact, Observation, Quality Control, and Program efficacy. After program implementation, the future outcomes of this movement are culture evolution, training, action, treatment, inclusion of Primary Care Providers, continued EHR enhancement, and Predictive Modeling. Ms. Stoll pointed out that a qualitative assessment of Veterans in SUD Treatment Clinics indicated that the chief determinants of suicidality were substance use disorders and chronic physical pain. In a 2012 study, Webster, et.al reported that 48%-66% of Veterans that committed suicide had visited a doctor 30 days before death. In 2009, Gilbert, et.al found that 50% of chronic pain, non-cancer patients had suicidal thoughts. This data reflects a strong relationship between chronic pain and the presence of substance use disorders in suicide deaths (Stoll, 2017). This endeavor produced an abundance of useful information for the Centerstone providers and community partners to combat suicides in their local populations.
Lastly, the “Community Collaboration” piece focused on: Target and Tennessee Lives Count (TLC) Connect, a Statewide Method, Enriched After Care Assistance, Collaboration, and Referrals (Stoll, 2017). The Target and Tennessee Lives Count (TLC) Connect encompasses provider training, instructions on Zero Suicide program application, enriched after care services, and the use of technology. Next, the Statewide method engages: School systems, Behavioral Health Agencies, Primary Care Providers, Mobile Crisis Units, and Inpatient Psychiatric Services and Emergency Departments. Then, Enriched After Care assistance combines community partners, a statewide scope, and specific referral criteria (i.e. a suicidal crisis that does not necessitate an advanced level of treatment or a referral due to crisis or crisis while in care). Subsequently, the Enriched After Care assistance factor incorporates up to a year of assessment; telephonic, face-to-face, or texting services; clinician assignment, safety plan, connection to services, and iPhone and Fitbit utilization. Next, Collaboration features the EFU program, monthly statistics acquiescence, monthly partner calls, mental health education information, assistance with Zero Suicide agenda, access to Enriched After Care services, and a cost/benefit evaluation. The final aspect is the referral procedure, which has a consent form, safety plan, and information releases to community partners which can be sent electronically to an automated system or an after care representative (Stoll, 2017). As a social worker and leader, Becky Stoll has done an amazing job implementing a thorough and evidence-based methodology to improving mental health services, addressing suicides in her client population, and securing grants to sustain current and future programs.
Overall, this conference imparted a plethora of information from providers, veterans, and community partners about issues that affect military communities and families. The presentations from Dr. Howard and Jean Somers and Becky Stoll were outstanding. I received two CEUs, breakfast and lunch, and the opportunity to interact with service providers across disciplines. I would recommend this conference to any social worker in the Kentucky area. For more information on the presentations emphasized in this article, go to Operation Engage America – Contact Us or contact Becky Stoll at Centerstone.