Covid 19: KY Emergency Response for Suicide Prevention C2715

A.1 -Population of Focus and Geographic Catchment Area - As spring bloomed in Kentucky (KY) in March and April, residents of the Commonwealth found themselves social distancing in an effort to avoid infection and the consequences of COVID-19. Only essential businesses kept doors open, with restaurants, religious institutions, and retail shuttering most services. The table below depicts the number of confirmed COVID cases, and COVID-related deaths as of May 20, 2020. The map illustrates that 117 of Kentucky’s 120 counties have had at least one positive COVID-19 case, with the majority of those testing positive living in or near urban settings where population density is higher. KY’s COVID-19 rate is 182/100,000. KY’s largest county, Jefferson, has a rate of 257/100,000. Unemployment has surged, with nearly 815,000 claims made between March 15 and May 9, and the state’s rate climbing 38% in March, to 5.8, the highest since the fall of 2014. Crisis calls to the various agencies supporting KY residents have skyrocketed (see table at right). COVID-related calls to the crisis and information center in Jefferson County have increased from only six in February to 930 in April. Reports from the national Crisis Text Line indicate KY residents are more frequently reporting the loss of a loved one – increasing from 9% to 14% of texts received – as the cause of their distress. Calls to the National Suicide Prevention Lifeline have not increased, nor have suicide deaths, however research following previous economic downturns indicate increased are to be expected in months following the pandemic and one study predicted that Kentucky’s “deaths of despair” are expected to increase at a rate of 20.3/100,000 compared to a 2018 baseline (Patterson, Westfall, & Miller, 2020). KY expects to face significant repercussions from the pandemic, many of which will exasperate existing behavioral health issues. In 2018, KY experienced its highest number of suicide deaths ever at 800, the latest data point in a six-year, 14% upward trend (CDC). The state’s suicide rate climbed 10.5 % in that time frame (AAS). Between 2016 and 2018, frequent mental distress increased 21% in KY adults. (America’s Health Rankings). Suicide-related emergency department (ED) visits increased 1.5% between 2016 and 2018. While the rate of self-harm hospitalizations decreased 7.7% during that same time period, data shows that persons 35 and older are more likely to be hospitalized as the result of their self-harm. (KIPRC). Eighty- Kentucky (n=4,467,673)1 Jefferson County (n=766,757)1 17% of state population Jefferson County incidence as % total KY incidence COVID Confirmed Cases (6 p.m., 5/20/20) 8,167 1,968 24.1% COVID Deaths 376 137 36.4% Suicides (2015-2019)3 3836 651 17% 12019 population estimate from https://www.census.gov/quickfacts/KY 2Data reported to the KY Dept for Public Health https://govstatus.egov.com/kycovid19 3Data reported to the KY Dept for Public Health/Kentucky Violent Death Reporting System Statewide Crisis Line % increase in calls during pandemic Disaster Distress Helpline 444% KY Substance Abuse Line 79% KY Abuse Line 24% KY Domestic Violence Line 50% eight percent of all suicide deaths in KY (2006-2018) were among those 25 years of age and older, a group that represents only 67.5% of the state population. The largest number of suicide deaths is among those 45-64 years old. Males represent 49.3% of the population but 80% of suicide deaths. Male suicide rates are not only higher (28.7 vs. 6.6) but climbing faster (5%.vs. 3%) than female suicides. Clients of Kentucky’s Community Mental Health Center (CMHC) system are also more likely to die by suicide than the general population. Between 2009 and 2019, 23% of KY suicide deaths involved CMHC clients within a year of receiving service (KDBHDID, AAS). Substance use and suicide are also significantly correlated in a state ranked 9th in the country for overdose deaths. From 2008–2017, 53.8% of suicide decedents whose autopsy included a toxicology screen were positive for substance use. More than 9% of those who died by suicide in the same time frame were caused by substances, a number that is thought to be significantly low. The geographic catchment area for the Kentucky Emergency Response for Suicide Prevention (KERSP) grant will be Jefferson County, where nearly 24.1% of KY’s COVID-10 cases have been confirmed, but where 17% of the state’s population reside. Jefferson County COVID-10 deaths come in at 36.4% of the state’s total deaths (376). Within that community, a disparate number of African Americans are affected by COVID-19 and suicide. Statewide, African Americans represent 8.4% of the population but 22.0% of the population in Jefferson County. African Americans represent 10.59% of statewide cases, but 17.79% of cases in Jefferson County. Due to a significant percentage of unknown racial consignment data for Jefferson County cases (38.5% unknown), it can be postulated that the Jefferson County cases are even higher for African Americans. KY’s African American COVID-19 death rate is 14.75%, but it is 30.7% for Jefferson County. Suicide rates per 100,000 for African Americans in KY is higher at 8.1 than the national average of 6.6 (CDC). Jefferson County suicide deaths for 2015-2019 represented 17% of KY’s total (3,836) suicide deaths. KY’s populations of focus for the direct services portion of the grant include those who access emergency department (ED) services for those experiencing (1) suicidal behaviors; (2) substance use disorders; (3) domestic violence and sexual assault, and (4) homelessness within the geographic catchment area. Efforts will focus on identifying and assessing those at greatest risk of dying by suicide; connecting them via care transition protocols to appropriate resources, including inpatient facilities; and providing peer support to aid in recovery. SECTION B - Proposed Implementation Approach B.1 Implementation of Required Activities - The COVID-19 national pandemic has disrupted the clinical pathways for individuals needing access to behavioral health care, resulting in severed connections with natural supports such as faith communities, and access to known providers at Community Mental Health Centers (CMHC), hospitals and other community resources. All of this comes at the same time as increases in the demand for mental health services as a result of increased anxiety and depression resulting from isolation and disconnection. To support those at risk and reduce suicide attempts and deaths, the KERSP grant project will utilize the current statewide infrastructure capacity for suicide intervention clinical initiatives in KY, expand capacity of those services to address suicide, add recovery supports, and focus efforts on the COVID-related highest-risk populations of those who attempt suicide, use substances, are victims of domestic violence and are homeless in a single geographic location. The Jefferson County geographic catchment area was selected because of its high number of suicide deaths as well as its high number COVID cases, as well as the readiness of providers in that community to engage more intentionally with those at highest risk of dying by suicide. Additionally, the project will include development of a comprehensive community suicide prevention plan that supports residents of the locale by increasing awareness of risk and warning signs among community partners, provides training to clinicians, and supports increase access to services. KDBHDID currently contracts with Seven Counties (SC) the CMHC in this community for mental health services. SC has existing partnerships with the other entities in the project allowing the opportunity to create more intentional collaboration around addressing increased risk arising from COVID-19. Building strong collaboration for sustainability of efforts is a vital component of the project. If they don’t currently have one, each participating agency will establish a Zero Suicide team. Using the organizational self-study, teams will embed policies/procedures, workforce development practices, and care processes that reduce suicide risk within the agency’s infrastructure. Attempt and loss survivors will be participatory members of the team with decision-making abilities. Grant sites will screen every client at every visit utilizing an evidence-based screening instrument. Screening processes will be embedded into EHR systems with identified processes for alerting staff that their client is at increased risk for suicide. Clients identified as at increased risk for suicide will be assessed and followed closely throughout their care. They will be assessed at every visit in regard to their suicidal status regardless of the reason for the follow up appointment. Peer support specialists who are attempt survivors will transition clients from inpatient facilities to outpatients and community services as needed. Plans to address specific required activities include: Develop and implement a plan for rapid follow-up: University of Louisville Hospital’s Emergency Psychiatric Service (ULH, EPS) will create linkages through care coordination and peer support specialists to ensure transitions of at-risk clients seen in their ED as well as their inpatient facility. EPS, along with their partners to whom patients will transition, will implement strategies that increase the likelihood that a client will connect with the appropriate next stage of care. Care for patients identified at increased risk for suicide will be provided in the least restrictive setting possible based on their risk level. Care options include brief interventions; follow-up from crisis; respite and residential care; and partial or full hospitalization. At-risk clients will receive care focused on their suicidality independent of any additional diagnosis. ZS implementation teams will embed within their agencies protocols to ensure client safety, especially among those who have attempted suicide, experienced a suicidal crisis, and/or have a serious mental illness. This protocol must include outreach telephone contact within 24 to 48 hours after discharge and a follow up appointment within one week of discharge. Strategies to increase follow-up care include: 1) partner MOAs which support for warm hand-offs and data sharing; 2) follow-up appointments within one week; 3) peer support for navigating the care process and making transitions between providers; 4) communication of client risk between providers; 5) crisis follow-up plan that includes assessment of risk at each contact, review of safety plan, problem solving barriers to care; 6) patient education on importance of care transition process and why it’s an important component of care; 7) include a peer support specialist on the care team to support navigating the care process. The agency crisis center will develop an implementation plan or evaluate their existing service delivery plan to ensure that maximum client support is provided. Partner agencies will develop a Suicide Care Management Plan for every individual identified as at-risk of suicide. This plan will continuously monitor the individual’s progress through their EHR and provide a living document on the client’s safety plan including strategies to decrease access to lethal means. A regional implementation team comprised of representatives of each partner will meet on a monthly basis to ensure continued collaboration between entities. Establish follow-up and care transition protocols: Research shows, and Kentucky data confirms, that the risk of a suicide death is highest in the first month after treatment for suicidal behavioral (Luxton, June, and Comtois, 2013). Additionally, research also shows that fewer than 50% of clients attend a follow-up appointment (van Heeringen, et al., 1995). For those reasons, developing intentional follow up and care transition protocols is a vital component of the KERSP. Efforts will focus on ensuring that those at risk for suicide are identified, treated and provided opportunities for recovery with sufficient safety nets in place to connect the stages of care. Lived experience peer support specialists will be added to the care team and will be available to clients at increased risk of suicide in the ED. They will walk through the transition process with clients, following protocols and procedures which ensure they transition to the next level of care and access appropriate community resources to support recovery, as identified by clinicians. Services and supports may include acute/brief intervention with linkages to community resources, psychoeducation, outpatient clinical services, integrated healthcare, medication evaluation, case management, targeted case management, peer support services, assertive community treatment, supportive housing, crisis stabilization and/or hospitalization. Implementation of these procedures and protocols and service delivery guidelines will be institutionalized within the organizational structure to increase sustainability. Family members and friends will be included in the care transition process as appropriate to increase follow-up participation by client. With the input of attempt and loss survivors, organizations will learn how their protocols and procedures are perceived by and impact those surviving a suicide attempt or those left behind by the death of a loved one, increasing the compassion and understanding offered in the care setting. Working together, each participating agency will develop a Suicide Care Management Plan for every individual identified as at-risk of suicide. This plan will continuously monitor the individual’s progress through their EHR and include strategies to decrease access to lethal means and identify natural supports. Access for the National Suicide Prevention Lifeline will be included in all care plans. Seven Counties, a partner agency, is currently NSPL accredited and responds to calls from this geographic region. Provide suicide prevention training: All employees of participating agencies will participate in EB trainings relevant to their position, to include the identification, assessment, management and treatment, and evaluation of at-risk individuals. Identification of protective factors will be highlighted. All clinical staff will be trained to provide best practice and suicide-specific treatment and evaluate individual outcomes. Trainings will include lethal means assessment treatment of the suicide risk specifically, and follow-up to ensure continuity of care. Staff receiving EB trainings will be provided TA and coaching to ensure implementation occurs with fidelity. Training selection will be guided by analysis of a yearly Behavioral Health Workforce survey. Pre and post training evaluation will be conducted to measure change in provider’s competence and confidence in the training areas. The BHW will be repeated to identify community-level change among this population. Community members will receive the opportunity to participate in gatekeeper trainings (QPR, ASIST) in order to increase awareness of warning signs and importance of connecting those at risk of suicide with appropriate care. These trainings will be delivered as part of a comprehensive suicide prevention plan for the target geographic location. Pre and post training evaluation will also be conducted. Work across state and/or community departments and systems: The implementation will include one CMHC, a community Level 1 trauma center with emergency psychiatric services, an agency tasked with supporting victims of domestic violence, the local health department which oversees community suicide prevention efforts, and a community coalition focused on increasing wellness. Representatives from these partners will join the Kentucky Interagency Council on Suicide (KICS), a state-level stakeholder group charged with coordinating suicide prevention efforts among various state agencies, including representatives from: behavioral health. public health, Medicaid, justice, corrections, vocational rehabilitation, labor, Veterans Affairs, CBOCs, National Guard, first responders, state- and regional-level suicide prevention coalitions, NAMI, suicide attempt survivors, suicide loss survivors and other appropriate agencies based on data-identified state-level needs. Representatives from KY’s Medicaid office will serve on the KICS and will advise on processes needed to increase reimbursement for care transition services, increasing sustainability of efforts. CMHCs currently bill Medicaid for services, and support will be provided to increase reimbursement. This team will oversee the execution of data sharing agreements among partner agencies. A community-level council mirroring the state council will be created to build collaboration among key stakeholders and will support development of a community level suicide prevention needs assessment and strategic plan to guide a comprehensive suicide prevention response to increased issues arising from COVID-19. Screen all individuals: All participating organizations will screen every client at every visit and in every service provided utilizing a validated screening instrument to assess suicide risk. Screening processes will be embedded into the EHR systems with identified processes for alerting staff that their client is at increased risk for suicide. At-risk clients will be assessed at each visit and care transition protocols will be implemented. Designated providers will use funds to deliver screening and assessment via HIPAA-compliant virtual and telephonic platforms as needed. The screening and assessment components of care will be provided in confidential settings. Through these processes, providers will develop treatment approaches to ensure access to and engagement in appropriate services. Providers will utilize screening and assessment tools (i.e. SBIRT) in order to identify possible behavioral health disorders, etiology of behavioral health symptoms and to guide decision-making for referrals for care. Providers for all identified populations, including healthcare practitioners, will utilize evidence-based screening and assessment tools to delineate proper diagnoses, linkages to appropriate providers and follow up care. Linkages to more specialized care will meet the clinical needs for the individual and the community as a whole. Provide community recovery supports: Partner agencies will provide or access through community collaborations recovery support services as needed by the client. These will include, but are not limited to, linkages to nutrition/food services, individual support services (individual contact check-in by peer support personnel, faith-based groups, etc.), childcare, vocational, educational, linkages to housing services, and transportation services which will improve access to, and retention in care. Partners will provide linkages to necessary recovery supports as part of the screening, assessment and service delivery processes. Linkages will occur with natural supports and community resources to meet the holistic needs of individuals and to address social determinants of health. Through these services, needs assessments will inform appropriate referrals to recovery supports. Prioritization of need will be based on service availability in the midst of the COVID-19 national crisis. Impacted family members will also be connected to appropriate services as needed in client needs assessment. Provide services via telehealth as needed: While social distancing mandates are preventing face-to-face contact between practitioners and clients, service provision is expanding into telephonic and virtual service delivery. Current partners have already started providing services via telehealth and will continue to do so to meet the needs of clients. Funding will support expansion of telehealth services to include telephone and audio-visual service provision. Training opportunities related to delivering care via a virtual method will be offered to clinicians and community recovery support partners in the target region. Kentucky anticipates an overall influx of calls to community providers by individuals with risk for suicide and social distancing requirements necessitates delivery of services via telehealth an important component in meeting needs during the ongoing health crisis. Provide enhanced services for victims of domestic violence: KERSP will include a partnership with the Center for Women and Families. The Center provides trauma-informed advocacy support for individuals, families and communities impacted by intimate partner violence and assault. The Center will embed the Zero Suicide Framework within their current operating procedures to ensure that victims of domestic violence are screened for suicide risk at intake and transitioned to appropriate behavioral health care depending on the outcomes. This will occur through their crisis response service, 24-hour on-site advocacy at area hospitals, including grant partner UofL, emergency shelter and transitional housing support. The Center will also provide enhanced emergency shelter options for those who are victims of domestic violence and are not able to return home. B.2- Timeline: Direct service delivery will begin no later than four months after grant award. Timeline for Key Activities Key: PI (Principal Investigators)/PD (Project Director)/SSPC (State Suicide Prevention Coordinator)/SME (Subject Matter Experts)/ ED(Evaluator)/PA (Partner Agency)/ (Regional Interagency Council on Suicide) /KICS (Kentucky Interagency Council on Suicide) Key Activities (Responsible Staff) 16-Month Project Period 1-2 mo. 3-4 mo. 5-6 mo. 7-8 mo. 9-10 mo. 11-12 mo. 13-14 mo. 15-16 mo. Orient Project Director (PI) X Identify/employ/orient Evaluation Director (PI, state implementation team) X Establish/orient/operate State Implementation Team (PI, PD) X X X X X X X X Establish/orient/operate KICS, RICS (PD, SME, ED, PA) X X X X X X X X Develop/update contracts/MOAs with partner agencies (PD) X X Develop/implement rapid follow up protocols (PI, PD, PA, SSPC) X X X X X X X X Develop/implement standardized care transition protocols (PI, PD, PA, SSPC) X X X X X X X X Conduct statewide Behavioral Health Workforce Survey (PD) X X Identify/review existing training network capacity for evidence-based programs (PD, PA, SSPC) X X Deliver training of EBPs (PD, SSPC, PA) X X X X X X X Collect, review, and report performance data (ED) X X X X X X X X Collect, review, report national evaluation data (ED) X X X X X X X X Establish/Implement/ Evaluate organizational ZS team (PA) X X X X X X X X Complete a Zero Suicide organizational assessment (PA) X X Develop/implement/ evaluate ZSF with fidelity (partner agencies) X X X X X X X X Develop/implement/ evaluate plan to prevent suicide among those receiving treatment for suicidal behavior, substance use, domestic violence or homelessness (PD, SSPC, PA) X X X X X X X X Develop/implement/ evaluate plan that ensures feedback and leadership of suicide loss and attempt survivors in all required activities (PD, SSPC, PA) X X X X X X X X Promote the NSPL within the catchment area (PA) X X X X X X X X Evaluate crisis line response (PD/ SSPC, PA) X X SECTION C - Proposed Evidence-Based Service Practice C.1 – Evidence-Based Practices to be Used-EBPPPs are the foundation of the KERSP. EBPPPs were selected to enhance and leverage KY’s system of suicide safe care while meeting those experiencing consequences of COVID-19. EBPPPs were selected from the systemic, prevention, and treatment categories for inclusion in the plan and focus on those who are over the age of 25, experience suicidal behaviors, substance use, or domestic violence and are or have been homeless. The selected EBPPPs are based on research that shows they are appropriate for the populations identified, complement each other, address consequences arising from the pandemic, and fit within KY’s comprehensive state suicide prevention plan goals. EBP/Best Practices Population of Focus Why selected Zero Suicide Framework Adult, CMHC and inpatient facility clients, SUD, domestic violence, homeless Systemic framework of suicide prevention, intervention, treatment and recovery in behavioral health systems that institutionalizes suicide prevention strategies and improves care for those at risk of suicide National Suicide Prevention Lifeline Universal, all ages 24-hour toll-free phone line for people in suicidal crisis or emotional distress; supports connection to services from community to care and from care to community Crisis Text Line Universal, all ages 24-hour free text, chat line for people in suicidal crisis or emotional distress; supports connection to services from community to care and from care to community The Continuity of Care for Suicide Prevention: The Role of Emergency Departments Universal; Primary Health Care Systems, EDs Systemic framework guiding ED policy/protocol development to care; includes screening, discussion of the patient’s condition and treatment options, discharge planning, referral to follow-up services, follow up after discharge, provider experience and training. Tip 50: Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment Universal; Adult; Substance Abuse Treatment Providers Guidance document for clinical providers working with adults with substance use disorders and suicidal risk Question, Persuade, and Refer Gatekeeper Training (QPR) Universal, Adult Increases awareness of warning signs and risk factors of suicide; encourages help seeking Applied Suicide Intervention Skills Training (ASIST) Universal, Adult; Peer Support Specialists; Targeted Case Managers Suicide first aid training appropriate for community, non-clinical health care staff as well as clinical providers. Builds skills to address suicidality Assessing and Managing Suicide Risk: Core Competencies for Health and Behavioral Health Professionals (AMSR) Universal, Adult; Behavioral Health Providers Clinical level training that guides providers in the assessment and management of suicidal risk in patients Assessing and Managing Suicide Risk Training for Substance Use Disorder Treatment Professionals Universal, Adult; Behavioral Health Providers Clinical level training that guides providers in the assessment and management of suicidal risk in patients experiencing substance use disorder Counseling on Access to Lethal Means (CALM) Universal, Adult; Behavioral Health Providers Training provided to clinicians to reduce access to means. Builds skills of staff to address access, increase client safety Collaborative Assessment and Management of Suicidality (CAMS) Universal, Adult; Behavioral Health Providers Clinical-level training that provides therapeutic framework to assess suicide risk; engages patient in their own treatment Safety Planning Intervention for Suicide Prevention Universal, Adult; Behavioral Health Providers Collaborative safety planning training for clinical and non-clinical staff as appropriate; increases safety of clients between visits. 0BNational Action Alliance Suicide Prevention and the Clinical Workforce: Guidelines for Training Universal, Adult; Behavioral Health Providers Training guidelines designed to advance the competency of the broad clinical workforce—including nurses, social workers, physicians, and mental health professionals—in serving individuals at risk of suicide Participating partner agencies will be required train clinical staff in AMSR or CAMS within six months of hire date and non. Non-clinical staff will be trained in an appropriate gatekeeper training. Non-clinical trainings include: 1) a gatekeeper training (QPR or other evidence-based program); 2) ASIST or another evidence-based skills-based training for all case managers and peer support specialists. CMHCs will also be encouraged to provide access to CAMS for those clinicians working directly with at-risk clients. The Behavioral Health Workforce survey, which assesses attitudes, behaviors and competencies related to suicide and suicide care, will be conducted as a baseline in the fall of 2020 and annually throughout the project. Every patient identified as at risk for suicide will participate in a safety planning process and will receive counseling and guidance on reducing access to lethal means. CALM will be made available to all clinical care providers. UofL Hospital will utilize The Continuity of Care for Suicide Prevention: The Role of Emergency Departments to guide implementation of the ZSF within its facility. Monitoring the organization’s fidelity of implementation of the Zero Suicide model be an integral requirement of participation. The evaluation team will coordinate the continuous quality improvement (CQI) process under the purview of the KICS, and track implementation measures and objectives. SECTION D - Staff and Organizational Experience D.1- Experience with Similar Project and Partners - KDBHDID: the applicant is the single state agency for administering programs for suicide prevention, and contracts with 14 regional CMHCs to deliver behavioral health services across the lifespan. It serves as the lead agency addressing the behavioral health component of Kentucky’s COVID response effort. KDBHDID has a long record of administering state-level SAMHSA grants, including four previous suicide prevention grants. KDBHDID will house the Principal Investigator, the Project Director, and multiple subject matter experts. KDBHDID staff will focus on state-level interagency policy and procedure development and support. Seven Counties, Inc (SC): SC is one of 14 CMHCs in the state serving respective geographic regions. Seven Counties has a 50-year history of serving the residents of Jefferson County and has experience implementing SAMHSA grants. SC will support the peer support position to engage clients in recovery efforts. SC also operates a Street Outreach Team and will expand its capacity to identify and connect those who are homeless with appropriate suicide care. University of Louisville Hospital (ULH): ULH is an academic teaching and research hospital in the Louisville Metro area. UHL operates an onsite Emergency Psychiatric Service in conjunction with its ED allowing rapid care transition for suicide attempt patients or those who have significant psychological distress. ULH currently partners with KDBHDID for the placement of a behavioral health consult team designed to connect patients arriving in the ED with appropriate behavioral health supports. The team currently focuses on substance use disorders and accesses supports for suicide ideation when needed, but through this project, will add peer support specialists specifically focused on identifying and addressing suicidal behavior and supporting the transition from the ED or inpatient unit to appropriate community outpatient care and resources. Center for Women & Families (CWF): CWF provides trauma-informed advocacy and support for individuals, families and communities affected by intimate partner violence and sexual assault. Their services include 24/7 crisis response; emergency shelter; 24-hour advocacy at area hospitals, including ULH, for victims of sexual assault; advocacy and support for physical and behavioral health consequences of victimization; transitional housing; and children’s services. CWF will provide enhanced services for clients experiencing domestic violence as a result of COVID-19, including specific assessment for suicide and appropriate care transitions as indicated as well as provide emergency shelter for victims of domestic violence who are not able to return home. In addition, they will integrate the Zero Suicide Framework into their system of care to ensure all clients are assessed and treated for suicidal ideation. Louisville Metro Public Health and Wellness is an independent, academic health department that supports overall health and wellness of residents of Jefferson County, and currently identifies addressing behavioral health as a key priority for its work. This project will support a dedicated prevention provider to coordinate a comprehensive suicide prevention plan for the community and support with implementation. Louisville Health Advisory Board (LHAB) is a collaborative partnership of key stakeholders in improving health of the community’s residents. Its members include representatives from the business, education, government, civic and non-profit arenas. LHAB will coordinate community and clinical trainings among its key stakeholders ensuring that a significant percentage of the community’s population is aware of suicide risks and warning signs, can connect at-risk individuals to appropriate care, and care providers have been trained to deliver suicide-safe services, increasing the safety of the community. KY Injury Prevention Research Center (KIPRIC), an agency with significant experience evaluating SAMHSA prevention projects, will provide evaluation services and coordinate data collection and performance measures as required in the RFP. The agency also has extensive experience in evaluating behavioral health efforts and reporting on federal evaluation requirements. D.2 – Key Personnel and Other Significant (Required*) Position Role Effort Qualifications *Project Director, Laura Edwards KDBHDID Liaison with SAMHSA; meet reporting requirements; provide daily oversight; oversee implementation of project activities; support sustainability. 1.0 Program Administrator, KDBHDID; more than 12 years’ experience working in substance use and suicide prevention, education, justice, grant management, program development; PD on federal Drug Free Communities grant; 3 years as a court designated specialist; masters’ in education. State Suicide Prevention Coordinator Beck Whipple KDBHDID Liaison between PD, and community partners/stakeholders implementing comprehensive suicide prevention services; will provide suicide and trauma subject matter expertise to project; support sustainability of .25 (in-kind) Program Administrator, KDBHDID; 15+ years’ experience program supervision, program development and management, staff development, collaboration with internal and external stakeholders, program reporting. Bachelors’ degree with concentration in social sciences; specialized training in suicide prevention, intervention and postvention services, and trauma informed care efforts by translating processes to other programs Principal Investigator, Patti Clark, KDBHDID Provide oversight and coordination of all PFS activities operated through the KY Division of Behavioral Health. Responsible for completion and submission of grant reports in a timely manner. Coordinate with related efforts within KY’s behavioral health system. .10 (in kind) Manager, Prevention/Promotion Branch, KDBHDID; over 14 years in substance use and suicide prevention initiatives at the national, state, regional and community levels; training and technical assistance specialist, PD and/or PI on three state-level prevention grants; masters’ in business administration; Ed.D in leadership and policy studies. Subject Matter Experts to Support Key Personnel: Koleen Slusher, Phyllis Millspaugh, Beth Jordan, Tom Beatty, Maggie Schroeder, Cathy Prothro, Amanda Foley Section E- Data Collection and Performance Management E.1. See the table below for specific information about how the required data will be collected and how these and other data will be utilized to manage, monitor, and enhance the program. Performance Measures Source Data Collection Method, Frequency & Responsible Staff Client-Level Outcome Data – to include: demographics; diagnoses; substance use characteristics; employment status; housing stability; suicidality; and social connectedness GPRA Client Outcome Measures Tool https://spars.samhsa.gov/sites/de fault/files/CSAT%20GPRA%20 Tool_021720_v19.pdf Staff from contracted entities will collect data from clients1 at intake, 6 months post-intake, and discharge and enter into a web-based portal to be managed by the Evaluation Team. The evaluation team will extract data for entry into SPARS. 1Client data will be collected telephonically or by other virtual means, when necessary to adhere to social distancing guidelines. Data will be analyzed by the Evaluation Team on a monthly basis and will generate reports for use by the Principal Investigator, Project Team as well as other stakeholders to inform CQI efforts. Following the above data collection plan, the Evaluation Team will create an online password protected dashboard. The dashboard will provide a snapshot of an aggregate and regional participant intake profile as well as intake profile by program area (e.g., suicide, domestic violence, homeless, etc.). The dashboards will be updated monthly and shared with the KERSP Project Team as well as program staff from contracted entities (e.g., UofL, Center for Women and Children, Seven Counties). KIPRIC will lead monthly guided discussions with the Project Team and contracted entities to review program and client outcomes and oversee quality improvement plan implementation using PDSA rapid cycle testing. Reports detailing program implementation (e.g. accomplishments, barriers, and summary of progress), and participant outcomes will be produced by the Project Director with support from the Evaluation Team at month five, 10 and at the end of the project and disseminated for use by SAMHSA and other key stakeholders. Quarterly reports as required will be submitted in the report format provided