OMB No. 0930-NEW
Expiration Date: XX/XX/XXXX
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-XXXX. Public reporting burden for this collection of information is estimated to average 40 minutes per respondent per year, including the time for reviewing instructions, searching existing data sources, gathering, and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E45, Rockville, Maryland, 20857.
Zero Suicide Evaluation
Prevention Strategies Inventory
The Prevention Strategies Inventory (PSI) catalogues the prevention strategies being developed and implemented as a result of Zero Suicide funding and the percentage of Zero Suicide funds expended to date by prevention strategy category.
In the first section report on all strategies implemented or in development as a result of your Zero Suicide funding. Items are reported under strategy types that align with the elements of the Zero Suicide Framework. Under each strategy are several sub-strategies which are shown below.
Lead: how your Zero Suicide program is led and organized, including oversight steering committees, organizational self-studies, and workforce surveys.
Train: various training programs being implemented, such as gatekeeper training on identifying people at risk for suicide or providing suicide care, training in screening practices, risk assessment and management practices, safety planning and lethal means safety practices, and training for specific settings or populations.
Identify: strategies used to identify individuals at risk through screening programs and risk assessments.
Engage: strategies to engage and support individuals, including collaborative safety planning, lethal means safety counseling, rapid follow-up, and safety protocols.
Treat: services specific to suicidality, such as services specific to suicidality, group treatments for suicidality, and services not specific to suicidality.
Transition: strategies that address care transitions, including follow-up after emergency department discharge, inpatient hospitalization, and services after non-engagement.
Improve: items that make improvements in the system, including health record implementation and/or utilization, coalitions and partnerships, and partnerships with agencies and organizations outside of the health system.
Strategy |
Sub Strategies |
Lead |
Oversight Steering Committee |
Organizational Self Study |
|
Workforce Survey |
|
Train |
Gatekeeper Training On Identifying People At Risk For Suicide Or Providing Suicide Care: |
Training In Screening Practices |
|
Training In Risk Assessment and Management Practices |
|
Training In Safety Planning and Lethal Means Safety Practices. |
|
Training For Specific Settings or Populations |
|
Identify |
Screening Program |
Risk Assessment |
|
Engage |
Collaborative Safety Planning |
Lethal Means Safety Counseling |
|
Rapid Follow Up |
|
Safety Protocols |
|
Treat |
Services Specific to Suicidality |
Group Treatments for Suicidality |
|
Services Not Specific to Suicidality |
|
Transition |
Care Transitions |
Follow-Up After Emergency Department Discharge |
|
Follow-Up After Inpatient Hospitalization |
|
Follow Up After Mobile Crisis Services. |
|
Follow-Up Services After Non-Engagement of Services |
|
Improve |
Health Record Implementation And/or Utilization |
Coalitions And Partnerships |
|
Partnerships With Agencies and Organizations Outside of the Health System |
In the Budget section report the total Zero Suicide budget expended to date and the percentage of funds expended to date by prevention strategy category.
If at any time while you are working to complete this inventory you need to save your entry and come back to it later (before submitting as final), you can do so by clicking the "SAVE STRATEGY" button to save your responses. You can then close the survey webpage.
If you have questions or need help related to entering information, please send an email to [EMAIL] for assistance. If you have any concerns about your participation in this study or have any questions about the evaluation, please contact Christine Walrath, principal investigator, at (646) 695-8154 or christine.walrath@icf.com.
Please click the "PROCEED" box below to proceed to the Prevention Strategies Inventory.
PROCEED
Part 1: Strategies
Lead
Oversight Steering Committee
The Oversight Steering Committee is responsible for guiding and overseeing the Zero Suicide program within your organization. This includes setting goals, monitoring progress, and ensuring the integration of suicide prevention practices across all relevant departments and services.
What is the name of your committee?(please spell out)
Describe your committee and their activities and responsibilities.
Indicate the participants in your Zero Suicide Oversight Steering Council that will oversee the development, implementation, and quality improvement of the Zero Suicide program. Select all that apply.
Senior leadership within your organization
Emergency department or crisis systems
Primary care providers
Behavioral health care providers
People with lived experience of suicidal ideation or suicide attempts
People with lived experience from diverse racial, ethnic, and sexual gender minority groups
Quality Improvement Personnel
Other, please specify: ____________________
Frequency of Council Meetings
Weekly
Monthly
Quarterly
Annually
As needed
Other, please specify: ____________________
Main Focus of Council Discussions. Select all that apply.
Program Development
Implementation Strategies
Quality Improvement
Crisis Management
Community Engagement
Resolving differences between diverse perspectives
Sustainability of services or funding
Other, please specify: ____________________
Organization Self-Study
An organizational self-study assesses the current state of your organization's suicide prevention efforts, identifies areas for improvement, and helps guide the development of strategies to enhance your Zero Suicide program.
Name of self-study (please spell out)
Type of self-study. Select all that apply.
General Organizational Self-Study. This version is for systems with multiple departments, outpatient behavioral health settings, integrated treatment for co-occurring disorders, primary care, FQHCs, and other settings that provide care and services to individuals at risk for suicide.
Inpatient Organizational Self-Study. This version is for organizations that focus on inpatient health and behavioral health care. These may include more intensive levels of care—such as partial hospitalization—or intensive outpatient programs if managed under the inpatient organizational structure.
Community-Based Organizational Self-Study with Clinical Providers. This version is for community-based organizations that employ health and behavioral health care providers (e.g., correctional facilities, homeless-serving organizations, elder care organizations, etc.) and are working in partnership with health systems to implement Zero Suicide.
Community-Based Organizational Self-Study without Clinical Providers. This version is for community-based organizations that do not employ health and behavioral health care providers (e.g., correctional facilities, homeless-serving organizations, elder care organizations, etc.) and are working in partnership with health systems to implement Zero Suicide.
Organizational Self-Study Addendum for Tribal or IHS-Led Health Systems. This assesses what components of the comprehensive Zero Suicide approach your organization currently has in place. The following three items, pulled from the existing Organizational Self-Study, represent both the background/rationale and questions that may be amended to be inclusive of Tribal communities in the process of implementing Zero Suicide in a Tribal or IHS-led health system.
Another type of Organizational Self-Study Not Listed here., please specify: __________________
Primary Areas of Impact from Self-Studies. Select all that apply.
Policy Changes
Staff Training Improvements
Service Delivery Models
Community Collaboration
Inpatient Care Strategies
Other, please specify: ____________________
Challenges Identified in Self-Studies. Select all that apply.
Staffing and Resources
Data Management and Reporting
Community Engagement
Integration of Diverse Perspectives
Financial Constraints
None Identified
Other, please specify: ___________________
Workforce Survey
The workforce survey is designed to identify the needs and areas for development among staff members related to suicide prevention, including training, screening, and support practices.
Name of your workforce survey (please spell out)
Describe your workforce survey efforts (which staff did you include, how did you recruit, etc.)
Areas of Staff Development Identified as Needed. Select all that apply.
Screening for Suicide Risk
Assessing for Suicide Risk
Suicide Prevention Training
Treatment and Support during Transitions
Enhancing Knowledge on Suicide
Improving Confidence in Communicating with at-risk Patients about Suicide
None Identified
Train
Gatekeeper Training on Identifying People at Risk for Suicide or Providing Suicide Care:
Gatekeeper training programs are designed to equip individuals with the skills to recognize the warning signs of suicide, provide initial support, and connect individuals at risk with professional help. These programs can be tailored to various settings and populations to enhance the community's overall ability to prevent suicide
What is the name of the training? (please spell out)
Indicate the type of training.
Assessing and Managing Suicide Risk (AMSR)
Applied Suicide Intervention Skills Training (ASIST)
Connect Suicide Prevention/Intervention Training
Connect Postvention Training
Question, Persuade, Refer (QPR): Gatekeeper Training for Suicide Prevention
Suicide Alertness for Everyone: Tell, Ask, Listen, and Keep Safe (safeTALK)
Other, please specify: ____________________
14a. [IF OTHER] Is this a locally developed training?
Yes
No
Indicate the delivery method for the training.
In person
Virtual (facilitated on a specific date)
Virtual (self-paced; trainee completes training at own time)
Hybrid (virtually and in person
Multiple methods, please explain: _____
Other, please explain: ____________
Does the training involve the use of technology (e.g., video conferencing online, social media, chat, text messaging)?
Yes
No
Indicate the types of trainees. Select all that apply.
Behavioral Health Professional and Clinicians
Health System and Clinic Administrators
Physical Health Professionals (physicians, physician’s assistants, nurse practitioners, nurses)
Peers
People with lived experience of attempts
Non-clinical staff
Other, please specify: ____________________
Does this training place emphasis or focus on any of these current priority populations? Select all that apply.
A specific age group
25–34,
35–44,
45–54,
55–64,
65-74
75 and over
A specific racial or ethnic group
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Survivors of suicide
Suicide attempters
Individuals with substance misuse disorder
Individuals with specific medical conditions. Describe: __________
Individuals in criminal justice settings
Rural populations
Veterans/Active military or military families
Lesbian, gay, bisexual, and transgender (LGBTQI+) populations
None
Other, please specify: ___________
Reason for selecting this raining. Select all that apply.
Specific needs of trainees
Alignment with program goals
Recommendations or guidelines
Other, please specify: ____________________
Adaptations made for trainee needs. Select all that apply.
Customized content
Flexible scheduling
Diverse teaching methods
Methods to improve accessibility to those with visual or other impairments.
Language or cultural considerations (CLAS standards)
None
Recruitment strategies for participants. Select all that apply.
Direct invitations
Internal announcements
Open calls
Collaborations with other organizations
Other, please specify: ____________________
[If Yes in 14a] Briefly describe the content (if locally developed curriculum): Please briefly describe the content of the locally developed curriculum. Include the main goals and strategies used to achieve them. This should provide an overview of what the curriculum aims to accomplish and how it is implemented.
What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Training in Screening Practices
Training in screening practices focuses on equipping professionals with the knowledge and skills to effectively identify individuals at risk for suicide using standardized screening tools. These trainings ensure that staff can reliably assess risk factors and take appropriate actions based on the screening results.
What is the name of training? (please spell it out)
Indicate the screening tool of focus for the training
Ask Suicide Screening Questions (asQ)
Beck Depression Inventory (BDI)
Behavioral Health Measure-10 (BHM-10)
Behavioral Health Screen (BHS)
Brief Symptom Inventory 18 (BSI 18)
Columbia Suicide Severity Rating Scale (CSSR-S)
Center for Epidemiological Studies Depression Scale (CES-D)
Outcome Questionnaire 45.2 (OQ 45.2)
Patient Health Questionnaire 9 (PHQ-9)
Patient Health Questionnaire 3 (PHQ-3)
Suicide Behaviors Questionnaire (SBQ-R)
Other, please specify: ____________________
25a. [IF OTHER] Is this a locally developed training?
Yes
No
Indicate the delivery method for the training.
In person
Virtual (facilitated on a specific date)
Virtual (self-paced; trainee completes training at own time)
Multiple methods, please explain: _____
Other, please explain: ____________
Does the training involve the use of technology (e.g., video conferencing online, social media, chat, text messaging)?
Yes
No
Indicate the types of trainees. Select all that apply.
Behavioral Health Professional and Clinicians
Health System and Clinic Administrators
Physical Health Professionals (physicians, physician’s assistants, nurse practitioners, nurses)
Peers
People with lived experience of attempts
Non-clinical staff
Other, please specify: ____________________
Does this training place emphasis or focus on any of these current priority populations? Select all that apply.
A specific age group
25–34,
35–44,
45–54,
55–64,
65-74
75 and over
A specific racial or ethnic group
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Survivors of suicide
Suicide attempters
Individuals with substance misuse disorder
Individuals with specific medical conditions. Describe: __________
Individuals in criminal justice settings
Rural populations
Veterans/Active military or military families
Lesbian, gay, bisexual, and transgender (LGBTQI+) populations
None
Other, please specify: ___________
Reason for selecting this training. Select all that apply.
Specific needs of trainees
Alignment with program goals
Recommendations or guidelines
Other, please specify: _____
Adaptations made for trainee needs. Select all that apply.
Customized content
Flexible scheduling
Diverse teaching methods
Methods to improve accessibility to those with visual or other impairments.
Language or cultural considerations (CLAS standards)
None
Recruitment strategies for participants. Select all that apply.
Direct invitations
Internal announcements
Open calls
Collaborations with other organizations
Other, please specify: ____________________
[If Yes in 25a]. Briefly describe the content (if locally developed curriculum): Please briefly describe the content of the locally developed curriculum. Include the main goals and strategies used to achieve them. This should provide an overview of what the curriculum aims to accomplish and how it is implemented.
What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Training in Risk Assessment and Management Practices
Training in Risk Assessment and Management Practices: Training in risk assessment and management practices equips professionals with the skills to identify, assess, and manage individuals at risk of suicide. These trainings focus on using specific tools and methods to ensure accurate risk evaluation and appropriate intervention.
What is the name of training? (please spell it out)
Indicate the risk assessment tool of focus for the training.
Assessing and Managing Suicide Risk (AMSR)
Chronological Assessment of Suicide Events (CASE)
Collaborative Assessment and Management of Suicidality (CAMS)
Recognizing and Responding to Suicide Risk (RRSR)
QPR-T (suicide risk assessment and training course)
Other, please specify: ____________________
36a. [IF OTHER] Is this a locally developed training?
Yes
No
Indicate the delivery method for the training.
In person
Virtual (facilitated on a specific date)
Virtual (self-paced; trainee completes training at own time)
Multiple methods, please explain: _____
Other, please explain: ____________
Does the training involve the use of technology (e.g., video conferencing online, social media, chat, text messaging)?
Yes
No
Indicate the types of trainees. Select all that apply.
Behavioral Health Professional and Clinicians
Health System and Clinic Administrators
Physical Health Professionals (physicians, physician’s assistants, nurse practitioners, nurses)
Peers
People with lived experience of attempts
Non-clinical staff
Other, please specify: ____________________
Does this training place emphasis or focus on any of these current priority populations? Select all that apply.
A specific age group
25–34,
35–44,
45–54,
55–64,
65-74
75 and over
A specific racial or ethnic group
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Survivors of suicide
Suicide attempters
Individuals with substance misuse disorder
Individuals with specific medical conditions. Describe: __________
Individuals in criminal justice settings
Rural populations
Veterans/Active military or military families
Lesbian, gay, bisexual, and transgender (LGBTQI+) populations
None
Other, please specify: ___________
Reason for selecting this training. Select all that apply.
Specific needs of trainees
Alignment with program goals
Recommendations or guidelines
Other, please specify: ____________________
Adaptations made for trainee needs. Select all that apply.
Customized content
Flexible scheduling
Diverse teaching methods
Methods to improve accessibility to those with visual or other impairments.
Language or cultural considerations (CLAS standards)
None
Recruitment strategies for participants. Select all that apply.
Direct invitations
Internal announcements
Open calls
Collaborations with other organizations
Other, please specify: ____________________
[If yes in 36a], briefly describe the content (if locally developed curriculum): Please briefly describe the content of the locally developed curriculum. Include the main goals and strategies used to achieve them. This should provide an overview of what the curriculum aims to accomplish and how it is implemented.
What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Training in Safety Planning and Lethal Means Safety Practices
Training in safety planning and lethal means safety practices equips professionals with the skills to develop effective safety plans and strategies to limit access to lethal means for individuals at risk of suicide. These trainings aim to enhance the ability of staff to create and implement safety plans that reduce the risk of self-harm.
What is the name of the training? (please spell it out)
Indicate the type of training.
CALM (Counseling on Access to Lethal Means)
Safety Planning for Youth Suicide Prevention
Other, please specify: ____________________
47a. [IF OTHER] Is this a locally developed training?
Yes
No
48. Indicate the delivery method for the training.
In person
Virtual (facilitated on a specific date)
Virtual (self-paced; trainee completes training at own time)
Multiple methods, please explain: _____
Other, please explain: ____________
49. Does the training involve the use of technology (e.g., video conferencing online, social media, chat, text messaging)?
Yes
No
50. Indicate the types of trainees. Select all that apply.
Behavioral Health Professional and Clinicians
Health System and Clinic Administrators
Physical Health Professionals (physicians, physician’s assistants, nurse practitioners, nurses)
Peers
People with lived experience of attempts
Non-clinical staff
Other, please specify: ____________________
51. Does this training place emphasis or focus on any of these current priority populations? Select all that apply.
A specific age group
25–34,
35–44,
45–54,
55–64,
65-74
75 and over
A specific racial or ethnic group
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Survivors of suicide
Suicide attempters
Individuals with substance misuse disorder
Individuals with specific medical conditions. Describe: __________
Individuals in criminal justice settings
Rural populations
Veterans/Active military or military families
Lesbian, gay, bisexual, and transgender (LGBTQI+) populations
None
Other, please specify: ___________
52. Reason for selecting this training. Select all that apply.
Specific needs of trainees
Alignment with program goals
Recommendations or guidelines
Other, please specify: _____
53. Adaptations made for trainee needs. Select all that apply.
Customized content
Flexible scheduling
Diverse teaching methods
Methods to improve accessibility to those with visual or other impairments.
Language or cultural considerations (CLAS standards)
None
54. Recruitment strategies for participants. Select all that apply.
Direct invitations
Internal announcements
Open calls
Collaborations with other organizations
Other, please specify: _____
55. [If Yes in 47a], Briefly describe the content (if locally developed curriculum): Please briefly describe the content of the locally developed curriculum. Include the main goals and strategies used to achieve them. This should provide an overview of what the curriculum aims to accomplish and how it is implemented.
56. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Training for Specific Settings or Populations
Training for specific settings or populations tailors suicide prevention education to the unique needs and circumstances of various groups. These trainings address the specific risk factors and intervention strategies relevant to different environments and demographics, such as military personnel, youth services, and primary care settings.
57. What is the name of the training? (please spell out)
58. Indicate the type of training.
Suicide in the Military (Psych/Armor)
SafeSide Behavioral Health
SafeSide Youth Services
Preventing Suicide in Emergency Department Patients
Recognizing and Responding to Suicide Risk in Primary Care
SafeSide Primary Care
Other, please specify: ____________________
58a. [IF OTHER] Is this a locally developed training?
Yes
No
59. Indicate the delivery method for the training.
In person
Virtual (facilitated on a specific date)
Virtual (self-paced; trainee completes training at own time)
Multiple methods, please explain: _____
Other, please explain: ____________
60. Does the training involve the use of technology (e.g., video conferencing online, social media, chat, text messaging)?
Yes
No
61. Indicate the types of trainees. Select all that apply.
Behavioral Health Professional and Clinicians
Health System and Clinic Administrators
Physical Health Professionals (physicians, physician’s assistants, nurse practitioners, nurses)
Peers
People with lived experience of attempts
Non-clinical staff
Other, please specify: ____________________
62. Does this training place emphasis or focus on any of these current priority populations? Select all that apply.
A specific age group
25–34,
35–44,
45–54,
55–64,
65-74
75 and over
A specific racial or ethnic group
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Survivors of suicide
Suicide attempters
Individuals with substance misuse disorder
Individuals with specific medical conditions. Describe: __________
Individuals in criminal justice settings
Rural populations
Veterans/Active military or military families
Lesbian, gay, bisexual, and transgender (LGBTQI+) populations
None
Other, please specify: ___________
63. Reason for selecting this training. Select all that apply.
Specific needs of trainees
Alignment with program goals
Recommendations or guidelines
Other, please specify: _____
64. Adaptations made for trainee needs. Select all that apply.
Customized content
Flexible scheduling
Diverse teaching methods
Methods to improve accessibility to those with visual or other impairments.
Language or cultural considerations (CLAS standards)
None
65. Recruitment strategies for participants. Select all that apply.
Direct invitations
Internal announcements
Open calls
Collaborations with other organizations
Other, please specify: _____
66. [If yes to 58a], Briefly describe the content (if locally developed curriculum): Please briefly describe the content of the locally developed curriculum. Include the main goals and strategies used to achieve them. This should provide an overview of what the curriculum aims to accomplish and how it is implemented.
67. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Identify
Screening Programs
Screening programs are designed to identify individuals at risk of suicide by using specific tools and questionnaires. These programs help in early detection and intervention, ensuring that individuals receive timely and appropriate support.
68. What is the name of the screening program? (please spell out)
69. Indicate the type of screening tool:
Ask Suicide Screening Questions (asQ)
Behavioral Health Measure-10 (BHM-10)
Behavioral Health Screen (BHS)
Brief Symptom Inventory 18 (BSI 18)
Columbia Suicide Severity Rating Scale (C-SSRS) – Screening version
Outcome Questionnaire 45.2 (OQ 45.2)
Patient Health Questionnaire 9 (PHQ-9)
Suicide Behaviors Questionnaire (SBQ-R)
The Patient Safety Screener (PSS-3)
Other, please specify: ____________________
69a. [IF OTHER] Is this a locally developed screening program?
Yes
No
70. Does the screening program involve the use of technology? (e.g., social media, chat, text messaging)
Yes
No
71. Frequency of Screening:
One-time
Periodic (e.g., annually, bi-annually)
Continuous/as
needed
72. Staff Involved in the Screening Process. Select all that apply.
Physicians
Nurses
Mental Health Professionals
Non-clinical Staff
Peer Support Specialists
Other (please specify): _______________
73. Data Collection and Analysis Methods. Select all that apply.
Electronic Health Records
Manual recording and tracking
Data analytics tools
Surveys/Questionnaires
Other (please specify): _______________
74. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Risk Assessment
Risk assessment programs use specific tools to evaluate the level of suicide risk in individuals. These assessments help identify those at high risk and guide appropriate interventions to prevent suicide.
75. What is the name of the risk assessment? (please spell out)
76. Indicate the assessment tool being used?
Beck Scale for Suicide Ideation (BSS)
Columbia-Suicide Severity Rating Scale (C-SSRS) Risk Assessment Version
Scale for Suicide Ideation-Worst (SSI-W)
Suicide Behaviors Questionnaire – Revised (SBQ-R)
Other, please specify: ____________________
76a. [IF OTHER] Is this a locally developed assessment program?
Yes
No
77. Does the risk assessment program involve the use of technology? (e.g., social media, chat, text messaging)
Yes
No
78. Frequency of Screening:
One-time
Periodic (e.g., annually, bi-annually)
Continuous/as
needed
79. Staff Involved in the Screening Process. Select all that apply.
Physicians
Nurses
Mental Health Professionals
Non-clinical Staff
Peer Support Specialists
Other, please specify: _______________
80. Data Collection and Analysis Methods. Select all that apply.
Electronic Health Records
Manual recording and tracking
Data analytics tools
Surveys/Questionnaires
Other, please specify:______________
81. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Engage
Collaborative safety planning involves creating structured plans to help individuals identified as at risk of suicide or self-harm. These plans are developed with the input of the individual and often include steps to reduce risk, coping strategies, and resources for support.
82. What is the name of the service? (please spell out)
83. Please provide a brief description of the service.
84. Does this plan utilize any of the following? Select all that apply
Rudd/Bryan/Joiner Crisis Response Plan
Stanley/Brown Safety Plan
Other, please specify:__________
85. Does the safety plan involve the use of technology? (e.g., social media, chat, text messaging)
Yes
No
86. How does your organization share safety plans/protocols with your clients? Select all that apply.
Paper
Electronic
Application-based
Other, please specify: ________________________
87. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place.)
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes.)
Don’t know
Lethal Means Safety Counseling
Lethal means safety counseling involves strategies to reduce access to means of self-harm for individuals at risk of suicide. These services include counseling on safe storage practices, distribution of safety devices, and other methods to limit access to lethal means.
88. What is the name of the service? (please spell out)
89. Please provide a description of the service.
90. Does lethal means counseling involve the use of technology (e.g., social media, chat, text message)?
Yes
No
91. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Rapid Follow Up
Rapid follow-up is a critical component in suicide prevention, involving timely engagement and support for individuals who have recently been discharged from care after a suicide attempt or crisis. This process ensures continuity of care and supports recovery and ongoing well-being.
92. What is the name of your rapid follow up process? (please spell out)
93. Please describe the approach and criteria you use for following up after a post-discharge attempt or suicidal crisis.
94. . Does rapid follow up involve the use of technology (e.g., social media, chat, text message)?
Yes
No
95. What is the typical length of time between suicide attempt or suicidal crisis and initiation of rapid follow-up?
Within 24 hours of discharge
Within 48 hours of discharge
Within 1 week of discharge
Within 2 weeks of discharge
Within 1 month of discharge
No typical length
Other, please specify: _______________________
96. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Safety Protocols
Safety protocols encompass structured procedures and guidelines designed to ensure ongoing client safety, particularly after a suicide attempt or during periods of high risk. These protocols include a range of preventive measures and strategies aimed at maintaining and enhancing safety over time.
977. What is the name of your safety protocol? (please spell out)
98. Please describe the approach used to provide follow up to ensure client safety after a suicide attempt or suicidal crisis?
99. Which modes of communication are part of this protocol? Select all that apply.
Letter
Postcard
Home visit
Phone call
Text message
Social media
Other mode or technology, please describe:
100. What is the typical length of time between suicide attempt or suicidal crisis and initiation of follow-up?
Within 24 hours of discharge
Within 48 hours of discharge
Within 1 week of discharge
Within 2 weeks of discharge
Within 1 month of discharge
No typical length
Other, please specify: _______________________
101. Who is responsible for monitoring or tracking an individual after a suicide attempt or suicidal crisis? Select all that apply.
Emergency department staff responsible for tracking and monitoring follow-up
Grant staff responsible for tracking and monitoring follow-up
Mental health agency staff responsible for tracking and monitoring follow-up
Other staff, please specify: __________________
102. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Treat
Services
Specific to Suicidality
Services
specific to suicidality are targeted interventions designed to
support individuals at risk of suicide or who have attempted suicide.
These services include various therapeutic approaches, support
groups, and preventive programs tailored to address suicidal ideation
and behaviors.
103. What is the name of the service? (please spell out)
104. Type of service
Attempted Suicide Short Intervention Program (ASSIP)
Brief Cognitive Behavioral Therapy (BCBT)
Brief Mindfulness-Based Intervention for Suicidal Ideation (MB-SI)
Cognitive Behavioral Prevention for Suicide in Psychosis (CBSPp)
Cognitive Behavioral Therapy for Suicide (CBT-SP)
Collaborative Assessment and Management of Suicidality (CAMS)
JASPR Health
Post Admission Cognitive Therapy (PACT)
Suicide Prevention Program
Survivors of Suicide Attempts (SOSA) Support Groups
Teachable Moment Brief Intervention (TMBI)
Other, please specify: _________________________
105. Please provide a brief description of the service.
106. Does this direct service involve the use of technology (e.g., social media, chat, text message)?
Yes
No
107. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Group Treatments for Suicidality
Group treatments for suicidality involve therapeutic group sessions aimed at providing support, coping strategies, and preventive measures for individuals at risk of suicide. These group treatments are designed to foster a sense of community, shared understanding, and collective resilience among participants.
108. What is the name of the service? (please spell out)
109. Type of service
Coping, Understanding, Support and Prevention (CUSP) Group
Grady Nia Project (Nia)
Interdisciplinary, Recovery-Oriented Intensive Outpatient Program (IR-IOP)
Spiritual and Religious Group Psychotherapy
Other, please specify: ________________________________
110. Please provide a brief description of the service:
111. Does this direct service involve the use of technology (e.g., social media, chat, text message)?
Yes
No
112. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Services NOT specific to Suicidality
This includes services that are NOT specific to suicidality yet are funded by Zero Suicide grant dollars. If there are services not funded by Zero Suicide, they DO NOT have to be included in this section.
113. What is the name of the service? (Please spell out)
114. Type of service
Attachment-Based Family Therapy (ABFT)
Acceptance and Commitment Therapy (ACT)
Dialectical Behavioral Therapy (DBT)
Digital Cognitive Behavioral Therapy for Insomnia (CBTI) via Sleepio
Interpersonal Therapy (IPT)
Mentalization Based Treatment (MBT)
Problem Solving Therapy (PST)
Other, please specify: ________________________
115. Please provide a brief description of the service:
116. Does this direct service involve the use of technology (e.g., social media, chat, text message)?
Yes
No
117. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Transition
Care transitions involve the pathways and management plans designed to ensure safe and continuous support for individuals at risk of suicide during critical periods, such as after discharge from a hospital or crisis intervention. These plans aim to maintain seamless care and prevent gaps in support.
118. What is the name of the pathway to care or suicide care management plan? (Please spell out)
119. Does the care transition pathway or plan utilize any of the following? Select all that apply.
Crisis Response Planning (CRP)
Safety Planning Intervention (SPI)
Other, please specify: _________________________
120. Please describe the pathway to care or suicide care management plan. Include information such as target populations, implementing agencies or providers, etc.
121. Indicate the types of elements included in the pathway to care or suicide care management plan. Select all that apply.
Specific protocols for client engagement and frequency of appointments
Psychoeducation groups specific to suicide
Attempt survivor support groups
Drop-in visits without appointments
Outreach/contact/protocol for missed appointments or transitions of care
Coordination of care within the organization for high-risk clients
Chart reviews to monitor risk assessments
Other, please describe: ___________________
122. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Follow-up after Emergency Department Discharge
This section focuses on the procedures and strategies used to provide follow-up care for individuals identified as at risk for suicide after being discharged from the Emergency Department. It ensures continuous support and intervention during the vulnerable transition period from emergency care to ongoing mental health services.
123. What is the name of this service?
124. Please provide a brief description of the procedures used for following up with individuals identified at risk for suicide after being discharged from the Emergency Department.
125. Which modes of communication do you use to follow up with individuals after Emergency Department discharge? Please select all that apply
Phone call
Text message reminders of appointments
Text message of support or encouragement
Use of apps
Letter
Postcard
Home Visit
Other, please specify: __________________________________
126. What is the length of time between individuals being discharged from the Emergency Department and initiation of follow-up?
Within 24 hours of discharge
Within 48 hours of discharge
Within 1 week of discharge
Within 2 weeks of discharge
Within 1 month of discharge
No typical length
Other, please specify:
127. Who is responsible for monitoring or tracking individuals after discharge from an Emergency Department to ensure that follow-up services (mental health or other support services) are received? Select all that apply.
Emergency department staff responsible for tracking and monitoring follow-up
Grant staff responsible for tracking and monitoring follow-up
Mental health agency staff responsible for tracking and monitoring follow-up
Other staff, please specify:__________________
128. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain this strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Follow-up after Inpatient Hospitalization
This section explores the follow-up procedures for individuals at risk of suicide after being discharged from inpatient hospitalization. It includes details about communication methods, responsible parties, and the timeline for initiating follow-up care to ensure continuous support and prevent relapse.
129. What is the name of this service? (please spell out)
130. Please provide a brief description of the procedures used for following up with individuals identified at risk for suicide after being discharged from an Inpatient Hospitalization.
131. Which modes of communication do you use to follow up with individuals after discharge from inpatient hospitalization? Please select all that apply.
Phone call
Text message reminders of appointments
Text message of support or encouragement
Use of apps
Letter
Postcard
Home Visit
Other, please specify: __________________
132. What is the length of time between individuals being discharged from an Inpatient Hospitalization and initiation of follow-up?
Within 24 hours of discharge
Within 48 hours of discharge
Within 1 week of discharge
Within 2 weeks of discharge
Within 1 month of discharge
No typical length
Other, please specify: ____________________
133. Who is responsible for monitoring or tracking individuals after discharge from inpatient hospitalization to ensure follow-up services (mental health or other support services) are received? Select all that apply.
Inpatient hospital staff responsible for tracking and monitoring follow-up
Grant staff responsible for tracking and monitoring follow-up
Mental health agency staff responsible for tracking and monitoring follow-up
Private alert system, such as ADT
Other staff, please specify:__________________
134. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain this strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t Know
Follow up after mobile crisis services.
This section explores the procedures and strategies for following up with individuals who have received mobile crisis services. It aims to understand the methods used to provide ongoing support and ensure continuity of care after the initial mobile crisis intervention.
135. What is the name of this service? (please spell out)
136. Please provide a brief description of the procedures used for following up with individuals identified at risk for suicide after being discharged from a mobile crisis services.
137. Which modes of communication do you use to follow up with individuals after discharge from inpatient hospitalization? Please select all that apply.
Phone call
Text message reminders of appointments
Text message of support or encouragement
Use of apps
Letter
Postcard
Home Visit
Other, please specify: __________________
138. What is the length of time between individuals being discharged from an Inpatient Hospitalization and initiation of follow-up?
Within 24 hours of discharge
Within 48 hours of discharge
Within 1 week of discharge
Within 2 weeks of discharge
Within 1 month of discharge
No typical length
Other, please specify: ____________________
139. Who is responsible for monitoring or tracking individuals after discharge from mobile crisis services to ensure follow-up services (mental health or other support services) are received? Select all that apply.
Inpatient hospital staff responsible for tracking and monitoring follow-up
Grant staff responsible for tracking and monitoring follow-up
Mental health agency staff responsible for tracking and monitoring follow-up
Private alert system, such as ADT
Other staff, please specify:__________________
140. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain this strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t Know
Follow-Up Services after Non-Engagement of Services
This section addresses the strategies and methods used to follow up with individuals who have missed appointments or disengaged from services. It aims to understand the approaches for re-engaging these individuals and ensuring they receive the necessary support.
141. What is the name of the service? (please spell out)
142. Please provide a brief description of the service.
143. Which modes of communication do you use to follow up with individuals after non-engagement of services? Select all that apply.
Phone call
Text message with reminders of appointments
Text message of support or encouragement
Use of apps
Letter
Postcard
Home Visit
Other, please specify: ______________________
144. What is the length of time between individuals missing services and initiation of follow-up?
Within 4 hours of missed appointment
Within 8 hours of missed appointment
Within 24 hours of missed appointment
Within 48 hours of missed appointment
Within 1 week of missed appointment
Within 2 weeks of missed appointment
Within 1 month of missed appointment
No typical length
Other, please specify: ________________________
145. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Improve
Health Record Implementation and/or Utilization
This section focuses on the implementation and use of health records within organizations. It aims to gather information about how health records are integrated into suicide prevention strategies, the technologies used, and how they enhance care coordination and support for individuals at risk.
146. What is the name of your Electronic Health Record? (please spell out)
147. Please describe how electronic health records are used to support suicide prevention efforts. Who is included/involved in implementation? In what setting is the electronic health record utilized?
148. In which of the following ways is the electronic health record used to enhance grant activities? Select all that apply.
Suicide screening and risk assessment
Monitoring progress and follow-up of individuals after identification
Communication between multiple providers
Creating and sharing safety plans with individuals and/or families
Tracking scheduled appointments
Tracking suicide attempts or deaths
Other, please specify: _____________________________
Coalitions And Partnerships
This section focuses on health system coalitions made up of multiple independent organizations working together as a network, coalition, or collaborative. It aims to gather information about the coalition's structure, goals, achievements, and strategies for sustaining the collaborative efforts.
[Note: use this section if your Zero Suicide health system is made up of multiple independent organizations working together as a network/coalition/collaborative.]
149. What is the name of the coalition? (please spell out)
150. Please provide a brief description of the coalition. Include information such as: what types of agencies participate in the coalition; what are the goals of the coalition; what are its major achievements; how frequently do the members meet; strategies for sustaining the coalition, etc.
151. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Partnerships with Agencies and Organizations Outside of the Health System
This section examines the collaborations and partnerships between health organizations and external agencies. It seeks to understand how these partnerships contribute to suicide prevention efforts, the nature of these collaborations, and their impact on supporting individuals at risk.
152. What is the name of the partnership strategy? (please spell out)
153. Please provide a brief description of your efforts to build partnerships with agencies and organizations.
154. What are your plans for sustaining this strategy after the end of your Zero Suicide cooperative agreement?
We do not intend to sustain this strategy after the end of our Zero Suicide cooperative agreement.
We intend to sustain the strategy but haven’t yet begun to discuss specific sustainability plans.
We are developing or have developed plans to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you have begun to identify options for sustaining the strategy, or have a sustainability plan, but formal sustainability mechanisms are not yet in place).
We already have mechanisms in place to sustain this strategy after the end of our Zero Suicide cooperative agreement (Note: Select this option if you are ready to sustain the strategy after your funding period. This would be relevant if you’ve already identified a funding source for the strategy, have modified policies or practices to sustain the strategy, or if you have identified ways to integrate the strategy into existing processes and do not need any additional funding sources or policy changes).
Don’t know
Part 2: Budget
This section collects information on the expenditures from your Zero Suicide budget, including any matching funds, over the past year. It also asks for an estimate of the percentage of your total budget spent on various prevention strategies to date.
155. How much of your Zero Suicide budget, including any matching funds, have you spent in the past to date? Specify dollar amount: ____________________
156. Please estimate the percentage of your total budget expended to date on the following prevention strategies.
Lead (This includes organizational self study and the workforce survey) |
___% |
Train (This includes the gatekeeper training, training in screening practices, risk assessment and management practices, safety planning and lethal means safety practices, and training for specific settings or populations) |
___% |
Identify (This includes screening programs and risk assessment) |
___% |
Engage (This includes collaborative safety planning, lethal means safety counseling, rapid follow-up, safety protocols, text lines, and chatlines) |
___% |
Treat (This includes services specific and NOT specific to suicidality and group treatments for suicidality) |
___% |
Transition (This includes care transitions, follow up after emergency department discharge and after inpatient hospitalization, and follow up services after non-engagement of services) |
___% |
Improve (This includes health record implementation and/or utilization, coalitions and partnerships, and partnerships with agencies and organizations outside of the health system. |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |