Transforming Suicide Prevention: Cincinnati Children’s Adopts Zero Suicide Framework
A shared experience of caring for someone who died by suicide prompted two providers at Cincinnati Children’s Mental and Behavioral Health Institute to lead the organization-wide adoption of a systems-based strategy to help reduce rates of suicide among young people.
The Zero Suicide framework—developed by the Education Development Center in collaboration with the National Action Alliance for Suicide Prevention, and inspired by pioneering work at the Henry Ford Health System roughly 25 years ago—takes a multi-pronged approach to suicide prevention. It’s also now a core pillar of the Mental and Behavioral Health Institute.
The model is built on two key ideas:
- Suicide is complex and can’t be eliminated with a single solution.
- Health and behavioral healthcare organizations have a unique opportunity to move the needle in suicide prevention.
Solutions Built on Data
Melissa Young, MA, PsyD, a psychologist in the Division of Behavioral Medicine and Clinical Psychology, and Brian Kurtz, MD, a psychiatrist in the Division of Child and Adolescent Psychiatry, co-lead Zero Suicide for the Mental and Behavioral Health Institute.
When the two providers began exploring the framework about three years ago, they were struck by the absence of system-level interventions given the complexity of the problem.
“Suicide arises from a mix of biological, psychological, social, cultural and economic factors,” Young says, “and it’s resistant to traditional, problem-solving approaches. That means that no one, single factor can be effective at eliminating suicide. Instead, strategies must be adaptive, multifaceted and continuously evaluated with data.”
In addition, they found evidence that traditional risk assessment tools that stratify suicide risk into categories (e.g., low, medium, high) are embedded in healthcare systems worldwide despite evidence demonstrating limited efficacy and validity.
“Attempting to predict who will die by suicide is no better than chance,” Young says. “Because suicide is rare, even the best tools produce more false alarms than anything else.”
To understand the scope of the problem within the Greater Cincinnati area, Young and Kurtz have been working with county coroner offices and public health agencies to obtain records of young people who had died by suicide in the past 20 years. After presenting their preliminary findings to the leadership team at Cincinnati Children’s, Young and Kurtz received buy-in to create a system that would provide access to real-time community data that could be shared with county public health and suicide prevention coalitions, as well as other care organizations.
Young and Kurtz are now working—in collaboration with local public health offices—to launch a regional suicide surveillance system. The surveillance system will also integrate social and policy drivers of well-being, such as economic inequality, healthcare access, discrimination and housing instability, at the individual and community levels, Young says.
Counseling on Access to Lethal Means (CALM) Training
Another key component of suicide prevention, Kurtz says, is focusing on the means and the “how” more than the “why.”
A recent study highlighting the importance of preventing access to suicide methods found that 60.5% of firearm suicide deaths among adolescents ages 15 to 20 happened in homes with unlocked firearms.
“This underscores that firearm storage practices are particularly critical for preventing suicide among young people,” Kurtz says, adding that it’s especially important because most people who die by suicide use a firearm.
To educate providers on the methods young people use to die by suicide and reduce their access, Young—in collaboration with the Office of Population Health, including the Pediatric Improvement Network for Quality, a regional learning network—began hosting Counseling on Access to Lethal Means (CALM) trainings for pediatric and behavioral health providers in January.
