MIRECC / CoE

Recommendation Resources

To date, there is limited evidence around public health and community-based interventions (CBI) that address either patient-level or population-level suicide outcomes. Further research will require special methodological approaches given that many community-based interventions are delivered concurrently as part of a multi-faceted suicide prevention approach.

CBIs aim to reach Veterans through multiple touch points and target universal, selective, and indicated prevention strategies. According to the National Strategy for Preventing Veteran Suicide:

• Universal strategies aim to reach all Veterans in the U.S. These include public awareness and education campaigns about the availability of suicide prevention resources for Veterans, promoting responsible coverage of suicide by the news media, and creating barriers or limiting access to hot spots for suicide, such as bridges and train tracks.
• Selective strategies are intended for some Veterans who fall into subgroups that may be at increased risk for suicidal behaviors. These include outreach targeted to women Veterans or Veterans with substance use challenges, gatekeeper training for intermediaries who may be able to identify Veterans at high risk, and programs for Veterans who have recently transitioned from military service.
• Indicated strategies are designed for the relatively few individual Veterans identified as being at high risk for suicidal behaviors, including someone who has made a suicide attempt. These include referring Veterans in crisis to the Veterans Crisis Line, putting time and space between a Veteran who has expressed thoughts of suicide and a firearm or prescription medication, and providing a Veteran survivor of a suicide attempt or loss with enhanced support and expedited access to care.

In VA, our foundational approach to CBI centers on coalition building and sustainment at the state and local level. Community coalitions are often used to promote and improve community health and health service systems (Granner & Sharpe, 2004) and is often characterized as an "organization of individuals representing diverse organizations, factions or constituencies who agree to work together in order to achieve a common goal" (Butterfoss et al., 1993).

VA's CBI work aligns state Governor's Challenge initiatives, the Together With Veterans rural peer-to-peer initiative and Community Engagement and Partnership Coordinators to help local communities adapt an evidence-informed public health model to local needs and resources. This model builds on VA's focus on high-risk individuals in health care settings while embracing cross-agency collaborations and community partnerships working to end Veteran suicide. Further, our program evaluation efforts are looking at the impact of the work and assessing quality, accountability, and effectiveness of this model and approach with an aim to further share outcomes with the broader Suicide Prevention community.

Across all components of VA's CBI work, we have three priority areas where we work with state and local coalitions to focus their action plans and activities on when working to address Veteran suicide:

1. Identify Service Members, Veterans and their Families and Screen for Suicide
2. Promote Connectedness and Improve Care Transitions
3. Increase Lethal Means Safety and Safety Planning

Priority Areas Across CBI-SP Unifying Model

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Priority Areas Across CBI-SP Unifying Model

Identify Service Members, Veterans, and their Families and Screen for Suicide Risk

• Identifying Veterans — "Ask the Question" — enables culturally competent care and access to resources; allows community members, families, and community service providers to connect individuals to appropriate care
• Suicide risk screening in healthcare settings allows providers to recognize and prevent self-harm

Promote Connectedness and Improve Care Transitions

• Connectedness to others (including family members, co-workers, community organizations, and social institutions) is an important factor
• Providing caring contacts upon discharge from one setting to another can reduce suicide attempts and increase compliance with treatment recommendations

Increase Lethal Means Safety and Safety Planning

• Limiting access to lethal means during periods of crisis can make it more likely that ht person will delay or survive a suicide
• Completing a personal safety plan is a clinical intervention that can help individuals manage and decrease suicidal feelings and help them stay safe when these feelings reoccur

• Training
• Manuals
• Webinars
• Videos
• Books
• Articles
• Podcasts

Training Resources

This section includes links to training resources for about community-based interventions.

Coalition Building

Society of Public Health Education (SOPHE) Learning: Coalition Building Resources

Toolkits | Community Tool Box (ku.edu)

Community Needs Assessment (cdc.gov)

Priority Area #1: Identify Service Members, Veterans and their Families and Screen for Suicide

VA Suicide Prevention — Community Outreach Toolkit

Ask the Question Toolkit

See resources for:

• CPG Recommendation #1: Universal Screening
• CPG Recommendation #2: Patient Health Questionnaire- 9 (PHQ-9)
• CPG Recommendation #3: Assessment of Risk Factors
• CPG Recommendation #4: Multiple Method Risk Assessment
• CPG Recommendation #5: Suicide Risk Stratification

Priority Area #2: Promote Connectedness and Improve Care Transitions

VA Community Provider Toolkit

Coaching Into Care | When a Veteran you know needs help — MIRECC / CoE (va.gov)

Community Toolkit | VA Suicide Prevention Resources (veteranscrisisline.net)

Social Media Safety Toolkit for Veterans, Their Families, and Friends (va.gov)

See resources for:

• CPG Recommendation #13: Caring Contacts
• CPG Recommendation #14: Home Visit
• CPG Recommendation #15: WHO BIC

Priority Area #3: Increase Lethal Means Safety and Safety Planning

What Is a Safety Plan? | VA Suicide Prevention Resources (veteranscrisisline.net)

Start the Conversation Template to create a Safety Planning (veteranscrisisline.net)

Suicide Prevention is Everyone's Business: A Toolkit for Safe Firearm Storage in Your Community (va.gov)

Gun Shop Project | Means Matter | Harvard T.H. Chan School of Public Health

See resources for:

• CPG Recommendation #18: Lethal Means

Manuals

This section includes links to treatment and/or implementation manual and resources about community-based interventions.

CDC — Preventing Suicide: A Technical Package of Policy, Programs, and Practices Rand Suicide Prevention Program Evaluation Toolkit

Webinars

This section includes links to webinars that are recommended about community-based interventions.

Coalition Building

Community-Based Interventions for Veteran Suicide Prevention (CBI-SP)

SMVF Webinar: Leadership—An Essential Element: Implementing Interagency Suicide Prevention Action Plans for Service Members, Veterans, and their Families in States and Communities

Priority Area #1: Identify Service Members, Veterans and their Families and Screen for Suicide

Evidence-Based Practice in Suicide Risk Screening and Evaluation: Why, What, How, and When?

Asking the Critical Question Came Make a Difference: "Have you or a loved one ever served in the military"

Priority Area #2: Promote Connectedness and Improve Care Transitions

It is That Simple: Nondemanding Caring Contacts for Suicide Prevention: Webinar Series — MIRECC / CoE (va.gov)

Priority Area #3: Increase Lethal Means Safety and Safety Planning

Partnering with Firearm Retailers to Promote Temporary Out-of-Home Firearm Storage

Community Prevention Progress: A Look at Governor's Challenge Efforts to Educate Communities on Lethal Means Safety

Videos

This section includes links to video resources about community-based interventions.

Public Health Approach to Suicide Prevention

VA's Public Health Approach to Suicide Prevention

Connecting with and Understanding Veterans

Make the Connection | Videos & Info for Military Veterans

Lethal Means Safety

Keep It Secure

Books

This section includes links to books that are recommended regarding community-based interventions.

Butterfoss, F.D. (2007). Coalitions and Partnerships in Community Health. Wiley.

Butterfoss, F.D. (2013). Ignite!: Getting Your Community Coalition Fired up for Change. AuthorHouse.

Keyes, K.M., & Galea, S. (2016). Population health science. Oxford University Press.

Articles

This section includes links to recommended articles about community-based interventions.

Caine, E. D. (2013, May). Forging an agenda for suicide prevention in the United States. American Journal of Public Health, 103(5), 822-9. https://doi.org/10.2105/AJPH.2012.301078

Carroll, D., Kearney, L. K., & Miller, M. A. (2020). Addressing Suicide in the Veteran Population: Engaging a Public Health Approach. Frontiers in Psychiatry, 11:569069. https://doi.org/10.3389/fpsyt.2020.569069

Frieden, T. R. (2014). Six components necessary for effective public health program implementation. American Journal of Public Health, 104(1), 17-22. https://doi.org/10.2105/AJPH.2013.301608

Granner, M. L., & Sharpe, P. A. (2004). Evaluating community coalition characteristics and functioning: a summary of measurement tools. Health Education Research, 19(5), 514-532. https://doi.org/10.1093/her/cyg056

Hegerl, U., Althaus, D., Schmidtke, A., & Niklewski, G. (2006). The alliance against depression: 2-year evaluation of a community-based intervention to reduce suicidality. Psychological Medicine, 36(9), 1225-1233. https://doi.org/10.1017/S003329170600780X

Isaac, M., Elias, B., Katz, L. Y., Belik, S. L., Deane, F.P., Enns, M.W., & Sareen, J. (2009). Gatekeeper training as a preventative intervention for suicide: A systematic review. The Canadian Journal of Psychiatry, 54(4), 260-268. https://doi.org/10.1177/070674370905400407

Kania, J., & Kramer, M. (2011). Collective impact. Stanford Social Innovation Review, 9(1), 36-41. https://doi.org/10.48558/5900-KN19

Knox, K. L., Pflanz, S., Talcott, G. W., Campise, R. L., Lavigne, J. E., Bajorska, A., Tu, X., & Caine, E. D. (2010). The US Air Force suicide prevention program: Implications for public health policy. American Journal of Public Health, 100(12), 2457-2463. https://doi.org/10.2105/AJPH.2009.159871

Lai, C., Law, Y. W., Shum, A. K., Ip, F. W., & Yip, P.S. (2019). A community-based response to a suicide cluster: A Hong Kong experience. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(3), 163-171. https://doi.org/10.2105/AJPH.2009.159871

Oyama, H., Watanabe, N., Ono, Y., Sakashita, T., Takenoshita, Y., Taguchi, M., Takizawa, T., Miura, R., & Kumagai, K. (2005). Community-based suicide prevention through group activity for the elderly successfully reduced the high suicide rate for females. Psychiatry and Clinical Neurosciences, 59(3), 337-44. https://doi.org/10.1111/j.1440-1819.2005.01379.x

Sarchiapone, M., Mandelli, L., Iosue, M., Andrisano, C., & Roy, A. (2011). Controlling access to suicide means. International Journal of Environmental Research and Public Health, 8(12), 4550-4562. https://doi.org/10.3390/ijerph8124550

Vriniotis, M., Barber, C., Frank, E., Demicco, R., & New Hampshire Firearm Safety Coalition (2015). A suicide prevention campaign for firearm dealers in New Hampshire. Suicide and Life-Threatening Behavior, 45(2), 157-163. https://doi.org/10.1111/sltb.12123

Walters, H., Kulkarni, M., Forman, J., Roeder, K., Travis, J., & Valenstein, M. (2012). Feasibility and acceptability of interventions to delay gun access in VA mental health settings. General Hospital Psychiatry, 34(6), 692-698. https://doi.org/10.1016/j.genhosppsych.2012.07.012

Wandersman, A., Imm, P., Chinman, M., & Kaftarian, S. (2000). Getting to outcomes: A results-based approach to accountability. Evaluation and Program Planning, 23(3), 389-95. https://doi.org/10.1016/s0149-7189(00)00028-8

Podcasts

This section includes links to recommended podcasts that are relevant to community-based interventions.

Rocky Mountain MIRECC Short Takes on Suicide Prevention

Community Partnerships for Preventing Veteran Suicide with Dr. Bryann DeBeer

Caring Contacts — Simple and Meaningful with Dr. Kate Comtois