The Zero Suicide Initiative (ZSI) is a key concept of the National Strategy for Suicide Prevention and is a priority of the National Action Alliance for Suicide Prevention (https://theactionalliance.org/?). In fiscal year (FY) 2022, the IHS awarded eight grants to Tribes, Tribal organizations, and Urban Indian organizations to combat the suicide public health crisis in Indian Country. This program aims to improve the system of care for those at risk for suicide by implementing a comprehensive, culturally informed, multi-setting approach to suicide prevention in Indian health systems.
In FY 2023, the IHS intends to fund ten health care facilities and systems sites operated by the IHS that will solely focus on the implementation of only one out of the seven Zero Suicide model elements. The element entitled Improve” focuses on applying a data-driven, quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk. Health care facilities and systems, operated by the IHS, that provide direct care services to AI/AN patients to raise awareness of suicide, establish an integrated system of care, and improve outcomes for such individuals in FY 2023 to FY 2028.
The purpose of this cooperative agreement is to improve the system of care for those at risk for suicide by implementing a comprehensive, culturally informed, multi-setting approach to suicide prevention in Indian health systems. This award represents a continuation of IHS's efforts to implement the Zero Suicide approach in Indian Country. Existing efforts have focused on training, technical assistance, and consultation for several `pilot' AI/AN Zero Suicide communities. As a result of these efforts, both the unique opportunities and challenges of implementing Zero Suicide in Indian Country have been identified. To best capitalize on opportunities and surmount such challenges, this award focuses on the core Seven Elements of the Zero Suicide model as developed by the Suicide Prevention Resource Center (SPRC):
- Lead—Create a leadership-driven, safety-oriented culture committed to dramatically reducing suicide among people under care. Include survivors of suicide attempts and suicide loss in leadership and planning roles;
- Train—Develop a competent, confident, and caring workforce;
- Identify—Systematically identify and assess suicide risk among people receiving care;
- Engage—Ensure every individual has a pathway to care that is both timely and adequate to meet his or her needs. Include collaborative safety planning and restriction of lethal means;
- Treat—Use effective, evidence-based treatments that directly target suicidal thoughts and behaviors;
- Transition—Provide continuous contact and support, especially after acute care; and
- Improve—Apply a data-driven, quality improvement approach to inform system changes that will lead to improved patient outcomes and better care for those at risk.
Required Activities:
The ZSICC award funds must be used primarily to provide training and technical assistance to all ZSI projects in the implementation of the ZSI model and support projects in meeting data collection, program evaluation and reporting requirements. The awardee will be required to:
- Establish staffing with expertise to implement and complete required activities.
- Review all ZSI projects applications and proposed work plans for implementing the ZSI model and provide a brief project summary report.
- All training materials produced should be 508 compliant and culturally informed in the prevention of suicide in Indian health systems.
- Coordinate all the logistics including securing a web platform, development of materials, agenda, meeting summaries, and PowerPoints for teleconferences and trainings.
- Provide an accessible web portal for all ZSI projects to access the ZSICC's materials.
- Provide a web portal to share information and resources in compliance with Information Technology (IT) policies and prepare all materials to be transferred back to the IHS at the end of the period of performance.
- Coordinate logistics as mentioned above and identify Subject Matter Experts for seven webinars focused on each of the seven ZSI model elements using the IHS Tele-Behavioral Health Center of Excellence (TBHCE) web platform.
- Coordinate logistics as mentioned above and participate in virtual or face-to-face site visits with ZSI Projects (not exceed three per period of performance) with program official. After each site visit, a report will be generated by the ZSICC.
- Coordinate logistics as mentioned above and participate in web conferences with the program official to report on the status of technical assistance activities.
- Communicate four times each budget year with key stakeholders such as the Substance Abuse and Mental Health Services Administration's (SAMHSA) SPRC and other identified organizations to best meet the suicide prevention needs of Tribal communities with a focus on policy and resource development and on issues related to suicide prevention in AI/AN communities.
- Submit one annual summary report of technical assistance activities provided to ZSI projects completed each budget period. This will be submitted directly to the assigned program official as a Grant Note in Grant Solutions. The ZSICC should submit a draft template for approval at least 30 days prior to submission. The template is subject to change at the request of the program official.
- Ensure the technical assistance strategies address the needs of AI/AN people at risk for suicide, older adults, veterans, the LGBTQIA+ community, and individuals with serious mental illness.
- Execute succession planning and transfer all deliverables to IHS program official at the end of the period of performance.
- Develop a National Evaluation Plan for the ZSI projects within 60 days of receiving funding:
- Coordinate a cross-site evaluation with the ZSI projects to cover their existing activities and data;
- Provide a Health Insurance Portability and Accountability Act compliant, online data collection instrument to collect and organize a quantitative and qualitative data set for each ZSI project that combines the data entered into one database at the end of each budget year. Data elements will be developed in consultation with the National Data Coordinator of the Division of Behavioral Health, IHS. At a minimum, the data elements will include the clinical pathway (series of actions) taken by the staff in order to prepare for and respond to a patient at risk for suicidal ideation, suicide attempt, or death by suicide and the outcomes of those actions. Awardee will complete the following, within 60 days of receiving the complete data set outlined in the Data Collection and Reporting section of this announcement;
- Complete an Evaluation Report within 30 days of the end of each budget year; and
- Create standard tables, slides, and talking points from the Evaluation Report within 30 days of the end of each budget year.
Pre-Conference Grant Requirements
The awardee is required to comply with the HHS Policy on Promoting Efficient Spending: Use of Appropriated Funds for Conferences and Meeting Space, Food, Promotional Items, and Printing and Publications,” dated January 23, 2015 (Policy), as applicable to conferences funded by grants and cooperative agreements. The Policy is available at https://www.hhs.gov/?grants/?contracts/?contract-policies-regulations/?efficient-spending/?index.html??language=?es.
Approximately $2,000,000 was funded from November 1, 2017, to October 31, 2020.
Applicants are encouraged to view the list of funded sites https://www.ihs.gov/?sites/?zerosuicide/?themes/?responsive2017/?display_?objects/?documents/?ZSIAwards20222027.pdf and are encouraged to visit https://www.hhs.gov/?surgeongeneral/?reports-and-publications/?suicide-prevention/?index.html to access a copy of the 2012 National Strategy.
Because relatively few resources currently exists that promote the use of culturally informed practices and activities for use with Evidence Based Practices (EBPs) in the treatment of suicide risk, applicants are also encouraged to explore, develop, and catalogue culturally informed practices and activities, and, utilize such activities and practices in conjunction with EBPs where appropriate. Applicants are expected to include how they plan to incorporate the use of culturally informed practices and activities in the Project Narrative.
The purchase of food (i.e., as supplies, for meetings or events, etc.) is not an allowable cost with this grant funding and should not be included in the budget/budget justification.