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Learning Session 2
Day 2October 17, 2019
Welcome and Recap of Day 1
Jennifer Leonardo, PhD, MSW, LCSWChildren’s Safety Network, Director
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Technical Tips
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Call (866) 835-7973 to listen and be heard
Download resources in the File Share pod (above the slides)
Mute yourself when you’re not talking (use phone’s mute button or press *#)
This session is being recorded
Use the chat (bottom left) to ask questions at any time
This webinar is subject to the CSLC data agreement*
CSLC Cohort 1 Highlights So Far
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All Teach/All Learn
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All TeachAll Learn
Successes to Share
Questions for Peers
Quality Improvement
Questions
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Welcome and Recap of Day 1 Jennifer Leonardo, Director
Review homework highlights Erin Ficker, CSLC Co-Manager
Team Present storyboard LA Suicide and Self-Harm Prevention
Using Data Effectively Maria Katradis, CSLC Co-Manager & Data Manager
Team Present storyboard IA Poisoning Prevention
Team Present storyboard WA Motor Vehicle Traffic Safety
Closing Remarks and Next Steps Jenny Stern-Carusone, Associate Director
Day 2
Review Homework Highlights
Erin FickerCSLC Co-Manager
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Where are you in your improvement journey? Develop? Test? Implement? Spread?
Homework Reflection Questions
Homework Reflection Questions1. How did you approach using the checklist?
2. What did you learn about your project?
3. What was the most challenging part of going through the Checklist?
4. After going through the Improvement Checklist, are you in the stage ofimprovement you initially thought you were?
5. Based on what you learned, what’s next for your work on this strategy?
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Improvement Checklist
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Improvement Checklist
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Improvement Checklist
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Improvement Checklist
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Improvement Checklist
Questions?
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Please enter your questions in the chat pod
Suicide and Self-Harm PreventionStoryboard Presentation
Jane Herwehe, LADebra Perna, LARosaria Trichilo, LA
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Facilitator: Maria Katradis, SSHP Topic Lead
Louisiana: Suicide and Self Harm Prevention
Presenters:
Jane Herwehe, MPH
Debra Perna, RN
Rosaria Trichilo, MPH
Bureau of Family Health – OPH – Louisiana Dept. of Health
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Project RationaleThe Problem: • Data from multiple sources demonstrate a need for suicide prevention programs in schools and
increased focus on children’s mental and emotional health• Legislation has recognized unexpected deaths of children as a significant public health concern
warranting review and action• National Violent Death Reporting System (NVDRS)
• In 2017, we began to gather critical data on homicide, suicide and unintentional firearm fatalities using NVDRS
• NVDRS helps state and local officials understand the circumstances contributing to violent deaths by linking data from multiple sources includingo Medical Examiner, Coroner, law enforcement, toxicology, and vital statistics records
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• NVDRS data show that among children 10-14 years old:• 22% of fatal injuries are from suicide • Suicides exceed homicides
Louisiana Youth Suicide
Louisiana suicide rates have been increasing
• Especially among youth ages 15-19
Louisiana suicide rate in 2017 for youth 10-19 years old exceeded the US rate
• 7.8 vs. 7.2 per 100,0000.0
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2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Louisiana Suicide Rate Per 100,000Ages 10-19
Source: Vital Records, 2007-2017
Louisiana Youth Suicide
• Among Louisiana High School students who took the 2017 Youth Risk Behavior Survey (YRBS) ◦ 17.8% seriously considered
attempting suicide◦ 16.8% attempted suicide
• Nationally, 7.4% of US high school students reported attempting suicide
Source: Centers for Disease Control and Prevention (CDC). 1991-2017 High School Youth Risk Behavior Survey Data.Available at http://nccd.cdc.gov/youthonline/.
Suicide Mechanism
Source: Vital Records, 2007-2017
Between 2007 and 2017, 375 Louisiana youth age 10-19 died of suicide
• 56% from firearms• 35% from suffocation• 5% from self poisoning
Louisiana State Child Death Review (CDR)and Suicide Prevention Recommendations
Established in 1992, CDR aims to identify the causes of unexpected child death and methods for prevention
CDR works to:
• Strengthen/identify opportunities to build capacity in:• Suicide prevention programs for children• School-based bullying prevention programs• Support for schools in effectively implementing suicide prevention tools and, should a
death occur, support schools in responding to the loss
• Determine if anticipatory guidance in healthcare exists when providers suspect a child is suicidal
• Support follow up care efforts after emergency visits for suicide attempts
• Enforce suicide safety intervention plans as a standard of care for suicidal children
AIM Statement
Increase by a minimum of 1 the number of emergency departments in LDH Region 4 that are implementing
universal screening for suicide risk with valid screening tools among children 10-19 years old.
Project Approach
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Team Member Roles
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CoLeads
•Data Team Lead, BFH•Office of Behavioral Health Suicide
Prevention Manager•NVDRS Coordinator, BFH•Department of Education, Program
Manager•ACES Coordinator, BFH•School Based Health Team, BFH•EMS for Children Manager
Local Partners
•Suicide Prevention Coordinator, Family Tree Lafayette
•St. Martin Parish School System•Regional Medical Director, OPH•Regional MCH Coordinator, OPH•Local Emergency Department
Physician and Pediatric Director•Acadiana Area Human Services,
Director•Mortality Epidemiologist•Statewide Surveillance Manager
Team Photos
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Impact Story • Feedback from the local community has resulted in
shift in AIM• Still in the 0 minus 90 day period
• Feedback from the targeted health providers has resulted in research into practices, tools and clinical pathways
• Team participants are more familiar with the principles of CQI, but there has not been the chance to practice these just yet given progress.
• Embarking on this work has elevated the awareness of child suicide within the Bureau of Family Health Title V program and garnered increased interest in success of this collaborative.
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Louisiana Pilot Community – Region 4• Lafayette, LA has a strong foundation
• Suicide coalition organized by local stakeholders
• Evidence-based screening in select schools• Commitment from local stakeholders,
including ED healthcare personnel, to the Learning Collaborative
• Region 4 includes the parishes of Evangeline, St. Landry, Acadia, Lafayette, St. Martin, Vermilion and Iberia
• Over the past 3 years the rate of suicide for Region 4 has been increasing for children 10 through 19 years of age
• In 2017 the rate per 100,000 was 11 compared to the state’s rate of 8
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Progress: Affectionately known as our “0 minus 90-Day” AIM Statement... where we are now...
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CSLC Progress Scale
Clinical Pathways Map
• Team and local partners got together to outline the process flow when youth report suicidal ideation
From school or from home
Identified ED as a key referral location by schools and parents
Began to map possible clinical pathway for EDs to use in conjunction with universal screening
• See next slide
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Screen
Primary Care ProviderInvolvement after d/c.
Evaluate
AdmitDischarge Home
Safety Plan Post d/cCase Management
Parental Education
• Safety Planning Guide : A quick guide for clinicians. (WICHE)
• Look for other, simpler guides for ED staff to use with parents/children while in ER.
• Medicaid Case Management? (how to access, what is their role, warm handoff. Will they check in with family?
• Private insurance (BCBS and United HC) Same questions.
• Warning Signs• Hotline Info• Established safety Plan, in writing and develop
with ED staff.• School Involvement• F/U plan: appointments, case management, etc.• General Info for parents:NASP Preventing Youth Suicide, Tips for Parents and Educators
• Confirm that no consent needed.
• Have conversation with parent while in ED, let them know that you are notifying the PMD.
Screeners to consider: • ASQ (suicide)• PHQ-9 modified (suicide+depression)• C-SSRS• QPR (suicide+depression)• Add screener to EMRWho to screen?• Universal vs targeted (“red flags” )• What ages if universal screening? i.e 8/10 and older• 8/10 + pediatric psychiatric ED patients (refer to Feb 2017 Prev Sci article)
• Role of CART• Role of Hospital Social Worker• Suicide Guide to ED Evaluation and Triage Suicide. (Suicide
Prevention Lifeline)
Screen positive - Yes
Actions: Research, Resources, and Needs Assessment
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Columbia Suicide Severity Rating Scale
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Option for universal screening . . .
Process Measures
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# of schools and health care organizations that use a valid and reliable screening tool for suicide risk
Decision to switch and start with health care organizations• Still 1 school system (St. Martin Parish School Based Health Centers)
As of October 2019 - 1 Emergency Department • Clinical champion is interested in CSLC and looking forward to meeting on
approach tools
Lessons Learned Relevance of the philosophy of “Slow down to go fast .. .”
Importance of deliberate planning, stakeholder analysis, stakeholder needs assessment, and researching best approach to meet needs
Need to include the Quality Improvement professional in the CSLC improvement projects
Testing interventions in systems within which the bulk of the CSLC team has no involvement requires more time. i.e. the majority of the team is considered state or local gov’t employees and not health care providers.
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Next Steps . . . • Start our 0-90 Day clock for original 90-day aim statement!
• Sign up hospitals• Identify the screening tool• Establish clinical process• Test, Refine as needed, Spread• Maintain team momentum
• Aspirations beyond the CSLC:• Coordinated resources around screening between hospitals and
community service providers to address mental health of youth• More comprehensive surveillance system of youth at risk• Funding to be able to amplify and support this work• Zero youth suicides!
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AcknowledgmentsThank you to our Team!
Lafayette Area Champions and Partners• Dr. Tina Stefanski, Debra Perna, Dr. Scott Hamilton, Marie Collins, Brad
Farmer, Brittney Williams, Adrienne HuvalLouisiana Office of Behavioral Health:• Danita LeBlancLouisiana Department of Education:• Janice ZubeLouisiana Office of Public Health - Bureau of Family Health• Norah Friar, Jane Herwehe, Amanda Perry, Jia Benno, Rosaria Trichilo,
Caitlin LaVine, Nora McCarstle
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Additional Information and Questions
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Jane Herwehe, MPHData Team LeadLouisiana Department of Health- Office of Public Health -Bureau of Family HealthJane.herwehe@la.govwww.partnersforfamilyhealth.org504-568-3504
Danita LeBlanc, LCSW-BACSSuicide Prevention CoordinatorLouisiana Department of Health – Office of Behavioral HealthAdult, Child and Family [email protected]
Questions?
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Please enter your questions in the chat pod
Using Data Effectively
Maria Katradis, Ph.D.CSLC Co-Manager, Data Director
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Data, Data, Data: What’s the Story with All that Data?
• Data help tell us the story of where we were, where we are, and where we intend to go.
• What kinds of data do we need to tell our quality improvement story?
It depends on where we are in our story.
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Phases of Improvement
Develop• Theory
and Prediction
Test• Test under a
variety of conditions
Implement• Make part
of routine operations
Spread• Sustain
and spread to other locations
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Phases of Improvement: Collecting Data
• We may need additional types of data depending on which phase we’re in. Our stories evolve, so can our data.
• You don’t need to be an epidemiologist or researcher to collect and analyze data.
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Theory and Prediction
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Activities
•Stakeholder Analysis•Help identify senior
leadership and champions
•Environmental Scan•Program Review
•Needs Assessment•Plan-Do-Study-Act
Cycle•Identify changes to
test•Form strategic
partnerships and team
•Establish data system
•Develop and/or secure materials and equipment
•Identify and engage pilot sites with frontline workers available to test strategies
Data Collection
•Initial Stakeholder Analysis
•Surveys•Interview/
Discussion Notes•State Data Review
Culling resources that you need to put together to begin testing
Informing Next Steps
•Consider:•Areas of greatest
need•Evidence-based
and evidence-informed programs
•State support & buy-in
•Volunteers?
Data to Submit to CSLC
•Monthly Reports•Qualitative
Description•Alternate
Measures•PDSAs•90-day Aims•Operationalizing
Forms
Test under a variety of conditions
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Activities
•Sequence child safety strategies
•Test change in a variety of locations and settings•Small tests•Test in parallel•Test in
extremes•Plan-Do-Study-
Act Cycle•Evaluate cost
implications of implementing the strategy in sites
Data Collection
•Document learning and adaptations from tests
•Progress Indicators identified in PDSAs
•CSLC Measures•Ongoing
Stakeholder Analysis
Informing Next Steps
•Differences observed in settings
•Adaptations/ Changes necessary for success•Scale•Age groups•Demographics•Type of Site•Time of day, day
of week•In-person or
virtual•Materials used
Data to Submit to CSLC
•Monthly Reports•Qualitative
Description•Quantitative
Measures•Alternate
Measures•PDSAs
•Adopt, Adapt, or Abandon Change
•90-Day AimsOperationalizing Forms
Make part of routine operations
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Activities
•Establish routine operations•Develop organizational
support through policy and procedure updates
•Incorporate child safety strategies into organization’s priorities and plans
•Update job descriptions and roles
•Develop training for frontline workers and new hires
•Conduct staff training•Develop plan with sites
to leverage existing funding or pursue new funding to sustain strategies
•Plan-Do-Study-Act Cycle
Data Collection
•Progress Indicators•CSLC Measures•Ongoing Stakeholder
AnalysisCompletion and periodic reviews of the Implementation Checklist (Phases of Improvement Checklist)
Informing Next Steps
•Differences observed in settings
•Adaptations/ Changes necessary for success•Scale•Age groups•Demographics•Type of Site
Data to Submit to CSLC
•Monthly Reports•Qualitative
Description•Quantitative
Measures•Alternate Measures
•PDSAs90-Day Aims
•Operationalizing Forms•Evolving Goals
•Implementation Checklist
Activities
•Identify a spread champion
•Engage senior leadership support
•Establish the spread aim
•Establish the spread team
•Develop a Spread Plan (use Spread Planner)
•Develop a communications strategy and materials
•Establish a feedback system
•Plan-Do-Study-Act Cycle
Data Collection
Spread PlannerDevelop a communications strategyDevelop a measurement planProgress IndicatorsCSLC MeasuresOngoing Stakeholder Analysis
Informing Next Steps
•Differences observed in settings
•Adaptations/ Changes necessary for success•Scale•Age groups•Demographics•Type of Site
•Identify and work with champions
Data to Submit to CSLC
•Monthly Reports•Qualitative
Description•Quantitative
Measures•Alternate Measures•Progress Towards
Aim•PDSAs
•Adopt, Adapt, or Abandon Change
•90-Day AimsOperationalizing Forms•Evolving Goals
Sustain and spread to other locations
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Phases of Improvement
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Develop• Theory
and Prediction
Test• Test under a
variety of conditions
Implement• Make part
of routine operations
Spread• Sustain
and spread to other locations
Poisoning PreventionStoryboard Presentation
Janet Nelson, IA50
Facilitator: Maria Katradis, PP Topic Lead
Iowa/Iowa Department of Public Health, Poisoning Prevention (PP)
Janet NelsonStrategy Team Manager
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Iowa’s Poison Prevention Team
Tammy Noble, RN, BSN, CSPITeam Data Manager
Education Coordinator and Specialist in Poison Information
Iowa Poison Control Center
Amanda McCurley, MSWTeam Member
Health Facilities SurveyorIowa Department of Public Health
Michele Tilotta, MPA, BSN, RN Project Coordinator
Substance Abuse Block Grant Manager/Synar CoordinatorIowa Department of Public
Health
Toby Yak, PhD, MPHEpidemiologist
Lead EpidemiologistIowa Department of Public
Health
The Poison Prevention Team also receives guidance from the State Epidemiological Workgroup and PreventionPartnership’s Advisory Council which is made up of state and local stakeholders throughout Iowa
Calls to IPCC
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Calls to the Iowa Poison Control Center from 2009-
2018 consistently decreased for information on all
substance poisonings and animal exposures, but calls for
human exposure stayed relatively constant.
Chart data provided to IDPH from Iowa Poison Control Center Opioid & Stimulant Stats 02.06.2019
Calls to Iowa Poison Control Center
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0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Total Calls to IPCC (All Substances)
Total calls Info Animal Exposure Exposure (Human)
Chart data provided to IDPH from Iowa Poison Control Center Opioid & Stimulant Stats 02.06.2019
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Charts and data from Iowa Poison Control Center Highlights – FY 2018
Where Poisonings Occur
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Chart and data from Iowa Poison Control Center Highlights – FY 2018
CSLC Strategy and Goals
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Strategy: • Implement and spread education (e.g., anticipatory guidance, written
materials, videos) on the services provided by poison control centers.
Measure: • Number of individuals receiving education
Goal 1)• By May 30, increase the distribution of Iowa Poison Control Center
materials by identifying gaps and establishing contacts with four new partners.
Goal 2) • By September 1, increase the distribution of Iowa Poison Control Center
materials by identifying at least one additional gap.
Poisoning Prevention Logic Model
Identify Information
Distribution Gap
Provide Poison Prevention Materials
Poisoning Numbers Decrease
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Gap Audience Identified
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Women, Infant’s and Children Program• 20 Agencies • Serving 99 Counties
Mission• To safeguard the health of low-income women, infants, and children up to age 5
who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.
Measure • Number of individuals receiving Iowa Poison Control Center education
Iowa Poison Control Center Report• IPCC Education Coordinator monitors and distributes materials• Numbers reached with speaking engagements• Monthly distribution report
Monthly Distribution Report Summary
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Chart from CSN CSLC Site
Impact & Lessons Learned with CSLC PP• Increased connections
• Snowball effect
• PDSA cycle• First timer
• Operationalize according to other’s time and resources• Be flexible
• Commitment from Stakeholders• People are busy
• Expand time to implement plan• Everything takes longer
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Next Steps• New 90-Day Aim Statement
• Identify additional stakeholders and distribution gaps
• Next Steps to Sustain Gains• Increase IPCC material distribution to all IDPH Prevention events
• Promote it in other departments throughout IDPH
• Add to YourLifeIowa.org resources
• Aspirations beyond the CSLC• Continue to assist with state poison prevention strategies
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Questions?
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Please enter your questions in the Q & A pod
Motor Vehicle Traffic SafetyStoryboard Presentation
Will Hitchcock, WA
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Facilitator: Jenny Stern-Carusone, MVTS Topic Lead
Washington State Motor Vehicle Injury Prevention
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What’s at StakeMotor Vehicle injuries continue to be one of the leading cause of unintentional injuries in the state of Washington.• Our Aim: To achieve Target Zero for zero traffic fatalities by 2030. By
April 2023, reduce annual traffic fatalities for ages 0-19 by 7.7% annually from 51 in 2017 to 31 in 2022.
• Our goals:• Implement and Spread CPS education to parents/caregivers
measured by number of inspections available to communities.• Maintain training and certifications given limited resources.• Implement and spread evidence based teen driver safety
programs to teens across the state using Impact Teen Driver curriculum
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Theory of Change Diagram
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Aim: Reduce annual traffic fatalities for ages 0-19 by 39% from 51 to 31 between 2017 to 2022.*
Implement and Spread teen driver safety programs
Track number of technicians
Track and follow-up with community members receiving TOT for ITD
Support and track number of ITD courses held and number of teens participating
CPSTsTarget Zero ManagersSafe Kids Coalitions
WTSC Safe Kids Worldwide
WTSCSafe Kids Impact Teen Driver OrgSchoolsParentsTeensCommunity Members
Track number of inspection stations.
*aligns with Target Zero goals related to the 0-19 age group proportion
Improve Driver attitudes and norms around safe driving culture
CPST training to maintain and enhance skills of certified techs and educate community
Track # of CPS Courses
Track renewal rate.
Our Ruler• New restraint law in effect Jan 1,
2020 – will shift focus to outreaching to daycare centers, birthing hospitals, etc. to increase education.
• Expectation is that by properly educating pediatricians, birthing hospitals, daycare settings on CPS, they will convey this information to parents/caregivers.
• Measures will include number of trainings provided outside CPST events to transporters. And number of orders for materials.
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Strategy 1: Implement and spread child passenger safety education to parents/caregivers(e.g. how to correctly install child safety seats, buckle harness, etc.)
Strategy 3: Train and certify child passenger safety technicians in counties throughout the state or jurisdiction
• WA currently has 480 CPSTs providing education to communities with effective outcomes in reducing CP serious injuries and deaths
• Seeking to maintain this number to address attrition and manage within budget constraints
• Measures will include number of CPSTs with active certification, recertification rate, inspections stations, certification courses.
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Our Ruler
Strategy 5: Implement and spread evidence-based teen driver safety programs to teens throughout the state
• Piloted external supplemental teen driver education with Safe Kids Chelan-Douglas implementing Teens in Cars in 2018-19.
• Partnering with the Impact Teen Drivers organization to conduct a landscape assessment across the state to determine who has been trained in curriculum and create a map of areas to target for implementation based on available trained trainers as well areas needing 'train the trainer' sessions to spread Impact Teen Drivers state wide.
• Measures will include 1# of Impact Teen Drivers courses across the state; 2number of participants per community population; 3number of ITD courses implemented within 90 days of training completion
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Our Ruler
Our Team• Will Hitchcock • Cesi Velez
• Xinyao deGrauw• Danielle King • Amanda Niedosmialek• Ginny Heller• Kannessa Thompson• Shawneri Guzman• Kathleen Clary-Cooke
• Katharine Flug
• WaDOH-IVP; Safe Kids Washington – Facilitator• WTSC–Child Passenger Safety Target Zero
Manager - Co-Lead• WaDOH – Injury Epidemiologist• Child Care Action Council – Safe Kids Thurston• Whitman Co. Health District – Injury prevention• Seattle Children’s Hospital• AMR – Safe Kids Clark• Snohomish Co Fire – Safe Kids Snohomish• Benton-Franklin Health District – Safe Kids
Benton-Franklin• WaDOH - IVP
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Where Are We Now?• Materials for distribution of new law are in development• Identifying key stakeholder organizations that can reach local community
agencies• CPST trainings are being scheduled • Planning and preparation phase for teen driving program
• Meeting with WTSC Youth Driver Manager and Impact Teen Driver organization for planning
• Contacting partners to develop plan for data collection in all strategies• Identifying base line numbers – Who is trained • Slow moving forward due to unforeseen scheduling conflicts resulting in
some canceled meetings.
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Where Are We Going Next?• Facilitate and record distribution of new materials
• Track CPST trainings and certifications and report
• Implement Impact Teen Driver Support program to assist trained trainers to connect with School Districts and help organize event through Safe Kids Coalitions and Target Zero Managers and their coalitions
• Establish PDSAs for each strategy to assist in moving forward
• Work on establishing group connectedness – to help team see themselves as a unit rather than different pieces of the work or solution
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Questions?
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Please enter your questions in the chat pod
Closing and Next Steps
Jenny Stern-Carusone, MSWChildren’s Safety Network, Associate Director
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Where We Are
Learning Session 1February 2019
Learning Session 2October 2019
Learning Session 3 April 2020
Launch Cohort 2
Cohort 1 November 2018 through April 2020
Where We Are Going
Cohort 2 April 2020 through October 2021
Cohort 3 October 2021 through April 2023
Applications for new teams will be posted on the CSN website in January 2020. We encourage current states to share this information with peers who might want to launch a new strategy team/new topic for your state.
Current teams are encouraged to continue into the next cohort. We will have a simple ‘confirmation form’ for those teams to complete towards the end of Cohort 1.
Upcoming Topic Calls and Deliverables
• November 5: Monthly Reports Due
• November topic calls:• Poisoning Prevention: Tuesday, November 12th, 1-2 pm ET• Bullying Prevention: Thursday, November 14th, 4-5 pm ET • Suicide and Self-Harm Prevention: Friday, November 8th, 1-2 pm ET• Motor Vehicle Traffic Safety: Tuesday, November 19th, 1-2 pm ET• SUID Prevention: Thursday, November 21st, 1-2 pm ET
• Ongoing: Submit/Update PDSAs and 90-Aim documents• Upload completed homework under the Submit Spread Documents
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What Will You Do By “Next Tuesday”
This Photo by Unknown Author is licensed under CC BY
Thank you!
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Visit our website:www.ChildrensSafetyNetwork.org
Please fill out our evaluation.
To request technical assistance, please fill out our TA Request Form.
Funding SponsorThis project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under the Child and Adolescent Injury and Violence Prevention Resource Centers Cooperative Agreement (U49MC28422) for $5,000,000 with 0 percent financed with non-governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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