Community Interventions to Prevent Veteran Suicide The Role of Social Determinants: Proceedings of a Virtual Symposium (2022) / Chapter Skim
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5 Community Interventions for Suicide Prevention and Support for Veterans
5 Community Interventions for Suicide Prevention and Support for Veterans
Pages 39-50
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From page 39... ...
, who reported on prevention efforts in Arizona. Joseph Simonetti (VA Rocky Mountain Mental Illness Research, Educa tion, and Clinical Center [MIRECC]
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From page 40... ...
Winkel described the program as a "team of teams," including partnerships across systems and sectors, and involving a host of participants: people who answer the support line phones, care navigators, career navigators, community outreach navigators, people fostering community engagement, and the risk reduction operations team. Be Connected grew out of an earlier program run by the ACMF, Be Resilient.
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From page 41... ...
Winkel noted that the ACMF has worked with the Service Members, Veterans, and their Families Technical Assistance Center for more than a decade, providing technical assistance to every other state and territory nationally during that time. Winkel also described Be Connected as rooted in a public health approach that integrates "crisis response, treatment, and proactive prevention." She commented that this also means "not using the exact same approach for every service member, veteran, and family member" but instead adopting "an upstream prevention model" that has a "layered approach of universal, selective, and indicated efforts" and seeks to pro vide support before a situation becomes urgent.
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From page 42... ...
"If you know who the segments are, how do you then translate that into a functional program or approach? " Winkel noted that Be Connected has taken a proactive approach that involves identifying high-risk groups, developing and implementing targeted programs, collecting data and evaluating outcomes, and iterating in ways that are responsive to that data and "lessons learned." One example of this that Winkel pointed to a project run with the State Department of Veterans' Services where that agency proactively refers veterans with a known or potential disability directly to the Be Connected team, which then connects them to resources needed for issues outside their disability claim.
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From page 43... ...
Providing firearm storage options for at-risk veterans is another area where community-based programs might have more success than clinical practice settings, said Simonetti. Temporarily storing firearms outside of the home can protect at-risk veterans and others, he noted, and reported that clinical practice data as well as "preliminary data from national studies" show that "veterans do in fact hold on to firearms for other individuals at risk or store their own firearms out of their homes when they are going through really hard times." Simonetti pointed to the Armory Project, a Louisiana-based coalition of firearm retailers and VA researchers who offer firearm storage options to at-risk veterans.
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From page 44... ...
Simonetti pointed to public service announcements as one intervention strategy that can reduce the stigma around "making changes to one's firearm access" as a way of protecting oneself or others; he commented that while such messaging may not be obviously community based, it plays a key role in normalizing conversation about the link firearms and suicide risk at both national and community level. He noted that such prevention efforts have been focused on increasing awareness about this link; one opportunity for development is community-driven efforts that focus on "the other side of the equation," that is, "helping at-risk persons navigate their concerns about victimization risk and whether or not they truly need to maintain firearm access in these situations," said Simonetti.
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From page 45... ...
• Show that there was evidence from at least one rigorous evaluation showing preventative effects on suicide or significant impact on risk or protective factors for suicide. Houry emphasized that this range is in response to the fact that suicide itself is not caused by a single factor, "and therefore will not be prevented by any single intervention." The technical package gathers "prevention strategies and approaches that address the range of suicide risk and protective factors at the individual, relationship, community, and societal levels." She said, "preventing suicide requires strategies at all levels of society." Houry also noted, "by building on community strengths and focusing not just on treatment but on this coordinated approach to prevention, we can meet the immediate needs of those already affected today while preventing future risks."
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From page 46... ...
Such changes might include reducing access to lethal means, including focused intervention at suicide hotspots; implementing policies aimed at reducing excessive alcohol use; and implementing organizational policies and values such as the promotion of seeking health care, changing social norms, and bringing awareness to helping services. As an example of the latter, Houry pointed to the U.S.
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From page 47... ...
Another domain is parenting skills; Houry noted that The Incredible Years is an example of a training program for parents, teachers, and children1 that has been shown to "decrease risk factors from suicide such as substance abuse and to increase protective factors, including emotion regulation and social competence." One aspect of the strategy of identifying and supporting people at risk for suicide is "gatekeeper training," where teachers, coaches, primary care providers, and other community members learn to identify and effectively respond to people who may be at risk of suicide, said Houry. Her example here is the Applied Suicide Intervention Skills Training, which "helps counselors, emergency workers, and others to identify and connect with individuals at risk for suicide and assist with linking individuals to resources." Evaluations have shown a reduction in suicide attempts in counties implementing gatekeeper training.
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From page 48... ...
He pointed to data showing that a difference in how clinicians and firearm owners define or think about "what firearm safety really is." He noted that there are some trainings around "cultural competence in firearm injury prevention;" he also urged talking with members of the community -- "whether that is veteran engagement at a local facility [or] walking into a firearm retail store and having a conversation with somebody" -- as a way of developing a shared language.
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From page 49... ...
Brenner, the panel moderator, posed the question of how best to implement the strategies and approaches discussed in the technical package and tool kits from various programs discussed by Houry and Winkel. Winkel commented on the essential nature of community groups partnering with programs and agencies that can provide technical assistance, helping to "translate information and intent into a plan" and building in evaluation of outcomes, as well.
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