Internship Activities, Methods, & Outcomes

Activities

Intervention activities that were used to address the goals and objectives of creating a successful and sustainable program to support suicide loss survivors included a Community Action Plan (Appendix I), a Roadmap and Guide for Stakeholders on how to most successfully use the Community Action Plan (Appendix II, Appendix III), a Suicide Loss Survey ( Appendix IV) to determine social determinant needs of survivors, awareness and education for mental health care workers on the different support needed for suicide loss (Appendix V) , the compilation of suicide postvention training data and qualitative data within the community of stakeholders to determine the best course of action for suicide postvention (AppendixVIIII), research and comparison of other successful and sustainable models in Oregon, Washington, Alaska and internationally to gain insight into best practices (Appendix IX), researching and interviewing the vulnerable populations of race, culture, mental illness, and LGBTQ populations to determine how to address the needs of vulnerable suicide loss survivors (Appendix X), educating the workforce and business owners on the value of a workplace action plan for postvention (Appendix XI), and a success checklist for the suicide postvention coalition (Appendix XII).

Meetings with NAMI board members, executive director, and program director provided knowledge and understanding of the Western Slope NAMI organization and the needs and capacities of the service population struggling with mental illness, their caregivers, and suicide loss survivors.

Field study and observation of the Mesa County community coupled with the Mesa County Public Health Community Impact Reports of the past five years, created further awareness of the needs and capacities of the target population.

Phone, virtual, and in-person interviews of stakeholders including first responders, public health professionals, mental health providers, educators, vulnerable populations, clergy, spiritual leaders, community residents provided a deeper knowledge and understanding of the needs for a community action plan for suicide postvention.

Learning from the field of the Suicide Loss Coordinator, Kari Sewell, coupled with discussions on evidence-based models and programs, helped form a custom action plan for support and healing for Mesa County suicide loss survivors.

Through research of current and historical practices locally, nationally, and internationally; evidence-based programs were examined, and significant capacities and gaps were identified. The data collected from surveys and interviews were compiled to identify significant capacities and needs within the community. The Mesa County community assessment data and conclusions were beneficial in creating a community plan.

The examination of the Mesa County workforce and business revealed the absence of a postvention program and lack of employee assistance programs (EAPs) including suicide prevention programs; the need to develop this socioecological level of the community action plan became apparent. The evidence of other national and international communities, the Association for Suicidology, and the Association for Workforce Suicide Prevention support the importance of workforce postvention for workforce and economic stability within a community. Awareness and education within the workforce community would be beneficial.

Methods

The products were developed by researching suicide postvention models and successes coupled with qualitative methods of phenomena - using a community-based approach to interview stakeholders, gatekeepers, and community members regarding the capacities and needs of the suicide loss survivors individually and corporately. The Suicide Loss Coordinator, housed in the Coroner’s office, Kari Sewell partnered with me to combine academic research and community.-specific experience to direct the development of the framework.

The Community Action Plan, Roadmap, Guide, and the Suicide Loss Survey have been implemented and are being effectively used to guide resource management for supporting the suicide loss survivor. As quantitative and qualitative data is collected and analyzed, the action plan and resource management will have the potential to improve support and recovery of the suicide loss survivor through necessary adjustments. The framework has provided a simplification and clarity of the resources and resource management needed to best manage and restore after a suicide survivor crisis. The action plan addresses which stakeholders are needed, the needed roles and responsibilities, the needed supplies and services, and the chain and unity of command for suicide postvention to be successful and sustainable.

Early on in the research of this project, it was evident that suicide creates a crisis in a community that can be addressed as a community crisis through FEMA’s National Incidence Preparedness Plan (FEMA, 2021), and this systems approach was applied to creating the community action plan.

The cultural needs of the vulnerable populations in the area were researched through mixed methods of quantitative data and then qualitative data to provide more understanding. Developing the community action plan included examining capacities and gaps in learning styles, a viable timeline, and developing the structure for a summative and formative evaluation plan.

The need for suicide postvention is evident. Suicide survivors experience three phases of grief and recovery. Support and resources in a community postvention program ensures greater success, sustainability, and return to health and wellness of an individual and collectively as part of the community. The increased social and economic capacity from such a program cannot be dismissed. Further data collection and study could reveal evidence-based data.

A community-based approach incorporated with postvention and suicide prevention is recognized as significant and includes the addition of volunteers to support the current suicide postvention crisis director which will. Loss survivors will also have an increased availability and accessibility to support survivors and support prevention through adequate follow-up for up to two years. Increasing the resource of community-based personnel, increases the opportunity for complete and sustainable recovery that will benefit the community. The grieving and recovery process for loss survivors is significantly different from other loss and takes a different approach for healing and sustainability (Jordan, 2020), and communities need a long-term plan for sustainable restoration of the loss survivors and their community (Fiegelmann et al., 2008; Kominsky et al., 2016; Jordan, 2008; Jordan, 2009; Jordan 2020). The community-based approach involving stakeholders, gatekeepers, loss survivors, and the social cohesion of volunteerism has the potential to best support a successful and sustainable postvention program..

Evidence-based models of postvention nationally and internationally provide valuable strategy and materials. Oregon, Washington, and Alaska are national examples of successful and sustainable postvention programs. The U.S. military has created evidence-based toolkits that can be successfully applied to the workforce and community. Internationally, the United Kingdom and Australia have developed and implemented evidence-based models of postvention based on the World Health Organization recommendations. As Adriessan et al. (2019) report in their systematic review of postvention models, there is a need for national and international collaboration as programs are operating and adapting, to provide quality models and mentorship for other developing postvention programs.

Outcomes

A significant outcome of developing a community action plan at the organizational level is the awareness of the need to provide education for the workforce and businesses on the necessity of incorporating a prevention and postvention plan. As a result of building a community plan, there is awareness of each level of the socioecological model from intrapersonal, interpersonal, organizational, community, and policy levels and for more population specific plans to operate under the overarching Mesa County Community Action Plan.

Relevant to the vulnerable populations of Mesa County community, it is significant to provide awareness of the social determinants of health and the association of practical needs beyond grief counseling. The outcome of this internship has revealed the heart of this community, the passion of the stakeholders, and the awareness of the key factor of meeting social determinant needs. The struggles of the youth, Hispanic, those with mental illness, and the LGBTQ populations in Mesa County, need to be included as key factors in a community action plan to adequately address the evidence-based vulnerability and needs that stem beyond grief. The Suicide Prevention Resource Center provides excellent toolkits for ethnic, race, mental illness, and LGBTQ populations (Suicide Prevention Resource Center (SPRC), 2021). NAMI has great programs in place like Ending the Silence and Curing the Stigma to address awareness and education regarding mental illness and suicide prevention. Cultural and spiritual beliefs, values, and behaviors are a key factor in communicating and supporting a suicide loss survivor especially in vulnerable populations (SPRC, 2021). Evidence-based inclusion of the socioecological model and attention to socioeconomic needs is a key factor in comprehensively providing support and prevention.