Background: Veterans are at 21% greater risk for suicide than non-veterans and of those that died by suicide, 14 out of 20 veterans had not previously sought care from a Veterans Affairs (VA) facility. Arizona ranks among the highest states in veteran suicide rates in the United States. In a statewide needs assessment, 41% of veterans reported experiencing suicidal ideations and 1 in 3 veterans and family members do not know of at least one number to call for help in a time of crisis.

Description: In 2017, the Be Connected program was established and includes a 24/7 support line, an online and in-person resource navigation, and training for service members, veterans, family members, providers, and helpers across Arizona.

Lessons learned: Be Connected has experienced tremendous and consistent increases in utilization since its inception. In total, the program has fielded over 8,000 support line calls, provided resource navigation to over 5,000 individuals, and trained 4,000 military and veteran resource navigators. Analysis of support line data shows that 44% of calls were related to housing, employment, or financial concerns, while only 6% of calls were specifically requesting mental health services.

Recommendations: Be Connected is often described as a suicide program that’s not focused only on suicide. The unique component of the Be Connected program, the upstream intervention model, focuses on providing resources across all social determinants of health before an individual reaches the point of a mental health crisis. This unparalleled, cross-sector effort attempts to leverage the resources and strengths of national, state, and community-based agencies to provide the right services at the right time. The Be Connected program model is an exemplar for delivering high-value, patient-centered care and working towards health equity for the American military community. Next steps include expanding current program evaluation of Be Connected and continuing ongoing efforts to share best practices and scale up the upstream intervention model across the United States. In addition to downstream crisis-oriented strategies, new efforts should consider using an upstream community-based approach to address the mental health disparity experienced by veterans.

Man-made and natural disasters produce substantial health effects on communities, including exacerbation of pre-existing illnesses, exposure to toxins, injury, interrupted care for chronic illnesses, and threats to mental health. With the accelerating instability of the climate, it is increasingly important to address the effects of climate change-associated disasters on population health, particularly under-recognized and potentially disabling mental health conditions such as depression, anxiety, and post-traumatic stress disorder. Mental health after disaster is further impacted as well by climate change-affected social risk factors for health such as financial and housing insecurities, education, and social support systems in communities. Effective and evidence-based community- and individual-level strategies to bolster resilience are increasingly necessary to mitigate both these health effects and to address concomitant social risk factors for health in communities recurrently affected by climate change-associated disasters.

The Community Resilience Learning Collaborative and Research Network (C-LEARN) is a multi-phase study in South Louisiana that uses a Community Partnered Participatory Research (CPPR) approach to examine opportunities to improve resilience on a community and individual level. C-LEARN tests the impacts of coalitions, technical assistance, and individual technologies to address mental health risks, social risk factors for health, as well as disaster preparedness and recovery. Phase I of C-LEARN engaged leaders and residents of communities in South Louisiana through key informant interviews to identify both local priorities for enhancing community resilience and community assets for community-level interventions in Phase II.

We interviewed individuals representing 47 community-based organizations and through a directed content analysis, identified key community priorities for fostering resilience, including forging relationships and building trust through longitudinal development and investment cross-sector coalitions before disaster strikes among agencies and community members, including non-profit service providers, Faith-Based Organizations (FBOs), academic institutions, hospitals, police and first responders, public health service providers, neighborhood associations, and other government agencies.

We will highlight the results of interviews as well as ongoing community and individual-level interventions studies in C-LEARN’s Phase II multi-level, randomized, controlled trial. Initial results encourage developing and testing evidence-based models to foster community and individual resilience in communities at risk of disasters secondary to climate-change.

Background: Latina immigrant women are particularly vulnerable to depression and anxiety due to the social, political and economic stressors that shape their lives in the United States. Amigas Latinas Motivando el Alma (ALMA) is a community-based, multi-level intervention to improve Latina immigrants’ mental health outcomes by reducing their stress, depression, and anxiety symptoms. Description: The 8-week ALMA intervention was developed based on evidence-based strategies and community input. The ALMA intervention focused on: (1) identifying positive coping strategies currently used to manage stress; (2) introducing new coping strategies (e.g. mindfulness techniques, body awareness, and importance of increased social support); and, (3) providing resources for additional mental health support if needed. The intervention is currently being implemented and tested in an intervention trial (N = 200). We present lessons learned in developing and implementing the program. Lessons Learned: 1) Partnering with local community agencies to deliver the program serves as an effective mental health pathway. While the ALMA intervention promotes mental health, and there is interest and receptivity to increased mental health services, this population is reticent to use and/or unfamiliar with mental health services due to historically limited access to mental health prevention and treatment programs; 2) Although very few interventions utilizing mind-body approaches have been developed or tested in this population, Latina immigrant women appear to be receptive to a mindfulness-based approach for facilitating self-care and improving health; 3) The ALMA intervention aims to help Latina immigrant women develop and utilize coping strategies for reducing depression and anxiety while also enhancing social ties and increasing social support. 4) Approaches that promote mind/body awareness can help Latina immigrant women understand connections between their thoughts, emotions and physical symptoms, which is important given that many Latinas report somatic symptoms of depression and anxiety. Recommendations: Given the current social and political climate and the growth of the Latina immigrant population in the United States, identifying interventions that reduce mental health disparities in this population can have a significant public health impact. ALMA addresses this gap, while also contributing to research on depression and anxiety among Latina immigrants.

Suicide is preventable but remains a major public health challenge across the country. Age-adjusted suicide rates increased 33 percent – from 10.5 per 100,000 Americans in 1999 to 14.0 per 100,000 Americans in 2017. Not only are rates rising, increasing rates are also accelerating from one percent every year from 1999 to 2006 to two percent every year from 2006 to 2017. In addition to devastating human costs, suicidal behavior costs $58.4 billion - $93.5 billion if adjusted for the well-documented under-reporting of suicidal behavior- in lost productivity and medical costs. Despite the disease burden, suicide prevention efforts often are uncoordinated, underfunded, and gravely misunderstood.

In early 2018, California’s Mental Health Services Oversight and Accountability Commission launched an effort to develop a suicide prevention strategic plan for the state. The Commission spent months consulting national and local experts, reviewing research and data, and convening public hearings and forums where community members, policy leaders, and people with lived experience provided guidance and insights.

The plan is a mix of public health approaches and behavioral health interventions, guided by evidence-based and community-defined practices, and framed by four strategic goals. The first is to establish suicide prevention infrastructure. This includes visible leadership, effective management of resources and performance monitoring, shared ownership of programs, and networked partnerships. The second strategic goal is to promote universal strategies to both minimize suicide risk and increase factors that can protect people from such risk. The third strategic goal is to increase the identification of people at risk and improve the connection of vulnerable people to appropriate services. The final strategic goal for California is to advance indicated prevention strategies to target people at high risk for suicide.

What resulted from this effort is an achievable policy agenda and a foundation for suicide prevention based on best practices in a state as complex and diverse as California. Recommendations include establishing visible leadership and required planning, expansion of evaluation and research innovation, aligning resources to target multiple forms of violence and trauma and increase resiliency, and advancements in health care and behavioral health care specific to suicide.

Suicide was the tenth leading cause of death in the United States in 2017, and mortality rates have been rising nationally, from 10.9 deaths/100,000 in 2005 to 14.0 in 2017. Death by suicide leaves a devastating ripple affect among survivors. It is estimated that 7% (22 million people) of the US population is exposed to a death by suicide in one year, and that 50% of the U.S. population has known someone who died by suicide. Risk of death by suicide increases at least two to three times across all kinship categories. Most suicide survivors do not seek out formal or informal support or mental health treatment. In one study, only about 25% of next-of-kin survivors reported receiving any help since the death, despite 74% indicating a desire for help. The Philadelphia Suicide Prevention Task Force conducted a Resource Mapping project and identified that little to no support exists in the city for survivors of suicide loss. The Task Force then implemented a community-based, peer-led support group for survivors of suicide loss. We will present relevant data to support the need for resources and support of survivors of suicide loss. We will demonstrate the importance of peer support among this population, as well as the importance of a specialized group for suicide loss through qualitative data collected in our group. We will also discuss implementation challenges and strategies to scale-up the effort in Philadelphia County.

Suicide is a complex and preventable public health issue that affects millions of Americans each year. Over the past nearly two decades, while the global suicide rate has declined, the U.S. suicide rate has increased by approximately 33%, contributing to an overall decline in U.S. life expectancy.

Suicide has no single cause and is affected by risk factors at the individual, relationship, community, and societal levels. While suicide is preventable, there is no single solution. Suicide prevention requires a coordinated, comprehensive national response that engages every sector of society to do its part.

The National Action Alliance for Suicide Prevention is the nation’s public-private partnership for suicide prevention that is charged with coordinating a comprehensive national response to suicide. The Action Alliance focuses on:

• Engaging partners to improve suicide care in health systems.
• Leveraging the news, entertainment industry, and other messengers to promote safe and hopeful messaging around suicide.
• Advancing effective strategies in communities, focusing on faith communities, workplaces, and reducing access to lethal means among those at risk for suicide.

Three examples of partnership-engaged suicide prevention will be shared: Development of the Action Alliance’s Zero Suicide model and recommended standards for suicide care; formation of a task force aimed at reducing access to lethal means among those at risk for suicide; and the Action Alliance Faith.Hope.Life. Campaign to engage faith leaders in suicide prevention.

Lessons learned include: achieving consensus takes time and compromise, and a common language; nontraditional partners (e.g., faith leaders, entertainment industry) increase the likelihood for collective impact; strong facilitation, communication, and coordination are key to maintaining a shared vision; working with such a diverse group of partners requires nimbleness, a willingness to take risks, and openness to innovation; and actively including the perspectives of affected populations in leadership, decision-making, strategy development, and messaging is essential.

Suicide prevention – whether at the national, state, or local level – requires a collective, cross-sector approach that involves both traditional and non-traditional partners. The Action Alliance encourages partnerships and strategies that accelerate systems changes that will ultimately reduce the burden of suicide across the country.

Psychological trauma, especially the trauma associated with adverse childhood experiences (ACEs), has been at the center of many recent national, state, and local conversations in public health. Research has demonstrated many negative effects trauma, such as ACEs, can have on short and long-term health outcomes in children, families, and communities. In Illinois, the Trauma Fee Illinois Initiative was developed by the Illinois Public Health Association (IPHA) to assist local health departments in becoming trauma-informed organizations. IPHA has created a toolkit and begun work with their local health departments to build capacity for local jurisdictions to address trauma through raising awareness, targeted training opportunities and collaborative partnerships to leverage a systemic response in their respective communities. Through this work, Boone County Health Department (BCHD) began the internal process of becoming trauma-informed with the long-term goal of developing multisectoral partnerships to tackle trauma and build a more resilient Boone County.

Belvidere Community School District #100 and BCHD have become partners to lead this community initiative to address trauma within this rural community. Efforts have included training school administrators, teachers, counselors, and janitorial/clerical staff as well as health department staff at all levels. Through this training we are building community awareness about trauma; and developing integrated approaches to align the local education, health care, governmental, faith-based, social services, and legal systems to function as trauma informed. The health department and school district have hosted a community forum, launched a movie series, and are creating a community-based task force.

This presentation will focus on the process undertaken to make this local initiative happen in as well as successes and challenges faced, providing practical lessons learned for communities hoping to embark on their own trauma-informed journey. This presentation will explore tangible examples of various stages of this process that are still ongoing including stakeholder analysis assessment, strategic planning efforts within departmental operations, and social emotional learning curriculum implementation. We will highlight evidence-based models for identifying leaders and determining and measuring success of those long-term multisectoral partnerships. In this small rural community, tackling trauma is building Boone’s resilience and contributing to the national trauma conversation.

Background: Many natural disasters have struck countries around the world in recent times. Research ahs shown the immediate and long-term emotional sequelae of these events on survivors. The importance of psychosocial support has also been shown in research, as well as included in targets in important international instruments, e.g., the United Nations 2030 Agenda for Sustainable Development and the Sendai Framework for Disaster Risk Reduction, to promote mental health and well-being. In these contexts, a five-day training for after-school teachers and other educators to help children cope with the anniversary of the tragic hurricane in the Caribbean was conducted by master trainers from New York who have provided such support in emergencies worldwide

Description: The training followed a train-the-trainer model whereby the master trainers trained the adult participants who then conducted the workshop with a group of children. Activities were selected from the toolbox designed by the master trainer, proven effective in other contexts, simple enough to be easily learned but based on solid psychological principles, adapted for the particular culture, and aimed at three constructs: resilience, empowerment and connection. The trainers included both an international and a local team, representing several NGOs, and supported by the local government ministry, thus representing a multi-stakeholder project as identified in the UN Agenda 2030. Trainees participants were selected by the local team. Pre-post questionnaires were administered to assess the impact of the experience on the trainees. Unstructured interviews provided other feedback.

Lessons Learned: The quantitative and qualitative results showed a positive impact on the participants’ personal and professional life, increases in the three constructs, and their enthusiasm to implement the workshop elements into their own contexts.

Recommendations/Implications: The value of such interventions for populations after natural disasters, and implications for policy, is emphasized and discussed in the context of many similar projects worldwide. Government health policies and programmes, and non-profit organizations should routinely include, and offer, such interventions. Research protocols need to be standardized and logistics managed to allow for assessments. Funding is essential from both government and private sector for such projects to continue and scale up. Video will be shown.

Background: Veterans, particularly those who participated in combat or experienced military sexual trauma may suffer from myriad mental health challenges. Some experience severe PTSD which puts them at risk for a lifetime of interpersonal and professional hardship causing many to resort to substance abuse and other harmful coping mechanisms. Mindfulness-based programs have been shown to help veterans learn self-regulation skills, increase stress management, improve sleep, develop self-awareness, and recover from substance use. However, mindfulness trainings can vary and some may not adequately reach the desired goals.

Description: Veteran's PATH is a unique California-based non-profit that has been providing mindfulness-based skills and programs to specifically 1990-to current era veterans since 2008. Their recently developed Anchor Program consists of a four-month long curriculum that includes three residential retreats, small group online monthly Zoom meetings, weekly mindfulness practices and monthly support phone meetings. Separate programs for both male and female veterans have been conducted with some having participated in prior Veteran's PATH activities.

Lessons Learned: For this paper data from one-on-one interviews with participants are reported on and reveal rich stories of how the Anchor program was paramount in grounding their mindfulness practice in moments of emotional reactivity, and how having a continuous interpersonal connection with likeminded others reinforced their intentions to find alternative ways to cope with present day triggers of past trauma. Many shared how this program gave them more effective tools than what has been offered in the past through general veterans programs. In addition, some reported methods to improve the effectiveness of the program including alternative ways to form small group support circles, location of venues, and better opportunities to integrate prior experiences of meditation and other similar self-help practices.

Recommendations: Quantitative evaluation data are needed to augment the qualitative findings in this report. However, this comprehensive training with extended social support and other reinforcement activities may be needed to better aid veterans who have experienced combat or military sexual trauma. A toolkit of the Anchor Program should be considered in order for this model to be adopted more easily by other agencies who work with veterans.

Background/Context: The growing literature on ACES (adverse childhood experiences) continues to document the association between experiencing abuse, neglect, and family dysfunction and increased risk of many chronic behavioral and physical health problems in adulthood, as well as during adolescence. Health risk behavior increases as ACES increase, but even without increased health risk behavior, such as substance abuse and smoking, ACES are associated with adult health problems in a dose-response relationship. Hyperarousal of the stress-response system is theorized to be one factor in this ACES-chronic disease relationship, impacting neurodevelopment and setting the stage for lifelong problems.

Program Description: Our pilot study, presented at APHA in 2018, found that children as young as 3 years old could learn simple techniques to bring calm to the body and mind. Our resilience learning collaborative in Gainesville, Florida, the Resilience Empowerment Project, has continued an initiative to expand the teaching of self-regulation skills, including mindfulness, in early childhood in our community. This project is especially designed for children who may be at risk for structural disempowerment and the ACES that produces. Our relatively simple model, which does not require extensive investment of time, energy, or other resources, is being taught to early childhood professionals in our community. These skills can assist children in learning awareness of the state of their minds and bodies, and simple methods to regulate and calm the mind and body. The project is currently in the community engagement phase as we continue to seek partners across sectors in the community.

In this presentation, we will outline the project’s efforts for community engagement and participation. Ways to evaluate the impact of the program and practices will also be discussed. Our hope is that community groups will tailor the program to meet their needs and design systems to continue to teach the skills for awareness and self-regulation of emotions within their organizations. This poses particular challenges for the evaluation component of our project. The Resilience Empowerment Project has important implications for reducing the social determinants of health.