#1SOUTH DAKOTA DEPARTMENT OF HEALTH South Dakota Preventable Death Review Committee Meeting February 15, 2019#2CI SOUTH DAKOTA DEPARTMENT OF HEALTH South Dakota Preventable Death Review Committee Objectives PURPOSE: To standardize and influence how South Dakota performs infant, child, maternal and violent preventable death reviews • Review current preventable death review efforts in South Dakota • Identify common processes Identify challenges with implementation and standardization of preventable death review teams Establish standard strategies critical to infant mortality, maternal mortality, child mortality and violent death reviews • Assist and support groups with selecting and targeting prevention efforts • Launch National Violent Death Review System (NVDRS) in Minnehaha and Pennington 1#3CI SOUTH DAKOTA DEPARTMENT OF HEALTH SD Preventable Death Review Committee . Infant mortality review- DOH . Child mortality review- DSS . Maternal mortality review- National and Local • Violent mortality reporting- DOH 2#4C SOUTH DAKOTA DEPARTMENT OF HEALTH Statewide Infant Death Review 3#50 10 20 30 40 50 Cl SOUTH DAKOTA DEPARTMENT OF HEALTH 1916 1918 1920 1922 1924 1926 1928 1930 1932 1934 1936 1938 1940 1942 1944 1946 1948 1950 1952 1954 1956 1958 1960 (infant deaths per 1,000 live births) Infant mortality rates, South Dakota 1916-2017 1962 1964 1966 1968 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 4#6OR Infant Mortality Rates, United States, 2016 New Hampshire 3.7 Massachusetts 3.9 New Jersey 4.1 California 4.2 WA 4.3 ME MT ND 5.8 5.9 6.5 MN 4.6 Washington 4.3 ID 6.1 5.1 VT 0.0 Iowa 6.1 Pennsylvania 6.1 Nebraska 6.2 New Mexico 6.2 NH SD WI NY MAZ 3.7 4.8 6.3 MI Illinois 6.3 New York 4.5 5.0 MO 4.5 CT38 WY 6.4 Wisconsin 6.3 RI Oregon 4.6 IA NE South Dakota 4.8 AG NV 5.7 A9 PA 5.7 6.1 6.1 NJ Michigan 6.4 6.2 OH 4.1 CA UT 5.4 IL IN 7.4 MD DE Missouri 6.5 CO Colorado 4.8 4.2 4.8 8% 6.3 7.5 www. 6.6 7.9 Connecticut 4.8 5.9 69 7.3 KS VA MO North Dakota 6.5 KY 5.8 6.5 6.7 NC Wyoming 5.0 TN OK AZ 7.4 NA 7.2 Minnesota 5.1 Alaska 5.4 NM 7.4 5.4 AR SC 6.2 8.1 7.0 MS 45 AL GA 9.1 7.5 8.6 Arizona 5.4 Utah 5.4 TX LA 5.7 8.0 FL Nevada 5.7 Rhode Island 5.7 Texas 5.7 Maine 5.8 AK 5.4 Virginia 5.8 Kansas 5.9 Montana 5.9 Florida 6.1 Hawaii 6.1 < 4.8 4.8 - 5.8 5.9 6.2 6.3-7.3 ≥ 7.4 Idaho 6.1 Maryland 6.6 Kentucky 6.7 South Carolina 7.0 North Carolina 7.2 West Virginia 7.3 Ohio 7.4 Oklahoma 7.4 Tennessee 7.4 Georgia 7.5 Indiana 7.5 Delaware 7.9 Louisiana 8.0 Arkansas 8.1 Mississippi 8.6 Alabama 9.1 US 2016 Infant Mortality Rate: 5.9 SD 2017 Infant Mortality Rate: 7.8 CDC https://www.cdc.gov/nchs/pressroom/sosmap/infant mortality rates/infant mortality.htm 5#7CI SOUTH DAKOTA DEPARTMENT OF HEALTH Source: SDDOH Vital Statistics Infant Mortality Rates, South Dakota and United States, 2008-2017 Rate per 1,000 live births 8.6 8.3 7.3 6.7 7.0 7.8 6.3 6.5 5.9 5.9 6.6 6.4 6.2 6.1 6.0 6.0 5.8 5.9 4.8 United States 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 6#8CI SOUTH DAKOTA DEPARTMENT OF HEALTH Source: SDDOH Vital Statistics 14.6 Infant Mortality Disparity, South Dakota, 2008-2017 Rate per 1,000 live births 13.4 12.6 12.3 11.2 12.2 11.4 10.1 10.4 8.6 8.3 8.6 6.7 7.0 7.3 6.3 6.5 7.8 5.9 4.8 7.0 6.4 6.0 5.8 6.4 4.8 5.2 6.0 4.4 3.6 -White 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 7#9CI SOUTH DAKOTA DEPARTMENT OF HEALTH History • • • 1997 Infant and Child deaths reviewed by two local teams - - Sioux Falls-Known as Regional Infant and Child Mortality Review Committee (RICMRC) reviewed a 10 county area Rapid City-reviewed infant and child deaths in Pennington and surrounding area. 2011, based on recommendations from the Governor's Task Force on Infant Mortality, the DOH used the existing teams to add the additional counties to review all infant deaths that leave the hospital. Data collected since 2011 has been entered into the Child Death Review Case Reporting System, from the National Center for Fatality Review and Prevention by the DOH. 8#10CI SOUTH DAKOTA DEPARTMENT OF HEALTH Current Review 2018- Sioux Falls- DOH now leads the East River Infant Death Review Committee. - Review only infants that have been released from the hospital. - No longer review children. - Small team focused on infants - Meet twice a year • Rapid City Review Team has not changed - Meet twice a year 9#11CI SOUTH DAKOTA DEPARTMENT OF HEALTH • Accomplishments In September of 2017 the Department of Health published its first report using data from the database: Infant Death Review South Dakota 2013-2015 authored by the State Epidemiologist, Dr. Lon Kightlinger. An infographic, South Dakota Infant Death Review, was produced to facilitate data dissemination found in the Infant Death Review South Dakota 2013-2017 report. Information from the 2017 report was shared with both death review teams to promote better data collection and to increase focus on prevention efforts. In May of 2018, Susanna Joy, Program Associate from the National Center for Fatality Review and Prevention provided training to the Statewide Infant Death Review Committee at their annual meeting. The Infant Death Review (IDR) infographic was updated in May to include 2016 data and an ad was created for the journal SD Medicine to share key data points with providers in the state. 10 10#12CI SOUTH DAKOTA DEPARTMENT OF HEALTH Challenges • • There is not a state mandate for infant/child death review. It has become more and more difficult to collect data for the review process due to concerns related to confidentiality, HIPAA and Marsy's Law. Inconsistency in how the teams conduct their reviews. Sustainability of the review teams (since all members are volunteers) and membership is not consistent. Funding not available for review teams to implement prevention recommendations. 11#13Child Death Review Pamela Bennett, Assistant Director JoLynn Bostrom, Protective Services Program Specialist Division of Child Protection Services – Reporting Requirement • ● Report child fatalities to NCANDS (National Child Abuse and Neglect Data System) NCANDS defines child fatality as "death of the child caused by injury resulting from abuse or neglect or where abuse or neglect was a contributing factor." . Report only cases that were reported to Child Protection Services ● In Federal Fiscal Year 2018 (October 1, 2017 to September 30, 2018), South Dakota had three substantiated cases of child abuse/neglect that resulted in a three child fatality. DSSO Strong Families - South Dakota's Foundation and Our Future 12#14Child Death Review Division of Child Protection Services Internal Child Death Review • • All fatality reports are reviewed by Division Director, Deputy Director, and Protective Services Program Specialist. Prior reports and history, if any, with the family and child is reviewed. • Child Protection Services staff and Law Enforcement work together to determine outcome. • • Law Enforcement's focus is regarding criminal charges, while Child Protection's focus is child safety. Case is followed from the time of the initial report to the date the final outcome is determined. DSSO Strong Families - South Dakota's Foundation and Our Future 13#15CI SOUTH DAKOTA DEPARTMENT OF HEALTH • . Maternal Mortality Review South Dakota does not currently have a maternal mortality review committee (MMRC) Approximately 30 states have committees. Definitions: - - Maternal death: death of a woman while pregnant or within 42 days from any cause Pregnancy associated: death of a woman while pregnant or within 1 year from any cause Pregnancy related: death of a woman while pregnant or within 1 year related to or aggravated by pregnancy (not from accidental or incidental causes) - CDC Pregnancy Mortality Surveillance System (PMSS): uses pregnancy- related definition 14#16CI SOUTH DAKOTA DEPARTMENT OF HEALTH Source: CDC PMSS 987 Number of Deaths Pregnancy-Associated Deaths, South Dakota, 2010-2014 8 8 7 6 5 65432 1 □ O 2010 2011 2012 2013 2014 15#17CI SOUTH DAKOTA DEPARTMENT OF HEALTH Source: CDC PMSS True Cause of Death as Determined by PMSS Non-cardiovascular condition Cardiovascular conditions 11.8% Hypertensive disorders of... 5.9% Hemorrhage 2.9% Infection 2.9% Amniotic fluid embolism 2.9% Cerebrovascular accident 2.9% 170.6% 0 20 40 60 80 Percent of Deaths by Cause 16#18CI SOUTH DAKOTA DEPARTMENT OF HEALTH Source: CDC PMSS Percent of Pregnancy-Associated Deaths by Type of Injury, 2010-2014 None 44.1% Motor vehicle accident 20.6% Poisoning/drug... 11.8% Suicide 11.8% Homicide 5.9% Falls/accidental 2.9% Unknown 2.9% 0 10 20 30 40 50 Percent of Deaths by Injury 17 17#19CI SOUTH DAKOTA DEPARTMENT OF HEALTH • Region VIII States Colorado: MMRC since 1958; 1993 official CDC MMRC; - Leading causes: injury, mental health conditions • Utah: committee since 1995; have legislation • Montana: 2013 FICMR Act amended to look at maternal deaths • - Averages 9 deaths/year; American Indian death disparity Wyoming: No MMRC - Discussion with ACOG in their state. - PQC since 2017; interested in establishing MMRC under this • North Dakota: 1953-MMR through UND Medical School; led by Dennis J. Lutz, M.D.; 2-4 deaths/year 18#20CI SOUTH DAKOTA DEPARTMENT OF HEALTH • • Maternal Mortality in South Dakota Interest from South Dakota's American College of Obstetricians and Gynecologists (ACOG) Chapter Interest from OB/GYN providers at Sanford, Avera and Regional Health • Informal meetings to discuss available data and next steps • Focus on prevention of maternal deaths 19#210.0 Source: South Dakota Vital Records SOUTH DAKOTA DEPARTMENT OF HEALTH 25.0 SD Suicide Rates, 1950–2017 20.0 15.0 10.0 5.0 1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 1986 6861 Av 1992 1995 1998 2001 2004 2007 2010 2013 2016 20 20#22New Jersey 8.1 Suicide Rates, United States, 2013-2017 15.4 18.1 21.2 25.6 18.3 13.0 14.5 13.6 19.7 24.4 8.2 $16.8 8.8 16.7 9.8 New York 8.2 Massachusetts 8.8 Maryland 9.6 Connecticut 9.8 California 10.5 Illinois 10.6 Rhode Island 11.3 14.2 14.2 13.0 19.7 13.8 Delaware 12.3 21.8 10.6 15.0 10.5 19.9 18.6 9.612.3 Texas 12.6 16.8 17.3 13.0 16.5 Georgia 12.9 13.4 15.8 18.0 19.5 22.3 18.7 15.3 Virginia 13.0 13.5 15.2 12.9 Minnesota 13.0 Nebraska 13.0 8.11 11.3 Alabama 15.2 South Carolina 15.3 Washington 15.4 Tennessee 15.8 Kentucky 16.5 New Hampshire 16.7 Kansas 16.8 Maine 16.8 Missouri 17.3 Vermont 17.3 Hawaii 13.3 North Carolina 13.4 Mississippi 13.5 Michigan 13.6 Ohio 13.8 Florida 14.1 Iowa 14.2 Pennsylvania 14.2 Louisiana 14.4 Wisconsin 14.5 Indiana 15.0 25.0 12.6 14.41 14.1 U.S. 2013-2017 Suicide Rate: 13.4 CDC WONDER https://wonder.cdc.gov/ucd-icd10.html Arizona 18.0 Oregon 18.1 North Dakota 18.3 West Virginia 18.6 Arkansas 18.7 < 13 13.0 14.9 15.0-17.9 ≥ 18 Oklahoma 19.5 Nevada 19.7 South Dakota 19.7 Colorado 19.9 Idaho 21.2 Utah 21.8 New Mexico 22.3 Wyoming 24.4 Alaska 25.0 Montana 25.6 21 21#23CI SOUTH DAKOTA DEPARTMENT OF HEALTH SD Suicide Death Rates by Race, 2008-2017 70 0 64.6 60.5 White American Indian Other 60 Crude Suicide Death Rates 30 50 50 41.4 40 40 35.4 35.4 31.7 47.2 40.7 41.3 32.1 29.2 29.5° 30 23.2 24.4 28.0 20 25.6 19.3 20 15.8 15.8 15.4 13.4 13.0 13.8 15.4 15.4 16.9 10 5.9 11.8 5.9 5.9 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Year Source: SDDOH Vital Statistics 22 22#24CI SOUTH DAKOTA DEPARTMENT OF HEALTH Rate per 100,000 Population 3 S 9 7 Homicide/Legal Intervention Injury Deaths (rate per 100,00 population) 0 2008 2009 2010 2011 2012 -United States 2013 2014 South Dakota 2015 2016 2017 23#25CI SOUTH DAKOTA DEPARTMENT OF HEALTH National Violent Death Reporting System . • • One of the ten remaining states to implement this reporting system CDC funding out of the National Center for Injury Prevention and Control 4 year project period (9/2018 - 8/2022) . Year 1 funding $184,173 WA CA MT ND MN WI OR SD ID WY NV UT CO NM IA PA NE OH IL IN wv VA KS MO KY TN AR SC MS AL GA LA PR NY MA CTR ME States added by year: 2002: MA, MD, NJ, OR, SC, VA 2003: AK, CO, GA, NC, OK, RI, WI 2004: KY, NM, UT 2009: MI, OH 2014: AZ, CT, HI, IA, IL, IN, KS, ME, MN, NH, NY, PA, VT, WA 2016: AL, CA, DE, DC, LA, MO, NE, NV, Puerto Rico, WV 2018: AR, FL, ID, MS, MT, ND, SD, TN, TX, WY 24#26CI SOUTH DAKOTA DEPARTMENT OF HEALTH South Dakota Violent Death Reporting System Roles; (SD-VDRS) Colleen Winter- Division Director, Family and Community Health - Lead committee • • • • Kiley Hump- Administrator, Chronic Disease Prevention and Health Promotion PI/Grant Manager, assist with the committee Ashley Miller-Chronic Disease Epidemiologist -Data collection and analysis Amanda Nelson- Injury Prevention Epidemiologist Data collection and analysis Mariah Pokorny- State Registrar, Office of Vital Statistics -Death certificates and work with coroners Dr. Josh Clayton- State Epidemiologist - Support data collection and analysis 25#27CI SOUTH DAKOTA DEPARTMENT OF HEALTH • • South Dakota Violent Death Reporting System (SD-VDRS) Initially the Department of Health will work with Minnehaha and Pennington Counties with the goal of collecting information on violent deaths statewide beginning January 2020 Data will be collected from death certificates, coroner/medical examiner reports, and law enforcement reports All of this information is combined to determine the "who, when, where, and how" Which will provide insights into the "why" SD-VDRS aims to provide our state and communities with a clearer understanding of violent deaths This information can be used to guide state and local prevention efforts. 26#28CI SOUTH DAKOTA DEPARTMENT OF HEALTH National Violent Death Reporting System Collects information on all violent deaths A violent death includes: - Suicides - Homicides - - Undetermined intent Unintentional firearm - Legal intervention - Terrorism 27 27#29CI SOUTH DAKOTA DEPARTMENT OF HEALTH Violent Deaths in South Dakota, by Category, 2008-2017 100% 90% 11.9 12 12.3 17.4 10 14.3 17.8 14.6 15 15.1 80% 70% 60% 50% 40% 77.4 77.2 79 83.1 71.9 74.9 77.5 74.6 75.2 80 60 30% 20% 10% 0% 2008 2009 Accidental death from a firearm 2010 2011 2012 2013 2014 2015 2016 2017 Suicide Homicide Legal Interventions Undetermined Intent 28#30Suicide rates rose across the US from 1999 to 2016. Increase 38 - 58% Increase 31-37% Increase 19-30% Increase Decrease 6-18% 1% PROBLEM: Suicide rates increased in almost every state. MN CDC developed a Vital Signs Report using information from the NVDRS reporting system WHAT CAN WE DO TO PREVENT SUICIDE? Preventing Suicide: A Technical Package of Policy, Programs, and Practices https://go.usa.gov/xQBGc NV UT CO MO AZ NM SOURCE: CDC's National Vital Statistics System: CDC Vital Signs, June 2018. Differences exist among those with and without mental health conditions. People without known mental health conditions were more likely to be male and to die by firearm. No known mental health conditions Known mental health conditions Sex Method Sex Female 16% Male 84% Method Poisoning 10% Other 8% Suffocation 27% Relationship problem (42%) Female 31% Poisoning 20% Other 8% Firearm 41% Firearm 55% Male 69% Preventing suicide involves everyone in the community. Know the Suicide WARNING SIGNS • Feeling like a burden S Increased anxiety • Feeling trapped or in unbearable pain Provide financial support to individuals in need. States can help ease unemployment and housing stress by providing temporary help. . Being isolated Strengthen access to and delivery of care. Health care systems can offer treatment options by phone or online where services are not widely available. + • Increased substance use • Looking for a way to access lethal means Create protective environments. Employers can apply policies that create a healthy environment and reduce stigma about seeking help. • Expressing hopelessness Increased anger or rage • Extreme mood swings Suffocation 31% Many factors contribute to suicide among those with and without known mental health conditions. Connect people within their communities. Communities can offer programs and events to increase a sense of belonging among residents. Teach coping and problem-solving skills. Schools can teach students skills to manage challenges like relationship and school problems. ■ Sleeping too little or too much ■ Talking or posting about wanting to die Making plans for suicide Problematic substance use (28%) Job/Financial problem (16%) Loss of housing (4%) Crisis in the past or upcoming two weeks (29%) Physical health problem (22%) Criminal legal problem (9%) Note: Persons who died by suicide may have had multiple circumstances Data on mental health conditions and other factors are from coroner/ medical examiner and law enforcement reports. It is possible that mental health conditions or other circumstances could have been present and not diagnosed, known, or reported. SOURCE: CDC's National Violent Death Reporting System, data from 27 states participating in 2015. Prevent future risk. Media can describe helping resources and avoid headlines or details that increase risk. Identify and support people at risk. Everyone can learn the warning signs for suicide, how to respond, and where to get help. NEWS 5 STEPS TO HELP SOMEONE AT RISK 1. Ask. 2. Keep them safe. 3. Be there. 4. Help them connect. 5. Follow up. Find out why this can save a life by visiting: www.BeThe1To.com https://www.cdc.gov/vitalsigns/pdf/vs-0618-suicide-H.pdf 29#31Examples from Other States THE BIG PICTURE The age-adjusted suicide rate in Oklahoma was 33% higher than the same rate for the U.S. in 2013. Oklahoma Violent Death Reporting System (OKVDRS) data illustrate the extent of this problem. • Suicide was the third leading cause of death for Oklahomans age 10-34 in 2013, and the most prevalent type of violent death from 2004-2013, accounting for nearly 600 resident deaths each year. • Suicides outnumber homicides by about three to one • The Veteran suicide death rate increased by 34% from 2005-2012, with over 1,000 veteran suicides during that time; the suicide rate among veterans was twice that of non-veterans. Among the 5,881 suicide deaths in Oklahoma from 2004- 2013: • 79% were male, and 21% were female .22% of suicide victims were veterans • 144 (2.4%) victims killed at least one other person before taking his/her own life, resulting in 173 homicide deaths. • Firearms (61%) were the most prevalent means of suicide, followed by hanging/strangulation (20%), poisoning (14%), and other means (5%); immediate access to lethal means may increase the risk for suicide. • Among suicide victims noted to have a diagnosed mental health 22% of the 5,881 suicide deaths from 2004- 2013 were veterans problem (2,098), 62% were currently receiving mental health treatment. • A significant number of suicides were associated with a current depressed mood, intimate partner problem, mental and/or physical health problem, and/or crisis in the past weeks. TRANSLATING DATA INTO ACTION Informing prevention planning • The Oklahoma Injury Prevention Service provides OKVDRS data and statistics and works closely with the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), the Oklahoma Suicide Prevention Council, and other suicide prevention groups. • OKVDRS suicide data informed the Council's 2011 Oklahoma Strategy for Suicide Prevention. Supporting veteran suicide prevention With five military bases in Oklahoma, veterans' health issues impact more than 300,000 Oklahomans. An OKVDRS special study and report on veteran suicides opened doors for collaboration with the Veterans Administration in Oklahoma, and helped illustrate the: • increased risk for suicide among veterans of all ages ■ leading circumstances associated with veteran suicides across the lifespan - physical and mental health problems, depressed mood, and intimate partner problems • most common means of suicide (firearms) Expanding the power of OKVDRS data • OKVDRS data will be linked to other state databases to better inform suicide prevention, mental health treatment, and problematic drug prescriptions related to suicide. • OKVDRS staff worked with law enforcement, the Child Death Review Board, and the Oklahoma Suicide Prevention Council to modify a pocket card that helps law enforcement collect more complete and accurate suicide circumstances. data, which are used to understand suicide risks. Partnering with law enforcement Opened doors for collaboration with the Veterans Administration The Oklahoma Association of Chiefs of Police hosts the OKVDRS Advisory Committee meetings and distributes data reports to its members. OKVDRS data showed increased risk & leading cicumstances of suicide among veterans Informs statewide suicide prevention program planning The Oklahoma State Bureau of Investigation maintains a full time program officer to collect law enforcement data for the OKVDRS through a contract with the Injury Prevention Service. • • . Oklahoma noticed their suicide rate was 33% higher than the US rate The suicide rate among veterans was twice that of non-veterans Significant number of suicides were associated with current depressed mood, intimate partner problem, mental and/or physical health, and/or crisis in the past weeks Data into Action: • • Inform prevention planning Opened doors for collaboration with the veterans administration 30#32Examples from Other States THE BIG PICTURE In Rhode Island during 2010, there were 165 violent deaths: 135 suicides, 26 homicides and 4 deaths of undetermined manner. The number of suicides in Rhode Island peaked in 2010, declining from 102 suicides in 2011 to 89 in 2012, based on provisional 2012 data. RIVDRS data for 2004-2010 show that: • During this seven year period, there were a total of 731 suicides in Rhode Island. • Males (78%) were far more likely to commit suicide than females (22%). • Male and female suicide deaths peaked in the age group 45-54 years. • There were 18 suicides among those aged less than 18 (15 males, 3 females). • Just over half (52%) of those who died by suicide had a current mental health problem, and 43% were currently receiving mental health treatment. - Nearly one in five (18%) of those who died by suicide experienced an intimate partner problem. • 25% of those who died by suicide experienced a crisis in the two weeks prior to death. 25% of those who died by suicide experienced a crisis in the two weeks prior to death. • Only 37% of those who died by suicide left a note. TRANSLATING DATA INTO ACTION Data from the Rhode Island Violent Death Reporting System (RIVDRS) provided new information on suicide and a better understanding of who is at risk. • RIVDRS data were used by the Department of Health's Violence & Injury Prevention Program and its prevention partners for ground-breaking priority setting and program planning. • Using new suicide data from the RIVDRS, the Suicide Prevention Subcommittee of the Rhode Island Injury Community Planning Group identified the adult, working age population as being at increased risk for suicide and suicide attempts. The data were shared with key partners through the subcommittee's members, including the State Medical Examiner, RIVDRS Program Manager and Epidemiologist, Violence & Injury Prevention Program manager, and representatives from the Samaritans, American Foundation for Suicide Prevention, community health and mental health centers, Bradley Children's Hospital, Brown University, Coastline Employee Assistance Program, and the Rhode Island Student Assistance Program. • An "Economic Impact of Depression and Suicide in the Workplace" symposium, co-sponsored by the Violence & Injury Prevention Program and Coastline Employee Assistance Program, increased awareness of depression and suicide among working age adults and provided strategies for integrating suicide prevention into worksites. • Symposium participants included high-level managers and human resource representatives from the two largest employers in Rhode Island. RIVDRS data show working age adults are at increased risk for suicide RIVDRS shares data with suicide prevention partners & 2 of state's largest employers • Coastline Employee Assistance Program integrated suicide prevention into its mission statement and now provides training in early identification and referral of at risk employees to their clinical staff as well as their clients. Employee assistance program adds suicide prevention to its mission, refers at-risk employees to clinical staff • • Rhode Island noticed 25% of those who died by suicide experienced a crisis in the two weeks prior to death 78% were males • 52% had a current mental health problem Data into Action: • • • Used to set priorities and program planning Identified the adult, working age population at increased risk Data shared with suicide prevention partners and 2 of the states largest employers Employee assistance program add suicide prevention to its mission, refers at risk employees to clinic staff 31#33Examples from Other States THE BIG PICTURE Domestic violence is one of the fastest growing violent crimes in Utah. Findings from the 2010 publication, Domestic Vio- lence Fatalities in Utah, 2003-2008, by the Utah Department of Health's Violence and Injury Prevention Program and the Domestic Violence Fatality Review Committee, include: • 1 out of 3 adult homicides are domestic violence homicides. • Females are 10 times more likely than males to die from domestic violence. • The majority of domestic violence homicides are committed by males. • While Hispanic persons comprise only 10% of Utah's population, they account for 77% of domestic violence victims. • 52% of intimate partner homicides were premeditated. • One-third of domestic violence perpetrators committed suicide after committing a homicide. • 91% of the domestic violence-related suicide victims experienced a crisis prior to the incident or faced an impending crisis - the most common of which was facing a criminal legal problem such as a recent or impending arrest, police pursuit, or an impending criminal court date (32.7%). In 44% of intimate partner 78% of the 147 children directly exposed to a homicide in 2003-2008 were age violence incidents, one or more 5 or younger children under age 18 were living at the victim's home at the time of the incident (76 children total). • 147 children under age 18 were directly exposed to the homicide - they saw it, heard it through the walls, were attacked or threatened during the incident, or discovered the body. Of these children, 78% were 5 years old or younger. TRANSLATING DATA INTO ACTION Better data provide more complete picture of domestic violence deaths A decade ago, it was difficult to know the extent of domestic violence in Utah because of limited data. The Utah Violent Death Reporting System (UTVDRS) has developed a more complete picture of domestic violence and its tragic impact on men, women, and children by: ⚫ fostering a strong partnership between the Utah Department of Health's Violence and Injury Prevention Program (VIPP) and the state's multi-disciplinary Domestic Violence Fatality Review Committee (DVFRC), which includes more than 9 agencies, ⚫ expanding domestic violence data collection beyond the victim and suspect to include any intimate partner, family member and/or roommate involved in the incident, ⚫ combining national and state-specific intimate partner violence variables to enable the UTVDRS to collect more - and more detailed domestic violence-related data, and • linking data in the UTVDRS to identify and review - for the first time - when a domestic violence suspect committed suicide after the homicide. Linking children of victims to needed services Intimate partner violence is particularly damaging to children who witness this violence. They are at greater risk of develop- ing psychiatric disorders, developmental problems, school failure, violence against others, and low self-esteem, and younger children typically display higher levels of distress than do older children. Through their collaboration on the UTVDRS, the VIPP and DVFRC helped inform a policy change to close a gap in services for the children ren of domestic violence-related homicide victims. Following recommendations from UTVDRS data expanded to include any intimate partner, family member or roommate in incident Worked with state DFCS to close gap in services for victim's children Children of victims now connected to mental health & other services a Domestic Violence Fatality Recommendations Symposium, the VIPP and DVFRC worked with the state Department of Children and Family Services (DFCS) to increase immediate referrals to DFCS at the time of a homicide - usually by law enforcement investigating the death - if the victim or perpetrator has one or more children in the home, regardless if a child was present during the incident. • These referrals enabled these children and their families to receive an assessment and get connected to intervention and follow-up services, such as mental health services, to help cope with the homicide and other domestic violence-related issues. A referral to DFCS was made in 13 (46%) of the 28 intimate partner violence incidents with children in the home during 2003-2008 • • • Domestic violence in Utah is on of the fastest growing violent crimes In 44% of intimate partner violence incidents one or more children under 18 were living in the victim's home 78% of children exposed to the homicide were age 5 or younger Data into Action: • . • Expanded data collection to include intimate partner, family member or roommate incident Worked with the state department of children and family services to close gap in services for victim's children Children of victims now connected to mental health and other services 32 32#34C SOUTH DAKOTA DEPARTMENT OF HEALTH NVDRS Data 33 33#35CI • SOUTH DAKOTA DEPARTMENT OF HEALTH NVDRS Data Over 600 Variables • • • • • Demographics Age, sex, race, ethnicity, place of residence, birthplace, industry, occupation, and education Injury and Death . Manner of death, injury location and time, external cause of injury codes, underlying causes of death, location of death, and wounds Circumstances . Mental health, substance abuse and other addictions, relationships, life stressors, crime and criminal activity, and manner specific circumstances Weapons Weapon type (firearm, blunt/sharp object, poisoning, fall, motor vehicle, etc.) Suspects Age, sex, and race of suspect; relationship to victim, and circumstances Toxicology Toxicology report findings Optional: Intimate Partner Violence, Child Fatality Review data, and overdose-specific data 34#36Coroners/Medical Examiners • Fills out death certificate •Files death certificate with Office of Vital Records SD-VDRS Data Collection Process Office of Vital Records* • Runs a report weekly to identify violent death cases •Notifies Department of Health of cases that meet the criteria for NVDRS •Notifies Coroners/ME of cases that meet NVDRS criteria Office of Chronic Disease Prevention and Health Promotion* •Tracks violent death cases internally on a secured network •Notifies Law Enforcement of violent death cases Law Enforcement •Completes SD-VDRS form for violent death cases •Sends form back to Department of Health Office of Chronic Disease Prevention and Health Promotion* •Collects forms and data from Law Enforcement and Office of Vital Records •Enters non-PII information into NVDRS web *Office of Vital Records and Office of Chronic Disease Prevention and Health Promotion are both programs under the Department of Health Coroner/Medical Examiner • Completes SD-VDRS form for violent death cases • Sends form back to Office of Vital Records 35#37CI SOUTH DAKOTA DEPARTMENT OF HEALTH Incident Overview >> SD 2018 Incident: 1 NVDRS Web Home Incidents Reporting Help About Log Out Amanda Nelson - State User (SD) Incident Search Q Search incident ID's MENU Victim 1: Demographics Injury and Death Circumstances Weapons Suspects Toxicology OD IPV CFR Victims Documents R Incident Summary Activity Log Demographics, Race, and Ethnicity Basic Demographics Race & Ethnicity Person type Sex QType here to search QType here to search Check all that apply White Day of birth ## First initial of last name [A-Z] Transgender Age Age unit QType to search Last 4 of CME Last 4 of DC Height Feet QType to search Height Inches QType to search Weight (lbs) Black or African American Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Unspecified Race Hispanic/Latino/Spanish QType here to search Extended Demographics Marital status QType here to search Relationship Status QType here to search Sex of Partner QType here to search Victim was pregnant Q(8) Not applicable ☑ ☑ ☑ Sexual Orientation QType here to search Current or former military personnel QType here to search 36#38CI SOUTH DAKOTA DEPARTMENT OF HEALTH • • • Death Record Data Sharing. Only specific individuals within the project have access to identifiable information for: • • Infant/Child Death Violent Death Maternal Mortality Only de-identified information is shared with national registries as well as published presentations or papers All records are stored in confidential and secure electronic folders maintained by DOH 37#39CI SOUTH DAKOTA DEPARTMENT OF HEALTH Death Record Data Sharing Only deaths occurring in South Dakota are automatically eligible for review SD resident deaths occurring in other states are only eligible for review if allowed by state of death 38#40Colorado Violent Death Reporting System (COVDRS): Program Background and Initiatives Kirk Bol, MSPH CDPHE South Dakota Preventable Death Committee February 15, 2019 COLORADO Center for Health & Environmental Data Department of Public Health & Environment 39#41CDPHE Presenter Introduction Kirk Bol, MSPH - - Manager, Registries and Vital Statistics Branch • Contains Colorado's Vital Statistics Program, CoVDRS, Central Cancer Registry, Birth Defects Monitoring Program and Medical Aid-in-Dying Principal Investigator, CoVDRS Since 2014 COLORADO Center for Health & Environmental Data Department of Public Health & Environment facts.co 40#42Colorado Violent Death Reporting System (COVDRS) First funded by NVDRS in 2003, first year of data was 2004 Housed at the Colorado Department of Public Health and Environment - - 1 Originally housed within Prevention Services Division, Injury Epidemiology Program Moved to Center for Health and Environmental Data, Vital Statistics Program in 2011 Continues to work close with current Violence and Injury Prevention-Mental Health Promotion Branch (PSD) CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 41 41#43Colorado Violent Death Reporting System (COVDRS) Current Staff - Principal Investigator: Kirk Bol, MSPH - Program Coordinator/Lead Epidemiologist: Ethan Jamison, MPH Coroner/Medical Examiner (CME) Record Specialist/Abstractor: Joshua Swanson Law Enforcement (LE) Record Specials/Abstractor: Karl Herndon - Essentially 3 FTE (with 2-5% of PI's time) CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 42 42#44CDPHE COVDRS Advisory Network Office of Suicide Prevention Colorado Colorado Violent Death Reporting System COVDRS Adivsory Leadership Team COVDRS Advisory Network Child Fatality Prevention System Maternal Mortality Review Program Suicide Prevention Statewide Steering Team* Local Review Committees Statewide Review Committees Commission COLORADO Center for Health & Environmental Data Department of Public Health & Environment Medical Review Committee Injury and Violence Review Committee* 43 43#45COVDRS Case load Violent Death Cases by Manner and Year: Colorado Occurrences, 2013-2017 2000 1519 1549 Number of deaths 1500 1316 1383 1419 1177 1188 1098 1114 1025 $1000 500 198 232 265 300 63 63 54 0 8 5 10 14 7 2013 2014 2015 2016 2017 Year CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 44#46CDPHE COVDRS Case load 4.9% Violent Death Cases by Manner: Colorado Оcquences, 2013-2017 16.6% COLORADO Center for Health & Environmental Data Department of Public Health & Environment 78.0% Suicide □ Homicide / Legal Intervention Undetermined □ Unintentional Firearm 45 45#47CDPHE COVDRS Information Flow Audiences - National, state, local violence prevention partners - Violence and injury researchers - Law enforcement agencies - Coroner/medical examiner offices - News/media Others COLORADO Center for Health & Environmental Data Department of Public Health & Environment Vital statistics death certificates Occurrence of violent death (Suicide, homicide, accidental firearm discharge) Principal reporting sources Coroner/medical examiner report Law enforcement report Colorado Violent Death Reporting System (COVDRS) Principal data recipients National Violent Death Reporting System (NVDRS) Child Fatality Prevention System Maternal Mortality Review Colorado Suicide Prevention Commission 46#48Data Sources Data collected from - Death certificates • Direct access to Colorado electronic death registration system (EDR) Coroner/medical examiner reports . 62 elected coroners, 1 appointed medical examiner (City and County of Denver) Law enforcement reports • ~240 law enforcement agencies, including elected county sheriffs and appointed police chiefs CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 47#49Case Initiation and Record Abstraction CDPHE Electronic procedures (SAS) in place to extract, manipulate and import death certificate data into NVDRS web-based system (NVDRSWeb) - - Selected data elements are reviewed post import, and others manually entered Updates cases in separate tracking spreadsheet (contains key for NVDRS ID and death cert number) SAS procedures in place to generate letters to CME and LE offices requesting records for specific cases - Form letter on front containing request language and important updates; on back is a table with decedent list COLORADO Center for Health & Environmental Data Department of Public Health & Environment 48#50CO CDPHE COLORADO Department of Public Health & Environment Dedicated to protecting and improving the health and environment of the people of Colorado January 30, 2019 To: James A. Wilkerson IV, MD 495 N. Denver Avenue Loveland, CO 80537 From: Ethan Jamison, MPH Colorado Violent Death Reporting System mi The Colorado Violent Death Reporting System collects data from Coroner and Law Enforcement reports in an effort to better understand and prevent violent deaths throughout the state. The program relies like your's providing detailed death records so we can gather the highest quality data for this grow problem. We appreciate the continued support from the Colorado coroner community, but are stil to get records from all agencies. We are requesting copies of coroner reports for the individual(s) listed on the back of this l Please include a copy of the coroner investigative report, a summary the events leading t and a copy of the autopsy report (if an autopsy was performed) for each individual. Periodi review the files and send a second request for records that have not yet been received. This maili contain both second and new requests. Enclosed is a postage-paid return FEDEX mailer for your convenience. Contact FEDEX for pack Additionally if you would like to email copies of these reports, we have included resources on ho can send a secure encrypted email including the reports as attachments. Due to the confidential n of these reports, it is important that if you choose to email them, that you use the secure process described here. If you have questions or concerns about this secure email option, you can contact technical support. All documents that you provide will remain strictly confidential. From CRS 25-1-122 (excer Reports and records resulting from the investigation of epidemic and communicable diseases, environmental and chronic diseases, reports of morbidity and mortality...held by the state depar of public health and environment or local departments of health shall be strictly confidential. Such reports and records shall not be released, shared with any agency institution, or made p upon subpoena, search warrant, discovery proceedings, or otherwise Thank you for your assistance. If you have any questions or concems, please contact me (303-69 [email protected]), or Kirk Bol (303-692-2170, [email protected]). You can learn more about the program on our webpage; https://www.colorado.gov/pacific/edphe/colorado-violent-death-reporting-system PLEASE SEE LIST ON REVERSE SIDE CO County CDPHE COLORADO Department of Public Health & Environment Dedicated to protecting and improving the health and environment the people of Colorado of Death Decedent Name Date of Birth Date of Responding Police Agency Death Manner Name (if applicable) Police Report # (if known) Larimer Last, First Middle MDY MDY S,HA,C Fort Collins Police Department #962FG21 Key for Manner. S= Suicide H= Homicide C=Could not be determined/Undetermined A= Accident/Unintentional Firearm Death CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 49#51Case Initiation and Record Abstraction Letters sent via USPS, and include a FedEx envelope and mailer slip with COVDRS account info pre-printed Format of records received: Paper copies, returned via FedEx Electronic copies, returned on CD/DVD or flash drive via USPS Faxed copies, via secure fax machine in our office On-Site abstraction - 1 CME agency, many LE agencies CME and LE abstractors visit agencies and are provided access to either paper records or the computerized record system May be abstracted directly into NVDRSWeb (internet access dependent) or abstracted electronically or on paper for future input into NVDRSWeb CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 50 50#52CDPHE Case Initiation and Record Abstraction 'Contract Abstracting' - - - - - Two coroners offices and Denver Medical Examiner's Office Two agencies provided Microsoft Access databases mirroring content of NVDRSWeb and list of cases to be abstracted One agency completes a fillable PDF All three agencies receive training from CoVDRS staff and follow NVDRS coding manual Costs: $20-$25 per abstract CDC CAUTION COLORADO Center for Health & Environmental Data Department of Public Health & Environment 51 51#53C NVDRS Suicide investigation Shell: Database-\\dphe.local\cheis\DataLib\NVDRS\CME Reports\Counties with FTP access\New database shell 2016-17\NVDRS Suicide investigation S (Access 2007-2013 file format) - Access DATABASE TOOLS EE Selection New Advanced 3 Refresh • Totals Save A Spelling Replace Find All-Delete More -> Go To- Select BIU A- Records Find Text Formatting FILE HOME CREATE EXTERNAL DATA ✗Cut Ascending E Copy Descending View Paste Filter Format Painter Remove Sort Toggle Filter Clipboard Б Views All Access Objects Tables tbINVORS ALL Queries 久 Sort & Filter Enter NVDRS Data NVDRS - Boulder County Click to Find a Case NVDRS Incident ID: Last Name: First Name: Middle Name: CLICK HERE FOR COMPLETE CASE LIST Victim Demographics Injury/Death Information Autopsy and Toxicology Weapon Suspect Information Circumstances and Narrative Unintentional Firearm Death Circumstances Comments Forms Enter NVDRS Data CDPHE DOB: Gender: Transgender? ☐ Alternative Sexual Orientation? Victim's Occupational Status Current Occupation: ✓ Retired? Unemployed? Victim's Physical Characterisitcs. Victim's Race (select all that apply) Victim's Residence White City of Residence: Black County of Residence: Asian State of Residence: Pacific Islander American Indian ☐ Zin Code of Residence Enter NVDRS Data Other Race NVDRS-Boulder County Click to Find a Case Unspecified F NVDRS Incident ID: Last Name: Victim's Hispanic Ethnicity Status Hispanic/Latino/Spanish: COLORADO Center for Health & Environmental Data Department of Public Health & Environment First Name: Middle Name: Victim Demographics Injury/Death Information Autopsy and Toxicology Weapon Suspect Information Circumstances and Narrative Unintentional Firearm Death Circumstances Comments Complete grey box for ALL MANNERS of death Relationship Problems Family relationship problem Other Relationship Problem Previous Exposure to Violence Abuse or Neglect led to death History of abuse or neglect as child Perpetrator of Interpersonal Violence in the Past Month Victim of Interpersonal Violence in the Past Month Complete blue box for SUICIDE and UNDETERMINED Relationship Problems Intimate partner problem Suicide Markers History of suicide attempts Discolsed suicidal thoughts or intent to commit suicide Disclosed thoughts/intent to whom? Left a suicide note History of expressed suicidal thoughts or plans Mental Health, Substance Abuse and Addictions Current depressed mood Current diagnosed mental health problem: MH Diagnosis #1 MH Diagnosis #2 Other MH Diagnosis: Current mental health treatment Ever treated for mental health or substance abuse Alcohol problem Other substance abuse problem Other addiction Life Stressors Contributing criminal legal problem Contributing civil legal problems Contributing physical health problem Job Problem School Problem Financial Problem Eviction/loss of home Suicide of friend/family in last 5 years NON-Suicide death of friend/family Anniversary of a traumatic event Disaster exposure Complete purple box for HOMICIDE or LEGAL INTERVENTION Misc. Circumstances Life Events Physical fight (2 people) Agument Timing of most recent argument: Crisis in Past Two Weeks Crime and Criminal Activity Precipitated by Another Crime Nature of Other Crime #1 Nature of Other Crime #2 Precipitating crime(s) in progress? Terrorist Attack Complete green box for HOMICIDE ONLY Walk-by assault Drive-by shooting Hate Crime ALL MANNERS (pink box) Any other circumstance not already listed: List other circ here: Mercy killing Narrative of the Incident (complete for ALL MANNERS). Be sure to briefly explain any checked circumstances in the narrative. Relationship Problems Intimate partner violence Justifiable self defense Crime and Criminal Activity Victim was a police officer on duty Victim was a bystander Victim used a weapon Stalking 52 52#54Colorado Violent Death Reporting System - Data Abstraction Form Colica Demme County: Abstractor Name: COPHE A Clear Form For questions regarding completion of this form, please contact Ethan Jamison, CoVDRS Project Coordinator, 303-692-2093, [email protected] Victim Demographic Information Last Name: Sex: ✓ Transgender' Sexual Orientation Currently in a Relationship: Residence City: Residence Zip: Current Occupation: First Name: Middle Name: DOB: ✓ Race: Hispanic/Latino/Spanish Age: Sex of Partner Residence County: Residence State: Retired Victim was homeless Unemployed Residence COUNTRY (if other than U.S.) Refer to Page 4-6 of the coding manual for additional information and coding choices Injury and Death Information Injury Date: Injury City: Injury County: Injury State: Injury Zip: Injury COUNTRY (if other than U.S.): Injured at own home Injured at work Injured while in custody Manner of Death: EMS at scene Recent release from an institution Unknown Alcohol use suspected Weapon Information Primary Weapon": 2nd Weapon Causing Injury": F Injury Location: Refer to Pages 7-10 of coding manual for answer choices Autopsy and Toxicology Information Height (in inches): Firearm type: Caliber: Refer to Page 11 of the coding manual for Weight (in pounds):. If Female, Pregnancy Status: For deaths involving firearms and sharp instruments only, enter the following: Number of Wounds (bullet entry counts as 1 wound; bullet exit counts as another): Number of bullets that hit victim: Wound Locations (check if present): Head Spine Face Thorax Neck Abdomen Upper Extremity Lower Extremity ☐ 3rd Weapon Causing Injury: Gauge: For any death involving a firearm, enter the following: Firearm model: Number of non-fatally shot persons: Firearm Make: Firearm Owner: Firearm stored locked Firearm stolen Firearm stored loaded Firearm Access Narrative: (enter a brief summary of how the victim obtained access to the gun and whether he/she had authorized access to the gun): Note: one shotgun blast = 1 wound For any death where a poison is the primary weapon, enter the following: Substance/Poison Name Cause of Death$ Drug Prescribed for³: Refer to Pages 13-17 of ח coding manual for more information & answer choices For deaths involving any weapon type, enter the following: Alcohol and Drug Testing (enter regardless of weapon type; tests may be from any bodily fluid, except blood alcohol concentration, BAC): Toxicology Tested Date Specimens Collected: Military time/24 hour clock ☑ Time Collected: Substance Type (if necessary, please refer Tested Positive to drug manual for info on substance types) Alcohol Carbon Monoxide (CO) Amphetamines ☐ ☐ ☐ ☐ .ப Anticonvulsants Antidepressants ୮ ☐ L ☐ (Please list any additional poisons on the back of this form) Suspect (or "S") Information (list in order of primacy; applicable only if NOT self-inflicted) or Suspect Info Unknown *Blood Alcohol Concentration (BAC) (mg/dl):, Co Source S Number Age (years) Gender Race Hispanic 1 2 ☐ ☐ History of abuse of victim by this S ☐ S was caregiver for the victim 5 attempted 5 mentally suicide ill ப 3 4 ப ☑ Π L L Page 1 of 4 Antipsychotics Barbiturates Benzodiazepines cocain Marijuana Muscle Relaxants Opiates (List any additional substances on back of this form) Refer to Page 12 of coding manual for answer choices Suspect-Victim Relationships (list all relationships that apply³): S1 is a S2 is a to the Victim S3 is a to the Victim ▾ to the Victim S4 is a to the Victim *Please list any additional suspects and suspect information on the back of this form Circumstances - Complete the following for ALL MANNERS OF DEATH Refer to Pages 18-19 of eading manual for answer choices NOTE: each circumstance checked should be explained in the narrative (see pg.4) CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment CoVDRS Data Abstraction Form -Version 2018.09 Mental Health and Substance Abuse Related: Current depressed mood ☐ Alcohol problem ☐ Crisis Current mental health diagnosis(es) Other substance ☐ Crisis ☐ problem/abuse Current mental health treatment ☐ Other addiction Please Lid Ever treated for mental health or substance abuse problem Crisis ☐ ☐ Relationship Problems: Intimate partner violence Intimate partner problem Crisis Crisis Family relationship problem Other relationship problem Crisis Crisis Page 2 of 4 ח Crisis Variables: These should be endorsed when the circumstance was noted to have occurred/or worsened 2 weeks prior to death CoVDRS Data Abstraction Form - Version 2018.09 53 53#55Previous perpetrator of violence in the past month Previous victim of violence in the past month Life Events: Physical fight (2 people) Argument Timing of Argument:- Previous Exposure to Violence: Abuse or neglect led to death History of abuse a child neglect as Crime and Criminal Activity: Precipitated by another crime Crime(s) Type: Prostitution or sex trafficking First crime in progress Stalking Gang related ப Terrorist attack ☐ Walk-by assault ☐ Circumstances - Complete the following for HOMICIDE & LEGAL INTERVENTION Deaths only Justifiable self defense ☐ Victim was a police officer on duty Mercy killing Hate crime ☐ Victim was a bystander ☐ Jealousy (lover's triangle) Random violence ☐ physical fight) Victim was an intervener ☐ Drive-by shooting Brawl (3 people or mare in a ☐ Victim used a weapon ☐ Drug involvement L Circumstances - Complete the following for SUICIDE & UNDETERMINED Deaths only Π Crisis Variables: These should be endorsed when the circumstance was noted to have occurred/or worsened 2 weeks prior to death History of suicide Contributing physical ☐ Civil legal problems Crisis ☐ ☐ Crisis attempts Disclosed suicidal thoughts Contributing criminal Crisis ☐ health problem Job problem ☐ Crisis or intent to commit suicide legal problem ☐ To whom Financial problem Crisis L School problem ☐ Crisis Left a suicide note ப Suicide of friend or family Crisis ப Eviction or loss of home History of expressed suicidal thoughts or ☐ Non-suicide death of friend or family Crisis ☐ Disaster exposure ☐ ☐ Crisis Crisis ☐ plans Anniversary of a ☐ traumatic event Brief Narrative of the Incident or See Attached Context of Injury Hunting Playing with gun Target shooting ☐ Other context of injury Self-defensive shooting Loading or unloading gun Circumstances - Complete the following for UNINTENTIONAL/ACCIDENTAL FIREARM DEATHS only: Mechanism and Context of Injury: Endorse any/all circumstances that apply to the situation and actions that led to the unintentional firearm injury Celebratory firing Showing gun to ☐ others Cleaning Gun Mechanism of Injury Thought safety was engaged Bullet ricochet П Fired while operating ☐ safety/lock Thought gun was unloaded ☐ Gun defect or malfunction Gun mistaken for toy Fired while holstering/ Unintentionally pulled trigger Dropped gun ☐ ☐ Other mechanism of injury ☐ ☐ unholstering ☐ Page 3 of 4 CoVDRS Data Abstraction Form-Version 2018.09 CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment Additional Comments: Page 4 of 4 CoVDRS Data Abstraction Form - Version 2018.09 54 54#56Key Challenges Increasing case load - Including increases in homicides Obtaining all records - - Response rates to CoVDRS requests Requirement to abstract on-site Substance in records - Limited circumstance and toxicology information Jurisdictional issues - US Military institutions - Tribal/Reservation considerations CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 55#57• Key Successes Obtaining all records - Response rates to CoVDRS requests - more frequent requests, compiled lists, investigation ID, FedEx return Requirement to abstract on-site - return with suicide reports, if not homicide reports Substance in records - Limited circumstance and toxicology information – pocket cards Incident Information Did the decedent have a... Current depressed mood? Current mental health problem? Current/previous treatment for mental illness? Alcohol problem? Other substance problem? Was the death related to... An argument? A physical fight? Intimate partner problems? Family relationship problems? Other relationship problems? A victim/perpetrator of violence? A history of abuse? A crisis (within 2 weeks) related to any of the above problems? Colorado Violent Death Reporting System Principal Investigator KirkBol 303-692-2170 Coroner Abstractor Ethan Jamison 303-692-2093 Law Enforcement Abstractor Karl Herndon 303-691-4962 Coroner/ME Abstractor Joshua Swanson 303-691-2246 COPE COLORADO Department of Public Health & Environment www.colorado.gov/cdph Pocket Card Resource Ideas for reports involving... Suicide Homicide Accident Sudden unexpected death Infant or child death In-custody death Overdose, firearm or violent death Decedent demographics... Age, sex, race Address of residence and injury Date & time of death. Manner/cause of death Military/veteran status Pregnancy status Sexual orientation Transgender status Suicide Circumstances Did the decedent... Leave a note? (What did it say?) Disclose suicidal intent (to whom)? Have a history of suicide attempt(s)? Speak of suicide? Have physical health problems? Have job, school or financial problems? Have criminal/civil legal problems? Experience the death/suicide of friend or family (past five years)? Have a crisis (within two weeks) related to above circumstances? Intimate partner violence What was the history of IPV? Victim's/perpetrator's convictions Victim/perpetrator's physical, mental, substance abuse problems Nature of relationship Restraining orders (type, amount) Homicide Circumstances Was the homicide related to... Another crime (describe)? Selling, using, possessing drugs? Jealousy (lovers' triangle)? Intimate partner violence? Gang involvement? A hate crime? A brawl (3+ people in physical fight)? A mercy killing? Was the decedent... A bystander? A police officer on duty? Acting in self defense? Using a weapon? Intervening to assist a crime victim? Firearm Information Ideas for reports involving... Firearm Information Describe the firearm Type (pistol, rifle, shotgun etc.) Make/model Caliber/gauge Was the firearm stolen? Who owns the firearm? Was the firearm stored loaded? Was the firearm stored locked? Poison Information What was the poison? Street/recreational drug Alcohol Pharmaceuticals Carbon monoxide/helium Other poison If prescription drug... Name of drug Prescribed to decedent? #prescribed/# remaining 56 56#58Key Successes Jurisdictional issues - US Military institutions - efforts to reach out to DOD national medical examiners office Tribal/Reservation considerations - limited interaction with tribal leadership, but work with local coroners and BIA investigators Data dissemination - Web presence • https://www.colorado.gov/pacific/cdphe/colorado-violent-death-reporting-system Colorado Suicide Data Dashboard • https://cohealthviz.dphe.state.co.us/t/HSEBPublic/views/CoVDRS_12_1_17/Story1?embed=y&:showAppB anner=false&:showShareOptions=true&:display_count=no&:showVizHome=no#4 CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 57 57#59Overview (counts) Crude Suicide Rates Age-adjusted Suicide Rates Methods, Circumstances and Toxicology Demographics for Circumstances and Toxicology Industry and Occupation Feedback and Questions Suicides in Colorado: An Overview Colorado Violent Death Reporting System 2004 Select years: a 2017 D Number of suicides by place of residence for selected years Click on a region or county to filter other charts; use "control" to select more than one at a time; click again to deselect Total suicides for selected population and years: 12,988 Number of suicides by demographics Click on one or more subgroups below to filter all other charts to that group(s): click again to deselect Choose view: County by age 10-14 years 164 -19 years 688 20-24 years 1.058 25-34 years 2,135 35-44 years 2,335 45-54 years 12.801 Yuma 17 75 55-64 years 2,052 Overview (counts) Crude Suicide Rates Age adjusted Suicide Rates Methods, Circumstances and Toxicology Demographics for Circumstances and Toxicology Industry and Occupation Feedback and Questions > Jackson Moffat 56 Routt 68 Larimer 775 Logan 50 Sedgwick 12 Phillips Weld 539 Morgan 53 Rio Blanco Grand 48 Boulder 28 7oomfield Adams Gilpin Washington 2 Garfield 88 Eagle Summit 31 Jefferso Clear Cred enve 1056 401Arabance 1.351 52 145 Elbert Kit Carson Pitkin Lake 553 64 20 Mesa 241 508 Delta 97 Park 75 Gunnison Chaffee Teller 105 Lincoln 12 by sex El Paso 1.785 Cheyenne 42 59 Montrose Fremont 200 118 Crowley Kiowa 5 Guray 19 San Miguel 12 Dolores San Juansdale Saguache Custer 24 Pueblo 474 14 19 Otero 45 Bent 16 Prowers by race/ 29 Whit Mineral Year: 2004 a Rio Grande Alamosa Huerfano 38 32 55. Montezuma á Plata 118 Cortilla Las Animas 50 129 Archuleta Conejos 26 9 Suicides in Colorado: Methods, Circumstances and Toxicology Colorado Violent Death Reporting System Health Statistics Region: 2016 (ALL) County: (ALL) D Baca Black/Af Sex: 13 Asian or A (ALL) Age: (ALL) Total suicides, entire state: 11,842 Selected population for all charts on this page Age: All, Gender: All, Race/ethnicity: All, Marital status: All, Veteran status: All, Medicaid: All Number of suicides per year, 2004-2017 HSR: All, County: All 1000 500 CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment by marit Method Cur by veter Veteran c Veteran: Race/Ethnicity: (ALL) **Select "Enable Medicaid view" to filter based on Medicaid** Standard view Employment status: (AID) Medicaid enrollment (within 2 yrs of death)*: AID Marital status: (ALL) * Medicaid enrollment includes deaths from 2008 onward, all deaths prior to 2008 are noted as 'Unknown' Veteran status: All) Total suicides, selected population: 11.842 For all charts below: the bars represent the values for selected population, the yellow reference bands are the values for the entire state. Firearm Hanging, strangulation, suffocation 24.7% Poisoning 20.5% Other 2.3% Fall 1.0% Sharp instrument 1.5% Circumstances Entire state 1- circumstances known 11.155 No circumstances known 687 49.5% Toxicology Selected population Entire state 1- circumstances known 11,155 No circumstances known 687 Current depressed mood Current mental health problem 60.7% 44.7% Toxicology info available No toxicology info available 1.957 Alcohol present Opiates present No toxicology info available Selected population 9.885 Toxicology info available Ever treated for mental health problem 39.5% Left a suicide note 38.8% Intimate partner problem | 37.6% Antidepressant present Marijuana present Benzodiazepines present 15.3% 13.9% 11.1% Crisis in in last two weeks 34.3% Disclosed suicidal intent 34.3% Physical health problem Amphetamine present Cocaine present 5.45 3.85 34.0% Diagnosis of depression 32.6% Current mental health treatment Problem with alcohol 31.0% 27.7% Carbon monoxide present 1.9% Anticonvulsant present 1.8% Antipsychotic present 1.2% History of previous suicide attempts Job problem Financial problem 27.2% Muscle relaxant present 1.1% 20.6% Barbiturates present 0.4% 19.8% Death preceded argument 17.8% 9.885 1,957 58 58#60Publications Peer-review (in-house) - Jamison EC, Bol KA, Mintz SN. Analysis of the effects on time between divorce decree and suicide. Crisis: The Journal of Crisis Intervention and Suicide Prevention. Doi: 10.1027/0227-5910/a000563, 2018. - Mintz S, Jamison E, Bol K. Suicide among healthcare practitioners and technicians in Colorado: An epidemiological study. Suicide and Life-Threatening Behavior. doi: 10.1111/sltb.12449, 2018. Jamison EC, Bol KA. Previous suicide attempt and its association with method used in a suicide death. American Journal of Preventive Medicine. 51(5-3): S226-S233, 2016. Peer review (external) - Carmichael H, Jamison E, Bol KA, McIntyre R, Velopulos C. Premeditated versus "passionate": Patterns of homicide related to intimate partner violence. Journal of Surgical Research. 230:87-93, 2018. Searles VB, Valley MA, Hedegaard H, Betz ME. Suicides in urban and rural counties in the United States, 2006-2008. Crisis. 2014;35(1):18-26. CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 59 59#61Publications Reports (HealthWatch) - - Johnson J, Jamison E, Bol K. The association between toxicology and suicide notes among firearm suicide decedents, 2004-2015: An analysis form the Colorado Violent Death Reporting System. HealthWatch No. 108, 2019. Mintz S, Jamison E, Herndon K, Bol K. Violent death among people experiencing homelessness in Colorado, 2004-2015: A summary from the Colorado Violent Death Reporting System. HealthWatch No. 103, 2018. Jamison E, Mintz S, Herndon K, Bol K. Suicide in Colorado, 2011-2015: A summary from the Colorado Violent Death Reporting System. HealthWatch No. 102, 2017. Jamison E, Mintz S, Herndon K, Bol K. Homicide in Colorado, 2004-2014: A summary from the Colorado Violent Death Reporting System. HealthWatch No. 101, 2016. Jamison E, Herndon K, Bui AG, Bol K. Suicide among first responders in Colorado, 2004-2014: A Summary from the Colorado Violent Death Reporting System. HealthWatch No. 97, 2015. Bui AG, Bol K, Jamison E, Herndon K. Suicide in Colorado, 2009-2013: A summary from the Colorado Violent Death Reporting System. HealthWatch No. 96, 2015. Jamison E, Bui AG, Herndon K, Bol K. Adolescent suicide in Colorado, 2008-2012. HealthWatch No. 94, 2014. CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 60 60#62Self-Care for NVDRS Staff • Detail oriented positions Regular exposure to the topic of death and violence - Often disturbing or depressing material - Secondary and vicarious trauma Unique position and experience May not regularly see the positive results of their efforts Current upward trends in violent deaths CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 61#63Emotional Survival for Law Enforcement¹ • Kevin M. Gilmartin, Ph.D Behavioral scientist specializing in law enforcement related issues Book accompanies in person seminars Concepts targeted to increase law enforcement self care and healthy habits after work ends Last chapter has many useful points larger then LE specific EMOTIONAL SURVIVAL FOR LAW ENFORCEMENT ***** POLICE A Guide for Officers and Their Families Kevin M. Gilmartin, Ph.D. "If you want to make it through to retirement wear your vest, wait for your backup, and read Gilmartin's book Sergeant Weaver Barkman Twenty-five-year law enforcement veteran Tucson, Arizona CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 1. Gilmartin, KM. Emotional Survival for Law Enforcement. Tucson, AZ. E-S Press; 2002. 62 42#64Source: http://corewalking.com/wp-content/uploads/2012/06/self-care.jpg Self-Care in Research Self-care and the Qualitative Researcher: When Collecting Data Can Break Your Heart, Kathleen B. Ragar² - Examines the emotional impact research can have on the scientist Breast cancer research and qualitative interviewing Abstractors/interviewers as an instrument and ignoring emotional aspects CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 2. Ragar, KB. Self-care and the Qualitative Researcher: When Collecting Data Can Break Your Heart. Educational Researcher. 2005;34(4)23-27. 63 63#65Violence Prevention Partnerships . Office of Suicide Prevention - Suicide Prevention Commission of Colorado - Mantherapy.org 1 - Colorado Gun Shop Project /Emergency Counseling on Access to Lethal Means (ED-CALM Department) Sources of Strength - Zero Suicide Bill - Colorado National Collaborative CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 64 44#66Suicide Prevention Commission of Colorado May, 2014, the 26-member Suicide Prevention Commission was created via the passage of Senate Bill 088 • First Year Priorities: Expanding and streamlining efforts to provide effective follow up care after emergency department discharge Expanding efforts to provide effective follow up care after inpatient discharge Promoting practices for reducing suicide risk among primary care patients Improving and integrating training for members of specific professional groups CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment Source: Hindman J. Office of Suicide Prevention Suicide Prevention in Colorado Annual Report 2014-2015. Colorado Department of Public Health and Environment. November 1, 2015. 65 55#67MAHOGANY Mantherapy.org THERAPY from the creators of pork chops and fighter jets Man Therapy is a tool designed to help men with their mental health. The more you tell me, Dr. Rich Mahogany, about what you're up against, the more I can cater the content you see below to your situation. Carry on! CDPHE ABOUT MAN THERAPY TAKE THE HEAD INSPECTION login sign up COLORADO Center for Health & Environmental Data Department of Public Health & Environment Source: Hindman J. Office of Suicide Prevention Suicide Prevention in Colorado Annual Report 2014-2015. Colorado Department of Public Health and Environment. November 1, 2015. 66 66#68CDPHE Colorado Gun Shop Project • 2014-2015 adapted from the New Hampshire Gun Shop Project Education and awareness project - firearm advocates, gun shops, firing ranges, and firearm safety course instructors Core message: "restricting a suicidal individual's access to firearms is a critical aspect of firearm safety" COLORADO Center for Health & Environmental Data Department of Public Health & Environment Source: Hindman J. Office of Suicide Prevention Suicide Prevention in Colorado Annual Report 2014-2015. Colorado Department of Public Health and Environment. November 1, 2015. 67 40#69Emergency Counseling on Access to Lethal Means Office of Suicide Prevention partnered with the Colorado School of Public Health, and the Harvard Injury Control Research Center Develop and pilot a means restriction program at Children's Hospital - Accompanied by formal evaluation Training for emergency department staff to educate parents of suicidal youth about techniques for restricting access to lethal means 90 percent reported the counseling was respectful and clear Respondents showed improvement in locking medications after receiving the counseling Children's Hospital adopted the training and continues to implement the intervention with all families in the emergency department because of a suicide attempt CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment Source: Hindman J. Office of Suicide Prevention Suicide Prevention in Colorado Annual Report 2014-2015. Colorado Department of Public Health and Environment. November 1, 2015. 68#70. Sources of Strength Comprehensive school based program aimed to increase connectedness within schools and train both adult and peer leaders "enhance protective factors associated with reducing suicide at the school population level" - Peer leaders as agents of social change Allows positive factors to spread through social network Office of Suicide Prevention priority through 2020 Sources of Strength increases student's school connectedness and connectedness to caring adults, both of which are CDPHE protective factors for: - Suicide - Teen dating violence Youth violence COLORADO Center for Health & Environmental Data Department of Public Health & Environment MEDICAL ACCESS SPIRITUALITY FAMILY SUPPORT POSITIVE FRIENDS MENTAL HEALTH HEALTHY ACTIVITIES GENEROSITY MENTORS SA https://sourcesofstrength.org/wp-content/plugins/sos-home/images/wheel.png 69#71Zero Suicide Bill STATE OF SB 147: Suicide Prevention Plan to Reduce Death by Suicide in the Colorado Health ● Care System COLORADO NIL SINE NUMINE 1876 Passed both the Senate and the House and is now on the Governor's desk waiting to be signed Zero Suicide Model: suicide deaths of individuals under care within health and behavioral health systems are preventable Integrates and enhances care within the medical system around patient safety Health care systems have reported a reduction of up to 80% in the rate of suicide in their hospitals Colorado is the first to adopt this model at the state level CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 70 70#72Colorado National Collaborative Original article Comprehensive, integrated approaches to suicide prevention: practical guidance Eric D Caine, Jerry Reed², Jarrod Hindman³, Kristen Quinlan4 Author affiliations + Abstract & PDF Background Efforts in the USA during the 21st century to stem the ever-rising tide of suicide and risk-related premature deaths, such as those caused by drug intoxications, have failed. Based primarily on identifying individuals with heightened risk nearing the precipice of death, these initiatives face fundamental obstacles that cannot be overcome readily. Objective This paper describes the step-by-step development of a comprehensive public health approach that seeks to integrate at the community level an array of programmatic efforts, which address upstream (distal) risk factors to alter life trajectories while also involving health systems and clinical providers who care for vulnerable, distressed individuals, many of whom have attempted suicide. Conclusion Preventing suicide and related self-injury morbidity and mortality, and their antecedents, will require a systemic approach that builds on a societal commitment to save lives and collective actions that bring together diverse communities, service organisations, healthcare providers and governmental agencies and political leaders. This will require frank, data-based appraisals of burden that drive planning, programme development and implementation, rigorous evaluation and a willingness to try-fail-and-try-again until the tide has been turned. http://dx.doi.org/10.1136/injuryprev-2017-042366 Injury Prevention 71#73Take Home Points • COVDRS is a partnership between the program, it's data sources, and data users The more information we receive the better our data can inform prevention programs We want to give back and maximize these successful partnerships CDPHE COLORADO Center for Health & Environmental Data Department of Public Health & Environment 72#74CO CDPHE Questions? Kirk Bol, MSPH COVDRS Principal Investigator [email protected] 303-692-2170 Ethan Jamison, MPH COVDRS Coordinator [email protected] 303-692-2093 COLORADO Center for Health & Environmental Data Department of Public Health & Environme 73 13