Workforce Capacity

Identify and offer training opportunities to staff in the priority areas of evidenced-based practices, reducing stigma, and trauma-informed care. The shared risk and protective factors of suicide, overdose, and ACEs provide an opportunity for cross-training to strengthen capacity at the intersection of these issues.

Evidenced-based practices: Training and education on evidence-based approaches equips the workforce to understand and focus on the shared risk and protective factors using the interventions and prevention programming based on the best available evidence. Evidenced-based prevention strategies and interventions may be both cross-cutting or topic-specific. For example, the Strengthening Families Program is an evidence-based family skills training program that prevents ACEs, and due to shared risk and protective factors, may reduce overdose and suicide risks as well.

Stigma: Training and education on identifying and reducing stigma —negative beliefs and attitudes that can lead to social exclusion and discrimination[1]—can reduce barriers to prevention and treatment at both the individual and community levels. Individuals with behavioral health concerns may avoid seeking support due to the shame and self-blame they feel or perceive from others. Those who do seek support following an overdose, suicide attempt, or potentially traumatic experience may be met with stigmatized responses that then further worsen behavioral health concerns. Community narratives and beliefs about behavioral health may be a barrier to gathering and reporting accurate data, and engaging partners to provide evidence-based responses to suicide, overdose, and ACEs.

Trauma-informed care: As they are highly interconnected, the experience of trauma is both a risk factor for and a potential outcome of suicide, overdose, and ACEs. ACEs--potentially traumatic experiences—are associated with increased risk for physical, mental, and social health issues, including substance use, overdose, and suicidality. For example, ACEs have been linked to depression, which is a risk factor for both suicide and substance use. Witnessing or experiencing an overdose or a suicide attempt is also potentially traumatic and may itself contribute to long-term health consequences that increase overall risks.

Trauma-informed care ensures that prevention efforts:

• Recognize the impact of trauma on individuals and groups by recognizing the signs, responding sensitively, and resisting practices that retraumatize.
• Seek to build feelings of trust, safety, empowerment, choice, cultural humility, and support amongst organizations and communities.
• Promote the consideration of the impact of trauma when developing and implementing programming and services.

Additional, LHD-specific training priorities: LHDs may have other training and education priorities specific to their structure or population served. Use results in the other domains of the SPACECAT to guide internal discussions about potential training priorities. For example, if the LHD needs to build capacity in shared planning and strategic plans, it might be appropriate to train staff in strategic planning facilitation.

__________________________________________________________

[1] Centers for Disease Control and Prevention. Reducing stigma webpage. Retrieved June 9, 2022, from https://www.cdc.gov/mentalheal...

Whenever possible, use community partners to provide training and include community partners in training offerings. A community is better equipped to prevent and respond to suicide, overdose, and ACEs when all public health staff and healthcare providers share similar perspectives and competencies in key areas.

Consider developing a bidirectional training relationship with community partners, using strategies like:

• Advertise training and educational opportunities to relevant community partners and/or coalitions to recruit attendees.
• Maintain awareness of trainings and educational opportunities offered by community partners and encourage LHD staff attendance (e.g., identify and join relevant listservs, provide contact information so partners can share training opportunities).
• Communicate your training goals and commitments regularly to partners, sharing data on the prevalence of suicide, overdose, and ACEs and exploring their ability or interest in making similar workforce development commitments.
• Build a shared training/education schedule with community partners.
• Ask for feedback from community partners about training plans, trainers, content, and identified areas of training needs.

Encourage a person-centered model of care that supports risk screening and assessment, integration of behavioral and physical healthcare, and continuity of care. LHDs are uniquely positioned to promote this model of care, even if the LHD is not a direct service provider. Person-centered care involves specific structures and systems to engage those receiving services as active partners in plans to improve health and quality of life.[1] Principles of this model incorporate respect for the values of the individual, prioritize informed decision-making and patient education, and practice cultural humility.

Respectful, collaborative relationships between those receiving services (including patients, clients, or community members), providers, and health service settings are an important foundation of effective, non-stigmatizing suicide, overdose, and ACEs prevention and intervention efforts. Person-centered care places the LHD and its partners as reliable sources of support, care, and information.

LHDs can promote and support specific elements of person-centered care that are known to reduce overall risks including:

• Risk screening/assessment: Screening and assessment tools are appropriate and effective only when they are followed up with connection to resources, referrals, or care for concerns identified. For example, additional assessment, counseling about treatment options and/or connection to resources or treatment must immediately follow a positive screen for substance use concerns.
• Integration of behavioral and physical healthcare: Coordinated behavioral health services and physical healthcare allows providers and patients to work together as a team to address the complex, interrelated risk factors underlying suicide, overdose, and ACEs to improve overall health outcomes. Integrated care promotes improved coordination and communication to achieve patient-driven goals.
• Continuity of care: Warm handoffs, referral follow-ups, and regular care coordination with both internal and external care team members increase engagement and treatment adherence.

__________________________________________________________

[1] Institute of Medicine (US) Committee on Quality Health Care in America (2001). Improving the 21^st-century health care system. In Crossing the quality chasm: A new health system for the 21^st century. Washington, DC: National Academies Press.