Suicide Prevention Offices and Committees Legal Map

Some answers have been edited for clarity.

[Music]

ALI MAFFEY:
All right, everyone. Thank you so much for joining us to in today's ASPO Connects webinar where we will explore new legal maps for state and territorial suicide prevention infrastructure. For those of you who are maybe not as familiar with the Association of State and Territorial Health Officials, we are a national membership organization of leadership across state and territorial public health. And our mission is to support, equip, and advocate for state and territorial health officials in their work of advancing the public's health and well-being.

And one of the key areas of their work to influence the public's health is through policy change, which brings us to our session today. Today we will discuss how to navigate the legal landscape of maps that identify laws on suicide prevention infrastructure across jurisdictions in this country. We will also uh support you to be able to describe the legal function, the purpose and function of the offices, commissions, and suicide fatality review teams that exist within jurisdictional policy frameworks. And then we'll be able to consider how these map insights might inform policy development, advocacy strategies, or program program implementation in your own jurisdictions.

So, a little about us. My name is Ally Mafy. I am the vice president of social and behavioral health here at ASTHO and I'll be sharing with you a little bit more about the goals of this project and the opportunities that we see uh to implement effective suicide prevention strategies and focus on the populations most at risk by improving the the policy infrastructure that exists within these jurisdictions.

After I give a little bit of information about the goals, I'm going to turn it over to Andy Baker White who is the senior director of state health policy at ASTHO and he's going to share a little bit more about ASTHO's legal epidemiology work or methodology and actually walk you through how to use these maps best. Woven throughout Andy's presentation, there'll be an opportunity to hear from two jurisdictions. Lena Hileman is a sibling suicide loss survivor as well as the director of the office of suicide prevention at the Colorado Department of Public Health and Environment. And Kelsey Tucker is the comprehensive suicide prevention grant director at the Rhode Island Department of Health. Each of them will share a little bit more about how policies like those included in the maps influence their work in their jurisdiction. I'm going to wrap it up at the end with a little bit about the applied uh work and how you can use these maps. and we wanted to share a little bit about questions. Sadly, with nearly 200 or over 200 uh registrants for today's webinar, uh we probably won't have time to address all of the questions that you may have. However, as you saw in the chat there, we would love for you to use the Q&A function to submit questions that come up throughout the presentation. What we would like to do is use those questions in order to inform um future work to potentially be able to um make improvements to the maps we already have and potentially create a frequently asked questions with responses that we can share out after uh the webinar and make that available to you all.

One one more thing we did want to acknowledge that this entire project was made possible through funding from CDC's National Center for Injury Prevention and Control. the views expressed here do not necessarily reflect the official policies of the federal government. So we'd love to learn a little bit more about you and who has joined us today. So there's going to be two poll questions for you. You should be able to check all that apply. So the first is I work at the and you can pick um which level you work at. You can pick multiple levels if maybe you work for the federal government but you're involved in local uh suicide prevention work as well. And then second, my work is focused on and again check all that apply suicide prevention crisis services, policy development, healthcare and mental health and treatment services, community support, education and youth um elevating voices of people with lived experience even if that might be your own. So, please feel free to share um a little bit more about yourselves.

All right, we have pretty strong participation here. A few more wrapping up.

It looks like we mostly have by a small amount um a an edge on state and territorial level representation here and 60% about are involved in suicide prevention directly as well as data. So analyzing tracking indicators and trends about 35% um fewer people involved in crisis services but about a third are involved in policy development and then representing a few other sectors. So thank you all so much for sharing that about your level of um work that you do.

So why are we here today? Suicide remains a significant public health crisis, ranking as the second leading cause of death for individuals between ages 10 and 34 as of 2023. And that means that we've lost more than 49,000 of our um fellow residents in this country to suicide uh in that year. Certain populations continue to experience disproportionately higher rates of suicide, including those in rural areas, older adults, American Indian or Alaskan Native individuals, individuals uh from uh sexual minority populations, people with disabilities, and veterans. We also know that more than 55% of US adults know someone affected by suicidal despair. That can include knowing someone who has considered, attempted, or died by suicide. And chances are for those of us on this call today looking at the percents that are involved in this work, it's probably a lot higher for us. Um chances are that for those of us drawn to the field, um many of us have experienced uh relatives, friends, family members um from suicide loss. So it's important that we acknowledge and I want to thank my colleague from Colorado for highlighting this. It's important that we acknowledge that statistics are human beings with the tears wiped away. This quote comes from Irving Celikov who was an asbestous researcher back in the 60s and even then he knew that when we highlighted the data that points to the scope of a problem it can mask the individual experience of loss and so it's important that we honor both through our work. But why focus on policy work? We know what works. We know what's effective. We have great resources about effective and focused prevention works to reduce suicide rates in the populations of most need across the country. It can help reduce those rates. There's been significant research. We have the suicide um prevention resource for action developed by the CDC. There's the 2024 White House National Strategy for Suicide Prevention. our colleagues uh at CDC and at SAMA worked closely with a incredible uh group of partners across the country at the national level and with insight and influence from um jurisdictions to be able to inform when in what went into that national strategy for suicide prevention. So we know that these strategies work, but we also know that a strong infrastructure lays the groundwork for effective prevention work. It helps galvanize and support the work implementation science has shown um that so much so that our country made an historic investment in improving the infrastructure for public health systems through a public health infrastructure grant program that went out recently. And this program is an incredible example of why we need broad investment in the administrative and organizational capacity areas that that lay the foundation beneath effective and evidence-based prevention work. So those capacity areas are things like a strong and resilient workforce, data and information systems that are aligned with the times and can keep up and report the data in a timely manner. that there are business processes like procurement um and administrative policy and planning as well as performance management and QI those business processes pro support programmatic efficiency that there's dedicated leadership inclusive of voices across multiple sectors and communities and that there's effective public health communication. So knowing that all of these things are important that is why policy can help create that floor of what is possible in public health that baseline infrastructure of what we need. So in this example for suicide prevention what a what policy can do can institutionalize a designated lead agency so that when a new funding opportunity becomes available it is clear um kind of where that authority and responsibility lies to pursue that funding. It can require multis- sector engagement. Many people working in this field know and understand the need to have a broad and diverse field represented at the table to inform suicide prevention work. But requiring that in statute means it can't change just based on new leadership, new staff in the position, new roles. It can mandate datadriven decisionmaking that um excuse me that focuses prevention and intervention efforts on the populations that would benefit most from those resources. It can open doors for data sharing across agencies while still protecting data privacy and it create can create continuity across grant-f funded initiatives so that there's a baseline level of support for the work um that doesn't just ramp up and it disappear um just on a grant funding cycle and it can also make state or other tax uh funds available as an option to support this work. So with that, I'm going to turn it over to Andy Baker White to share a little bit more about legal epidemiology and the methodology behind these maps.

ANDY BAKER WHITE:
All right. Hi everyone. Um thank you for being here this afternoon and thanks Ali. Um going to talk a little bit about the concept of legal mapping. Uh legal mapping is part of a broader field known as legal epidemiology.

And really the um the point of legal epidemiology is to to see what is the uh actual health um impact of our laws, policies and and so forth. Uh so there are a lot of different um activities that that you can undertake within the field of of legal epidemiology. Um, and one of kind of the more uh baseline efforts is is known as legal mapping.

And what we do with legal mapping is it's it's kind of a it's basically a snapshot of of what the laws are across the jurisdictions on a given topic. And and what we can do is it's a um we can plot those laws um or the legislation or other different policies uh within a visual tool. And we'll be showing you the visual tool that we use um in in a little bit. Um what this does is it kind of like this visualization it can really help uh the user to understand what the legal landscape is around a topic. Um, so you'll see um shortly, you know, that there's a map and it kind of you can like instantly see like how many um states, how many jurisdictions have laws that establish uh uh suicide prevention offices or coordinators um and then we can highlight uh different components of those laws um within the visualization.

And so it can really um be useful in um answering questions that that we often get here at ASTO from our members, which is um you know, we're interested in doing such and such. What are others doing in that area? And and so it has been helpful um since we've established our our legal mapping center on these few topics um to to really be a resource and a reference for our members um as they're interested in um different topic areas that we're that we're um covering.

Um and so far we do have uh this this recent the the suicide prevention map um along with an overdose prevention and public health infrastructure uh maps as well.

So a little bit about how we um how we developed the map, you know, the process that we went through uh to get where we are today. Um this is a a process. It's it's been standardized um by um by the the University of Temple, the public health law center there. Um uh we we've partnered with them um in in doing this work as to be able to host the map and so forth. Um but it really starts out with a um identifying the policy that you want to map and to do so um we start out with a scoping memo. And so we started working on this um last um last fall um and uh with our colleagues at CDC kind of like deciding what you know what are the topics that we're going to um to look at. I mean if you know you think about all the different um policy areas within suicide prevention um you have to narrow narrow it down. Um so our first step was to do a scoping memo and um that's where first we identified a few different policies. Um uh the first and and I have listed here the different policies that we took a look at in that memo. Um so one was kind of the the suicide prevention the infrastructure side of things. So laws that establish um uh offices and state coordinators for suicide prevention. Um we also decided to look at to scope um laws that support housing first policies as well as laws that address environmental lethal means andor medication safe storage. And so within that memo, uh we selected five jurisdictions uh based on population um geographic location um as well as um looking at some of the statistics around suicides within those jurisdictions. And we had a team here at Ato uh look at the laws within those jurisdictions um on those three topic areas.

Um, and so that kind of give it gave us a a kind of a a start within those different areas and to be able to kind of figure out which of these should we kind of go further with in developing this map. Um, we took that memo and we um took a uh you know, we made a um based on our our research kind of a a suggested topic and we received feedback from um from ASTHO members and some of our ASTHO peer groups um and so forth. And um based on the feedback, based on what we found uh in the research for the memo, we decided to select the suicide prevention infrastructure. And then within that we um kind of focused on three different areas which are offices or coordinators for suicide prevention uh task force councils or other advisory bodies. So kind of you know not ex not quite a an officer coordinator but another type of body that um can have some responsibility or uh a role in addressing suicides. and then also um suicide fatality reviews.

Once we had the uh topic area identified, we developed a um question development table as well as a research protocol. Um and these are available on our legal mapping center. Um, and what this does is it kind of sets out uh the questions for the legal researchers to answer as they go and they identify the laws within the jurisdictions. Um, we uh we contracted with a couple of of legal consultants uh to conduct the legal scan and to do the data entry and that itself was a process. We um they initially scanned 10 jurisdictions.

We came all together, we kind of we had a check-in to review, maybe make some tweaks to the question development table, um and so forth. And then when we when we got that all settled, um the consultants went and they scanned all the jurisdictions. Uh we know that when you have two different people um kind of answering these questions, there going to be some differences. Um so we did have check-ins um and then um we did a divergence check um of the coded laws and um did a quality review of of the data entry. Um and so that kind of makes the back end of the map that you're going to see. Um and with that uh you know after we we did the research we put together a policy report which kind of shows some of the u the findings um as you know where we where we looked at each of these different areas um that report is also um available on our map.

Um and then we um we published the map and that's why we're here today to share that and show you all um how that works.

Um but a little bit I want to go in a little bit before we show the map kind of about the different topic areas and kind of what the what we what we're asking the different questions that we're asking for these three areas um within um suicide prevention infrastructure at the state level. So for an office or the coordinator um category you know what we're looking for is like you know where is the coordinator of the office located? Is it in the department of health? Is it in the governor's office? Is it maybe in an education department or some other agency um or department? And then we wanted to look at you know what are the required duties you know what does the law set out um what does the statute set out as required duties for these bodies and then also you know what are the duties um in general for the task forces the councils and other advisory bodies um we looked at whether you know how do they designate certain representatives like who are who's required to be on those task forces um or the councils Um and then also we asked the question around are these um bodies are they focused on certain high-risisk populations or suicide in general. Um and then we identified like what are those high-risisk populations um that are the focus of these bodies.

And then for the suicide fatality reviews, um we looked at uh you know what again what are the populations of focus. Um and we also kind of dug a little bit deeper to see um you know were not just the the suicides themselves, but were suicide attempts part of the um required to be reviewed uh by the fatality reviews. And then um also looking at any sort of requirement that the fatality review bodies um share data or have some sort of coordination or connection with other um suicide u prevention um bodies.

All right. So the first map I want to show, we're going to kind of walk through the office um or the coordinator statutes. Um and again um we we did focus our research uh only on on statutes. Um so we do know that um some jurisdictions may have uh offices, coordinators, programs, so forth that might not be established in in statute um itself. Uh but as Ally mentioned before, we wanted to really focus on um statutes um because it does kind of kind of bring a um perhaps more of a permanence uh to these types of interventions. Um so so again, we do understand that in some jurisdictions there may be responsibilities or maybe efforts um but again that but those might not be within statutes. So they they weren't captured necessarily by our um by our research and our efforts. Okay. So I'm going to share my screen now.

Okay. So I'm trusting everyone can see this. Kelsey, could you give me a head nod if you can see it? Okay. Thank you. All right. So this is the homepage for our uh ASTHO public health um legal mapping center. Um and you can see here the three different maps that we have. So we'll click here on suicide prevention.

And here on the right side of the screen you can see the different links to our policy report, our resource protocol, the code book and our data sheet. Um so again if you you know feel free um to to explore those kind of see what the findings that we saw are and even more about how we conducted um this uh work.

So here it is. So here's here's kind of the the visualization of um of of the of the work. It kind of starts out with question one um and then the the sub questions under one are focused on the office and coordinator and then two are the task force council and other advisory body and then if I scroll down a little bit more we'd get to three which are on the fatality reviews. Um but you know the the map is you know it allows you to select um you know to to look at each of these questions and select you know does the jurisdiction law establish a prevention office a suicide prevention office or coordinator. And you can you know you see here what we found were about that in 12 jurisdictions there were statutes that established um these bodies. Um now we did find and this is why you know a lot of the research we have check-ins we kind of make uh we either make changes or additions as as we go along. We did find that in 11 jurisdictions um the law assigns or or or directs um the responsibilities of these types of bodies uh to to maybe suicide prevention programs within an agency um or actually to to an individual. So, for example, in Minnesota, the commissioner of health is directed to undertake um a lot of the responsibilities that that we find are are often given to um suicide prevention offices and coordinators. So, we did capture those. So, um so you might see here if we go down to look at you know what are the required duties of the office. So if we click on to educate the community, you can see here that the ones with the kind of dark those are the ones that where it's established in statute and with the red are the ones that also have the responsibility to educate the community. You'll see here in Georgia and Maryland, those states the law actually establishes a program within the within the uh health department. And so we went ahead and captured those because there is a function to educate the community even though it might it's not necessarily established through a prevention office or coordinator.

So you can again like if you're interested in you know what jurisdictions um have coordinators or offices and they are required to produce a report. You can then again select there and see the jurisdictions that are um produce reports.

Um then what this also allows is you can go and you can highlight you can click on the state and again it shows you the the answer the question and the answer. Um sometimes there are notes. Um, so here we it notes that the suicide prevention officer coordinator is specific to youth and it also has a link to the legal source. So you can actually click click on see the full law.

So there is established a youth suicide intervention and prevention coordinator within the part of the Oregon Health Authority that works with mental health and addiction issues. So we really tried, you know, it's it's um pretty robust. It takes you straight to where the law is, what the language is, provides you the citation and um and and the language of the law itself. Um we also have a table view. Um, so not just the map, but you can have a table view. And again, it'll show you the jurisdiction, the question, and how the question is answered. And then allows you to click on for more details.

All right. So again like I said we have the other questions for the establishing the task force council or other advisory body and then also um the fatality review. Yep. And I think right now I will stop my screen share and we we will hear from Colorado a little bit about their suicide prevention efforts and then I'll be back in a little bit to show everyone again the map about on the fatality reviews. So thank you.

LENA HYMAN:
Great. Thank you so much. Thanks for having me. My name is Lena Hyman and I use she her pronouns. I'm the director of the Colorado Office of Suicide Prevention. We are housed at the Colorado Department of Public Health and Environment. I'm going to take about 5 minutes to talk at a high level about our office and the Suicide Prevention Commission.

So, our Colorado Office of Suicide Prevention is the designated lead entity for suicide prevention efforts in the state and this was created in the Colorado Revised Statutes. Our office was created in the year 2000. So we just had our 25 year OSP anniversary. And really what we are charged with is being the lead agency to collaborate with other state and community partners and agencies to coordinate and align suicide prevention programs across the state. So that's our work in a nutshell. If you're interested in knowing a little bit more about it, I put our website here, cosp.org.

And every year we release an annual legislative report. It comes out November 1st of every year. So right now our last year's report is available online and we'll be releasing our FY25 report on November 1st. So you can set that in your calendar if you're curious for the release date.

This is our wonderful office of suicide prevention team. Again, our work as a team is to serve as that lead entity for the state of Colorado for coordinating and aligning suicide prevention, intervention supports, and post vvention efforts, which we do by collaborating with communities statewide to reduce the impact of suicide. I'll be talking a little bit more the next few minutes about our suicide prevention commission. And although we have a commission that serves as the advisory body for the office of suicide prevention, I wanted to also acknowledge that our office of suicide prevention team works really closely and is integral to communicating with that advisory board. So for example, I'm the director of the office of suicide prevention. I also serve as the co-chair, the public co-chair of the commission. And it's possible that my fellow co-chair is in the chat. I saw an organization name there. So hi if you are. Um, Seth Tyra is our commission coordinator. So, they're in charge of convening and facilitating and supporting all the commission work and making sure that we are aligning with the bylaws. And everyone else on the Office of Suicide Prevention team might be supporting commission workg groups, working with commissioners, and working to implement recommendations and guidance into the work in our community. So we have a whole team approach to aligning our office of suicide prevention work with the commission that advises our office.

So what is the suicide prevention commission? Well, first it's a type two board. So what that means is our commission is an advisory board. So it advises it does not create policy. So, the Suicide Prevention Commission in Colorado advises the Office of Suicide Prevention and makes recommendations for our office and for partners across Colorado. Per statute, we have 22 appointed commissioners who represent a variety of sectors and organizations and lived experiences to make sure that we are representing different viewpoints and different agencies and partnerships across all of Colorado.

The commission the quarterly meetings are open to the public and we facilitate numerous topic specific workg groups that are also open to the public. Our commission like our office of suicide prevention implements a comprehensive approach to suicide prevention. So everything from upstream prevention focusing on connectedness and economic stability and supports to education and awareness to increasing access to suicide safer care to addressing lethal means safety and supporting post vvention. all falls under our purview.

In conjunction with our commission, we have identified priority populations that are based on suicide related data and the commission has state funding allocated toward one FTE, our suicide prevention coordinator, but does not include any funding to implement any of the recommendations. So our commission was created in 2014 per statute and was charged with providing collaborative leadership for suicide prevention efforts. This initial commission was set up for 10 years after which time it went it underwent a sunset review. So last year we underwent the sunset review and thanks to the department of regulatory agencies, they made a recommendation to the legislature to extend the commission for another 10 years and that passed and so we are now in year one of a renewed 10-year commission. All right. So, we have a number of populations of focus that are based on our data and the outcomes and the recommendations of the suicide prevention commission. So, the the top line there is looking at different age categories that Coloradoatans um are in across the lifespan knowing that every age category can and does experience suicidal despair attempts and deaths by suicide. And then we have a number of additional populations that experience additional disparities related to suicide related indicators. We continue to be really cognizant both on the commission and our office of suicide prevention that these populations and communities intersect.

So, we want to be really thoughtful that the programs that we are implementing are meeting the needs of all Colorado communities, including the communities on this slide, and understanding that, for example, we would be also supporting older adults in rural communities or a young adult veteran or um a working age adult working in a high-risisk industry who might also be part of the LGBTQIA2s plus community. So these circles are separate on this slide, but we really see them as dynamic and intersecting. I want to be thoughtful about addressing all populations in our work. Um, this is a pretty busy slide, so I won't go into it in detail. It is in our annual report. We are in the process of updating it right now. This is just a shorthand key to looking at our some of our main suicide prevention initiatives across the state. So there's a key at the bottom there. Each shape represents a program that we implement and these are our 64 Colorado counties. So we have uh office of suicide prevention programs in all 64 Colorado counties and this is helpful for our local partners too to note where our office of suicide prevention programs and partnerships are currently existing.

All right, that was 5 minutes. So, if you have any questions at all, please don't hesitate to reach out to me and I'll connect with you or connect to one of our wonderful team members to answer any questions you have. Thank you so much.

ANDY BAKER WHITE:
All right. Thank you, Lena. And um let's I'll go ahead. Okay. So, the next um category that I'll kind of do a quick review of the map on is the fatality reviews. Before I get there, I do want to touch um real quickly about the um the category that we had around task forces, commissions, and other advisory bodies. Uh the map in with the map, we indic we identified 12 jurisdictions that have statutes establishing uh those types of bodies. And again, we realized that um not all states or jurisdictions um establish those through statutes. And we did identify in at least three jurisdictions where uh those types of bodies have been established through um a governor's executive order.

But now let's take a few minutes and look at the oops wait.

Okay, here we go. For the fatality reviews. Okay. So again, the basic question, does the jurisdiction does the jurisdictional law establish a committee or body that reviews suicides or fatalities? What we found is that as of the beginning of this year, um, January 1, 2025, 30 jurisdictions establish in statute a um a a some sort of body that reviews suicide fatalities. Um, these do vary. the statutes around those um some of them are at the state level, some of them are local level efforts um and so forth. Um we also kind of found and categorize you know kind of what the population is um or or populations are that that the the where the focus for these committees or to to review the suicides are. So we kind of found um you know that bodies that you know are the population is is around suicides themselves um in a certain number of states um sometimes some of the bodies of suicides are uh reviewed within a body that is focused on overdose fatalities. So we we indicate that others on child deaths um maternal mortality looks like we didn't find any. And then domestic violence um several jurisdictions um suicides are reviewed as part of a domestic violence um fatality review.

Um we also noted I'm going to skip down to this one I think. Um yeah. Oops. Sorry. Getting kind of the map is kind of going off the screen. In four jurisdictions, we found that the um that the suicide uh fatality review committee uh is is required to to share information or kind of have some sort of connection with a uh suicide prevention body. Um so that might be in efforts around developing annual recommendations or requirements that the suicide prevention body is is directly consulted in some way. And then the other question that we had around fatality reviews was about suicide attempts. And we found um in Illinois that the statute requires um the suicide fatality committee to collect data on suicide attempts. Again, when we kind of dig a little bit deeper into Illinois, we first see a note um that these are statewide and regional teams, but also that um that the that the scope of the Illinois um let me see, yep, I think is also is domestic violence.

So, it's a uh it's a it's a domestic violence um fatality review um uh committee or body, but within there the statutes for that body, they are required to review um suicide attempts by the survivor. So again, kind of shows you kind of how you can really drill down and kind of look at the different components um the different areas uh these statutes and these um laws.

All right. So with that, I'm going to go back. Actually, can I ask you a question on that real quick? It popped up in the chat there. Um if you reshare your screen, can you just show the different layering of colors? Um just just one more time. Um because you can choose up to four options to highlight at the same time and you can choose which four those are.

Yes. So by clicking you know your yes no on does the jurisdictional law establish a committee Andy has in that dark blue upper left color and then you can add additional colors down below to highlight just a few more. So really the colors are up to you to be able to um kind of highlight and prioritize up to four layers at a time uh to be able to examine the different jurisdictions, but the uh the table will help you look at more than just those four things at a time. Um but just wanted to answer that question live while we were on it. Okay. Yes. Here's the table with um four different layers um selected with the question above and then kind of answering for each of those. Right. Okay. So now let me stop sharing and turn it over to Kelsey.

KELSEY TUCKER: Right. Thank you. Thanks Andy. Hi everyone. I'm Kelsey Tucker. I am with the Rhode Island Department of Health. I oversee our comprehensive suicide prevention grant. Um I use she her pronouns.

So before we jump into the impact of the legislation that we have here in Rhode Island related to fatality review teams, I just wanted to give a brief overview of the law itself. Uh this particular piece of legislation is nestled within the responsibilities of the Rhode Island Office of the State Medical Examiners which is within our Rhode Island general laws. There are three main points within the legislation.

The first is that it requires the office of the state medical examiners to establish a multidisciplinary team and it outlines a few of the different folks who should be in attendance.

The second part outlines that the group will be confidential, protected under all applicable privacy and confidentiality laws and exempt from access to public records or APA requests. And then the final part of the legislation explains that the group will be responsible for creating recommendations annually for whomever is overseeing suicide prevention work in Rhode Island at the time, whether that be a coalition or a specific state agency.

So to talk a little bit about some of the successes and challenges of this legislation, I will preface this with the fact that our legislation was only passed last June. So we have only had this legislation in place for one year.

Um and we are still learning about the implications, right? So sometimes when these things pass, it takes a little bit of time for us to learn, but these are the takeaways so far. So the big the biggest success is really kind of the main point of the legislation that it established our first uh suicide fatality review team. We do have other fatality review teams in Rhode Island that are also nestled within that legislation, but this is the first one dedicated specifically to suicide uh fatality reviews. It has also uh helped to provide the health department with the authority to oversee and implement the team. So this is particularly important because not all of our suicide prevention work in our state is overseen by one agency or group. So when there's a project like this, it's just helpful for us to have a clear guideline uh around you know who is providing that oversight and that and that administration.

The legislation also outlines some potential members of the group which is helpful as a jumping off point for us and it also grants us exemp exemption from app requests. This piece is also really important because um I personally have seen an uptick in APPA requests over the past few months related to different projects I work on. And while we want to be as transparent and responsive as possible to the public, when you're working on something as sensitive as fatality reviews, we also need to balance that desire to be transparent with protecting the privacy of those who have unfortunately died by suicide. Moving over to look at the challenges.

One major hurdle that we've had to deal with for all of our fatality review teams in Rhode Island is that the Rhode Island Department of Health is a HIPPA covered entity. So, I have learned that not all health departments are HIPPA covered entities, but since we are, this requires us to have legislation in place in order to be able to physically share identified information with partners and stakeholders outside of the department related to these deaths. Um, if we didn't have legislation in place, it would have to be an internal review team. We wouldn't be able to have any external partners involved.

Uh it also makes it challenging for us to the legislation makes it challenging um for us to engage in any next of next ofkin interviews. So because we're HIPPA covered we can't we can't reach out to next ofkin without specific legislation in place. This legislation doesn't include that. It is something that um other fatality review teams, specifically our overdose fatality review team in Rhode Island, wants to implement, but they haven't been able to figure out how to get around that HIPPA status. Uh there are some, you know, legal processes that they can engage in and are trying to engage in, but I think it's it's just a complicated, nuanced process that um is just a little bit of a challenge right now. Uh currently we fund our work um through a CDC comprehensive suicide prevention grant but once that ends Rhyo is going to be required because of this legislation to find another funding source uh or we would you know risk being in conflict with state law. So that is you know that is another big challenge I think uh for anyone who works at the state level it can be difficult to have an unfunded mandate uh however we are you know hopeful that we will be able to identify additional funding to continue this work because it's so important.

So, while these challenges are difficult, they really do also present us with an opportunity uh because they are challenges that all of our other death review teams, we have three, are also facing in Rhode Island. Um, our pregnancy and postpartum death review, our overdose fatality review, and our child death review teams have really been excellent resources for us to learn from and collaborate with. And so while these challenges are hard, it's really been a great opportunity for all of the review teams to come together to talk about how we can move different different aspects of our work forward in alignment with each other. And so since the creation of the fatality the suicide fatality review team, we have been meeting monthly with leadership with from all of the teams to discuss these challenges and other ways that we can make sure that our work is in alignment.

And I think that is it from me.

ALI MAFFEY:
Thank you so much, Kelsey. We really appreciate you sharing that. And I I think that helped to answer one of the questions um benefits and challenges of having these policies in place um to be able to uh accomplish this work. I know that when I was working at a state level, an unfunded mandate created the opportunity to request state dollars to help support it, but it doesn't mean you always get it. and it may put you in the position of still having to deliver on the reports without funding unless you can find that external source. So that's definitely a challenge. Um and then related to that, how can jurisdictions continue to use these maps? What we hope is that these maps can help leaders identify ways that they might strengthen their own work. They can examine the national landscape of policies, enable leaders to identify the potential infrastructure gaps that policy could help improve and build that broader sector and community direction of the investment in prevention by requiring that multis- sector engagement. It can help them replicate best practices and learn from other jurisdictions. How did they accomplish something? Um how might uh they learn from that and how did another jurisdiction do that? Who all did they include? um how could our commission be more inclusive and then also strategically support sustainable and focused infrastructure over time? Um those that question and sorry I'm just pulling it back up. Um some of the benefits of ch or challenges of having these policies, it really comes into play right here and in everything that that Kelsey and and Lena shared. Um, Lena does have a few staff that are fully funded by those uh, state dollars and um, uh, so it does did open the door for them, but as Rhode Island shared, it would be unfunded for for their jurisdiction without this federal grant.

So then that could be a challenge. So both the opportunity can also be the challenge if the legislature doesn't follow through with that. So all of these questions that you have included have been incredible and we are learning quite a bit. I know that Andy um just included in the chat advantages of scientific legal mapping um as a resource. Uh I see there was a question about local jurisdictions. There are some challenges um in legal mapping at a municipal level. um the it's it is a different approach than what is done at the state and territorial level and um and we'll try and get some other questions for you Alisa um on this the search terms I know the research protocol is really helpful but we'll we'll work on getting those questions answered. Um so wrapping up um this was fast and furious a lot of information coming at you quickly. Um, so hopefully you now know how to navigate this resource on seeing what the legal landscape is, being able to drill down and describe some of the legal functions of each entity that was established um through statute or regulation, and also consider some insights about how you might be able to use this work in your jurisdiction. So, what we'd like to learn from you a little bit more is how else can ASTHO support your work in these areas? So, Leslie's going to pop up a poll for you here. And this is again a check all that apply. So feel free to answer um multiple ways that ASTHO can continue to support your work in um policy or suicide prevention um and moving forward.

Oh, this one was single choice. My apologies.

So, you have to pick one. Your top candidate.

All right. So coming through in these results, we're seeing a learning community for peer collaboration across strategies would be incredibly helpful, followed by effective policy communication, and then about tide, we have additional policy or legal analysis or improved policy or advocacy work. So thank you very much for chiming in in those ways that will help us.

If you would like to connect with any of us individually, um here's our information. Uh, please feel free to reach out and ask further questions. Um, Kelsey, I know Lena and I were chatting about fatality review. So, I have a feeling Lena's gonna be reaching out to you, Kelsey, to ask more. And with that, the most important thing that you can do is give us your feedback on this session, how it went, how we can improve, and what you found to be the most useful. So, please complete the session evaluation. You can use your phone to u pull up the QR code or you can also use the link that um is there on screen. It'll be dropped in the chat for you um just now.

And again, thank you. Remember, a strong legally supported infrastructure is paramount to sustaining prevention efforts, especially amid an evolving funding landscape at the federal level.

So, we hope that you found today's session valuable. We hope that you've learned quite a bit and we look forward to connecting with you soon. Thank you all very much.