Building Capacity to Navigate the Prevention of Suicide, Overdose, and Adverse Childhood Experiences

July 28, 2023 | Tanya Baker, Jonathan Purtle

Three men use their right hands to grip another's wrist, creating a strong triangleWith rising trends in suicide and overdose rates—and youth mental health a nationwide focus—health agencies are prioritizing the critical need for comprehensive, jurisdiction-wide prevention efforts by reimagining unconventional solutions to these behavioral health issues with partners representing multiple perspectives.

In 2021, 48,183 people in the United States died by suicide, 1.7 million made a nonfatal suicide attempt, and an estimated 106,699 died from drug overdose. Of note, such a sizeable proportion of these deaths occur among parents and primary caregivers, contributing to the estimated 7% of children nationally who experience the death of a parent. Additionally, more than 20 years of adverse childhood experiences (ACEs) research clearly illustrates how youth experiencing adverse life events (e.g., losing a parent/primary caregiver to suicide or overdose death, having a parent/caregiver misusing substances) are at greater risk of injury or death by suicide or overdose.

The original ACEs study found that rates of attempted suicide double later in life for children who live with a person with a substance use disorder. Building on this foundational research, more recent data indicate that a child having a family member attempting suicide increases the odds of that child attempting suicide by 94%, which highlights how the intersectional and intergenerational nature of suicide, overdose, and ACEs needs an integrated public health response focused on preventing ACEs as a root cause.

Primary prevention (upstream) strategies aimed at scaffolding the social and emotional well-being of children and their caregivers (e.g., early childhood home visitation programs, high-quality childcare, teaching skills, after-school programs, and connecting youth to caring adults) and that address shared risk and protective factors can serve to mitigate adverse events and negative health outcomes, injury, or early death.

SPACECAT and the Importance of Partnerships Among Health Agencies

From 2021-2022, ASTHO administered the Suicide, Overdose, Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) to 59 state, territorial, and freely associated state health agencies, which provided the first comprehensive snapshot of health agency capacity to address suicide, overdose, and ACEs. Results from the national fielding of the SPACECAT, a survey completed by 43 health agencies, highlight upstream actions to address the intersection of suicide, overdose, and ACEs across ten capacity elements (e.g., partnerships and leadership, shared planning and strategic plans, and risk and protective factors).

SPACECAT results emphasized the importance of multi-sectoral partners to prevent suicide, overdose, and ACEs. The results revealed a high capacity to coordinate with partners such as child, family, and adult-focused social service organizations, local public health, and community-based coalitions. Health agencies can leverage these existing partnerships to build relationships where coordination is lower (e.g., faith-based organizations, housing service organizations, and veteran-serving organizations).

Opportunities exist for health agencies to build coalitions, committees, and task forces that engage community-level organizations, elected officials, and individuals with lived experience who share a mission to address these intersecting priorities. The examples below demonstrate how two jurisdictions continued building the capacity to coordinate with key stakeholders while participating in the SPACECAT Learning Community.

The Commonwealth of the Northern Mariana Islands Healthcare Corporation partners with primary, secondary, and tertiary prevention experts in hospital and behavioral health clinics to educate the workforce and providers on shared risk and protective factors. These partnerships aim to enhance data collection efforts to inform resources for individuals and families affected by suicide, overdose, and ACEs and more comprehensively meet the needs of the community. These partners share a priority to increase community awareness of these intersecting issues and build trust among partners and community members.

Joseph Kevin Villagomez, director of the Commonwealth Healthcare Corporation (CHCC) Community Guidance Center, elaborates on this partnership. “Working with ASTHO in bringing together our CHCC programs that serve populations affected by ACEs has allowed for focused identification of service strengths and areas of improvement. These areas include collecting, reviewing, and utilizing data to inform and establish priorities, bridge service gaps, and collaboratively plan and implement evidence-based strategies to best serve our CNMI children, youth, and families addressing ACEs. This important work and collaboration with ASTHO reinforce our mission of providing hope, healing, and health for our CNMI communities in need.”

The Michigan Department of Health and Human Services is taking a shared risk and protective factor approach to address and prevent suicide, overdose, and ACEs throughout their state. Injury and violence prevention program staff mapped multi-sectoral stakeholders (e.g., youth/family-serving organizations, behavioral health providers, and medical associations) who work on suicide, overdose, and ACEs prevention. By braiding and layering resources, they engage in shared planning with their partners to implement crosscutting initiatives and develop unified messaging around suicide, overdose, and ACEs prevention.

Linda Scarpetta, Michigan’s Department of Health and Human Services Division of Chronic Disease and Injury Control Director, says, “Participating in the ASTHO SPACECAT Learning Community provided the support we needed to become more deliberate about addressing the intersection of suicide, overdose, and ACEs in Michigan. The site visit provided an excellent opportunity to designate a specific amount of in-person time to reflect on our work (individually and collectively), examine potential gaps within our programs, and explore partnerships, programs, and funding in more detail. This resulted in identifying many ideas that we can implement to collectively address the shared risk and protective factors for these three urgent public health issues.”

Looking Ahead

Focusing on partnerships and leadership, shared planning and strategic plans, risk and protective factors, and the other interconnecting capacity elements in the SPACECAT will help health agencies regardless of their capacity levels. Whatever stage agencies are in addressing the intersection of suicide, overdose, and ACEs, ASTHO’s SPACECAT Capacity Elements Toolkit simplifies action ideas for health agency staff and leadership to begin or continue their efforts. Asynchronous resources that support advancing health equity, stakeholder mapping, building partnerships and coalitions, strategic planning, and other capacity building resources are available for jurisdictions.

The potential to co-design a comprehensive jurisdictional approach that reduces the risk of ACEs and adversity later in life exists in all states, territories, and freely associated states. Health agencies are uniquely poised to lead collaborative efforts that influence positive health outcomes throughout their jurisdictions. Prioritizing upstream strategies addressing risk and protective factors shared by multiple adverse experiences ensures health agencies efficiently manage their resources. Strategically leveraging partnerships equips health agencies with the valuable insight needed to create environments that promote positive childhood experiences and reduce intergenerational cycles of adversity and health disparities in all communities.

ASTHO thanks Jonathan Purtle, DrPH, The Commonwealth of the Northern Mariana Islands Healthcare Corporation, and the Michigan Department of Health and Human Services for informing this publication.

This publication was made possible by the OT18-1802 Cooperative Agreement, award #6 NU38OT000290-04-01 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.