IHS Area Level Response

Immediate (Acute Phase): One of the highest priorities for the community in a suicide crisis response, like any critical incident, is to contain the crisis. The initial response of any agency often sets the tone for what is to follow. Important aspects of the acute phase include:

1. Coordinate: Contain the crisis via the use of resources.
2. Notify: Protect and respect the privacy rights of the deceased and those at risk.
3. Communicate: Reduce the potential for a contagion effect by implementing team development and crisis response protocols to increase team cohesion.
4. Support: Offer practical assistance to those affected, individuals, families, and community. This phase allows
5. Timeline: Typically 3 to 4 months.

Short Term (Recovery Phase): As recovery proceeds, the CRT should be aware that for a smaller subset of people, a more profound emotional reaction might result in response to the suicide such as: complicated grief, trauma reaction, and even suicidal ideation. As such, clinical, education, and training resources will need to be readily accessible. This phase will create a culture that promotes and supports help-seeking behavior and allows those in need to disclose their needs and seek services confidentially. Important aspects of the recovery phase include:

1. Consultation with and support of the leadership team in what is often a dynamic situation.
2. CRT provide formal communication to the community members on issues such as the availability of support services, normalizing reactions, and psycho-education on self-care and recovery (see Appendix XII).
3. Meet with affected family members and community members individually and in small groups depending on the setting and individual/family preferences, to help facilitate resiliency and recovery.
4. Encourage those experiencing complicated grief or trauma reactions to follow through with additional support resources as available, especially the community mental health resources.
5. Consider utilization of psychological autopsy (see Appendix XI Psychological Autopsy) to better understand the precipitating events and better shape the response.
6. Timeline: Typically 5 to 8 months.

Long Term (Reconstructing Phase): At this point the focus is sustaining positive change and maintaining readiness for anniversary dates. For those most deeply affected by the suicide, anniversary or milestone reactions may emerge. Because of the complicated nature of suicide, a small subset of the community may be still struggling with the experience months after most others have moved on. In preparation for this, the CRT may consider a way to honor the loss and celebrate the life that was lived while following safe memorialization practices (e.g., not glamourizing or romanticizing the death, not erecting a permanent structure, giving people safe space to remember but not re-live). Important aspects of the reconstructing phase include:

1. Honor: Prepare for reactions to anniversaries, events, and milestones.
2. Sustain: Transition from postvention to prevention.
3. Educate: Develop community leaders and refine the community response plan in an effort to build preparedness for future crises.
4. Timeline: Typically 9 to 12 months.

Once the response plan is selected and implemented by the CRT, each member of the CRT will carry out their assigned duties to include:

1. Immediately brief stakeholders on the incident which prompted the response.
2. Review the respective responsibilities and tasks with each of these stakeholders.
3. Prepare to provide support to these individuals working directly with the families impacted by the crisis.

During the course of the response the appropriate CRT team member will:

1. Maintain clear lines of communication with the team.
2. Identify the direction of the response and guide the resources to be utilized.
3. Ensure interventions include:
   1. Clinical services with extended hours (as needed).
   2. Educational outreach services and CRT contact information is made available to all students, school employees, and teachers.
   3. Consider social media campaign.
   4. Identification and utilization of available trainings such as gatekeeper training and suicide risk assessment (see Appendix XIII Resource Toolbox).
   5. Those responding to high risk situations or emergency calls bring team members to include trained healthcare responder and community para-professional or peer responders.
   6. Develop means of documenting services utilized.

IHS Area response leadership team will:

1. Be led by the Director of Field Operations who will report directly to the Area Director.
2. Will consist of the Area Director of Field Operations, Area Chief Medical Officer, and Area Director of Health Programs, Area Behavioral Health Consultant, Area Injury Prevention Officer, and the Area Finance Officer.
3. The Area Behavioral Health Consultant will serve as the subject matter expert (SME) and direct the response in coordination with the tribal leadership and the corresponding IHS Service Unit CEO (if applicable).

Area Behavioral Health Consultant will:

1. Select local staff to serve as team members that will assist in functional roles of operations, planning, logistics, finance/administration, and the public information officer.
2. Meet with the Tribe and CRT to review the response that was initiated at the tribal level.
3. Determine assets and needs for the Area level response.
4. Work with the Community, tribe and CRT, non-tribal organizations (BIA, FBI, State, etc.) and IHS Service Unit CEO to collect information, clarify goals and objectives of the response, and provide overview of how the response will unfold.
5. Define goals and objectives of the response.
6. Review roles and responsibilities with team members.
7. Select appropriate providers in the area and community who will participate in the response. The activation request will include the location of the response, identified need of the community, funding availability, requested length of stay for each provider, resources/specialty services required, sample supervisor release letter, and equipment/lodging accommodations.
8. Conduct weekly meetings with:
   1. Area Leadership;
   2. Selected Area staff team members;
   3. Tribal leadership, IHS Service Unit CEO and Behavioral Health Director, non-tribal organizations and on-site behavioral health responder;
   4. On-site provider team leader and members;
   5. School officials, faith-based leaders, and youth-focused groups.
9. Request permission from the Tribal Chairperson to record the presentation so all CRT members will have the opportunity to listen to this presentation prior to arriving in the community.

Tribal Chairperson/Leadership:

1. Will provide the team with background information (tribal chairperson’s discretion) about the history of the tribal community, culture, people, and their perspective on the current suicide behavior related events.
2. Will inform team about how team members can best present themselves to the community in a respectful, culturally appropriate manner.
3. This information will be communicated verbally or in written form depending on the prerogative of the Tribal Chairperson.

Area team leads will consist of:

1. Operations: Establish strategy and actions to accomplish goals and objectives set by the Area Director.
2. Logistics: Support Area Behavioral Health Consultant (Command) and Operations lead in matters related to personnel, supplies, and equipment. Performs technical assistance on matters such as IT, facilities, and other processes.
3. Planning: Coordinate support activities for response planning, process response information, and coordinates information activities across the response system
4. Admin/Finance: Support Command and Operations with administrative issues such as expenses, initiate/maintain credentialing and licensure compliance.
5. Public Information Officer: Communicating with the public, media, and/or coordinating with other agencies, as necessary, with response related information requirements, in compliance with all applicable laws and requirements governing information disclosure and dissemination.

CRT Lead (on-site) will:

1. Communicate directly with tribal leadership, tribal department directors, non-tribal organizations (BIA, BIE, FBI, State, etc.) and IHS Service Unit CEO.
2. Assign, implement, and oversee the delivery of services provided by the team members to the community. Serve as supervisor of team members on-site.
3. Ensure services are delivered in a professional, timely, and culturally appropriate manner.
4. Document services provided and complete necessary documentation.
5. Participate in all required meetings.

CRT Team Lead (off-site) will:

1. Be required to participate in Tribal Chairperson’s presentation prior to their arrival in the community.
2. Participate in weekly team meetings to improve their understanding of current activities and services being provided to the community.