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Working Under One Umbrella: Aligning the Prevention of Substance Misuse and Suicide in Wyoming
Wyoming’s Prevention Management Organization represents a unique approach to addressing substance use and suicide prevention in an integrated way.
Faced with shrinking budgets and a pressing need to maximize limited resources, in 2011 the Wyoming Department of Health, assisted in the formation of the Prevention Management Organization (PMO): a single management system responsible for providing both fiscal and technical support to the state’s diverse portfolio of prevention efforts. The new system, funded in part by a State Prevention Enhancement grant from SAMHSA, provided an efficient way to quickly allocate resources to communities of highest need. It also provided the sustainable infrastructure needed to address the related problems of substance use, misuse, and suicide in a coordinated way. Whereas in the past practitioners working to address these problems frequently did so in isolation, today Wyoming supports a team of highly skilled community prevention professionals (CPPs) who work across the state’s 23 counties to support a comprehensive approach to these closely connected problems.
Under the PMO, CPPs who had previously supported either substance use or suicide prevention efforts were now expected to support both. “We were asking people to work outside their comfort zones,” says Erica Mathews, Substance Abuse and Suicide Prevention Program Manager for the Wyoming Department of Health. “It was especially scary for staff members who had never before addressed suicide prevention.”
To prepare staff for their new roles, the PMO implemented an extensive “onboarding” process designed to build staff knowledge and skills, clarify job responsibilities, and ease anxiety. The PMO also established “cross-discipline” mentor relationships that enabled practitioners to draw on their peers for information and advice. According to Feliciana Turner, Director of Statewide Prevention and Wellness for the PMO, these efforts were extremely helpful in moving practitioners along a “continuum of readiness” and in strengthening connections between practitioners.
A primary goal of the onboarding process was to help CPPs understand and appreciate that they were all partners working together to address a common problem. For example, since alcohol and other substance use disorders are risk factors for suicide, both fields share an interest in preventing alcohol and drug use and misuse. The CPPs needed to understand that their goals were the same, and develop a shared language to describe their work moving forward. SAMHSA’s Strategic Prevention Framework (SPF) provided the foundation for this shared understanding—initially among the CPPs themselves, and later among the communities with which they worked. Regardless of their prevention focus, CPPs learned to consistently return to the model to guide their prevention efforts. According to Turner, “The SPF was the ‘glue” that held these areas of prevention together.”
To further underscore the relationship between substance use and suicide, the PMO also added an “S”—for suicide—to the commonly used acronym ATOD—alcohol, tobacco and other drugs. The new acronym, ATODS, formally reflected the state’s commitment to addressing both issues equally. “When we first launched the PMO, suicide prevention efforts were much more visible than substance abuse prevention efforts,” says Turner. “Creating the new acronym helped us move beyond division and competition, and publicly declare that both areas of prevention are equally valued.”
Before the PMO era, most communities supported separate coalitions that worked independently to prevent substance use or suicide. With the launch of the PMO, communities were required to address ATODS through coordinated coalition efforts. The role of CPPs facilitates the shared framework being used across ATODS coalition/s. “This integrated approach was new to many communities,” says Mathews. “It took a lot of TA [technical assistance] to bring communities together, to look at a community as a whole and to work on making it “well” as a whole.” During the first year of PMO operations, much of this TA focused on helping communities assess their prevention needs—which, for the first time, required coalitions to look not only at their substance use data, or their suicide data, but at both together.
Effective communication has been key to the success of the PMO. Staff members are quick to pick up the phone to share experiences and stories, and are provided regular opportunities to talk about their work and trouble-shoot problems collectively. PMO leadership also relies on communication with CPPs to know what is happening at the local level. “Communication is key,” says Mathews. “You can’t rely solely on written reports. You need to communicate regularly, be involved, and get to know everything.”
Regular communication with the public has also been an important factor in building an understanding and acceptance of the PMO model, and correcting misperceptions. “People were afraid that the PMO meant a loss of funding to their communities,” says Mathews. “We needed to explain that funds would still get to their communities—just through a different mechanism.” Whenever possible, the PMO delivered these messages face- to-face, with the help of the CPPs.
Over the past four years, Wyoming’s integrated model has produced multiple benefits. The creation of a state-level PMO has introduced new opportunities for collaboration with other state-level entities, such as the Wyoming Association of Sheriffs and Chiefs of Police (WASCOP) and the State Epidemiological Outcomes Workgroup (SEOW). These partnerships have leant credibility to products and messages coming from the PMO, and facilitated the sharing of data across agencies.
Under the PMO, prevention practitioners receive standardized cross-training in both substance use and suicide prevention, resulting in a stronger, better equipped workforce and higher quality programming at the local level. Every CPP is required to complete both the Substance Abuse Prevention Skills Training (SAPST) and the Applied Suicide Intervention Skills Training (ASIST). Additional funding for the PMO from SAMHSA’s Substance Abuse Block Grant and Partnerships for Success (PFS) 2015 programs has made these additional activities possible.
Across the state, there has also been a cultural shift in how these problems are understood and addressed. “The integration of ATODS [prevention]—alcohol, tobacco, other drugs, and suicide—makes sense to people,” explains Dr. Terresa Humphries-Wadsworth, Director of Statewide Suicide Prevention for the Prevention Management Organization of Wyoming. “They see that a healthier, safer community will impact all of them. By connecting substance abuse and suicide prevention, they feel like their time is being leveraged more efficiently.”