Lycoming County Health Assessment Table of Contents

Lycoming County General Overview 1

Demographics 2-3

Social Economic Status 3-4

Crime Rate 4

Lycoming County vs Pennsylvania Selected Health Measures 2012 5-6

Leading Causes of Death 6

National Organizations – Leading Causes of Death 6-7

Lycoming County Health Organizations 7-8

Suicide as a Health Issue 8

Healthy People 2020 Objectives 9-10

State Health Improvement Plan & Lycoming County Health Improvement Coalition 10

National Strategy for Suicide Prevention 10

Pennsylvania Adult Suicide Prevention Plan 10-11

Suicide Prevention Agencies 11-12

Suicide Preventive Measures 12

PRECEDE – PROCEED Model 13

Health Belief Model 14

Lycoming County Suicide Prevention Plan 15

Program Mission, Goals, & Objectives 15-16

US Air Force Suicide Prevention Program – Best Practice 16

Ganntt Chart – Timeline 17

References 18-20

US Air Force Suicide Prevention Program Detailed Study 21-29

Lycoming County, Pennsylvania

Lycoming County is located in north central Pennsylvania. The county is divided between the Appalachian Mountains in the south, the dissected Allegheny in the north and east, and the valley of the West Branch Susquehanna River. It is situated near major transportation arteries I-180, US Route 15, and US Route 220. Lycoming County is about 130 miles northwest of Philadelphia and 165 miles east-northeast of Pittsburgh. This county is the largest county in land mass and has the 30th largest in population in the State of Pennsylvania. Lycoming County, as shown in Map 1, is surrounded by Union, Clinton, Tioga, Sullivan, Columbia, Montour and Northumberland Counties. Map 2 depicts the townships, cities, and boroughs of Lycoming County. Williamsport is the county seat and is the largest city in Lycoming County. The county is comprised of fifteen incorporated cities (Lycoming County, 2011).

Map 1 – Counties in Pennsylvania

(Digital Topo Maps, 2006)

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Map 2 – Townships, Boroughs, and Cities of Lycoming County

(Lycoming County, 2011)

Demographics

According to the U.S. Census in 2010, the population of Pennsylvania was 12,702,379. The 2010 Lycoming County population was estimated at 116,111. In 2010, 49.0 percent of this population consisted of males and 51.0 percent were females. Individuals under the age of five comprised 5.5% of the population (See Table 1). Those individuals aged 65 and older accounted for 6.5% of the county population. The population of Pennsylvania increase 3.4% between 2000 and 2010, however the population of Lycoming County decreased by 3.3% during the same time frame. As illustrated in Table 1, the population breakdown by age is very similar between Lycoming County and the state.

In 2010, 91.7% of Lycoming County’s population was white and 4.7% who were black. This is a predominately white county when compared to the state. In 2010, white individuals accounted for 83.8% of the population and blacks accounted for 11.3% (United States Census Bureau, 2012).

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Table 1 – Population by Age and Sex 2010

(United States Census Bureau, 2012)

Social Economic Status

Data collected from the U.S. Census Bureau in 2010, and shown in Table 2, notes that in Lycoming County 68.1 percent of the occupied housing units are owner occupied, which is slighter lower than the state average of 69.6 percent. Lycoming County has a slighter higher rate of vacant housing units as well. The table also shows or demonstrates the differences between the housing units and how Lycoming County compares to the state.

Table 2 – Lycoming County Housing compared to Pennsylvania

Own or Rent Estimate Percent StateTotal Housing Units 52,500 5,567,315Occupied Housing Units 46,700 89.0% 90.1%Owner Occupied Housing Units 31,802 68.1% 69.6%Renter Occupied Housing Units 14,898 31.9% 30.4%Vacant Housing Units 5,800 11% 9.9%

In Lycoming County the median annual income is $33,000 which is 18.7% lower than the state median income of $40,604. Lycoming County has a slightly higher rate (14.4%) of individuals living below poverty levels than the state of Pennsylvania (12.4%). Living in poverty has been shown to decrease the quality of life of individuals and in some instances has substantial negative effects on child and adolescent well-being. Over the last decade, the percentage of the population living below poverty has increased from 10.3% to

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14.4%. The unemployment rate increased 1.4% since 2000 (6.3% to 7.7%). Additionally, a larger portion of the population is eligible for medical assistance. In 2000, 13.5% of the population was eligible. In 2010, 17.0% of the population was eligible. Similar increases can be seen across the state (United States Census Bureau, 2012).

Crime

Crime lowers the quality of life for individuals due to lost productivity, psychological injury and the rise of health care costs required for victims and their families. Statistics in Table 3 shows crime data collected by the Pennsylvania Uniform Crime Reporting System (UCR) for the year 2010 in Lycoming County and the state of Pennsylvania. The data shows offenses reported and arrests made by State and local law enforcement agencies. It is important to note that not all law enforcement agencies consistently report offense and arrest data to the UCR. Part I crimes are the more serious offenses often involving violence. Part II crimes consist of the less serious offenses that do not fall under Part I. In 2010, the Part I Crime rate in Lycoming County was 2179.1 per 100,000, approximately 14% lower than the state rate of 2537.6 per 100,000. Lycoming County’s Part II crime rate of 4696.4 per 100,000 was only 2.1% lower than the state rate of 4769.5 per 100,000. Only selected crimes are show below, however the totals include all crimes reported in 2010.

Table 3 – Crimes reported to Pennsylvania Uniform Crime Reporting System (2010)

Crime Number of Offenses

Lycoming County PennsylvaniaPart I Crimes

Criminal Homicide 2 657 Rape 28 3,024 Burglary 463 16,314 Aggravated Assault 102 25,884 Robbery 66 7,534 Total 2,552 322,333

Part II Crimes Drug Violations 469 52,196 Other Alcohol Crimes 1,040 95,717 Other Assaults 705 86,145 Vandalism 949 107,777 Other Sex Offenses 91 7,821 Total 5,500 609,273

(Pennsylvania Uniform Crime Reporting System, n.d.)

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Lycoming County Health Profile Assessment

The following chart shows the comparison of selected health measures between Lycoming County and Pennsylvania. It is color coded to depict how the county is doing in comparison to the rest of the state. Green means the county is doing better than the state. Yellow denotes a relatively small difference. Red signifies the county is doing worse than the rest of the state.

Health Status Measure YearLycoming County

MeasurePA Measure

Difference(+ or -)

Per Capita Personal Income 2010 $33,000 $40,604 - $7,604

Median Age of Population 2010 41.1 40.1 + 1

% Population below poverty level 2010 14.40% 12.40% + 2.00%

% Population 65 y/o and older 2010 16.50% 15.40% + 1.10%

% Labor force unemployed 2011 7.70% 7.90% - 0.20%% Reported births ending in induced abortion 2010 11.40% 19.70% - 8.30%

% Births to moms <18 y/o 2010 3.30% 2.60% + 0.70%

% Low Birth Weight 2010 7.30% 8.30% - 1.00%% Receiving no prenatal care 1st trimester 2009 27.30% 28.70% - 1.40%Proportionate death rate of heart disease 2010 22.60% 25.32% - 2.72%

Proportionate death rate of cancer 2010 20.71% 23.32% - 2.61%

Crude death rate per 1000 2010 10.5/1000 9.7/1000 + 0.8/1000

Crude birth rate per 1000 2010 10.5/1000 11.2/1000 -0.7/1000

Lycoming CountyRate

PA RateDifference

(+ or -)

185.7 194 -8.3

173.5 183.8 -10.3

39.5 40.1 -0.6

58.7 39.9 + 18.8

34.3 40.4 -6.1* Per 100,000 2000 U.S. Standard populationAccidents

Lycoming County vs Pennsylvania Selected Health Measures 2012

Selected Major Causes of Death, Average Annual Age-Adjusted Death Rate* (2008-2010)

Cause

Diseases of Heart

Cancer

Stroke

C.L.R.D.

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Some of these issues were discussed in greater detail in the overview of Lycoming County such as per capita income, population below poverty level, and unemployment. Not shown in the table is infant mortality rate (infant deaths < 1 year of age per 1,000 live births), which is a good indicator of the overall health of a population. Lycoming County’s infant mortality rate in 2010 was 9.1 deaths per 1000 births, 7.69% higher than the state rate of 8.4 deaths per 1000 births. As the chart shows, the abortion rate in Lycoming County was 8.30% lower than the rest of the state. In Lycoming County 11.40% of reported births ended in induced abortion as opposed to 19.70% in the state. Lycoming County had a slighter higher percentage (0.70%) of births to mothers under the age of 18 years. In 2009, Lycoming County had a slightly higher percentage of expectant mothers receive prenatal care. Even though Lycoming County had a higher rate, 27.30% is still a fairly large percentage of pregnant women not getting the care they require (Pennsylvania Department of Health, 2012).

Lycoming County mirrors the state and nation in respect to the top three leading causes of death, which are:

1 – Diseases of the Heart2 – Cancer3 – Stroke

An analysis of the selected major causes of death, average annual age-adjusted death rate for 2008-2010 shows slightly lower death rates for the top three causes. Lycoming County residents died of heart disease at a rate of 185.7 deaths per 100,000 which is 8.3% lower than the state rate of 194 deaths per 100,000. Lycoming County had a death rate of 173.5 deaths per 100,000 for cancer. That is 10.3% lower than the state rate. The county and state death rates for strokes are relatively close with only a 0.6% difference. Lycoming County had a significantly higher death rate for chronic lower respiratory disease. The county rate was 58.7 deaths per 100,000, 18.8% higher than the state rate of 39.9 deaths per 100,000 (Pennsylvania Department of Health, 2012).

Many of these deaths were preventable as modifiable behavioral risk factors most likely contributed to these diseases and eventually death. Those behavioral risk factors include: tobacco use, physical inactivity, obesity, poor nutrition, excessive alcohol use, and UV radiation exposure (Murphy, Xu, & Kochanek, 2012).

Organizations: There are numerous organizations and other resources available to combat these diseases. I have listed a few of organizations available for the top three leading causes of death.

Diseases of the Heart American Heart Association: http://www.heart.org/HEARTORG/ Children’s Heart Association: http://childrensheartassociation.org/ National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/ World Heart Federation: http://www.world-heart-federation.org/ WomenHeart: http://www.womenheart.org/

Cancer American Cancer Society: http://www.cancer.org/

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National Breast Cancer Foundation: http://www.nationalbreastcancer.org/ National Cancer Institute: http://www.cancer.gov/ Skin Cancer Foundation: http://www.skincancer.org/ Pancreatic Cancer Action Network: http://www.pancan.org/

Stroke National Stroke Association: http://www.stroke.org/site/PageNavigator/HOME American Stroke Association: http://www.strokeassociation.org/STROKEORG/ American Stroke Foundation: http://americanstroke.org/ Brain Attack Coalition: http://www.stroke-site.org/ Brain Aneurysm Foundation: http://bafound.org/

Listed below are several organizations and health care systems located in Lycoming County that can be used as resources:

PA Department of Health, Northcentral District – WilliamsportNorthcentral District Office1000 Commerce Park Dr., Ste. 109Williamsport, PA 17701570-327-3400http://www.portal.health.state.pa.us/portal/server.pt/community/

department_of_health_home/17457

Lycoming County Health Improvement Coalition40 East Fourth StreetSuite 107Williamsport, PA 17701570-323-0390http://www.lchic.org/

Divine Providence Hospital 1100 Grampian BoulevardWilliamsport, PA 17701570- 326-8000http://www.susquehannahealth.org/patients-visitors/divine-providence-hospital-location/page.aspx?id=1723

Family Support Center – Williamsport200 East StreetWilliamsport, PA 17701570-323-2929

George C. Meck Senior Center – WilliamsportOne South Main StreetMuncy, PA 17756570-546-2542

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Jersey Shore Hospital1020 Thompson StreetJersey Shore, PA 17740570-398-0100http://www.jsh.org/

Susquehanna Health Systems700 High StreetWilliamsport, PA 17701570-321-1000http://www.susquehannahealth.org/

Williamsport Hospital700 High StreetWilliamsport, PA 17701570-321-1000http://www.susquehannahealth.org/about-us/our-campuses-locations/williamsport-regional-medical-center/page.aspx?id=1725

YMCA320 Elmira StreetWilliamsport, PA 17701570-323-7134http://williamsportymca.org/home/

50 Fitness Drive #1Muncy, PA 17756570-546-8822http://elymca.org/home/

Over the last decade, the top three leading causes of death have remained the same. Suicide is becoming a major health problem in the United States and increasing at alarming rates. In 2004, suicide was the 11th leading cause of death. Suicide was the 10th leading cause of death in the United States among all age groups in 2010 with 37,793 people committing suicide. Suicide was the 3rd leading cause of death for ages 15-24 years in 2010. It was the 4th leading cause of death for ages 25-44 and the 8th leading cause for ages 45-64.

Suicide in Lycoming County: Suicide is a health issue that I believe needs to be addressed in Lycoming County. According to the National Institute of Health, suicide is the eleventh leading cause of death in the United States (National Institute of Mental Health, 2012). People may consider suicide when they are hopeless and can't see any other solution to their problems. Often it's related to serious depression, alcohol or substance abuse, or a major stressful event. People who have the highest risk of suicide are white men. But women and teens report more suicide attempts. In 2010, suicide was the second leading cause of death for age groups 5-24 years and 25-44 years. In 2010, there were 15 suicides in Lycoming County accounting for 12.3% of all

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deaths. Statewide, there were 1,547 suicides (12.5% of all deaths. Seven people between the ages of 25-44 years committed suicide in 2010 accounting for 21.88% of all deaths. That was the same number of people who died from accidents, which is the leading cause of death for the state and nation for this age range. In Lycoming County, white males accounted for 11/15 suicides – an astounding 73.33% (Pennsylvania Department of Health, 2012).

Early detection of mental disorders is crucial to preventing suicides. According to the World Health Organization, more than 90% of suicide victims have a diagnosable psychiatric disorder, and most individuals who attempt suicide have a psychiatric illness. The most common psychiatric conditions associated with suicide or serious suicide attempts are mood disorders, but personality disorders, substance abuse, anxiety disorders, and schizophrenia are also frequently associated with this behavior (World Health Organization, 2012). I believe it is imperative that suicide and mental health issues be addressed for males aged 25-44 in Lycoming County.

Healthy People 2020 Objectives related to reducing suicide rate (Healthy People 2020, 2010):

MHMD-1 Reduce the suicide rate (Leading Health Indicator) Baseline: 11.3 suicides per 100,000 occurred in 2007 2020 Target: 10.2 suicides per 100,000

MHMD-4.2 Reduce the proportion of persons who experience major depressive episode (MDE) – Adults aged 18 or older

Baseline: 6.8 percent of adults aged 18 years and older experienced a major depressive episode in 2008

2020 Target: 6.1 percentMHMD-5 Increase the proportion of primary care facilities that provide mental health

treatment onsite or by paid referral Baseline: 79 percent of primary care facilities provided mental health treatment onsite or

by paid referral in 2006 2020 Target: 87 percent

MHMD-9.1 Increase the proportion of adults with mental health disorders who receive treatment (Adults aged 18 years and older with serious mental illness (SMI))

Baseline: 58.7 percent of adults aged 18 years and older with serious mental illness (SMI) received treatment in 2008

2020 Target: 64.6 percentMHMD-9.2 Increase the proportion of adults with mental health disorders who receive

treatment (Adults aged 18 years and older with major depressive episode) Baseline: 68.3 percent of adults aged 18 years and older with major depressive episode

received treatment in 2008 2020 Target: 75.1 percent

MHMD-10 Increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders

Baseline: 3.0 percent of persons with co-occurring substance abuse and mental disorders received treatment for both disorders in 2008

2020 Target: 3.3 percentMHMD-11.1 Increase depression screening by primary care providers

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Baseline: 2.2 percent of primary care physician office visits screened adults aged 19 years and older for depression in 2007

2020 Target: 2.4 percentMHMD-12 Increase the proportion of homeless adults with mental health problems who

receive mental health services Baseline: 37 percent of homeless adults with mental health problems received mental

health services in 2006 2020 Target: 41 percent

SA-7 Increase the number of admissions to substance abuse treatment for injection drug use Baseline: 254,278 Level I and Level II trauma centers to substance abuse treatment

programs for injection drug use were reported in 2006 2020 Target: 279,706 Level I and Level II trauma centers

SA-14.3 Reduce the proportion of persons engaging in binge drinking during the past 30 days—Adults aged 18 years and older (Leading Health Indicator)

Baseline: 27 percent of adults aged 18 years and older reported that they engaged in binge drinking during the past 30 days in 2008

2020 Target: 24.3 percentSA-15 Reduce the proportion of adults who drank excessively in the previous 30 days

Baseline: 28.1 percent of adults aged 18 years and older reported that they drank excessively in the previous 30 days in 2008

2020 Target: 25.3 percentSA-20 Decrease the number of deaths attributable to alcohol

Baseline: 79,646 deaths attributable to the harmful effects of excessive alcohol use occurred in 2001–05 (average annual number)

2020 Target: 71,681 deaths

The Pennsylvania State Health Improvement Plan (SHIP) for 2006-2010 uses the Healthy People 2010 objectives as a baseline and tracks the same leading health indicators (Pennsylvania Department of Health, 2012). Locally, the Lycoming County Health Improvement Coalition has a focus group for mental health and substance abuse. The task force reports that depression and anger management issues are prevalent in Lycoming County, but “masked” by a lack of community awareness. They also noted that alcohol and illegal substances were common in Lycoming County. It is relatively easy to access illegal substances in Lycoming County and many treatment programs tend to rely too much on using medication to relieve drug addiction. The task force highlighted that the general public was not aware of the services available within their own community (Lycoming County Health Improvement Coalition, 2012).

National Strategy for Suicide Prevention: The U.S. Surgeon General and the National Action Alliance for Suicide Prevention recently released a revised National Strategy for Suicide Prevention (2012). The Action Alliance selected four priorities that will help the group reach its goal of saving 20,000 lives in the next five years. The priorities are:

Integrate suicide prevention into health care reform and encourage the adoption of similar measures in the private sector.

Transform health care systems to significantly reduce suicide. Change the public conversation around suicide and suicide prevention.

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Increase the quality, timeliness, and usefulness of surveillance data regarding suicidal behaviors.

Pennsylvania Adult Suicide Prevention Plan: This plan was written with the national objectives in mind. It is designed to draw attention to a wide range of actions so that specific activities can be developed to fit the resources and areas of interest of people in everyday community life as well as professionals, groups, and public agencies. Suicide prevention is everyone’s business. The plan seeks to integrate suicide prevention into existing health, mental health, substance abuse, education, and human service activities. Settings that provide related services, such as schools, workplaces, clinics, medical offices, correctional and detention centers, eldercare facilities, faith communities, and community centers are all important venues for seamless suicide prevention activities. The goals of the plan are (Pennsylvania Recovery and Resiliency, 2012):

Promote Awareness that Suicide is a Public Health Problem that is Preventable Develop Broad-based Support for Suicide Prevention Develop and Implement Strategies to Reduce the Stigma Associated with Being a

Consumer of Mental Health, Substance Abuse, and Suicide Prevention Services Develop and Implement Suicide Prevention Programs Promote Efforts to Reduce Access to Lethal Means and Methods of Self-Harm Implement Training for Recognition of At-Risk Behavior and Delivery of Effective

Treatment Develop and Promote Effective Clinical and Professional Practices Improve Access to and Community Linkages with Mental Health and Substance Abuse

Services Improve Reporting and Portrayals of Suicidal Behavior, Mental Illness, and Substance

Abuse in the Entertainment and News Media Promote and Support Research on Suicide and Suicide Prevention Improve and Expand Surveillance Systems

Currently, Lycoming County does not have a County Task Force dedicated to adult suicide as part of the Pennsylvania Adult/Older Adult Suicide Prevention Coalition. However, they do have a representative for the Child and Adolescent Service System Program (CASSP). There are not enough resources or efforts being placed on preventing suicide in our adult population. The resources and plans are in place at the state and national level; now, we need to bring this priority issue to the forefront at the local level. Adults, those age 20-64, represent the largest group of suicide victims in the Commonwealth. Additionally, adults, in general receive far less attention in suicide prevention than other populations.

The following is a list of suicide prevention agencies:

Suicide Prevention Resource Center: http://www.sprc.org/ American Association of Suicidology: http://www.suicidology.org/home American Foundation for Suicide Prevention: http://www.afsp.org/ National Suicide Prevention Lifeline: http://www.suicidepreventionlifeline.org/ U.S. Substance Abuse and Mental Health Administration: http://www.samhsa.gov/

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National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml Pennsylvania Adult/Older Adult Suicide Prevention Coalition:

http://www.preventsuicidepa.org/ Office of Mental Health and Substance Abuse Services (PA):

http://www.dpw.state.pa.us/dpworganization/officeofmentalhealthandsubstanceabuseservices/index.htm

Pennsylvania Psychiatric Association: http://www.papsych.org/ Pennsylvania Psychological Association: http://www.papsy.org/

Critical Preventive Measures to be implemented to reduce rates of suicide (Wright, McGorry, Harris, Jorm, & Pennel, 2006):

Primary Prevention Treatment of psychiatric disorders Treatment of substance abuse disorders Promote healthy lifestyle Reduce Poverty Reduce violence Suicide awareness Screening for mental health issues

Secondary Prevention Effective suicide risk assessment screenings Mental health assessments Reduce access to highly lethal means for committing suicide, such as guns

Tertiary Care Diminish consequences Intensive psychotherapy Assessment of family members Use of support groups

Suicide is a major public health problem in Lycoming County for males aged 25-44 years old. Many individuals exhibit risk factors, yet, only a few will ever attempt suicide. However, there are issues of decreased functioning contributing to lost workdays, reduced productivity, great personal suffering, and substantial family distress. Lycoming County should consider a program that emphasizes early prevention, by intervening at the first signs of dysfunctions or distress before the risk of suicide is imminent. The program should also enhance the detection and treatment of those at increased risk of taking their own lives.

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(Doyle, Ward, & Oomen-Early, 2010, pp. 116-120)

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(Doyle, Ward, & Oomen-Early, 2010, pp. 106-108)

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Possible stakeholders: Mental health service providers General practitioners Community Health Services PA Department of Health West Branch Drug and Alcohol Commission Valley Prevention Services Lycoming County Health Improvement Coalition Williamsport Vet Center

Project Title: Lycoming County Suicide Prevention Program

Mission Statement: Promote suicide awareness and prevention in Lycoming County

Goal: Reduce rate of suicide in Lycoming County for males aged 25-44

Objectives:Process:1. Publish one article per month in the Williamsport Sun Gazette discussing suicide prevention.2. Design pretest and post-test that assesses knowledge of the eight biopsychosocial risk factors, the four environmental risk factors, and the five socialcultural risk factors for suicide as published by SAMHSA.3. Mail out 4,000 behavioral health surveys to males aged 25-44 no later than March 2013.4. Conduct supervisor awareness training for top 20 employers in Lycoming County no later than June 2013.5. Conduct pretest of materials at Penn College by the end of February 2013.6. Send posters and pamphlets to all mental health providers in Lycoming County no later than February 2013.7. Send posters to all general practitioners in Lycoming County no later than February 2013.8. By the end of 2012, establish a multidisciplinary critical incident stress management team in Lycoming County.

Impact:1. By the end of the program, at least 80% of program participants will be able to list at least 5 of the 8 biopsychosocial risk factors for suicide.2. By the end of the program, at least 80% of program participants will be able to list the 4 environmental risk factors for suicide.3. By the end of the program, at least 80% of program participants will be able to list 4 of the 5 socialcultural risk factors for suicide.4. By the end of the program, at least 80% of program participants will be able to describe at least 3 signs and symptoms of a major depressive episode.5. By the end of the program, at least 80% of program participants will be able to list at least 5 resources in Lycoming County for mental health or substance abuse treatment.6. By the end of the program, at least 80% of program participants will be able to describe the referral process for people potentially at risk.

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Outcome:1. Within six months of program completion, personnel exposed to the program experience a 30% reduction of risk of committing suicide compared with people prior to implementation.2. Within six months of program completion, personnel exposed to the program experience a 50% reduction of risk for severe family violence.3. Within six months of program completion, personnel exposed to the program experience a 50% reduction of risk for homicide.4. Within six months of program completion, personnel exposed to the program experience a 30% reduction of risk for moderate family violence.5. Within six months or program completion, mental health providers experience increase of 10% use of resources.

To accomplish these goals and objectives, I recommend using the United States Air Force Suicide Prevention Program. It can be found in SAMHSA’s National Registry of Evidence-based programs and practices. The program takes a population-oriented approach to reducing the risk of suicide. The Air Force’s prevention program can be generalized to a non-military population. It focuses on the age range needed for Lycoming County and can be conducted in the workplace. The Air Force implemented 11 initiatives aimed at strengthening social support, promoting development of social skills, and changing policies and norms to encourage effective help-seeking behaviors (The Substance Abuse and Mental Health Services Administration, 2012). These initiatives include:

Leadership involvement Suicide prevention in professional education Guidelines for use of mental health services Community preventive services Community education and training Investigative interview policy Critical incident stress management Integrated delivery system Limited privilege suicide prevention program Behavioral health survey Suicide event surveillance system

This program is effective and relatively inexpensive to implement. The implementation materials are clear and easily accessible through the program website free of charge. The intervention targeted reducing risk factors and enhancing factors considered protective. The US Air Force attempted to reduce the stigma of seeking help for mental health problem. The program also enhances the understanding of mental health issues.

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Gantt Chart – Timeline

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References

Digital Topo Maps. (2006). Pennsylvania county map. Retrieved from Pennsylvania Map:

http://www.digital-topo-maps.com/county-map/pennsylvania.shtml

Doyle, E. I., Ward, S. E., & Oomen-Early, J. (2010). The Process of Community Health

Education and Promotion. Long Grove: Waveland Press, Inc.

Healthy People 2020. (2010). Healthy People 2020 topics and objectives. Retrieved from

http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

Knox, K. L., Litts, D., Talcott, G., Feig, J., & Caine, E. (2003). Risk of suicide and related

adverse outcomes after exposure to a suicide prevention programme in the US Air Force:

Cohort study. British Medical Journal, 7428.

Lycoming County. (2011). County overview. Retrieved from Lycoming County Commissioners:

http://www.lyco.org/ElectedOfficials/Commissioners/CountyOverview.aspx

Lycoming County Health Improvement Coalition. (2012, September 20). Strategic targets.

Retrieved from Lycoming County Health Improvement Coalition:

http://www.lchic.org/about-us/strategic-targets

Murphy, S., Xu, J., & Kochanek, K. (2012, September 14). Deaths: Preliminary Data for 2010.

Retrieved from CDC National Vital Statistics Report, Vol. 60, No.4:

http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_04.pdf

National Institute of Mental Health. (2012, September 27). Suicide in the U.S.: Statistics and

prevention. Retrieved from National Institute of Mental Health:

http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/

index.shtml

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Pennsylvania Department of Health. (2012, September 14). State and county health profiles.

Retrieved from Pennsylvania Department of Health:

http://www.portal.state.pa.us/portal/server.pt?open=514&objID=596007&mode=2

Pennsylvania Department of Health. (2012, September 19). State health improvement plan.

Retrieved from Pennsylvania Department of Health:

http://www.portal.state.pa.us/portal/server.pt/community/state_health_improvement_plan

_%28ship%29/14132

Pennsylvania Recovery and Resiliency. (2012, September 27). Statewide initiatives: Suicide

prevention. Retrieved from Pennsylvania Recovery and Resiliency:

http://www.parecovery.org/services_suicide_prevention.shtml

Pennsylvania Uniform Crime Reporting System. (n.d.). 2010 online annual crime report.

Retrieved from Pennsylvania Uniform Crime Reporting System:

http://ucr.psp.state.pa.us/UCR/Reporting/Annual/AnnualSumArrestUI.asp

The Substance Abuse and Mental Health Services Administration. (2012, September 27). United

States Air Force suicide prevention program. Retrieved from National Registry of

Evidence-based Programs and Practices:

http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=121

United States Census Bureau. (2012). State and county quick facts. Retrieved from United States

Census Bureau: http://quickfacts.census.gov/qfd/states/00000.html

World Health Organization. (2012, September 27). Mental health: Suicide prevention. Retrieved

from World Health Organization: http://www.who.int/mental_health/prevention/en/

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Wright, A., McGorry, P., Harris, M., Jorm, A., & Pennel, K. (2006). Development and

evaluation of a youth mental health community awareness campaign - the compass

strategy. BMC Public Health, 6, 215.

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