Abstract
BACKGROUND: Pioneered at HFH Behavioral Health Services in 2001, the Zero Suicide (ZS) model is comprised of several evidence-based approaches including suicide screening and assessment, caring contacts, care coordination, and suicide specific psychotherapies. The ZS model has been successfully introduced in more than twenty countries; however, to date the model has been primarily introduced in higher income countries within large health systems. It is important to understand the feasibility of this approach in a range of other settings. In the current project, a feasibility study was conducted, and a pilot program is currently underway to adapt the model for use in Community-based Organizations (CBOs) serving refugee populations. METHODS: This feasibility study focused on Afghan refugees arriving in Michigan as a part of the U.S. government "Operation Allies Welcome" program. The qualitative study included interviews with social, health, and behavioral health providers and staff at CBOs serving refugee and asylum-seeking populations in Michigan and behavioral health specialists at HFH and Wayne State University. A Stakeholders' Advisory Board was established including HFH and CBO partners. RESULTS: Afghan refugees encountered challenges on arrival and during their settlement into life in Southeastern Michigan, including linguistic, social, economic, medical, and behavioral health barriers. The data include specific recommendations made by the respondents for adaptations to the Zero Suicide model. CONCLUSION: While the need for behavioral health services for refugee communities is recognized, challenges remain in the implementation of accessible, acceptable, and adaptable programs. Within Michigan, CBOs have developed strong relationships with refugees and asylum seekers resettled into the state. The current project was designed to build on these existing infrastructures within CBOs and determine the feasibility of integrating an evidence-based suicide prevention program. Through the feasibility study, it was evident that CBOs were interested in including the Zero Suicide model as a part of their health services. However, it was clear that adaptations were needed to support the introduction of the model and that those adaptations would have to account for diverse refugee communities and varied resources and structures within each CBO.