September is National Suicide Prevention Month (https://suicidepreventionlifeline.org/promote-national-suicide-prevention-month/) and all of us in mental health are reflecting on our ability to prevent suicide. The CANS or ANSA data you are collecting can help you understand both the nature of suicide needs in your population, as well as your programs’ ability to mitigate this need.
Regardless if you are a state administrator, or just someone with a small caseload of individual clients, here are some tips for mining your CANS & ANSA data for helpful information on the suicide needs in your clinical population.
Tip one: Make sure you pick the right item in your CANS or ANSA form for identifying ‘suicidality’ needs. Historically, there have been a few different items meant to log that a client has a self-harm concern, these include items with the name “Danger to Self,” “Self-Harm,” or even “Suicidality.” Further, there are some CANS that distinguish between “Suicidal Self-Harm,” and “Non-Injurious Self-Harm.” Point is, when doing a query, just make sure you know what your form has, and that you are looking at the right data.
Tip two: Find the suicidality “incoming actionability rate” for all your levels of care. Each program should have its own steady percentage of people presenting with a suicidal need. If your system is sorting clients to the right level of care, lower intensity programs like outpatient should have lower incoming actionability rates of suicidality.
Here is an example of two real CDR partner organizations, which have three identical levels of care: blended case management, outpatient therapy (OP) and intensive community based treatment (ICB). The graph shows the incoming actionability rates for each provider’s programs. Both providers are showing a good rationalization of care, in the sense that the suicidality actionability rate is lowest for their low risk programs, and highest in their higher risk program.
Tip three: Comparing your programs to others provides insight. The CDR DataPool collects CANS and ANSA data from all across the world, and thus provides norms that allow the comparison of needs in one program with another. For instance, in the graph above, we can see that each agency has suicidal need actionability go up with the higher levels of care, however the same nominal program in one agency has a very different suicidality need rate than the other agency. To make this even clearer: Look at this graph below, which takes the same information as above, but puts each program’s incoming actionability side-by-side with the comparable level of care from another program, and you can see that Agency 2 has higher suicidality actionability rates across the board than Agency 1.
Tip Four: Find your program’s outcomes in reducing self-harm/suicidality needs. Below I have taken the same two agencies, but now we see the incoming and outgoing actionability rates for suicidality/self-harm. We can see that there are very different impacts that each program is having on suicidality.
For instance, Agency 1’s BCM program has relatively few clients with self-harm, and that number stays consistent throughout care. Meanwhile, Agency 2’s BCM program on average is more likely to have consumers with self-harm concerns as their intervention starts, but through time the rate of people in the program with suicidal risk is below 2%.
Another intriguing situation is on the other end of the spectrum: the high-risk programs. Agency 2’s ICB program is having more than 1 in 10 of its clients present with suicidality concerns, and seems to meaningfully reduce that clinical need to around 7% of the population. Notice, interestingly, that this 7% is pretty much the incoming actionability rate for Agency 1’s ICB program, and they have a similarly impactful reduction in self-harm/suicidal needs in their population through care as well (down to 4% by treatment’s end).
Bottom line: Agency 2 simply has higher suicidality risk profiles across its treatment spectrum, and also has a stronger reduction on that need. Agency 1, meanwhile, has programs with lower concerns with self-harm, and also has a generally smaller impact on that need over time. Both agencies probably have some next steps they want to take in response to this information, and one that would be helpful for their agencies’ continued improvements in suicide prevention.
In conclusion: In suicide prevention, your CANS and ANSA information is power. By reviewing your CANS and ANSA data in the ways we present above (among many other ways as well!) you can gain insight as to whether your clinical programs are working to reduce suicidal needs, or not. Other analyses you could do would be to look at the profiles of people who’s self-harm reduces, versus those for whom it doesn’t change, or worsens. This could help you devise appropriate interventions for those who are not currently succeeding in your program. Likewise, analyses by worker could be insightful too. In total – information is power, and CANS and ANSA data should be harnessed to help improve your organization’s clinical performance.