Implementing the Zero Suicide Framework in Youth-Serving Behavioral Health Systems

Body of Abstract: New Jersey’s Department of Children and Families (DCF) is the state’s Cabinet-level agency dedicated to serving and supporting at-risk children and families. Comprising approximately 6,600 staff members, DCF is committed to assisting and empowering residents to be safe, healthy, and connected. Within DCF, the Children’s System of Care (CSOC) functions as New Jersey’s public behavioral health system for youth under 21 with emotional and mental health care needs, substance use challenges, and/or intellectual/developmental disabilities, along with their families. Youth suicide prevention programming at DCF is managed through CSOC.
In 2022, DCF began integrating the Zero Suicide (ZS) framework into the Children’s System of Care. Previously implemented primarily in healthcare settings, the application of the ZS framework within a youth behavioral health system represents a new application for the model. The implementation involved 57 children’s behavioral health agencies across New Jersey, including care management, family support, and out-of-home youth residential programs. These system partners participated in a nine-month Community of Practice (CoP) hosted by the Education Development Center (EDC). This initiative explored the seven elements of the ZS framework and reviewed agency implementation efforts, such as updating policies and procedures to include suicide care plans, identifying staff training needs, and employing screening tools for youth.
To sustain the initial CoPs, meetings titled “Quarterly Connections” are held with system partners. These meetings provide agencies an opportunity to share insights on ZS implementation, discuss successes and barriers, review framework elements, and learn from experts in the field on various suicide prevention topics.
As part of the ZS implementation, CSOC is conducting an evaluation to identify barriers, challenges, and necessary supports for integrating the ZS framework, particularly within primarily non-clinical, youth-serving behavioral health programs. Annual Organizational Self-Study and Workforce Assessment surveys are distributed to assess how providers' confidence and competence in this framework have developed. Focus groups revealed specific translational challenges in the youth-serving context, such as balancing the needs of both youth and caregivers in care plans and addressing systemic challenges (e.g., securing family buy-in, navigating culturally specific suicide-related stigma, providing resources, and enhancing coordination among hospitals and crisis centers). The information from these findings is used to guide progress and improvement practices.
Zero Suicide is a promising model for preventing suicide within youth-serving behavioral health settings. We continue to measure the long-term outcomes of this program in reducing overall youth suicide risk, attempts, and deaths.