Risk and Protective Factors

ACEs, suicide, and overdose share risk and protective factors that are interconnected and preventable. Shared risk and protective factors can be assessed on the individual, relationship, community, and societal levels. The Suicide, Overdose, and Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) can be used to estimate organizational capacity to address shared risk and protective factors at each level of the social-ecological model for ACEs, suicide, and overdose. Below is a list of beginner, intermediate, and advanced actions your organization can take based on your SPACECAT results.

Beginner Action Ideas

• Determine team members' level of understanding of shared risk and protective factor (SRPF) approaches to address the intersection of ACEs, suicide, and overdose.
  • Create a self-assessment for team members. Use the Safe States Connections Lab as a resource for self-assessment creation.
• Create a list of individual and organizational trainings about SRPF approaches. Then, offer trainings to team members (see resources below).
• Identify existing work already in place that fits in a shared risk and protective factors framework.
• Determine the health department's role in impacting approaches to address shared risk and protective factors for multiple outcomes.
  • Networking: Does the health department convene stakeholders for meetings? Are shared risk and protective factors woven in as a theme to agenda items being discussed? Is the health department connecting individuals doing similar or related work?
  • Programming: Is the health department coordinating resources across multiple programs, sections, or agencies?
  • Funding: Are there funding streams that contribute to work being done with your agency around shared risk and protective factor approaches?
  • Collaboration: Are there any other departments or agencies doing related work?
• Determine where programs are working in siloes and where programs or agencies can collaborate for more efficient use of resources.
• Investigate strategies to integrate behavioral, mental health, and physical healthcare, such as braiding funding, using Medicaid 1115 waivers, creating data sharing agreements, and linking data sources.

Intermediate Action Ideas

• Determine which programs within your organization are working across SRPF. Review work to ensure that you are addressing the same risk or protective factors with ACEs, suicide, and overdose prevention.
  • of internal and external programs working on similar shared risk and protective factors and share the map with internal and external partners.
• Review funding sources that support work on upstream approaches that address shared risk and protective factors.
• Identify opportunities for using a topical funding source to support evaluation regarding shared risk and protective factors.
• Create a shared dictionary for internal and/or external use with upstream prevention language and definitions between SRPF sectors and disciplines.
  • Determine how external programs relate to internal programs.
  • Discuss possible collaborations based on shared priorities.
• Identify barriers to integrating behavioral, mental health, and physical healthcare in your state, including funding structures, state policies and regulations, processes and procedures, and technological gaps.
• Convene your team and facilitate discussions around shared risk and protective factor approaches. For example, can projects work together to scale up certain interventions? Can staff be shared across funding sources? Can you determine priority risk or protective factors to pursue collectively?

Advanced Action Ideas

• Working with partners, develop shared internal and external strategies for addressing shared risk and protective factors within your agency and community.
• Develop or host a training for internal staff and stakeholders on shared risk and protective factors.
• Review existing funding sources to identify opportunities to braid or layer funding to offer sustainability for upstream work.
• Apply for grant funding to support shared risk and protective factors approaches.
• Evaluate how changes in shared risk and protective factor indicators influence multiple public health outcome areas.

Resources

• Analyzing the Use of Shared Risk and Protective Factor Language in Michigan's Injury Prevention Legislation: A Technical Package | Safe States
• Applying a Shared Risk & Protective Factor Approach to Injury and Violence Prevention - Evaluating Shared Risk and Protective Factors to Address ACEs, Suicide, and Opioid Misuse - Examples from States - Safe States Alliance Training | Safe States
• ASTHO Interconnecting Behavioral and Public Health | ASTHO
• ASTHO Introduction to the Shared Risk and Protective Factor Framework | ASTHO
• CDC Presentation: Shared Risk and Protective Factors | CDC
• Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence | PMC
• Connections Lab: Home | Safe States
• Shared RFPF Toolkit V2_User Guide_Final.docx | CDC
• New Approaches for Moving Upstream | Safe States
• Shared Risk and Protective Factor Framework: A Collaborative Process for Upstream Investments | US Department of Veteran's Affairs
• Shared Risk and Protective Factors Framework | Washington State Department of Health
• Upstream Approach to Suicide Prevention | US Department of Veteran's Affairs
• USA Grant Applications | USA Grant Applications

Health Equity Questions to Consider

• Do you work to identify and focus on priority populations within your work to address suicide, overdose, and ACEs prevention?
  
  • Learn more about priority populations. 
• Who in your agency is involved in learning about risk factors and promoting protective factors? 
  • Read the document, “Colorado: A Decade-Long Single Minded Focus on Shared Risk and Protective Factors.”
• What existing efforts resemble a shared risk and protective factor approach in your agency?
  
  • Review the web page, “Defining the Shared Risk & Protective Factor (SRPF) Approach.” 
• Is there existing work with community partners to help inform what shared risk and protective factors are present in the community? Is health equity prioritized within this existing work?
  
  • Learn from Safe States’ Connections Lab.
  • See how Utah collaborated with community partners and prioritized health equity within its SRPF approach to injury and violence prevention. 
• What upstream prevention strategies are already in place to address higher-risk populations?
  
  • Learn more about moving upstream.
• Do your suicide, overdose, and ACEs prevention strategies accurately reflect the diversity of your jurisdiction's communities?
  
  • Review the report, “Prevention with Purpose: Considering Culture Throughout the Strategic Prevention Framework.”