Provider Survey
Presented by the Zero Suicide Implementation Committee of RiteLife Services, Inc.
Our Purpose
The Zero Suicide Implementation Comittee is a collaborative effort aimed at reducing suicide rates by embedding evidence-based suicide prevention strategies across healthcare systems and community organizations. This initiative recognizes that suicide is preventable and seeks to create systemic changes by enhancing the skills, tools, and resources available to identify and support individuals at risk. By partnering with key stakeholders across St. Lucie, Martin, Okeechobee, and Indian River counties, we aim to develop a comprehensive, data-driven approach to ensure no one falls through the cracks. The purpose of this questionnaire is to assess the needs, gaps, and opportunities within our communities to guide the development of a Zero Suicide framework tailored to the unique characteristics of our region. We thank you for taking the time to help us find solutions to something that has touched so many lives.
Date
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Month
-
Day
Year
Date
Which county or counties do you serve?
Okeechobee
St. Lucie
Indian River
Martin
Palm Beach
Other
Name of agency:
Does your organization currently provide mental health or suicide prevention services?
Yes
No
Does your organization have existing policies or protocols for identifying and responding to individuals at risk of suicide?
Yes
No
Does your staff receive training in suicide prevention, such as QPR (Question, Persuade, Refer) or ASIST (Applied Suicide Intervention Skills Training)?
Yes
No
What resources or tools does your organization use to address mental health crises?
Are there barriers to implementing additional training or resources (e.g., funding, staffing, time)?
What do you see as the most significant gaps in suicide prevention services in your community?
Are there particular populations in your area that are at higher risk for suicide or have less access to support?
What types of support would be most helpful to your organization to improve suicide prevention efforts (e.g., funding, partnerships, training)?
Are there any specific strategies, resources, or community assets you think would be beneficial to include in a regional suicide prevention plan?
Do you have suggestions on how we can better engage your organization or the community in suicide prevention efforts?
How familiar are you with the Zero Suicide framework or similar prevention models?
Very
Somewhat
Unsure
Not at all
Would your organization be interested in partnering with Ritelife Services to develop or expand suicide prevention initiatives?
Yes
No
I am open to discussion
Who is the primary contact person at your organization for discussions about suicide prevention?
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Would you like to receive updates on Zero Suicide initiatives and opportunities for collaboration?
Yes
No
Additional comments
Submit
Should be Empty: