BACKGROUND: Surveillance of suicidal ideations (SI) and suicide attempts (SA) can prevent the progression of these behaviors into deaths by suicide. In 2016, the United States Marine Corps (USMC) Behavioral Health branch (BH) created the Suicide Tracking and Reporting Tool (START), which is a centralized and comprehensive surveillance system for all suicide-related incidents. START’s function was to monitor SI, SA, and deaths by suicide, identify high-risk service members, and enable clinical care coordination among BH providers. The purpose of this study is to describe the design, testing, and implementation phases of START and discuss preliminary results.
METHODS: START was developed in three phases: design, testing, and implementation. Each phase required the collaboration of a multidisciplinary team lead by the USMC BH Data Surveillance Section at headquarters and involved several processes and iterations. The design phase started with the allocation of a secure server and database. Simultaneously, START’s team worked on creating and defining START’s data collection fields and variables. During this process, feedback loops with software developers and data analysts were used to ensure that the sensitivity and specificity of the tool. The testing phase included a three-step release process: a primary release to data managers, a secondary release to the data surveillance team, and a field release to clinical providers. User input was collected and incorporated into START throughout the testing phase. The implementation phase consisted of the launch of START for all users. This phase also included online trainings to BH staff at headquarters and local levels to allow the optimal utilization of START’s features and ensure data quality.
RESULTS: START has allowed the systematic and centralized collection, analysis, and interpretation of suicide data across USMC. START’s implementation has also improved suicide data quality; data management and reporting capabilities, and user access control. In addition, START has increased the visibility of high risk Marines and attached Sailors at the local level of intervention, improved care coordination across BH providers, and guided policy analysis, delivery of clinical services, and allocation of funding.
CONCLUSIONS: Empirical findings support the value of implementing a public health surveillance tool such as START for monitoring suicide-related incidents and preventing the progression of suicidal behaviors into suicide. The integration of public health surveillance into clinical care also creates partnership, cooperation, and collaboration opportunities between public health and clinical care entities, which can translate into better BH at the population and individual levels within the USMC.