,,ii  #aafth ,,congress  #b;d ,session  
,s4 #dede  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #i1 
#bjbj,ms4 ,rosen 7for herself and ,mr4  
,cramer7 introduced the following bill2 
which was read twice and referred to the
 ,committee on ,veterans' ,affairs  ,a  
,,bill  ,to direct the ,secretary of    
,veterans ,affairs to establish the     
,zero ,suicide ,initiative pilot program
 of the ,department of ,veterans        
,affairs4  #a4 ,short title ,this ,act  
may be cited as the ,,va ,zero ,suicide 
,demonstration ,project ,act of #bjbj4  
#b4 ,zero ,suicide ,initiative pilot    
program  7a7 ,establishment ,not later  
than #ahj days after the date of the    
enactment of this ,act1 the ,secretary  
of ,veterans ,affairs shall establish a 
pilot program called the ,zero ,suicide 
,initiative 7referred to in this section
 as the program74  7b7 ,purpose ,the    
program shall implement the curriculum  
of the ,zero ,suicide ,institute of the 
,education ,development ,center         

7referred to in this section as the     
,institute7 to improve safety and       
suicide care for veterans1 thereby      
significantly reducing rates of suicide4
  7c7 ,development ,the first year of   
the program shall be dedicated to       
program development1 including planning 
and site selection4 ,in developing the  
program1 the ,secretary shall consult   
with-- 7#a7 the ,secretary of ,health   
and ,human ,services2  7#b7 the         
,national ,institutes of ,health2  7#c7 
public and private institutions of      
higher education2  7#d7 educators2  7#e7
 experts in suicide assessment1         
treatment1 and management2  7#f7        
veterans service organizations2 and     
7#g7 professional associations the      
,secretary determines relevant to the   
purposes of the program4  7d7 ,staff    
leaders2 program elements ,the program  
shall consist of not less than #aj weeks
 of education regarding suicide care1   
beginning with the selection of five to 
ten staff leaders from each site        

selected under subsection 7e7 who shall 
carry out the following program         
elements3 7#a7 ,complete the            
organizational self-study of the        
,institute as a team4  7#b7 ,attend the 
two-day ,zero ,suicide ,academy of the  
,institute4  7#c7 ,formulate a plan to  
collect data to support evaluation and  
quality improvement using the data      
elements worksheet of the ,institute4   
7#d7 ,communicate to staff at the       
respective site the adoption of a       
specific suicide care approach4  7#e7   
,administer the workforce survey of the 
,institute to all staff at the          
respective site to learn more about     
perceived comfort with and competence in
 caring for patients at risk of suicide4
  7#f7 ,review1 develop1 and implement  
training on processes and policies      
regarding patients at risk of suicide1  
including-- 7,a7 screening2  7,b7       
assessment2  7,c7 use of electronic     
health records2  7,d7 risk formulation2 
7,e7 treatment2 and  7,f7 care          

transition4  7e7 ,sites  7#a7 ,number   
,the ,secretary shall carry out the     
program at five medical centers of the  
,department of ,veterans ,affairs1 one  
of which primarily serves veterans who  
live in rural and remote areas as       
determined by the ,secretary4  7#b7     
,timeline ,the ,secretary shall select--
 7,a7 #ae candidate sites for the       
program not later than #ahj days after  
the date of the enactment of this ,act2 
and  7,b7 the final five sites not later
 than #bgj days after the date of the   
enactment of this ,act4  7#c7           
,consultation ,in selecting sites at    
which to carry out the program1 the     
,secretary shall consult with experts   
including officials of-- 7,a7 the       
,national ,institute of ,mental ,health2
  7,b7 the ,substance ,abuse and ,mental
 ,health ,services ,administration of   
the ,department of ,health and ,human   
,services2  7,c7 the ,office of ,mental 
,health and ,suicide ,prevention of the 
,department of ,veterans ,affairs2  7,d7

 the ,health ,services ,research        
,division of the ,department of         
,veterans ,affairs2  7,e7 the ,office of
 ,health ,care ,transformation of the   
,department of ,veterans ,affairs2 and  
7,f7 the ,zero ,suicide ,institute4     
7#d7 ,factors ,in selecting sites for   
the program1 the ,secretary shall       
consider the following factors3 7,a7    
,interest in1 and capacity of1 the staff
 of the medical centers to implement the
 program4  7,b7 ,geographic variation4  
7,c7 ,variations in size of medical     
centers4  7,d7 ,regional suicide rates  
of veterans4  7,e7 ,demographic and     
health characteristics of populations   
served by each medical center4  7f7     
,annual progress report  7#a7 ,in       
general ,not later than two years after 
the date on which the ,secretary        
establishes the program1 and annually   
thereafter until termination of the     
program1 the ,secretary shall submit to 
the ,committees on ,veterans' ,affairs  
of the ,senate and the ,house of        

,representatives a report on the        
program4  7#b7 ,elements ,each report   
under paragraph 7#a7 shall include the  
following3 7,a7 ,progress of staff      
leaders at each site in carrying out    
tasks under paragraphs 7#a7 through 7#e7
 of subsection 7d74  7,b7 ,the          
percentage of staff at each site trained
 under paragraph 7#f7 of subsection 7d74
  7,c7 ,an assessment of whether        
policies and procedures implemented at  
each site align with standards of the   
,institute with regards to-- 7i7 suicide
 screening2  7ii7 lethal means          
counseling2  7iii7 referrals for        
comprehensive assessment of suicidality2
  7iv7 safety planning for patients     
receiving referrals under clause 7iii72 
7v7 risk management during care         
transitions2 and  7vi7 outreach to      
high-risk patients4  7,d7 ,a comparison 
of the suicide-related outcomes at      
program sites and those of other medical
 centers of the ,department of ,veterans
 ,affairs1 including-- 7i7 the          

percentage of patients screened for     
suicide risk2  7ii7 the percentage of   
patients counseled in lethal means      
safety2  7iii7 the percentage of        
patients screened for suicide risk      
referred for comprehensive assessment of
 suicidality2  7iv7 the percentage of   
patients referred for comprehensive     
assessment who complete safety planning2
  7v7 emergency department utilization2 
7vi7 inpatient psychiatric              
hospitalizations2  7vii7 the number of  
suicide attempts among all patients and 
among patients referred for             
comprehensive assessment of suicidality2
 and  7viii7 the number of suicide      
deaths among all patients and among     
patients referred for comprehensive     
assessment of suicidality4  7g7 ,final  
report  7#a7 ,in general ,not later than
 one year after the termination of the  
program1 the ,secretary shall submit to 
the ,committees on ,veterans' ,affairs  
of the ,senate and ,house of            
,representatives a final report4  7#b7  

,elements ,the report under this        
subsection shall include the following3 
7,a7 ,a detailed analysis of information
 in the annual reports under subsection 
7f74  7,b7 ,the determination of the    
,secretary whether it is feasible to    
continue the program4  7,c7 ,the        
recommendation of the ,secretary whether
 to extend the program or make the      
program permanent4  7h7 ,termination2   
extension  7#a7 ,in general ,subject to 
paragraph 7#b71 the program shall       
terminate on the date that is five years
 after the date on which the ,secretary 
establishes the program under subsection
 7a74  7#b7 ,authority to extend ,the   
,secretary may extend the program for   
not more than two years if the          
,secretary notifies ,congress in writing
 of such extension not less than #ahj   
days before the termination date under  
paragraph 7#a74