Applied Suicide Intervention Skills Training Research Articles

Feasibility of Incorporating the Applied Suicide Intervention Skills Training Program into Nursing Education

Feasibility of Incorporating the Applied Suicide Intervention Skills Training Program into Nursing Education

A commentary on suicide prevention training: The process of implementing an ASIST pilot in postsecondary nursing education

This commentary provides an overview of existing literature on suicide and suicide prevention in the context of postsecondary and nursing settings. WHO (2022) reported that more than 50% of the medical workforce are made up of nurses and midwives who are in an optimal position to provide care for individuals who may be at risk for suicide. Suicide continues to be a major public health issue in Canada, with the postsecondary student population being at a heightened risk for mental health crises. A best practice for suicide prevention is education. Applied Suicide Intervention Skills Training (ASIST) has been used and evaluated internationally by various institutions. We present a pilot project for the delivery of ASIST as both a co-curricular activity for nursing students and as professional development for faculty and staff. We include the process for implementing a pilot of ASIST within the postsecondary education setting, and an evaluation plan for the pilot project.

Changes in Gatekeeper Beliefs Following ASIST and Relation to Subsequent Gatekeeper Suicide Prevention Behaviors.

This study examines relations between suicide prevention gatekeeper beliefs and actual helping behaviors following participation in Applied Suicide Intervention Skills Training (ASIST). Participants (n = 434) completed measures examining suicide-related beliefs and behaviors using a naturalistic pre-post design. All beliefs demonstrated significant change from pre- to posttest. Regression analyses indicate that beliefs about perceived barriers to action and the controllability of suicide predicted identification of high-risk youth; perceived barriers to action were also negatively related to helping responses and referrals 6-9months post training. Self-efficacy was not related to suicide prevention behaviors at follow-up. The importance of anchoring training curriculums and measurement to health behavior change theories is discussed.

‘Listen closer’: home-delivered meal volunteers’ understanding of their role in suicide intervention

AbstractSuicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.

Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Validation of the Suicide Counseling Skills Inventory.

Background: The self-report measures used in evaluations of the Applied Suicide Intervention Skills Training (ASIST) program have tended not to detect an improvement in a broad range of suicide counseling skills from pre- to posttraining or among trainees with better skills at pretraining. Aims: The purpose of this study was to develop and validate the Suicide Counseling Skills Inventory (SCSI), which included ten brief counselor-client scenarios and three counselor responses to each scenario. Method: Data were collected from several samples to develop and evaluate the SCSI. Trainee scores were subtracted from criterion expert scores to create discrepancy scores. Results: The SCSI detected an improvement in skills from pre- to posttraining across samples, including among trainees with better skills at pretraining. Internal consistency and test-retest reliability were good. Limitations: The results may not generalize across different training models. Conclusion: Trainee scores were more like expert scores at posttraining. The SCSI may be useful in evaluating suicide counseling competency.

Counselors in training identifying and responding to suicidal clients: a matched-control study

ABSTRACTUsing a matched-control experimental design, this study explored the use of Applied Suicide Intervention Skills Training (ASIST) with fifty-four counselors in training (CIT). Over the course of 10 weeks CIT self-reported interactions with suicidal clients and their use of counseling skills. Trainees who completed ASIST were significantly more likely to report they had identified and used specific intervention strategies and counseling skills with suicidal clients during sessions. Implications for future training and research are provided.

Gatekeeper training for suicidal behaviors: A systematic review.

Gatekeeper training (GKT) is a common intervention aiming to prevent suicidal behavior. We investigated updated evidence for the effectiveness of GKT in suicide prevention using data from randomized controlled trials (RCTs) and intervention studies, and we also describe variations in existing GKT programs. We performed a systematic review. The literature search was conducted using PubMed, PsycINFO, CINAHL, the Cochrane databases, and reference lists from previous reviews. RCTs or intervention studies utilizing prospective or quasi-experimental designs were included. The search terms identified 343 articles. Ten randomized clinical trials and six intervention studies were identified as eligible for inclusion. Among the eligible studies, a number of different types of GKT were identified, including Question, Persuade, and Refer, Applied Suicide Intervention Skills Training, OSPI, Youth Aware of Mental Health, and approaches based on e-learning. For the RCTs, the effects of GKT remained unclear in relation to knowledge, appraisals, and self-efficacy after training, though some supportive evidence was found in the uncontrolled pre-post studies. The overall quality for each RCT was rated as either low or unclear. We could not perform a meta-analysis because comparable outcomes could not be identified across studies. The effects of GKT remain unclear. There are many variations in GKT and there is a need to replicate studies in target populations. Future research should examine the effectiveness of a standardized GKT program using high-quality RCTs which include the evaluation of pre-specified primary outcomes in comparison with appropriate control groups.

Suicide intervention training for college staff: Program evaluation and intervention skill measurement

ABSTRACTObjective: Suicide remains a pressing issue for college communities. Consequently, gatekeeper trainings are often provided for staff. This study examines the effect of one such program, Applied Suicide Intervention Skills Training (ASIST). Participants: 51 college employees received ASIST in August of 2014 and were compared to 30 wait-list control participants. Methods: Repeated Measures ANOVA were used to analyze pre- and post-training: (a) skills at responding to students-at-risk; (b) attitudes toward suicide; (c) knowledge about suicide; and (d) comfort/competence/confidence at helping a student-at-risk. Results: Significant positive training effects were observed for ASIST on self-report measures and also for objectively assessed skill at responding, after adjusting for a potential scoring limitation of the Suicide Intervention Response Inventory, Revised (SIRI-2). Conclusions: ASIST improved the self-perception of college staff at working with students-at-risk of suicide and also their skills at performing an intervention. Further, analysis of SIRI-2 data provides support for a potential instrument revision.

Assessment of suicide-related knowledge and skills in a sample of health professionals and students

ObjectiveAssessment of suicide risk is of paramount importance for proper prevention.AimsTo examine the association between gatekeeper training and suicide-related knowledge among a diverse set of health care workers (psychiatrists, nurses, psychologists, and educators) and students enrolled in medical and psychological schools who took part in the world suicide prevention day 2015 conference.MethodAmong 223 participants who completed the assessment, 204 provided complete data for analyses. Participants were administered the applied suicide intervention skills training (ASIST), a 13-item survey questionnaire to assess participants’ knowledge about suicidal behavior and comfort dealing with suicidal clients. There were 62 psychiatrists; 23 nurses, 51 psychologists, 11 educators, and 57 university students.ResultsAmong participants, 57.1% of the sample had experiences of suicide a patient (students were excluded from these analyses). Those who reported a suicide among patients (compared with others) less frequently answered that suicide risk is more alarming in older adults than youths. They also less frequently disagreed with questions asking if they had the training to deal with suicidal patients. Students more frequently answered correctly on the association between depression and suicide risk, and less frequently chose the correct answer on the seriousness of suicide intent in borderline personality disorder. Students also more frequently disagreed with questions asking on their suicide assessment skill.ConclusionsOur study highlights that differences exist when it comes to knowledge and skills related to suicide risk assessment both among health professionals and students. Our results also indicate that suicide awareness among these groups should be promoted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Impact of applied suicide intervention skills training on resilience and suicide risk in army reserve units.

Impact of applied suicide intervention skills training on resilience and suicide risk in army reserve units.

Suicide Intervention Training for K–12 Schools: A Quasi‐Experimental Study on ASIST

This quasi‐experimental study investigated differences between 104 school personnel who received a standardized suicide awareness and prevention training (i.e., Applied Suicide Intervention Skills Training) and 45 control group participants. Pre‐ and posttraining data included experimental and control group participants' (a) suicide intervention skills; (b) attitudes toward suicide; (c) knowledge of suicide; and (d) comfort, competence, and confidence in responding to individuals at risk of suicide. Results indicated a significant positive effect for training on all measures. Implications for training of school personnel and future research are discussed.

Identification, Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training.

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre-post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self-reported identification of at-risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre-test to 6- to 9-month follow-up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self-reported skill utilization including identification as a "natural helper" and attitudes about suicide prevention.

Suicide-Related Knowledge and Confidence Among Behavioral Health Care Staff in Seven States.

Death by suicide is a serious and growing public health concern in the United States. This noncontrolled, naturalistic study examined professionals' knowledge about suicide and confidence in working with suicidal individuals, comparing those who had received either of two gatekeeper trainings-Question, Persuade, and Refer (QPR) or Applied Suicide Intervention Skills Training (ASIST)-or other suicide-relevant training or no training. Participants (N=16,693) were individuals in various professional roles in the field of behavioral health care in Indiana, Kentucky, New York, Pennsylvania, Tennessee, Texas, and Utah. Participants completed a survey assessing suicide knowledge and skills confidence. Most participants (52.9%) reported no previous suicide prevention or assessment training. Individuals with suicide-relevant training demonstrated greater suicide knowledge and confidence than those with no such training. Among those who had received any training, no differences were found in suicide knowledge; however, individuals who had received ASIST reported greater confidence in working with suicidal individuals, compared with those who had received other training. Professional role and prior experience with a client who had died by suicide had significant positive relationships with suicide knowledge and confidence. Regional differences emerged between states and are examined within the context of statewide suicide prevention initiatives. Increasing access to and incentives for participating in suicide-relevant training among behavioral health care staff may foster a more knowledgeable and confident group of gatekeepers. Future research should examine whether increases in knowledge and confidence among staff translate into actual changes in practice that help protect and serve at-risk individuals.

Evidence-based gatekeeper suicide prevention in a small community context

ABSTRACTThis review examines 10 studies of suicide prevention programs conducted in small communities using these programs: (1) Applied Suicide Intervention Skills Training (ASIST), (2) Connect, (3) Campus Connect, and (4) Question, Persuade, and Refer (QPR). These evidence-based programs are listed in the Best Practices Registry funded by the Substance Abuse and Mental Health Services Administration. The programs with the strongest evidence of efficacy and effectiveness are ASIST and QPR. Recommendations are the following: (1) increase research on prevention programs with diverse trainees; (2) create decision models that consider program costs relative to impacts; and (3) develop more suicide prevention programs that target at-risk adults.

Curriculum development through understanding the student nurse experience of suicide intervention education – A phenomenographic study

Suicide remains a global public health issue and a major governmental concern. The World Health Organisation argues for continued investment in education for front-line professionals, with a particular focus on nurses, to address the rising suicide levels. Considering this rate, it could be argued that suicide has impacted on the lives of many, including the student nurse population. Understanding the psychological impact, and influence on learning, whilst developing suicide intervention knowledge is crucial. However, little is known of the student experience in this complex and challenging area of skills development. This phenomenographic study examines the experiences of second year Bachelor of Nursing (mental health) students who participated in the Applied Suicide Intervention Skills Training (ASIST). Experiences were illuminated through two focus groups, Experiences were distilled and categorised through hierarchically relationships to construct a group experiential field to illustrate understandings of the impact this approach has on learning Students found ASIST to be emotionally challenging yet an extremely positive experience through bonding, peer learning, and class cohesion. The supportive workshop facilitation was essential allowing for full immersion into role simulation thus developing student confidence. Appropriate pedagogy and student support must be considered whilst developing suicide intervention in the pre -registration curricula.

Implementing Evidence-Based Suicide Prevention Training in Communities: Implications for Quality Improvement

Suicide prevention trainings are implemented to equip the public’s ability to intervene with those who are at-risk, but their implementation is not often monitored for quality. In this study, we propose a quality improvement model to improve trainer skill, demonstrate evidence of knowledge uptake, and document the quality of training workshop implementation. We collected participant data (N=2006) from over 127 Applied Suicide Intervention Skills Training (ASIST) training workshops that evaluated workshop satisfaction, confidence to intervene, and likelihood to intervene and refer immediately post-training. We also collected trainer data by measuring fidelity and adherence to the ASIST protocol at five live ASIST workshops. Training participants reported improved confidence and likelihood to intervene and refer after the workshop. Participants also reported high satisfaction. In three of the five workshops, newly trained trainers covered 75% or more of the fidelity items demonstrating thorough review of the training. Trainers generally adhered to one of four competencies specific to ASIST and five of the 11 general competencies relating to group management. Trainers may need to improve their efforts to tailor content to specific audiences, promote cultural competence, and manage time.

Science from Evaluation: Testing Hypotheses about Differential Effects of Three Youth-Focused Suicide Prevention Trainings

As part of an evaluation component of a youth suicide prevention, a quasi-experimental repeated measures design tested hypotheses about two brief suicide prevention gatekeeper trainings (Question, Persuade, Refer [QPR] and RESPONSE) and one longer suicide intervention skills training (Applied Suicide Intervention Skills Training [ASIST]). All three trainings showed large changes in prevention attitudes and self-efficacy, largely maintained at follow-up. ASIST trainees had large increases in asking at-risk youth about suicide at follow-up. Convergent with other research, modeling and role-play in training are crucial to increased prevention behaviors. Practice and research implications are discussed, including social work roles in suicide prevention and research.

Corrigendum

In the article by Madelyn Gould and colleagues titled “Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline” (Suicide and Life-Threatening Behavior 43(6): 676–691), two in-text citations were inadvertently transposed. On page 679, the dynamic wait-list design for randomized trials should have been attributed to Hendricks Brown, et al. (2006), and not to Gregory Brown, et al. (2005). On page 688, cognitive therapy interventions for preventing suicide attempts should have been attributed to Gregory Brown, et al. (2005), and not to Hendricks Brown, et al. (2006). The authors wish to apologize for this error.

Measuring trainer fidelity in the transfer of suicide prevention training.

Finding effective and efficient models to train large numbers of suicide prevention interventionists, including 'hotline' crisis counselors, is a high priority. Train-the-trainer (TTT) models are widely used but understudied. To assess the extent to which trainers following TTT delivered the Applied Suicide Intervention Skills Training (ASIST) program with fidelity, and to examine fidelity across two trainings and seven training segments. We recorded and reliably rated trainer fidelity, defined as adherence to program content and competence of program delivery, for 34 newly trained ASIST trainers delivering the program to crisis center staff on two separate occasions. A total of 324 observations were coded. Trainer demographics were also collected. On average, trainers delivered two-thirds of the program. Previous training was associated with lower levels of trainer adherence to the program. In all, 18% of trainers' observations were rated as solidly competent. Trainers did not improve fidelity from their first to second training. Significantly higher fidelity was found for lectures and lower fidelity was found for interactive training activities including asking about suicide and creating a safe plan. We found wide variability in trainer fidelity to the ASIST program following TTT and few trainers had high levels of both adherence and competence. More research is needed to examine the cost-effectiveness of TTT models.