Suicide Intervention Training Research Articles

Key Improvements to the Army's Suicide Prevention and Intervention Training: An Interagency Collaboration to Develop the New "ACE Base +1" Curriculum.

Suicide is a prevalent problem impacting the military community. The U.S. Army recognized the need to address this complex issue; one line of effort has been to provide suicide prevention and intervention education and training that is informed by current research, doctrine, and implementation best practices. The purpose of this article is to outline and present the genesis of the Army's new suicide prevention and intervention training-"Ask, Care, Escort (ACE) Base +1"-that aligns with the DoD newly published regulation-driven initiatives. The development of the "ACE Base +1" curriculum was a collaborative effort between two organizations within the Defense Health Agency: The Defense Centers for Public Health-Aberdeen and the WRAIR. A multidisciplinary team was formed by selecting specific operational and subject-matter experts from each organization based on educational qualifications and practical experiences expected to aid the development of curriculum content (e.g., subject-matter experts) and/or the training design. Revisions to the curriculum were informed by the Army's existing suicide prevention training module, current research in suicide prevention and public health, updated and relevant Army regulations, and current public health policy guidance from the CDC and the Department of Suicide Prevention Office. A detailed account of the systematic and iterative curriculum development process is provided. The interagency collaborative efforts resulted in a suite of training products, "ACE Base +1" version 1.3 that is modernized in training content, delivery methods, and design. Four primary elements shaped the final products: (1) A modular framework allowing a tailored approach to mandatory training, (2) a public-health approach that focuses on earlier intervention opportunities while building trust and cohesion, (3) a training design centered on peer discussions and behavioral rehearsal, and (4) an expansion of the curriculum to be inclusive of the entire Army community. Practical implications for each element are discussed.As the program of record, "ACE Base +1" training satisfies the annual requirement for all Active Army, Army National Guard, U.S. Army Reserve, and Department of the Army (DA) civilians. Both the training content (e.g., public-health concepts) and design of "ACE Base +1" reflect a comprehensive approach, focused on developing concrete, applicable skills that support the shared responsibility to suicide prevention and intervention. Limitations, such as delayed interagency collaboration and time constraints, are discussed. Future directions include recommendations for future curriculum projects, specifically within military populations, such as interprofessional, interagency collaboration, and selecting a multidisciplinary team of subject-matter experts. Additionally, WRAIR plans to continue their support to Directorate of Prevention, Resilience and Readiness with the expansion of the +1 menu of trainings, ongoing program evaluation, and longitudinal analysis to inform future revisions and ensure the content and delivery methods remain modernized, relevant, and effective.

Suicide Intervention Training for Counselors: A Quasi-Experimental Study on Self-Efficacy

ABSTRACT This study explored the influence of the Applied Suicide Intervention Skills Training (ASIST), a 14-hour gatekeeper training, on emerging counselors’ self-efficacy in working with individuals experiencing suicidal thoughts. Through a pre-post design, counselor participants from five ASIST trainings were assessed. The results demonstrated a significant increase in self-efficacy among counselors after completing ASIST, underscoring its potential as an effective method for bolstering self-efficacy within counselor training. The implications for counselor preparation are discussed, highlighting the value of integrating ASIST to augment clinicians’ preparedness in addressing suicidal ideation.

Evaluation of a Brief Training of Police Constables in Recognizing Suicidal Behaviour in Lagos, Nigeria

Background: Given the high frequency with which police officers encounter people challenged by mental health issues, including those at risk for suicide, a well-trained police force has the potential to play an important role in community-based suicide awareness and mental health prevention. Objectives: This paper addresses the need to understand the effects of brief suicide intervention training for police constables on the participant’s knowledge about suicide, self-rated confidence in enquiring about suicidal behaviours, and their attitudes towards suicidal behaviours. Methods: A quasi-experimental design was employed to examine the changes from pretest to post-tests with participants acting as their controls. Participants included 289 police constables who attended a 90-minute training and completed self-report surveys. The training included both didactic and experiential components. Paired t-test was used to compare means on variables across the pre-training and post-training. The significance level was set at ≤ 0.05. Results: Although the training program was brief, significant improvement in perceived knowledge, t (288) = 3.45, p < .001; self-confidence to prevent suicide, t (288) = 3.5, p < .001, and attitudes toward suicidal patients were observed immediately after training t (288) = 4.6, p < .001. Conclusion: The role of police officers as gatekeepers in suicide prevention is essential and often underestimated. A competent appearance and knowledge of suicidality can promote adequate interaction with those affected.

Pilot Evaluation of the Online 'Chaplains-CARE' Program: Enhancing Skills for United States Military Suicide Intervention Practices and Care.

Chaplains frequently serve as first responders for United States military personnel experiencing suicidal thoughts and behaviors. The Chaplains-CARE Program, a self-paced, e-learning course grounded in suicide-focused cognitive behavioral therapy principles, was tailored for United States military chaplains to enhance their suicide intervention skills. A pilot program evaluation gathered 76 Department of Defense (DoD), Veterans Affairs (VA), and international military chaplain learners' responses. Most learners indicated that the course was helpful, easy to use, relevant, applicable, and that they were likely to recommend it to other chaplains. Based on open-ended responses, one-quarter (25.0%) of learners indicated that all content was useful, and over one-quarter (26.3%) of learners highlighted the usefulness of the self-care module. One-third (30.3%) of learners reported the usefulness of the interactive e-learning features, while others (26.3%) highlighted the usefulness of chaplains' role play demonstrations, which portrayed counseling scenarios with service members. Suggested areas of improvement include specific course adaptation for VA chaplains and further incorporation of experiential learning and spiritual care principles. The pilot findings suggest that Chaplains-CARE Online was perceived as a useful suicide intervention training for chaplains. Future training can be enhanced by providing experiential, simulation-based practice of suicide intervention skills.

Alcohol Use disorders and harm-reduction in indigenous coastal communities of Hudson Bay Northern Canada

: Alcohol use disorders are a major contributor to morbidity and mortality across the globe. Binge drinking and suicide have a high prevalence in northern latitudes, including Canada, Alaska, Greenland, and northern Europe. Many factors are associated with alcohol misuse and suicide in these northern regions such as climate, geographic location, history of the population, which in Canada includes colonisation-related harms such as the introduction of alcohol and systematic suppression of native cultures, on-going psychosocial stressors, and governmental policies. Due to the high prevalence of alcohol misuse and suicide in the studied population, the authors introduced contextually relevant Brief Intervention (BI) into the ER and ambulatory care settings as a harm-reduction measure. The impact of BI on binge drinking and suicide is discussed. The co-ordination of BI with other harm-reduction strategies in the region include suicide awareness and intervention training, efforts by provincial and federal governmental agencies using special teams to limit the social and psychological impact of recent suicides in communities, the return of AA groups after a ten-year hiatus, and importantly the establishment of native healing programmes.

Suicide Response in American Muslim Communities: A Community Case Study

This community case study describes the experiences of two neighboring Muslim communities in the United States, following respective incidents of suicide. Case summaries are first presented to contextualize the community response to the suicides. Subsequently, the discussion highlights relevant cultural and religious factors that impacted the responses of mosque leadership, mental health professionals, and the communities at large. Concerns related to the deceased’s afterlife, community connectedness, privacy, shame, and communication barriers were prominent in each case and shaped the courses of response. The COVID-19 pandemic and divergent responses to external support played significant roles in creating disparate outcomes in these communities. The discussion emphasizes the need for dissemination of evidence-based, religiously grounded, and culturally competent curricula for implementing mental health awareness programming and long-term suicide prevention efforts. Insights about cultural and religious factors influencing community responses were derived from the described cases in this paper and informed the development of a comprehensive suicide prevention, intervention, and postvention manual and training program tailored for Muslim communities.

Evidence-Based vs Informal Suicide Training: Nurse Confidence and Comfort With Suicidal Patient Care

IntroductionEmergency nurses are on the front line of patient care for suicidal persons, yet many nurses report feeling unprepared to effectively manage suicidal patients owing to a lack of suicide-specific training. The purpose of this study was to examine the suicide-specific training experiences of emergency nurses and evaluate how training relates to burnout, confidence, and comfort working with suicidal patients. MethodsEmergency nurses at critical access and community hospitals completed an anonymous online survey during work hours. The survey included questions about training experiences, burnout, confidence, and comfort working with suicidal patients, perceptions of the quality and interactive nature of training, and desires for future suicide-specific intervention training. ResultsGroup comparisons among the 117 emergency nurses revealed that those who received evidence-based/expert-delivered training reported greater confidence, comfort, and perceived ability to treat suicidal patients and lower burnout than those who received informal or no training. Those with informal training reported greater confidence and ability to treat suicidal patients, but similar levels of comfort and burnout as those with no training. Mediation analyses showed that training was associated with greater comfort working with suicidal patients through its effect on increased confidence. A majority desired additional suicide-specific training. DiscussionEvidence-based/expert-delivered professional training in suicide intervention is associated with improved confidence, comfort, and perceived ability to care for suicidal patients and lower burnout. Providing evidence-based suicide intervention training may improve quality of care for suicidal patients by improving emergency nurse confidence and comfort for treating these high-risk patients.

Suicide intervention training with law enforcement officers.

Law Enforcement Officers' (LEO) interactions with people facing mental health crises have risen exponentially since the era of deinstitutionalization. On average, about 10% of the individuals law enforcement interacts with daily have mental health challenges. Several factors influence the outcome of these interactions, not least of which is an officer's role as a gatekeeper as well as their training related to people with mental health challenges. We hypothesized that participating in the online QPR Training for Law Enforcement Officers would be associated with improved knowledge about suicide, attitudes to suicide and suicide intervention, and self-efficacy. Additionally, we hypothesized that these outcomes would be associated with greater use of intervention skills when encountering individuals at risk for suicide in the community. Results of our longitudinal analysis find that most of the participating officers reported some prior training and yet demonstrated statistically significant improvements in knowledge and attitudes after controlling for previous training. No significant changes were observed in LEO's use of intervention skills following training. We conclude by suggesting that there is substantial need for increased training; and offering possible conceptual and empirical explanations for the observed results.

Law Enforcement Officers’ Knowledge, Attitudes, Self-Efficacy, and Use of Suicide Intervention Behaviors

Objective: Given the high frequency with which law enforcement officers (LEOs) encounter people challenged by mental health issues, including those at risk for suicide, this paper addresses the need to understand officers’ use of suicide-prevention strategies in the community and factors that might impact those prevention activities. Method: A nonrandom sample of 476 LEOs completed a series of anonymous online surveys measuring their experiences encountering suicidal individuals in the community, previous suicide intervention training, levels of knowledge and self-efficacy for engaging in intervention activities, attitudes toward suicide intervention, and use of seven LEO-specific community-based intervention activities. Results: LEOs rated their perceived knowledge as positive even though scores for factual knowledge were low. Self-efficacy and attitudes toward prevention were generally positive. Multiple regression analyses indicate statically significant differences between LEOs with previous training on three of the seven intervention activities related to identifying and assessing suicide risk. Conclusions: Results of this study are consistent with similar studies in other nonclinical populations. Suicide intervention training and self-efficacy are the strongest predictors of engagement in suicide intervention activities. Results support a call for systematic suicide training in law enforcement.

Changes in Practice following a Continuing Education Training on Suicide Assessment and Intervention: Training Participants’ Perspectives

ABSTRACTIn the United States, suicide rates have risen 30% from 1999 to 2016. To decrease suicide rates, mental health professionals must use best practices to assess, manage, and intervene with clients with suicidal thoughts and behaviors. This qualitative research study (N = 60) interviewed participants of a one-day continuing education training titled Suicide Assessment and Intervention Training for Mental Health Professionals (SAIT) to explore if and how they changed their practice as a result of the training. Most participants (N = 54) described changes in practice. The major themes involved conversations about suicide, responses to client disclosure of suicidal thoughts and behaviors, and relationships with clients.

Development of a suicide intervention training programme for secondary mental health services

This article describes the elements of a suicide intervention training programme, known as the ‘I CARED and Shared’ model, which has been introduced in one NHS mental health service in England. The article outlines the development of this model and explains how it was adapted to ensure suitability for secondary mental health services. When developing the model, it was recognised that the fundamental elements of a suicide intervention training programme, such as establishing a connection with the person at risk of suicide, asking about suicide, and safety planning or crisis management, are immutable. However, there remains scope to ensure suicide intervention training programmes are up to date and increasingly comprehensive and suitable for mental health professionals, including nurses.

Analysis of a Standardized Suicide Intervention Training for Counselor Trainees

Analysis of a Standardized Suicide Intervention Training for Counselor Trainees

Use of a mnemonic to support suicide intervention training for nursing students

Recently, there has been an increased awareness of the extent of suicide as a global issue. In the UK, the reduction of deaths caused by suicide is a governmental goal in England, Northern Ireland, Scotland and Wales, which has led to the development of training initiatives to improve the recognition and management of suicide risk. Since many of the groups of people who are at increased risk of suicide are in contact with healthcare services, nurses will frequently encounter people who experience suicidal ideation. This is recognised in the updated Nursing and Midwifery Council standards of proficiency for registered nurses, which state that nurses in all fields of practice are required to be able to recognise and assess people who show signs of self-harm and/or suicidal ideation.This article explores the use of the mnemonic ‘TIPTOES’ (trauma, intent, plan, time frame, other experience of suicide, encouragement, support recovery) to support nursing students to develop their confidence and competence in suicide intervention.The Scottish Government’s Suicide Prevention Action Plan (Scottish Government 2018) identified the need for ongoing improvement in strategies to prepare and support people working with individuals at risk of suicide. Suicide intervention training is an integral element of pre-registration nurse education programmes, although evidence suggests that nurses often find this issue challenging in practice (Thomas 2017). This article explores how the mnemonic ‘TIPTOES’ (trauma, intent, plan, time frame, other experience of suicide, encouragement, support recovery) may assist nursing students in remembering and understanding the main steps of the suicide intervention process. The article also discusses the wider applicability of the mnemonic, which was developed by the School of Health and Nursing at the University of the West of Scotland, for nurses and other healthcare professionals.

When a patient talks about suicide: Adding a social worker led session on the pharmacist's role in suicide prevention to the PharmD curriculum

Background and purposeSuicide is the tenth leading cause of death in the US. Frontline health professionals like pharmacists can be trained to intervene with patients displaying warning signs of suicide. The purpose of this activity was to introduce student pharmacists to suicide prevention concepts. Educational activity and settingA social worker on faculty at the school of social work and a pharmacy practice faculty member collaborated to deliver a 50-min didactic session to first year students on the role of pharmacists in suicide prevention. The session included: (1) suicide statistics and public health signiifcance, (2) protective factors, risk factors, and warning signs of suicidal ideation, (3) strategies for asking about suicidal ideation, including practice asking about suicide, (4) resources and referrals, and (5) brief case scenarios and student questions. FindingsAn electronic survey was administered to 108 students and 83 responses (76.9%) were received. The results suggested the topic was new to most students and was relevant to their role as pharmacists. Most students (91%) reported that the session increased their confidence in asking about suicide for someone displaying warning signs. Student comments on the survey were generally positive with students requesting additional exposure to scenarios. Pharmacy programs may benefit from collaborating with social work or mental health professionals to deliver basic suicide intervention training tailored to pharmacy. SummaryA social worker-led session about suicide prevention was positively received by first year student pharmacists.

Dissemination of the Safety Planning Intervention (SPI) to University Counseling Center Clinicians to Reduce Suicide Risk Among College Students

Suicide risk on college campuses remains a pervasive problem. Structural deficits in current clinical care models often result in sub-optimal treatment for suicidal students. This study reports on the feasibility, acceptability, and utility of the Safety Planning Intervention (SPI), a brief, empirically validated, clinician-administered suicide prevention intervention, in a university counseling center (UCC) setting. A group of 12 university counseling center direct service staff completed a 2-hour training in SPI. Participants reported on suicide intervention practices, training needs, and confidence at baseline and 10 weeks post-training. Acceptability, utility, and frequency of SPI use were assessed at follow-up. All clinical staff attended the training and found it useful, reporting that confidence in managing suicide risk increased as a result. Two-thirds of staff implemented SPI least once. Results suggest that SPI is a feasible, acceptable, and useful suicide intervention tool for UCCs.

Training youth services staff to identify, assess, and intervene when working with youth at high risk for suicide

Youth in the child welfare system are often at increased risk for suicide due to the numerous physical and psychological challenges they face. This study was a longitudinal assessment of the impact of suicide intervention training on staff's abilities to identify, assess, and intervene when working with these youth in a child welfare setting. Participants received an adapted version of the “Youth and Depression” suicide intervention curriculum (Massachusetts Society for the Prevention of Cruelty to Children, 2010) designed to improve participants' attitudes toward suicide intervention, knowledge about suicide intervention, self-efficacy for engaging in intervention behaviors, and increased use of assessment and intervention behaviors over time. ANOVA tests yielded large effect sizes for increasing knowledge and self-efficacy. There were no statistical changes in attitudes and reluctance, but these were very positive even before training. Results for changes in the use of assessment and intervention skills were more modest but demonstrated some improvements from pre-training to post-training. Further refinement of the curriculum may yield larger and consistent improvements in intervention behaviors.

Patterns of Signs That Telephone Crisis Support Workers Associate with Suicide Risk in Telephone Crisis Line Callers.

Signs of suicide are commonly used in suicide intervention training to assist the identification of those at imminent risk for suicide. Signs of suicide may be particularly important to telephone crisis-line workers (TCWs), who have little background information to identify the presence of suicidality if the caller is unable or unwilling to express suicidal intent. Although signs of suicide are argued to be only meaningful as a pattern, there is a paucity of research that has examined whether TCWs use patterns of signs to decide whether a caller might be suicidal, and whether these are influenced by caller characteristics such as gender. The current study explored both possibilities. Data were collected using an online self-report survey in a Australian sample of 137 TCWs. Exploratory factor analysis uncovered three patterns of suicide signs that TCWs may use to identify if a caller might be at risk for suicide (mood, hopelessness, and anger), which were qualitatively different for male and female callers. These findings suggest that TCWs may recognise specific patterns of signs to identify suicide risk, which appear to be influenced to some extent by the callers’ inferred gender. Implications for the training of telephone crisis workers and others including mental-health and medical professionals, as well as and future research in suicide prevention are discussed.

Effectiveness of a Brief Suicide Intervention Training

Effectiveness of a Brief Suicide Intervention Training

SafeTALK suicide training: An evaluation of attitudes and actions among medical students

Background: SafeTALK is a half-day gatekeeper training program on recognizing persons at risk for suicide and intervening appropriately. Primary care clinicians have been increasingly targeted for suicide intervention training; however, evidence surrounding the effectiveness of safeTALK is lacking, particularly among medical learners. The aim of this study was to assess whether suicide literacy and intervention skills were enhanced by safeTALK training among medical learners.Methods: Undergraduate medical students from an Ontario university were invited to complete an online survey regardless if they had taken safeTALK training as part of their curriculum. Suicide literacy was measured with the Literacy of Suicide Scale (LOSS) and intervention skills were measured with the Suicide Intervention Response Inventory (SIRI).Results: The majority believed that suicide risk assessment training was very important to undergraduate medical education. Although limitations were noted, this study did not demonstrate that safeTALK training significantly improved medical students’ suicide literacy levels or suicide intervention skills.Conclusions: A more comprehensive program including the epidemiology of suicide and mental health disorders in addition to intervention skills is recommended to ensure medical learners are equipped to dispel the stigmas surrounding suicide and offer the appropriate care and follow up to their patients in future practice.

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.