Resource Types: Program/Practice

Developed by Yellow Ribbon, Ask 4 Help! is a one-hour high school-based curriculum that provides students with knowledge that may increase help-seeking for themselves or on the behalf of others. A central feature of the curriculum is the Ask 4 Help! wallet card. The card contains information on how to seek help, including a three-step action plan for helping others (stay with the person, listen to the person, get help for the person). Training can be provided by teachers or representatives of Yellow Ribbon. In addition to information about how to use the card, the curriculum includes information on:

• Risk Factors and warning signs of suicide.
• School and community referral points for those who may need help.
• The National Suicide Prevention Lifeline phone number.

Instructional materials include the PowerPoint presentation (provided on a CD), a teacher’s manual that includes talking points for each of the PowerPoint slides, a program overview and outline, an FAQ, a preparation worksheet, and links to additional resources.

Program Objectives

After participating in the Ask 4 Help! curriculum, students should have:

1. Increased knowledge of warning signs of suicide and depression in youth.
2. Increased knowledge of how to respond to those at risk.
3. Increased knowledge of local and community referral points and local resources.

Implementation Essentials

• School teachers, staff, and administrators should be trained in basic suicide prevention prior to implementing the student curriculum (Yellow Ribbon’s Be A Link! or similar training would be appropriate).
• A school-based crisis management plan, such as that found in the Maine Youth Suicide Prevention, Intervention, and Postvention Guidelines should be adopted prior to implementing Ask 4 Help!

2012 NSSP Objectives Addressed: 

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

Developed by Washington State, the Helping Every Living Person: Depression and Suicide Prevention Curriculum (HELP) educates students about depression and suicide prevention. HELP consists of four 45-minute lesson plans on the following topics:

• Stress and depression.
• Risk factors and warning signs of suicidal behavior.
• Suicide intervention skills.
• Practice of intervention skills and problem-solving skills (for overcoming obstacles).

HELP lessons integrate interactive teaching and participatory learning principles. The curriculum has a problem-solving orientation and is based on issues that students currently deal with, such as keeping confidences. Lessons are supplemented by a DVD, A Cry for Help: How to Help a Friend Who is Depressed or Suicidal, which features young people discussing some of the difficult issues associated with depression and suicide. The program does not take a therapeutic approach; rather, it empowers students to recognize the warning signs of suicide in their peers and to seek help. The curriculum materials are designed for students in grades 9-11 and can be incorporated into existing health classes.

Program Objectives

After participating in the curriculum, students should have:

1. Increased knowledge about stress, depression, and suicide prevention strategies.
2. Increased willingness to communicate about suicide with their peers.
3. Increased knowledge of helping resources within their school and their community.

Implementation Essentials

• Teachers should identify helping resources in the school and in the community prior to student instruction.
• A school-based crisis management plan, such as those found in the Maine Youth Suicide Prevention, Intervention, and Postvention Guidelines should be implemented prior to student instruction.

2012 NSSP Objectives Addressed: 

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

Developed by HeartLine, Inc., HELP is a suicide awareness program that targets youth 10 to 24 years of age. The purpose of HELP is to educate youth about the warning signs of depression and suicide, and empower them to get help for themselves or someone else who is feeling suicidal. The cornerstone of HELP is a 3 step intervention model of Ask, Listen, and Tell. The program uses interactive teaching techniques including an educational presentation by a trained facilitator, a 20-minute video, group discussion, and a group activity. The HELP checklist is administered at the end of classroom instruction and contains of a 5-question screening tool. The checklist reinforces the information students receive and identifies students who may be at risk for suicide or depression. At-risk students are referred to the school counselor or school psychologist for individual follow-up attention. 

Program Objectives

After training, HELP participants will have increased:

1. Knowledge of facts related to youth suicide.
2. Understanding of the causes of suicide.
3. Ability to recognize the three Signals of Suicide.
4. Understanding of the three steps to help a suicidal youth.
5. Understanding of the limits of their responsibility to a suicidal youth.

Implementation Essentials

• Schools are required to complete a 12-item assessment of their readiness to implement the HELP program prior to program start.
• Schools must have a crisis management plan, such as the Maine Youth Suicide Prevention, Intervention, and Postvention guidelines, implemented prior to the start of the HELP program.

2012 NSSP Objectives Addressed: 

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

Multisystemic Therapy with Psychiatric Supports (MST-Psychiatric) is a psychological treatment program for children and adolescents that has demonstrated reductions in suicide attempts, among other positive outcomes, in children and adolescents. It is available from MST Services for a fee.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

Outcome(s) Reviewed (Overall Quality of Research Rating-scale of 0 to 4)

1: Mental health symptoms (3.5)
2: Family relations (3.3)
3: School attendance (3.1)
4: Suicide attempts (3.3)
5: Days in out-of-home placement (3.0)

Read more about this program’s ratings.

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* NREPP changed its review criteria in 2015. This program is a “legacy program,” meaning that it was reviewed under the pre-2015 criteria. The evidence for each outcome was reviewed and scored on a scale of 0-4, with 4 indicating the highest quality of evidence and 0 indicating very poor quality of evidence. The overall rating was based on ratings of six criteria: 1) reliability of measures, 2) validity of measures, 3) intervention fidelity, 4) missing data and attrition, 5) potential confounding variables, and 6) appropriateness of analysis. When considering programs, we recommend (a) assessing whether the specific outcomes achieved by the program are a fit for your needs; and (b) examining the strength of evidence for each outcome.

2012 NSSP Objectives Addressed: 

Objective 8.3: Promote timely access to assessment, intervention, and effective care for individuals with a heightened risk for suicide.

Developed by NAMI New Hampshire, the Connect Suicide Postvention program increases the capacity of a community or organization to respond effectively to a suicide death in order to prevent additional suicides and promote healing for survivors of suicide loss. The shock and grief of a suicide goes well beyond immediate family and friends and can ripple throughout the community affecting friends, co-workers, schools and faith communities.

Connect postvention training uses a holistic, socio-ecological model thatexamines suicide in the context of the individual, family, tribe, community and society.

Connect has developed specific best practice protocols for social services, mental health and substance abuse, education, law enforcement, emergency medicine, faith leaders, and others. These protocols were created through statewide stakeholder groups and then reviewed by national suicide prevention experts. Connect training activities and materials are based on these protocols and were created in consultation with experts in training and suicide prevention, and then tested and evaluated.

Training includes interactive case scenarios, facilitated discussion, activities, written materials, PowerPoint presentation, and consultation. Connect staff welcome collaboration with organizations, tribes, and villages to customize the training to be culturally effective. Connect staff encourage and facilitate dialogue between service providers to build a comprehensive and consistent response to suicide based on best practices.

Program Objectives

After training, participants in Connect Suicide Postvention will have increased:

1. Understanding of how to coordinate a safe and supportive response to a suicide.
2. Knowledge of appropriate memorial activities, safe communication, and responses to media inquiries.
3. Understanding of how to reduce the risk of suicide-related phenomena (contagion,copy-cat, and pacts).
4. Understanding of the complexity of suicide-related grief for different age groups and over time.
5. Knowledge of strategies to encourage help-seeking, reducing stigma, and promoting healing for survivors.
6. Knowledge of resources for survivors of suicide loss.
7. Competency in how to recognize and respond to suicide warning signs in survivors and community members after a suicide.
8. Opportunities for networking, relationship building, problem solving and information sharing among participants.

Implementation Essentials

• Community support and resources to support postvention efforts.

2012 NSSP Objectives Addressed: 

Objective 1.2: Establish effective, sustainable, and collaborative suicide prevention programming at the state/territorial, tribal, and local levels.

Objective 10.4: Adopt, disseminate, implement, and evaluate guidelines for communities to respond effectively to suicide clusters and contagion within their cultural context, and support implementation with education, training, and consultation.

Developed by the Syracuse University Counseling Center, Campus Connect is a gatekeeper training program for college and university faculty, staff, and students. The experientially based training is designed to enhance participant’s knowledge, awareness, and skills concerning college student suicide. Specifically, Campus Connect aims to increase participant’s knowledge about suicide statistics, risk and protective factors, warning signs, and referral resources; to increase empathic listening skills, communication skills, and the ability to ask individuals if they are thinking about suicide; and to increase self-awareness concerning the potential emotional reactions gatekeepers may experience when interacting with students in crisis.

Campus Connect is highly interactive, with gatekeepers participating in multiple exercises throughout the training to increase both their skills and awareness concerning the emotional intensity of responding to suicidal college students. The two-and half hour training culminates with a role play, in which gatekeepers are given the opportunity to practice the skills they are taught during the course of the training.

Program Objectives

After training, participants will have

1. Increased knowledge of suicide warning signs and referral points for students at risk for suicide.
2. Increased skills to respond to college students at-risk for suicide.
3. Increased self-efficacy regarding their ability to respond to a student at-risk for suicide.

Implementation Essentials

• Completion of the Campus Connect readiness checklist to ensure that the campus is adequately prepared for program implementation. (Although not an implementation essential, a Framework for Developing Institutional Protocols for the Acutely Distressed or Suicidal College Student, developed by the Jed Foundation, may be useful.)
• Training conducted by qualified Campus Connect trainer.

2012 NSSP Objectives Addressed: 

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

ASIST is a two-day, two-trainer, workshop designed for members of all caregiving groups. Family, friends, and other community members may be the first to talk with a person at risk, but have little or no training. ASIST can also provide those in formal helping roles with professional development to ensure that they are prepared to provide suicide first aid help as part of the care they provide.

The emphasis is on teaching suicide first-aid to help a person at risk stay safe and seek further help as needed. Participants learn to use a suicide intervention model to identify persons with thoughts of suicide, seek a shared understanding of reasons for dying and living, develop a safeplan based upon a review of risk, be prepared to do follow-up, and become involved in suicide-safer community networks. The learning process is based on adult learning principles and highly participatory. Graduated skills development occurs through mini-lectures, facilitated discussions, group simulations, and role plays.

Workshop instructors take a five-day training for the trainer course and agree to be part of a quality control program that supports them in their trainer roles and encourages them to provide feedback to the developers of ASIST.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP). 

Outcome Reviewed (Evidence Rating)*

• Personal Resilience/Self-concept (Promising)

ASIST was rated as promising for improving personal resiliency and self-concept among suicidal individuals calling a hotline. This finding was based on use of ASIST in a specific context: to train suicide crisis line counselors. NREPP reviewed a study that randomized suicide crisis centers into an intervention group, in which counselors received ASIST training, and a wait-list control group. A strength of this study was that it examined the effects of training on distressed individuals (i.e., callers to the hotline), not just on those who received the training.  Data from monitored calls of suicidal individuals showed a significant improvement in callers (e.g., less depressed, less suicidal, less overwhelmed) by the end of calls handled by ASIST trained counselors, compared with the wait-list control group (Gould et al., 2013). 

Read more about the program’s ratings.

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* NREPP changed its review criteria in 2015. This program was reviewed under the post-2015 criteria. To help practitioners find programs that fit their needs, NREPP reviews the evidence for specific outcomes, not overall programs. Each outcome was assigned an evidence rating of Effective, Promising, or Ineffective. A single program may have multiple outcomes with different ratings. When considering programs, we recommend (a) assessing whether the specific outcomes achieved by the program are a fit for your needs; and (b) examining the strength of evidence for each outcome.

Program Objectives

After training, ASIST participants should be able to:

1. Recognize that caregivers and persons at risk are affected by personal and societal attitudes about suicide.
2. Discuss suicide in a direct manner with someone at risk.
3. Identify risk alerts and develop related safeplans.
4. Demonstrate the skills required to intervene with a person at risk of suicide.
5. List the types of resources available to a person at risk, including themselves.
6. Make a commitment to improving community resources.
7. Recognize that suicide prevention is broader than suicide first-aid and includes life promotion and self-care for caregivers.

Implementation Essentials

• Two-day training session by certified ASIST trainers.

2012 NSSP Objectives Addressed: 

Objective 1.2: Establish effective, sustainable, and collaborative suicide prevention programming at the state/territorial, tribal, and local levels.

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

Developed by Gryphon Place, the Gatekeeper Suicide Prevention Program: A High School Curriculum is organized into four class-period length lessons. A gatekeeper philosophy—i.e., identification of those exhibiting risk behaviors, asking about behaviors of concern, and referral of those possibly at-risk to a trusted adult—is the primary theme of the lessons. Also emphasized are the de-stigmatization of mental illness, breaking the “culture of silence,” and the encouragement of help-seeking. Teacher training and parent education components are included. Linkages to helping resources and personnel within schools and a local 24/7 crisis line are promoted.

For over 15 years Gryphon Place has used a continuous evaluation and quality improvement process, collecting input from teachers, youth, and the suicide prevention field, to modify and improve the curriculum program. Gryphon Place has been providing a comprehensive array of suicide prevention services, training, and consultation since 1988.

Program Objectives

After program implementation, participating students will have:

1. Increased knowledge related to suicide and suicide prevention.
2. Increased awareness of their attitudes toward suicide and depression.
3. Increased knowledge of suicide warning signs.
4. Increased knowledge of intervention skills for at-risk peers.
5. Increased knowledge of referral strategies and helping services.

Implementation Essentials

• The program must be presented by personnel trained by Gryphon Place.
• Specific school referral points for at-risk students and linkages to helping services must be identified and incorporated into the curriculum content prior to implementation.

2012 NSSP Objectives Addressed: 

Objective 7.1: Provide training on suicide prevention to community groups that have a role in the prevention of suicide and related behaviors.

Emergency Room Intervention for Adolescent Females is a program for teenage girls 12 to 18 years old who are admitted to the emergency room after attempting suicide. The intervention, which involves the girl and one or more family members who accompany her to the emergency room, aims to increase attendance in outpatient treatment following discharge from the emergency room and to reduce future suicide attempts. A review of the literature suggests that factors related to treatment noncompliance following a suicide attempt include family discord, maternal psychopathology, attempter depression, and negative experiences with emergency room staff. The intervention consists of three components designed to improve the emergency room experience for the adolescent and family, thereby changing the family’s conceptualization of the suicidal behavior and expectations about therapy. First, a 2-hour training is conducted separately with each of the six groups of staff working with adolescents who have attempted suicide. Second, the adolescents and their families watch a 20-minute videotape, filmed in Spanish and dubbed in English, that portrays the emergency room experience of two adolescents who have attempted suicide. Last, a bilingual crisis therapist delivers a brief family treatment in the emergency room.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

Outcome(s) Reviewed (Overall Quality of Research Rating-scale of 0 to 4)*

1: Treatment adherence (2.1)
2: Adolescent symptoms of depression (3.0)
3: Adolescent suicidal ideation (2.9)
4: Maternal symptoms of depression (2.8)
5: Maternal attitudes toward treatment (2.2)

Read more about the program’s ratings.

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* NREPP changed its review criteria in 2015. This program is a “legacy program,” meaning that it was reviewed under the post-2015 criteria. The evidence for each outcome was reviewed and scored on a scale of 0-4, with 4 indicating the highest quality of evidence and 0 indicating very poor quality of evidence. The overall rating was based on ratings of six criteria: 1) reliability of measures, 2) validity of measures, 3) intervention fidelity, 4) missing data and attrition, 5) potential confounding variables, and 6) appropriateness of analysis. When considering programs, we recommend (a) assessing whether the specific outcomes achieved by the program are a fit for your needs; and (b) examining the strength of evidence for each outcome. 

Implementation Essentials

• Prior to training the peer team, crisis management protocols found in the Sources of Strength Start-up Guide should be fully implemented and local adult advisors should be identified and trained.

2012 NSSP Objectives Addressed: 

Objective 8.4: Promote continuity of care and the safety and well-being of all patients treated for suicide risk in emergency departments or hospital inpatient units.

Objective 9.4: Adopt and implement guidelines to effectively engage families and concerned others, when appropriate, throughout entire episodes of care for persons with suicide risk.