Resource Types: Program/Practice

The Army ACE Suicide Intervention (ACE-SI) Program is a three-hour training that provides soldiers with the awareness, knowledge, and skills necessary to intervene with those at risk for suicide. ACE stands for Ask, Care, and Escort. The purpose of ACE is to help soldiers and junior leaders become more aware of steps they can take to prevent suicides and confident in their ability to do so. ACE encourages soldiers to directly and honestly question any battle buddy who exhibits suicidal behavior. The battle buddy should ask a fellow soldier whether he or she is suicidal, care for the soldier, and escort the soldier to the source of professional help. This training helps soldiers avoid letting their fears of suicide govern their actions to prevent suicides.

ACE program materials include: a trainer’s manual; PowerPoint slides with embedded video messages; suicide prevention tip cards (which list risk factors and warning signs for suicide); and ACE wallet cards (with simple directions for identifying and intervening with those at risk).

ACE was created in response to an army leadership request to develop a suicide intervention skills training support package (TSP) for army-wide distribution. The program is based on relevant research literature and has undergone a process of testing and revision that included focus group interviews and pilot testing to determine training utility and feasibility. A preliminary report describing the results of the pilot test is available for review. ACE has been reviewed by Army Medical Command personnel and Army G-1 for applicability and was approved for army-wide training by the Army Task Force on Suicide Prevention.

Program Objectives

After training, Soldiers should:

1. Feel increased individual and group responsibility for the well-being of others.
2. Have increased awareness of stigma and its negative effects on help-seeking.
3. Have increased knowledge and skills for identifying, intervening, and referring suicidal Warriors for help.
4. Have increased competence and confidence in the application of these skills.
5. Have increased knowledge of military and community resources for Warrior referrals.

Implementation Essentials

• ACE should be implemented as instructed in the training protocols. Deviations from these protocols should be approved in advance by the ACE development team.

2012 NSSP Objectives Addressed: 

Objective 5.3: Intervene to reduce suicidal thoughts and behaviors in populations with suicide risk.

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

Developed in Washington State, LOOK LISTEN LINK is a curriculum designed for middle school-aged youth. It consists of four 45-minute lessons that focus on identifying causes of stress along with healthy ways of coping with stress and anxiety. Another significant focus of the program is teaching youth how to recognize friends who are depressed and how to link them to resources.

The LOOK LISTEN LINK curriculum includes interactive exercises, classroom discussion, role-play practice, and observation through an accompanying instructional DVD. The lessons integrate interactive teaching and participatory learning principles. They are problem-centered and based on issues relevant to students. The program empowers students to recognize the signs of anxiety and depression in their peers and to seek help.

Development of LOOK LISTEN LINK was based on research about middle school learners. The curriculum authors relied heavily on feedback from Washington State middle school teachers and middle-school aged youth leaders. The curriculum was beta tested with students from two culturally diverse seventh grade health classrooms in Washington State.

Program Objectives

After participating in the curriculum, students should be able to:

1. Identify causes and symptoms of stress and anxiety in themselves and friends.
2. Identify and demonstrate healthy ways to deal with stress and anxiety.
3. Understand facts about teen depression.
4. Recognize symptoms of depression in a friend.
5. Name adult resources to go to for help.

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.

Reconnecting Youth: A Peer Group Approach to Building Life Skills (RY) is a school-based prevention program for students ages 14-19 years that teaches skills to build resiliency against risk factors and control early signs of substance abuse and emotional distress. RY targets youth who demonstrate poor school achievement and high potential for school dropout. Eligible students must have either (1) fewer than the average number of credits earned for all students in their grade level at their school, high absenteeism, and a significant drop in grades during the prior semester or (2) a record of dropping out of school. Potential participants are identified using a school’s computer records or are referred by school personnel if they show signs of any of the above risk factors. Eligible students may show signs of multiple problem behaviors, such as substance abuse, aggression, depression, or suicidal ideation.

RY also incorporates several social support mechanisms for participating youth: social and school bonding activities to improve teens’ relationships and increase their repertoire of safe, healthy activities; development of a crisis response plan detailing the school system’s suicide prevention approaches; and parent involvement, including active parental consent for their teen’s participation and ongoing support of their teen’s RY goals.

The course curriculum is taught by an RY Leader, a member of the school staff or partnering agency who has abilities as a “natural helper,” has healthy self-esteem, is motivated to work with high-risk youth, and is willing to comply with implementation requirements.

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: School performance (3.3)

2: Drug involvement (3.2)

3: Mental health risk and protective factors (3.3)

4: Suicide risk behaviors (3.3)

Read more about this program’s ratings.

———————

* 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 3.1: Promote effective programs and practices that increase protection from suicide risk.

Objective 5.2: Encourage community-based settings to implement effective programs and provide education that promote wellness and prevent suicide and related behaviors.

Objective 5.3: Intervene to reduce suicidal thoughts and behaviors in populations with suicide risk.

Kognito At-Risk is a 45-minute interactive, web-based training simulation that gives higher education faculty and staff the knowledge necessary to identify and refer students exhibiting symptoms of mental distress, including depression, anxiety, and thoughts of suicide. In the simulation, users assume the role of a faculty member who is concerned about several of his students. Users analyze profiles of these virtual students – including information about their academic performance, behaviors, and appearance – to identify those who are at-risk and then engage in simulated conversations with them to determine whether and how to refer them to the counseling center. If users decide to refer a student, they must respond to the student’s hesitations and help the student understand how counseling could benefit them. The training is completed once the user successfully identifies and refers the at-risk students.

At-Risk was created by Kognito, a developer of role-playing training simulations in partnership with the Mental Health Association of New York City. University counselors provided further feedback and insight to ensure that the end product provides a valuable and comprehensive learning experience. At-Risk is built upon Kognito’s Human Interaction Simulation Platform™, which enables users to practice having conversations with realistic, fully animated and emotionally responsive avatars. This innovative learning approach provides learners with comprehensive experience having conversations with at-risk students, thereby making them better equipped and more confident to handle similar situations in real life.

Program Objectives

After training, faculty and staff will have:

1. Increased knowledge of signs of student psychological distress.
2. Increased knowledge of how to communicate with at-risk students.
3. Increased knowledge of local resources and referral points for at-risk students.

Implementation Essentials

• The At-Risk implementation manual should be thoroughly reviewed prior to program implementation.
• At-Risk has several customizable features that should be modified to inform faculty and staff of the unique resources of each campus.
• At-Risk is most effective when used as part of a campus’ larger strategic plan to identify and help at-risk students.

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 mental health professionals and educators with funding from the National Institute of Mental Health, EndingSuicide.com is a group of online continuing education modules on suicide prevention for health professionals and school professionals. EndingSuicide.com has been shown to improve knowledge and attitudes toward suicide prevention in a wide range of professionals. Each of the 19 modules can stand alone, or be used with one or more of the others to create a custom continuing education curriculum. Continuing professional education credit is available for physicians, social workers, and certified counselors. Modules are also being taken for professional development by NJ teachers/educators as part of their mandated suicide prevention training.

Modules range from the introductory-level materials for those without health training to more complex modules for practicing health professionals. All content has been peer reviewed, is free of commercial bias or support, has extensive references and resource sections, and advocates evidence-based practices.

EndingSuicide.com was developed using the Clinical Tools, Inc. Development Process, with Small Business Innovative Research (SBIR) funding from NIH/NIMH. Each module is based on a needs analysis, and includes educational objectives, need, goal, author bios, and disclosure information. Further, each module was peer reviewed by a content expert and a direct care provider. Each module includes built-in knowledge, attitude, and
self-efficacy assessments.

Program Objectives

After training, participants will have:

1. Increased knowledge of suicide prevention;
2. Increased feelings of self-efficacy to deal with those who may be suicidal;
3. Increased positive attitudes towards intervention with those who may be suicidal;
4. Increased intention to intervene appropriately with those who may suicidal.

Implementation Essentials

EndingSuicide.com offers levels of training for a variety of professionals. Participants should access levels of training that correspond best with their level of experience and training needs.

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.

Objective 7.2: Provide training to mental health and substance abuse providers on the recognition, assessment, and management of at-risk behavior, and the delivery of effective clinical care for people with suicide risk.

Developed by Elaine Frank and Mark Ciocca, CALM: Counseling on Access to Lethal Means is a 1.5 to 2 hour workshop designed to help providers implement counseling strategies to help clients at risk for suicide and their families reduce access to lethal means, particularly (but not exclusively) firearms. It includes a number of components: background on suicide data and lethal means; an introduction to firearms; video presentation that models the counseling strategy; a presentation and discussion on conducting a counseling session; optional role plays; and a course evaluation.

A typical 90-minute training agenda includes:

1. The problem: Youth suicide and access to lethal means.
2. Negotiation of means restriction (video presentation).
3. Conducting a family firearms assessment.
4. Wrap-up and evaluation.

The CALM program has developed over time with the benefit of initial funding from the Suicide Prevention Partnership/Gutin Family Foundation and in collaboration with Means Matter, a project of the Harvard Injury Control Research Center. It has benefited from evaluations received from many different audiences in a variety of states.

A free online version of this course has also been developed.

Program Objectives

At the end of the training, CALM training participants will have:

1. Increased knowledge about the association between access to lethal means and suicide, and the role of means restriction in preventing suicide.
2. Increased skills and confidence to work with clients and their families to assess and reduce their access to lethal means.

Implementation Essentials

• CALM training should be conducted by a qualified CALM trainer.

2012 NSSP Objectives Addressed: 

Objective 6.1: Encourage providers who interact with individuals at risk for suicide to routinely assess for access to lethal means.

The Lifelines Prevention student curriculum (formerly known as the Lifelines Curriculum) is one component of Lifelines: Helping A Comprehensive Suicide Awareness and Responsiveness Program for Teens, a comprehensive, schoolwide suicide prevention program for middle and high schools. The goal of the overall Lifelines program is to promote a caring, competent school community in which help-seeking is encouraged and modeled and suicidal behavior is recognized as an issue that cannot be kept secret. Lifelines aims to increase the likelihood that school staff and students will be able and willing to identify at-risk youth when they encounter them, provide an appropriate initial response, and obtain help. Lifelines includes a set of sequential components, including reviewing available resources and establishing administrative guidelines and procedures for responding to students at risk; training school faculty and staff to prepare them for their role in identifying and responding to suicidal students; providing a workshop and informational materials to parents; and implementing a curriculum for students to educate them about suicidal behavior and discuss their role in suicide prevention.

The outcomes listed below are based on research that assessed only the Lifelines Prevention student curriculum, the educational component for students that is implemented last in the sequence. The student curriculum consists of four 45-minute or two 90-minute lessons that incorporate elements of the social development model and employ interactive teaching techniques, including role-play. Health teachers and/or guidance counselors teach the lessons within the regular school health curriculum. These lessons were developed specifically for students in grades 8-10 but can be used with students through 12th grade. The curriculum manual and materials are available from Hazelden Publishing for a fee.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated the Lifelines Prevention student curriculum 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: Student knowledge about suicide (2.9)
2: Student attitudes about suicide and suicide intervention (2.9)
3: Student attitudes about seeking adult help (2.9)
4: Student attitudes about keeping a friend’s suicide thoughts a secret (2.9)

Read more about the program’s ratings.

———————

* 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. 

Implementation Essentials

• Before implementing Lifelines, schools should develop linkages with local mental health services.

2012 NSSP Objectives Addressed: 

Objective 5.2: Encourage community-based settings to implement effective programs and provide education that promote wellness and prevent suicide and related behaviors.

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

The American Foundation for Suicide Prevention’s (AFSP) Interactive Screening Program (ISP) provides a mechanism to reach out to students who are at risk for depression, suicide, and related problems, and encourages them to get help. By proactively engaging those in need, ISP supports student mental health and helps create a campus culture that recognizes that stress and depression are common and treatable problems in today’s world.

ISP starts with a brief, confidential online Stress & Depression Questionnaire that students are invited to complete. The questionnaire incorporates the PHQ-9, a 9-item standardized depression screening scale, as well as questions about suicidal ideation and attempts, problems related to depression such as anger and anxiety, alcohol and drug abuse, and eating disorder symptoms. The questionnaire contains 35 questions and normally takes less than 10 minutes to complete. To fully protect their anonymity, students identify themselves only with a self-assigned user ID. Each student who submits the questionnaire receives a personal written response from a campus counselor, offering options for follow-up evaluation and treatment. Students may “dialogue” with the counselor online while maintaining their anonymity, schedule a telephone or in-person meeting, or request a referral for treatment or support services. Each college or university that implements the ISP has its own customized, secure website that is fully managed by AFSP. The website houses the Stress & Depression Questionnaire and supports all online exchanges between students and counselors.

Program Objectives

When implemented in a college setting, the ISP should:

1. Identify students who are depressed and/or at risk for suicide.
2. Engage these students in a supportive and meaningful way.
3. Refer students to an appropriate mental health care provider for evaluation and possible treatment.

Implementation Essentials

• The program counselor should be comfortable interacting with those at risk for depression and suicide, and able to use the basic technology (email, web forms) inherent with ISP.
• School or community-based mental health professionals need to be available for referrals from the program counselor.

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 Yellow Ribbon, Be A Link! is a two-hour adult gatekeeper training program. The program can be implemented in a variety of settings, including schools, workplaces, and community groups. The training provides participants with knowledge to help them identify youth at risk for suicide and refer them to appropriate help resources. Training includes information on:

• Risk and warning signs of suicide.
• Community referral points for those who may need help.
• Crisis protocols for those who may be at risk.

Training materials include a PowerPoint presentation (provided on a CD) and a Be A Link! trainer’s manual, which includes talking points for each of the PowerPoint slides, a program overview and outline, an FAQ, preparation worksheet, recommendations for safe and effective messaging, and links to additional resources.

Program Objectives

After participating in the Be A Link! training, participants should have:

1. Increased knowledge of warning signs of suicide.
2. Increased understanding of protocols for referring youth to helping resources.
3. Increased knowledge of help resources.

Implementation Essentials

If implemented in a school setting, a school-based crisis management plan, such as those found in the Maine Youth Suicide Prevention, Intervention, and Postvention Guidelines should be adopted prior to implementing Be A Link!

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.