Resource Types: Program/Practice

Assessing and Managing Suicide Risk (AMSR) is a series of one-day or half-day trainings designed for health and behavioral health professionals interested in the latest intersectional suicide care practices.

AMSR Curricula

• Assessing and Managing Suicide Risk: Core Competencies for Health and Behavioral Health Professionals Working in Outpatient Settings (AMSR–Outpatient) is a 6.5-hour in-person training for behavioral health clinicians with a master’s degree or above.
  
• Assessing and Managing Suicide Risk: Core Competencies for Behavioral Health Professionals Working in Inpatient Settings (AMSR–Inpatient) is a 6.5-hour in-person training for behavioral health clinicians with a master’s degree or above.
  
• Assessing and Managing Suicide Risk for Direct Care Staff Working in Outpatient Health and Behavioral Health Care Settings is a 3.5-hour training for staff who provide direct care to clients and support the clinicians managing client treatment.
  
• Assessing and Managing Suicide Risk for Direct Care Staff Working in Inpatient Behavioral Health Care Settings is a 3.5-hour training for staff who provide direct care to clients and support the clinicians managing client treatment.
  
• Assessing and Managing Suicide Risk for Substance Use Disorder Treatment Professionals is a 6.5-hour in-person training for providers who offer any level of substance use treatment to clients at risk for suicide.

Participants who complete a full-day AMSR-Outpatient, AMSR-Inpatient, or AMSR-Substance Use Disorder (SUD) training are eligible for 6.5 continuing education (CE) and continuing medical education (CME) credits. Credit offerings vary by curriculum.

Program Objectives

After training, participants will have:

1. Increased knowledge in the following core competencies: maintaining an effective attitude and approach, collecting accurate assessment information, formulating risk, developing a treatment and services plan, and managing care.
2. Increased willingness, confidence, and clarity in working with individuals at risk for suicide.
3. Increased ability to identify how they can better care for individuals at risk for suicide.

Implementation Essentials

• Training by an authorized AMSR trainer.

2012 NSSP Objectives Addressed: 

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.

Objective 9.1: Adopt, disseminate, and implement guidelines for the assessment of suicide risk among persons receiving care in all settings.

Complicated Grief Treatment (CGT) targets adults experiencing complicated grief (CG), also known as prolonged grief disorder, traumatic grief, or persistent complex bereavement disorder. If left untreated, CG may result in impaired long-term functioning. CGT is based on a model of grief as a natural response to the death of a loved one that typically decreases in intensity as the bereaved person adapts to the loss. CG occurs when something interferes with the coping and adaptation process and bereavement becomes stalled.

CGT is designed to promote resilience and access to natural adaptive processes. It is a semi-structured, manualized treatment administered by a licensed and trained therapist. The intervention includes seven core procedures: (1) psychoeducation about CG and CGT; (2) self-assessment and self-regulation; (3) aspirational goals work; (4) rebuilding connections; (5) revisiting the story of the death; (6) revisiting the world changed by the loss; and (7) addressing memories and continuing bonds. CGT is provided through 16 45-minute sessions, which are organized into four phases. Training and program materials are available through The Center for Complicated Grief of the Columbia School of Social Work.

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 (Evidence Rating)*

• Trauma and Stress-related Disorders and Symptoms (Effective)
• General Functioning and Well-being (Effective)
• Suicidal Thoughts and Behaviors (Promising)
• Depression and Depressive Symptoms (Promising)

Read more about this program’s ratings.

———————

* 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.

2012 NSSP Objectives Addressed: 

Objective 10.2: Provide appropriate clinical care to individuals affected by a suicide attempt or bereaved by suicide, including trauma treatment and care for complicated grief.

Adolescent Coping with Depression (CWD-A) is a cognitive behavioral treatment (CBT) intervention that targets specific issues typically experienced by depressed adolescents, including discomfort and anxiety, irrational/negative thoughts, poor social skills, and limited experiences of pleasant activities. The program consists of 16 two-hour sessions that are conducted over an eight-week period for mixed-gender groups of up to 10 adolescents.

Core components of the program include the CBT model of change, mood monitoring, increasing pleasant activities (behavioral activation), social skills training, relaxation training, identification of negative thoughts and cognitive restructuring, communication and problem-solving training, and relapse prevention. Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework forms. To encourage generalization of skills to everyday situations, adolescents are given homework assignments that are reviewed at the beginning of the subsequent session. The CWD-A course was originally adapted from the adult version of the Coping with Depression course.

CWD-A has been implemented with adolescents in more than 12 diverse settings, including urban and rural areas, schools, juvenile detention centers, and state correctional facilities. It is delivered by mental health professionals with appropriate training and experience (e.g., in the assessment and treatment of adolescent disorders) and who adequately prepare to deliver this specific intervention through study of program materials, training, and/or supervision. In some cases, non-clinicians can deliver the program under the supervision of a licensed mental health professional. See the archived NREPP listing and program dissemination website for additional details on implementation materials and training.

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 (Evidence Rating)*

• Social Connectedness (Effective)
• Depression and Depressive Symptoms (Promising)
• Suicidal Thoughts and Behaviors (Promising)
• General Functioning and Well-being (Promising)
• Disruptive Behavior Disorders and Externalizing/Antisocial Behaviors (Ineffective)
• Internalizing Problems (Ineffective)

Read more about this program’s ratings.

———————

* 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 reviewed 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.

2012 NSSP Objectives Addressed: 

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

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

Problem-Solving Therapy (PST) is a brief psychosocial treatment for patients experiencing depression and distress related to inefficient problem-solving skills. The PST model instructs patients on problem identification, efficient problem-solving, and managing associated depressive symptoms.

While there are different types of PST, they are all based on the same principle of resolving depression by re-engaging the client in active problem-solving and activities. In general, PST involves the following seven stages: (1) selecting and defining the problem, (2) establishing realistic and achievable goals for problem resolution, (3) generating alternative solutions, (4) implementing decision-making guidelines, (5) evaluation and choosing solutions, (6) implementing the preferred solutions, and (7) evaluating the outcome. A primary focus is learning and practicing PST skills, which are centered around empowering patients to learn to solve problems on their own.

Overall, the number of PST sessions may range from between 4 and 12. Individual sessions are, on average, 40 minutes long; however, group sessions can last up to 90 minutes. Each PST session follows a typical structure of agenda-setting, reviewing progress, engaging in the PST model problem-solving activities, reviewing action plans, and wrap-up.

PST can be used in wide range of settings and patient populations, including adaptations for those in primary care and those who are homebound, medically ill, and elderly. It can be delivered by a variety of providers, including mental health professionals, social workers, and health professionals, including primary care physicians and nurses.

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 (Evidence Rating)*

• Suicidal Thoughts and Behaviors (Effective)
• Depression and Depressive Symptoms (Effective)
• Self-Concept (Effective)
• Social Competence (Promising)
• Self-Regulation (Promising)
• Non-Specific Mental Health Disorders and Symptoms (Promising)
• Physical Health Conditions and Symptoms (Ineffective)
• General Functioning and Well-being (Ineffective)
• Anxiety Disorders and Symptoms (Ineffective)

Read more about the program’s ratings.

———————

* 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.

2012 NSSP Objectives Addressed: 

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

The Program to Encourage Active, Rewarding Lives (PEARLS), an intervention for adults and older adults with a depression or dysthymia diagnosis, aims to reduce symptoms of depression and suicidal ideation and improve quality of life.

Designed to empower clients through behavioral techniques, PEARLS consists of these primary components:

• Problem-solving treatment: Participants learn to understand the link between unsolved problems and depression and to apply a seven-step approach to solving their problems.
• Social and physical activation: Participants are encouraged to engage in social and physical activities that most interest them.
• Pleasant activity scheduling: Participants identify and participate in activities they find pleasurable.

PEARLS is delivered in six to eight 50-minute sessions by a trained health or social service professional (e.g., social worker, nurse, case manager) in the client’s home or other community-based setting. Sessions are initially held weekly and become less frequent over a four- to five-month period. During sessions, clients choose the problems they would like to discuss, and the counselor guides, teaches, and supports the client in developing action plans that are to be implemented between sessions to address these problems.

Originally developed for older adults, PEARLS has been implemented with a variety of populations, including adults and older adults with chronic conditions, veterans and the spouses of veterans, older adults with minor depression or dysthymia who were receiving home-based social services, and individuals with epilepsy and depression who were receiving outpatient services.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its review and rating by the Clearinghouse for Military Family Readiness and its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).

(1)  Clearinghouse for Military Family Readiness Review of PEARLS

• The Clearinghouse rates programs, not individual outcomes. PEARLS was rated as Promising.
• The evidence summary states: “In the second study, at the 12-month follow-up, suicidal ideations decreased by 24% in the intervention group, while they decreased by 12% in the control group.  An additional study, conducted in individuals with epilepsy, demonstrated lower scores of depression severity, less suicidal ideation, and better emotional well-being 18 months after baseline compared to participants in usual care.”  

Read about the Clearinghouse review and rating process.

(2)  National Registry of Evidence-Based Programs and Practices (NREPP) Review of PEARLS

Please note that the National Registry for Evidence-based Programs and Practices (NREPP) has been discontinued and the full review is no longer available.     

Outcome(s) Reviewed (Evidence Rating)*

• General Functioning and Well-Being (Promising)
• Depression and Depressive Symptoms (Promising)
• Receipt of Health Care (Promising)
• Physical Health Conditions and Symptoms (Ineffective)

In an earlier NREPP review, PEARLS was listed as effective for reducing suicide ideation, but suicide-related outcomes were not listed after the program was re-reviewed using new criteria in 2015. 

* 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 reviewed the evidence for specific outcomes, not overall programs. Each outcome was assigned an evidence rating of Effective, Promising, or Ineffective. A single program could have multiple outcomes with different ratings.

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

The Good Behavior Game (GBG) is a universal classroom-based behavior management strategy for elementary school that teachers use along with a school’s standard instructional curricula. GBG uses a classroom-wide game format with teams and rewards to socialize children to the role of student. It aims to reduce aggressive, disruptive classroom behavior, which is a shared risk factor for later problem behaviors, including adolescent and adult illicit drug abuse, alcohol abuse, cigarette smoking, antisocial personality disorder (ASPD), violent and criminal behavior, and suicidal thoughts and behaviors.

In GBG classrooms, the teacher assigns all children to teams, balanced with regard to gender; aggressive, disruptive behavior; and shy, socially-isolated behavior. Basic classroom rules of student behavior are posted and reviewed. When GBG is played, each team is rewarded if team members commit a total of four or fewer infractions of the classroom rules during game periods.

GBG is an “upstream” prevention program implemented by teachers in grade 1 and 2 classrooms. Outcomes have been measured over 15 years after school entry. One study found that GBG participants at ages 19 to 21 were significantly less likely to have experienced suicidal ideation compared to those in control classrooms, and mixed effects, depending on the model used, were found for suicide attempts (Wilcox et al., 2008). These positive results were not replicated in a subsequent cohort, although the authors note that the GBG was implemented with less precision in the second cohort.

Designation as a “Program with Evidence of Effectiveness”

SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in Blueprints for Healthy Youth Development, a registry of evidence-based positive youth development programs.

Evidence Rating for Overall Program: Promising*

Outcome(s) Reviewed (not individually rated)

• Alcohol
• Antisocial-aggressive Behavior
• Illicit Drug Use
• Internalizing
• Mental Health – Other
• Suicide/Suicidal Thoughts
• Tobacco

Read more about this program’s evidence and ratings.

———————

* Blueprints for Healthy Youth Development rates overall programs (not individual outcomes) as Promising, Model, or Model Plus. The evidence for the Good Behavior Game is rated as Promising. The evidence for each program is reviewed according to multiple criteria in the following categories: Evaluation Quality, Intervention Impact, Intervention Specificity, Dissemination Readiness, and Independent Replication. Promising programs meet the minimum standard of effectiveness, Model programs meet a higher standard, and Model Plus programs meet the Model Program criteria and one additional standard (independent replication). 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 the program and your intended outcomes.

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.

SOS Signs of Suicide (SOS) is a universal, school-based prevention program designed for middle school (ages 11-13) and high school (ages 13-17) students. The goals of this program are:

• Decrease suicide and suicide attempts by increasing student knowledge and adaptive attitudes about depression
• Encourage personal help-seeking and/or help-seeking on behalf of a friend
• Reduce the stigma of mental illness and acknowledge the importance of seeking help or treatment
• Engage parents and school staff as partners in prevention through “gatekeeper” education
• Encourage schools to develop community-based partnerships to support student mental health

Through a video and guided discussion, students learn to identify warning signs of suicide and depression in a single class period. At the end of the session, students complete a seven-question screening for depression (anonymous or signed – the school can decide) to further encourage help-seeking and connect students at risk with trusted adults. The curriculum raises awareness about behavioral health and encourages students to ACT (Acknowledge, Care, Tell) when worried about themselves or their peers. Schools can purchase a program license through MindWise Innovations (formerly Screening for Mental Health, Inc.).

The annual license provides access to planning materials, classroom videos, curricula, and screening forms as well as resources for training faculty, staff, and parents. Although training is not required to deliver SOS, many schools/districts prefer a structured training to help increase awareness and ensure fidelity to the program. MindWise Innovations offers an in-person Train-the-Trainer workshop that prepares participants to train students, faculty/staff, and parents in youth suicide prevention.

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 (Evidence Rating)*

• Suicidal Thoughts and Behaviors (Promising)
• Knowledge, Attitudes, and Beliefs about Mental Health (Promising)
• Receipt of Mental Health and/or Substance Use Treatment (Ineffective)
• Social Competence Related to Help-Seeking (specifically, seeking help when feeling depressed or suicidal) (Ineffective)

Read more about this program’s ratings.

———————

* 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.

Implementation Essentials

• SOS provides school staff planning materials to help staff prepare for timely follow up. SOS encourages students to seek help through the ACT: Acknowledge, Care, Tell message. Refer to the Quick Start Guide and Planning Checklist.
• A school-based crisis management plan, such as that found in the Maine Youth Suicide Prevention, Intervention, and Postvention Guidelines, should be created prior to implementing the SOS Signs of Suicide program.

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.

This online suicide risk assessment training module is geared to primary care providers and other clinicians, as well as students, who want to identify youth at risk for suicide in their practices and clinical locations. The program focuses on the assessment of background and subjective risk factors using the well-known HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality) interview instrument for psychosocial risk assessment. It is designed for those who need basic knowledge concerning suicide risk assessment. Specific topics include the following:

• Importance of suicide risk assessment
• Prevalence/epidemiology of suicide
• National efforts for suicide prevention
• Reasons why suicide becomes an option
• Performing an adolescent assessment (background and subjective factors)
• Levels of suicide risk
• Referral
• Treatment
• Assessment tools
• Family assessment

Review questions that users must answer are displayed periodically throughout the module. These and two pretest/post-test videotaped vignettes reinforce the content and help users assess their learning.

Program Objectives

After training, participants should be able to:

1. Explain the role of clinicians in the prevention of suicide.
2. Assess adolescents for suicide risk by inquiring about background risk factors (using HEADSS) and subjective risk factors.
3. Refer adolescents at risk for suicide for the appropriate level of care.
4. Identify possible treatments and how to measure success.
5. Assess family needs, strengths, resource, and supports. 

Implementation Essentials

Practitioners who take the Adolescent Suicide Risk Assessment training should familiarize themselves with their agency’s protocols for managing patients who may be at risk for suicide

2012 NSSP Objectives Addressed: 

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.

Friend2Friend is a 25-minute, online, interactive training program for high school students. In the training, users assume the role of a high school student concerned about a friend and engage in a simulated conversation with this friend. Users learn and practice effective conversation strategies for broaching the topic of psychological distress, motivating the peer to seek help, and avoiding pitfalls, such as giving unsolicited advice and criticizing. This program is based on At-Risk for College Students.

Program Objectives

Students who complete the training will have increased knowledge of:

1. Signs of psychological distress including verbal, behavioral, and situational clues
2. How to communicate with peers and motivate them to seek help
3. Habits for mental wellness
4. National crisis and mental health resources and local resources and referral points 

Implementation Essentials

• High schools that use Friend2Friend should identify on- and off-campus resources for students and ensure all program participants are aware of these resources.

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.

Together Strong is a web-based and mobile interactive gatekeeper and re-integration training simulation that prepares veterans or active duty military service members to provide support to one another when confronting challenges such as adjusting to coming back from a deployment or struggling with psychological distress including suicidal ideation. Through hands-on practice engaging in virtual conversations with virtual fully-animated and emotionally responsive veterans and service members, users learn (1) how to identify when a fellow veteran or service member might need peer support, (2) conversation techniques to encourage productive problem-solving, (3) warning signs of psychological distress, and (4) how to refer veterans or service members exhibiting signs of psychological distress including suicidal ideation to appropriate resources. The course takes approximately 30 to 40 minutes to complete, depending on the individual user’s decisions in the course. The course is available in both English and Spanish and can be accessed online and downloaded as a mobile app through the Google Play and Apple App stores.

This course is based on Veteran on Campus: Peer Program. Development was informed by a group of mental health experts and an advisory board of representatives from veteran-focused organizations, such as Iraq and Afghanistan Veterans of America, The Soldiers Project, and Single Stop USA. Kognito also conducted several face-to-face focus groups and one-on-one interviews with veterans during the development and as part of the final beta testing.

Program Objectives

Individuals who complete the training will have increased:

1. Knowledge of warning signs that a fellow veteran is in distress
2. Motivation to approach a fellow veteran to discuss his/her struggles and to refer him/her to support services.
3. Knowledge of mental health and crisis resources available to veterans