Program/Practice – Page 2 – Suicide Prevention Resource Center

Making Educators Partners in Youth Suicide Prevention: ACT on FACTS

ACT on FACTS is an updated version of the school-based suicide awareness program “Making Educators Partners in Suicide Prevention”. Like its predecessor, ACT on FACTS is a two-hour online interactive training program, designed in a series of modules. It addresses the critical but limited responsibilities of educators in the process of identification and referral of potentially suicidal youth. It focuses on the practical realities and challenges inherent in the school setting through a variety of training formats that include lecture, question and answer with content experts, interactive exercises and role plays. In addition to its other content, the program highlights four categories of youth who may be at elevated risk for suicide: youth involved in bullying, LGBTQ youth, gifted youth, and students being reintegrated back into school after a suicide attempt. The training includes optional content that addresses suicide in elementary and middle schools. There is also an additional module that includes the stories of individual survivors of suicide loss as well as a high school that experienced an episode of contagion. The focus in telling these stories is to highlight the importance of emphasizing resilience and protective factors after a loss event.

The program is adapted from the educator component of LIFELINES: A School-based Program for Suicide Prevention initially developed in 1989 by John Kalafat and Maureen Underwood. It incorporates material from the previous Making Educators Partners in Youth Suicide Prevention training as well as current data about risk, warning signs, and populations at higher risk. The segment on LGBTQ youth was developed in partnership with The Trevor Project and the section on bullying was created in conjunction with the Olweus Bulling Prevention Program. Content was also developed with input from survivors of suicide loss and those with lived experience.

Program Objectives

After training, participants should be able to:

Define suicide prevention as a part of school culture by contextualizing it as a component of a “competent school community”
Describe the critical but limited role of the educator in the prevention process
Explain why specific categories of students may be at elevated risk
Discuss strategies for dealing with at-risk students

Implementation Essentials

Educator training is only one facet of effective school-based suicide prevention; additional critical components include the identification of on-site referral points (for example: school psychologists or counselors), the development of linkages to community mental health services, and the institution of crisis protocols, such as those developed by the Maine Youth Suicide Prevention 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.

The Suicide Prevention Resource Center at the University of Oklahoma Health Sciences Center is supported by a grant from the U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), under Grant No. 1H79SM083028-03

The views, opinions, and content expressed in this product do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS.

Families Are Forever

Families Are Forever is an educational video and guide that educates families on how to support their LGBT children and decrease their suicide risk. The video shows the journey of a religiously devout family from struggling to respond to accepting and supporting their young gay son. The video, discussion guide, and family education booklet are based on extensive research and family intervention work conducted by the Family Acceptance Project. This educational video and guide is part of a planned video series to give LGBT youth and families hope, increase communication, and teach families how to identify and change rejecting behaviors and increase supportive behaviors to help prevent suicide and other negative outcomes and to promote their LGBT child’s well-being. The 20-minute video in English and Spanish is closed-captioned, and the discussion guide includes talking points, information to stimulate family discussion, related statistics, and additional helping resources.

Program Objectives

Users of the video and discussion guide should have greater understanding and knowledge of:

How families can support their LGBT children.
How family support contributes to well-being and safety for LGBT children.
How family rejection contributes to risk of negative outcomes, including risk for suicide, for LGBT children.
The challenges that diverse LGBT youth and families experience in trying to integrate multiple identities to increase empathy and connectedness (with family, peers, members of their congregation and community).
Resources for families with LGBT children and suicide crisis-support services.

Implementation Essentials

Those who distribute the educational video should be aware of local helping resources.

2012 NSSP Objectives Addressed:

Objective 2.1: Develop, implement, and evaluate communication efforts designed to reach defined segments of the population.

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

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

Cognitive Therapy for Suicide Prevention

Cognitive Therapy for Suicide Prevention is a cognitive–behavioral psychotherapy program designed for patients who have previously attempted or thought of suicide. The intervention teaches patients skills to use alternative ways of thinking and behaving during episodes of suicidal crises and assists them in building a network of mental health services and social supports to prevent future suicide attempts. It is designed to be provided by individual therapists on a one-to-one basis. Therapists must have a master’s degree and must either be a licensed mental health provider or work under the supervision of a licensed mental health provider.

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)*

Depression and Depressive Symptoms (Effective)
Suicidal Thoughts and Behaviors (Promising)
Personal Resilience/Self-Concept (Promising)
Social Functioning/Competence (Promising)

Read more about this 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.

2012 NSSP Objectives Addressed:

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

Suicide Prevention: A Gatekeeper Training for School Personnel

Suicide Prevention: A Gatekeeper Training for School Personnel, developed by the Riverside Trauma Center, is a two-hour training for licensed school personnel. It covers basic suicide facts, warning signs, and risk and protective factors. It also offers ways to ask students about suicidal thoughts and behaviors and ways to help students who may be struggling to access resources. The information is presented through lecture, PowerPoint, discussions, role plays, behavioral modeling, video, and case studies. This training is relevant for elementary through high school teachers, administrators, and support staff.

Program Objectives

After completion of Suicide Prevention: A Gatekeeper Training for School Personnel, participants should be able to:

Describe the scope of the problem
Provide a clinically accurate definition of suicide • List suicide warning signs and risk and protective factors
Demonstrate their comfort level in asking directly about suicide
Identify school and community resources for students and families at risk
Describe a school’s role in reducing risk factors and increasing protective factors

Implementation Essentials

Trainings are conducted by staff from the Riverside Trauma Center.
Suicide Prevention: A Gatekeeper Training for School Personnel should be used as part of a school’s 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.

Assisted Outpatient Treatment (AOT)

This intervention is the practice of delivering outpatient treatment under court order to adults with severe mental illness who are found by a judge, in consideration of prior history, to be unlikely to adhere to prescribed treatment on a voluntary basis. AOT laws allow courts to order individuals to comply with outpatient treatment or services as a condition of remaining in the community. AOT is a form of civil commitment for individuals who meet state-defined legal criteria, e.g. they have been repeatedly hospitalized or arrested as a consequence of treatment nonadherence. One of defined group of institutions or individuals must petition the court and include reasons why the petitioner meets the criteria for AOT as well as an affidavit from a physician. Case managers monitor compliance with the court’s order.

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

1: Assault or threat of violent behavior (2.0)

2: Hospitalization (2.7)

3: Quality of life (2.8)

4: Suicide risk (2.5)

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 previous 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. Over time, all legacy programs will be re-reviewed using the current criteria. 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

Enabling legislation in the state or jurisdiction
Knowledge of the specific legal process outlined in the applicable law
Collaboration among local mental health authorities, treatment providers, and the court with jurisdiction over civil commitments

2012 NSSP Objectives Addressed:

Objective 9.5: Adopt and implement policies and procedures to assess suicide risk and intervene to promote safety and reduce suicidal behaviors among patients receiving care for mental and/or substance use disorders.

Suicide Assessment and Intervention Training for Mental Health Professionals

Developed by Riverside Trauma Center, Suicide Assessment and Intervention is a one-day (6 CEU hours) training for clinicians and other mental health professionals on suicide risk assessment, formulation, and crisis response. It covers warning signs, risk and protective factors, risk assessment, and formulation approaches as well as safety planning. Also discussed are liability, the impact of this work on clinicians, and skills for managing the clinician’s personal reactions. A section on the value of postvention and grief support services is included. The information is presented through lectures with PowerPoint slides, discussion, role plays, behavioral modeling, videos, and case studies.

Program Objectives

After taking the training, participants will have: 1. Increased knowledge about suicide, including risk factors, risk formulation, crisis planning , and suicide postvention; 2. Increased understanding of ambivalence in suicidal thinking and the idea of suicide as a coping strategy; 3. Increased knowledge of tools and interviewing strategies for assessing risk of clients with suicidal ideation and behaviors; 4. Increased confidence in their ability to assess or conduct crisis intervention with clients with suicidal ideation or behaviors; and 5. Increased confidence in managing their own reactions when working with at-risk clients.

Implementation Essentials

Training by a Riverside Trauma Center 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.

Survivor Outreach Team Training Manual

Developed by the Kern County (CA) Mental Health Department (now Kern Behavioral Health and Recovery Services), The Survivor Outreach Team Training Manual serves as a resource for how to develop and implement a survivor outreach team. The survivor outreach team is made up of of trained survivors who visit and provide support to families and loved ones who have recently lost someone to suicide. The manual includes:

Step-by-step instructions for developing necessary community partnerships to help support a survivor outreach team.
Specific procedures on how to implement a survivor outreach team
Instructions on how to recruit and train survivor outreach team volunteers.
Customizable survivor outreach team program templates (e.g., volunteer confidentiality agreement and feedback survey)

Program Objectives

Users of the Survivor Outreach Team Training Manual will acquire:

Knowledge of how to set up a Survivor Outreach Team; and
Knowledge of how to train volunteers to do survivor outreach.

Implementation Essentials

Familiarity with local support groups and other resources for survivors of suicide loss.

2012 NSSP Objectives Addressed:

Objective 10.1: Develop guidelines for effective comprehensive support programs for individuals bereaved by suicide and promote the full implementation of these guidelines at the state/territorial, tribal, and community levels.

Community Gatekeeper Training: Lesbian, Gay, Bisexual, Transgender (LGBT) Older Adults & Suicide Prevention

Community Gatekeeper Training: LGBT Older Adults & Suicide Preventionis a 120-minute program, designed by Crisis Support Services of Alameda County, to train gatekeepers to recognize when a lesbian, gay, bisexual, or transgender (LGBT) older adult may be at risk for suicide and respond appropriately. The target audience for this program is caregivers and service providers for older adults and/or LGBT communities (i.e. doctors, pharmacy technicians, care center staff, home health aides, residential facility staff, housing and transportation staff, Meals on Wheels volunteers, mental health professionals, and faith communities). Workshop topics include: unique challenges to successful aging faced by LGBT older adults; risk and protective factors associated with suicide; suicide warning signs; latest research, statistics, and theories on suicidal behavior; risk assessment; safety planning; and resources. There are also skill-building, interactive activities for participants to practice asking about suicide and applying what they have learned through a sample vignette.

Program Objectives

At the end of this training, participants will have:

Increased knowledge to recognize suicide warning signs;
Increased knowledge of suicide risk & protective factors;
Increased knowledge of suicide intervention resources;
Increased awareness of the gatekeeper role;
Increased comfort and willingness to ask directly about suicide; and
Increased willingness to respond appropriately to a suicidal individual.

Implementation Essentials

This workshop is designed to be presented by a skilled facilitator with a background in suicide prevention and mental health. It is preferred but not required that facilitators have a degree in the mental health or social service profession.

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.

Check-in With You: The Older Adult Hopelessness Screening Program (OAHS)

Check-in With You: The Older Adult Hopelessness ScreeningProgram (OAHS), developed by Tulare County Health and Human Services Agency, assesses levels of hopelessness in older adults and provides early intervention services to reduce suicide risk, improve quality of care, and prevent the onset of serious mental illness. All adults 55+ receiving primary health care services are screened for hopelessness and suicidal intent. The Beck Hopelessness Scale® is administered before patients’ health appointments. Those who screen as moderate to severe are offered early intervention services. Patients who choose to participate receive ongoing support, mental health case management, short-term intervention, and warm linkages to local services that can help improve social, physical, environmental, emotional, and financial wellness.

Program Objectives

Organizations that implement OAHS will:

Increase their capacity to identify suicide risk in older adult patients in primary care;
Improve their identification of older adults (55+) who are feeling hopeless or may be at risk of suicide;
Make more interventions available to older adults identified to be at risk of suicide; and
Increase both awareness of mental health and community resources, and access to these resources.

Implementation Essentials

Primary care settings that use OAHS should have established protocols for managing patients who may be at risk for suicide.

2012 NSSP Objectives Addressed:

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

Objective 5.4: Strengthen efforts to increase access to and delivery of effective programs and services for mental and substance use disorders.

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

Suicide Prevention among LGBT Youth: A Workshop for Professionals Who Serve Youth

Suicide Prevention among LGBT Youth: A Workshop for Professionals Who Serve Youth, developed by the Suicide Prevention Resource Center, is a free kit of materials to help staff in schools, youth-serving agencies, and suicide prevention programs provide a workshop on suicide prevention among LGBT youth. Individuals attending this workshop may include teachers, school administrators, child welfare staff, clergy, group home staff, juvenile justice staff, foster parents, therapists, and recreation workers.

Topics covered include suicidal behavior among LGBT youth, protective factors for suicidal behavior, strategies to reduce suicide risk, and ways to increase school or agency cultural competence. Materials in the kit include a PowerPoint slide presentation, leader’s guide, and handouts. Instructional methods include lecture, small group exercises, and group discussion. The workshop kit provides a foundation from which leaders can adapt the workshop to meet their needs and the needs of their audience. Leaders are welcome to shorten or lengthen the workshop from the suggested 4-hour format. They may also add materials specific to local programs, resources, or activities.

Program Objectives

The goal of this workshop is to build the capacity of schools, youth-serving organizations, and suicide prevention programs to identify and serve LGBT youth who are suicidal. At the end of the workshop participants will be able to:

Use correct terminology for suicidal behavior and LGBT issues;
Describe research related to suicidal behavior among LGBT youth;
Discuss risk and protective factors for suicidal behavior in LGBT youth;
Assess the cultural competence of their schools and agencies in relation to LGBT youth, and plan next steps for increasing LGBT cultural competence; and
Describe strategies to reduce suicidal behavior among LGBT youth.

Implementation Essentials

Workshop facilitators should have knowledge and experience in both suicide prevention and LGBT issues.
Workshop facilitators should have knowledge of local helping resources.

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.