Resource Types: Program/Practice

Offered by the Samaritans of Merrimack Valley, MA, Suicide and Aging: A Gatekeeper’s Workshop is a 4-hour gatekeeper training designed to decrease the incidence of suicide in older adults by training caregivers to (1) better understand the difference between normal aging and mental health problems/challenges, (2) identify common myths about aging and suicide, (3) identify suicide risk and protective factors in older adults, and (4) know under what circumstances their supervisor and/or manager should be informed of a possible suicide risk.

The workshop features vignettes, small group exercises, and question and answer sessions to explore ideas and generate comments. The training works best in groups of 5 to 20 and is typically done in one 4-hour session. Training participants receive a binder with a copy of the PowerPoint presentation shown, as well as statistic sheets, reading recommendations and crisis line phone cards.

Suicide and Aging: A Gatekeeper’s Workshop training was adapted from the 8-hour Suicide Prevention Training for Gatekeepers of Older Adults workshop. This 4-hour version has a less clinical focus and is designed for all levels of staff/volunteers, including nurses, social workers, home health aides, personal care attendants, food service workers, transportation workers, and volunteers, helping them learn the risk factors for suicide and encouraging them to reach up/out for assistance rather than engage the older adult directly.

Program Objectives

At the end of training, participants will be able to:

1. Distinguish between normal aging and mental health issues.
2. Identify common myths and misperceptions about suicide, mental health, and the aging process.
3. Identify suicide risk and protective factors in older adults.

Implementation Essentials

• Participants should be aware of their institution’s protocols and policies regarding the identification and referral of those who may be at risk for suicide.  

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 QPR Institute,Question, Persuade, Refer (QPR) for Nurses is a 3- to 6-hour online training program that teaches nurses how to detect, intervene with, and manage someone at risk for suicide. Nurses have a high degree of exposure to suicidal behaviors in the work setting, especially in hospital emergency departments, and training in suicide prevention, intervention, assessment, treatment, management, and postvention is limited in nursing curricula. To address these training deficits (and with an emphasis on patient safety and emergent practice expectations), this online interactive program teaches nurses at all levels of training and experience how to use the basic QPR Gatekeeper Training for Suicide Prevention within their social networks; how to screen for suicide risk (using a modified version of basic QPR); and how to conduct and document a suicide risk assessment. The QPR for Nurses program offers two certificates. One is for three hours of training in basic QPR, screening and brief assessment. A second certificate (an additional three hours) includes: how to help families; means restriction/environmental safeguards; and a lecture series on foundations in understanding suicide, followed by a national knowledge mastery exam. The second certificate (QPR for Nurses Certificate in Suicide Prevention) requires the completion of an additional five modules for a total of at least six hours of online training.

Established QPR training protocols were adapted for nursing applications through collaborations with the Washington State University College of Nursing in Spokane, Washington, the Emergency Nurses Association of Colorado, and beta testing with nursing groups in Indiana and California, whose members provided peer-reviewed input. The QPR-specific suicide screening questions were developed as part of the federally funded Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) project. Assessment protocols are based on the BPR-registered QPRT Suicide Risk Assessment and Management Training Program.

Program Objectives

Nurses who complete QPR for Nurses will have increased:

1. Knowledge of warning signs and risk factors for suicide.
2. Ability to recognize those at risk for suicide.
3. Ability to assess suicide risk.
4. Intervention skills with those at risk for suicide.
5. Self-efficacy in terms of intervening with suicidal patients.

Implementation Essentials

• QPR for Nurses participants should have knowledge of, and be trained in, institutional protocols for those 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.

Developed by the Training Institute for Suicide Assessment & Clinical Interviewing (TISA), the Chronological Assessment of Suicide Events (CASE Approach) is a flexible interviewing strategy for sensitively and skillfully uncovering suicidal ideation, planning, behaviors, and intent. It was created for use in a variety of settings from outpatient clinics, inpatient units, and school counseling centers to emergency departments and telephone crisis centers. This one-day training is designed to provide participants with intensive experiential training on how to use the CASE Approach effectively. Seven interviewing techniques for enhancing validity when exploring suicidal ideation and other sensitive topics that often lead to suicidal thought are practiced using Scripted Group Role-Playing (SGRP). (The seven techniques are normalization, shame attenuation, the behavioral incident, gentle assumption, denial of the specific, the catch-all question and symptom amplification.) In SGRP all role-plays are scripted—no need for acting—and skills are consolidated repeatedly to enhance the likelihood of their effective use in clinical practice. Each technique and its use in the CASE Approach is practiced in groups of four, coached by the trainer(s) and fellow participants (maximum of 28 participants). Completion of the one-day training results in a Level 1 Certification in the CASE Approach.

Scripted Group Role-Playing (SGRP) was developed over the past decade by borrowing educational techniques from Allen Ivey’s microtraining, as well as macrotraining developed by Shea. As the SGRP training evolved, feedback was garnered from participants to enhance the model. The result is a concise, fast-paced, and uniquely enjoyable role-playing experience.

Program Objectives

At the end of the training, CASE Approach training participants will:

1. Understand the importance and complexities of uncovering suicidal ideation, planning, behavior, and intent, including the concept of the equation of suicidal intent.
2. Understand and be able to demonstrate each of the seven validity enhancing interviewing techniques used in the CASE Approach.
3. Understand and be able to demonstrate the sequential and flexible use of these techniques in various strategies utilized in the CASE Approach.

Implementation Essentials

• A trainer from the Training Institute for Suicide Assessment and Clinical Interviewing (TISA) is required

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.

Kognito At-Risk for Middle School Educators is a 50-minute, online, interactive gatekeeper training program that teaches middle school educators and staff how to (1) identify students exhibiting signs of psychological distress, including depression and thoughts of suicide, (2) approach students to discuss their concern, and (3) make a referral to school support personnel. During the training, learners assume the role of a middle school teacher concerned about three students. Learners explore each student’s profile, including descriptions of social and classroom behavior. Then they engage in simulated conversations with each student. In these virtual conversations, users learn effective conversation strategies for broaching the topic of psychological distress, motivating the student to seek help, and avoiding pitfalls, such as attempting to counsel. Specific attention is paid to increasing student resiliency, discerning situations of potential bullying and/or cyber-bullying, and intervening when concerned for a student’s immediate safety.

The program was developed by Kognito Interactive with input from a group of mental health experts who were highly involved in content development and review, including experts from Mental Health America of Texas. Over 100 middle school counselors and teachers provided feedback in multiple online focus groups and user-testing sessions.

Program Objectives

After training, middle school educators should have increased:

1. Knowledge of signs of student psychological distress including verbal, behavioral and situational clues.
2. Motivation to approach students to discuss their concern, and if necessary, refer.
3. Knowledge of how to communicate with at-risk students and motivate them to seek help.
4. Knowledge about prevalence of psychological distress and suicidality among middle school students.
5. Knowledge of how to handle a situation when concerned that a student may plan to harm him/herself.
6. Knowledge of local resources and referral points for at-risk students.

Implementation Essentials

• The At-Risk for Middle School Educators Implementation Manual should be thoroughly reviewed prior to program implementation.
• Teachers and staff who use At-Risk for Middle School Educators should be aware of their school’s referral policies and protocols.
• At-Risk for Middle School Educators is most effective when used as part of a middle 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.

Developed by QPR Institute, OnlineCounseling and Suicide Intervention Specialist (OCSIS) is an online training program that prepares both volunteers and professionals to detect, assess, and mitigate suicide risk in persons requesting or requiring text-only communications. Learners must successfully complete 130 exam items and practice challenges to complete the course, which consists of a highly structured, multimedia, interactive learning experience. OCSIS competencies are derived from the National Suicide Prevention Helpline recommendations. Two phases of training and two certificates are available. The OCSIS Certificate of Course Completion (phase 1) requires 40 hours of training in basic helping skills, gatekeeper training, foundational knowledge and theory about the nature of suicide, and evidence-based crisis intervention strategies. The OCSIS Certificate of Competency (phase 2) requires 10 hours of mentor-guided interactive training with other learners and the production of three reviewable text-only work products from scripted role-plays. These “cases” are evaluated by a qualified expert using a standardized protocol review tool to identify more than 25 core competencies. A final one-hour interview/exam completes the process. 

The OCSIS program was developed by combining existing QPR Institute programs with materials used in suicide risk assessment, as well as intervention content from other publicationsLearning tools and skill evaluation methodologies were developed in classroom settings and adapted for online delivery. The OCSIS training was developed in consultation with a number of organizations interested in e-learning and online suicide intervention services.

Program Objectives

At the end of the training, participants in the 40-hour Online Counseling and Suicide Intervention Specialist program will have greater:

1. Understanding of suicidal behavior, terms, statistics, and phenomenology.
2. Understanding of suicide risk assessment, particularly as it applies online.
3. Ability to intervene with individuals who may be at risk for suicide, particularly as it applies online.

Implementation Essentials

• Online Counseling and Suicide Intervention Specialist participants should have knowledge of local helping resources.

2012 NSSP Objectives Addressed: 

Objective 2.3: Increase communication efforts conducted online that promote positive messages and support safe crisis intervention strategies.

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 at Boston Children’s Hospital, Break Free from Depression is a school-based curriculum designed to increase adolescents’ awareness and knowledge about depression, enhance their ability to recognize signs and symptoms in themselves and their friends, and increase students’ skills and strategies for finding help for themselves and their peers. This 4-session curriculum for high school students combines didactic and interactive activities.

The cornerstone of the curriculum is a documentary that focuses on a diverse group of real adolescents (not actors) talking about their struggles with depression and suicide in their own words. They discuss the stigma often associated with depression, their symptoms, the course of their illness, and the methods they have used to manage the depression. Each session lasts 45 to 60 minutes and can be taught by high school personnel such as guidance counselors, health teachers, or school nurses, or by community health providers partnered with the school. 

The online resources include all materials needed to facilitate the curriculum and to lead workshops for school staff and parents. It is important to note that Break Free from Depression is not a treatment or counseling intervention, but rather is a universal program designed for depression awareness.

The Break Free from Depression curriculum builds on existing research, pilot studies, and program implementation of the Boston Children’s Hospital Neighborhood Partnerships Program to raise awareness of depression among adolescents. Break Free from Depression is based on best practices and is also informed by feedback from clinicians, students, teachers, and school staff.

Program Objectives

After program implementation, participating students will have:

1. Increased knowledge about depression and suicide;
2. Greater confidence to identify signs of depression and suicide in themselves and their peers;
3. Improved ability to find help for themselves and their peers.

Implementation Essentials

• All school faculty, administrators, and staff should receive basic suicide prevention training, including school protocols and policies regarding students at risk for suicide, prior to using the Break Free from Depression curriculum with 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.

Attachment-Based Family Therapy (ABFT) is a 16-week treatment for youths ages 12-24 who have experienced depression, suicidal thoughts, suicide attempts, or trauma. The model is based on an interpersonal theory of depression, which proposes that the quality of family relationships may precipitate, exacerbate, or prevent depression and suicidal ideation. In this model, ruptures in family relationships, such as those due to abandonment, neglect, or abuse or a harsh and negative parenting environment, influence the development of adolescent depression. Families with these attachment ruptures lack the normative secure base and safe haven context needed for an adolescent’s healthy development, including the development of emotion regulation and problem-solving skills. These adolescents may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. ABFT aims to strengthen or repair parent-adolescent attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help the adolescent cope with stress, experience competency, and explore autonomy. The treatment manual and additional training and resources are available from the program developer. See the NREPP website for contact information.

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)

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.

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 NH, Youth Leaders is a two-day training for youth leaders and adult co-facilitators that prepares youth and adults to conduct Connect Youth Suicide Prevention training for teenage audiences.

Friends of youth at risk are typically the ones who see suicidal warnings before adults. Because youth may not know what to do about a friend at risk, or may keep a suicide plan “secret,” it is important for youth to be trained in suicide prevention and intervention. Research consistently shows that peer training is a very effective method for educating youth.

Youth leaders should be selected to represent a cross-section of local youth culture and should be offered continued adult support in their role as co-trainers after the training is completed. The training emphasizes that the role of youth is to seek help from an adult when there is a concern, NOT to take on the role of a counselor.

Youth Leaders is based on Connect Suicide Prevention Training. This training takes into account developmental considerations of high school-age youth as well as safe messaging guidelines. All materials, activities, and PowerPoint slides were developed to meet the needs of youth and guide their involvement in youth suicide prevention.

Program Objectives

After Day One training, participants (adults alone) will have greater:

1. Understanding of suicide as a public health issue and its impact on communities and individuals.
2. Insights into suicide data and how age, gender, culture, and other factors impact suicide risk.
3. Knowledge of communication techniques for parents and others to use in crisis situations.
4. Knowledge of best practices concerning restricting access to lethal means, safe messaging, and communication about suicide, and how these differ when working with youth.

After Day Two training, participants (adults and youth leaders) will have greater:

1. Understanding of the risk and protective factors and warning signs associated with suicide.
2. Skills and confidence to recognize warning signs of suicide in a friend or family member.
3. Understanding of the importance of involving adults when concerned about someone at risk.
4. Knowledge of resources and comfort level for connecting others with help.
5. Positive attitudes towards helping others.
6. Awareness of the benefits of treatment for mental health and substance abuse issues.

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.