Collaborative Assessment and Management of Suicidality (CAMS): Feasibility trial for next-day appointment services

University of Washington, Seattle, Washington, USA.
Depression and Anxiety (Impact Factor: 4.41). 11/2011; 28(11):963-72. DOI: 10.1002/da.20895
Source: PubMed


Despite the ubiquity of suicidality in behavioral health settings, empirically supported interventions for suicidality are surprisingly rare. Given the importance of resolving suicidality and therapists' anxieties about treating suicidal patients, there is a clear need for innovative services and clinical approaches. The purpose of the current study was an attempt to address some of these needs by examining the feasibility and use of a new intervention called the "Collaborative Assessment and Management of Suicidality" (CAMS) within a "Next-Day Appointment" (NDA) outpatient treatment setting.
As part of a larger feasibility study, n = 32 suicidal patients were randomly assigned to CAMS care versus Enhanced Care as Usual (E-CAU) in an outpatient crisis intervention setting attached to a safety net hospital. Intent to treat suicidal patients were seen and assessed before, during, and after treatment (with follow-up assessments conducted at 2, 4, 6, and 12 months).
The feasibility of using CAMS in the NDA setting was clear; both groups appeared to initially benefit from their respective treatments in terms of decreased suicidal ideation and overall symptom distress. Although patients rated both treatments favorably, the CAMS group had significantly higher satisfaction and better treatment retention than E-CAU. At 12 months post-treatment, CAMS patients showed significantly better and sustained reductions in suicidal ideation, overall symptom distress, and increased hope in comparison to E-CAU patients.
CAMS was both feasible in this NDA setting and effective in treating suicidal ideation, distress, and hopelessness (particularly at 12 months followup).

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Available from: Stephen S O'Connor, Oct 04, 2015
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    • "Specifically, psychiatrists, mental health nurses, psychologists, mental health social workers, and mental health counselors all receive the CAMS training either in-person or online (Marshall et al.). CAMS is a systematic assessment, intervention and tracking for suicidality, recommended for Veteran populations in systematic reviews (Bagley et al., 2010; Comtois et al., 2011; Ellis et al., 2012; Jobes, 2006; Jobes et al., 2011; York, Lamis, Pope, & Egede, 2013). If the outpatient provider has been trained in CAMS, CAMS can become part of the discharge plan for a Veteran with a PRF. "
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    ABSTRACT: In total, 75% of suicides reported to the Joint Commission as sentinel events since 1995, have occurred in psychiatric settings. Ensuring patient safety is one of the primary tasks of inpatient psychiatric units. A review of inpatient suicide-specific safety components, inclusive of incidence and risk; guidelines for evidence based care; environmental safety; suicide risk assessment; milieu observation and monitoring; psychotherapeutic interventions; and documentation is provided. The Veterans Health Administration (VA) has been recognized as an exemplar system in suicide prevention. A VA inpatient psychiatric unit is used to illustrate the operationalization of a culture of suicide-specific safety. We conclude by describing preliminary unit outcomes and acknowledging limitations of suicide-specific inpatient care and gaps in the current inpatient practices and research on psychotherapeutic interventions, observation, and monitoring.
    Issues in Mental Health Nursing 04/2015; 36(3):190-199. DOI:10.3109/01612840.2014.961625
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    • "There are now five published correlational studies supporting the feasibility and clinical value of CAMS and the SSF with suicidal outpatients (Arkov et al., 2008; Jobes et al., 1997; Jobes, Kahn-Greene, Greene, & Goeke-Morey, 2009; Jobes, Wong, Conrad, Drozd, & Neal-Walden, 2005; Nielsen et al., 2011). A recent randomized clinical trial of CAMS both replicates and extends previous correlational support of the approach (Comtois et al., 2011). In this study, CAMS led to rapid and sustained reductions in suicidal ideation and overall symptom distress while increasing reasons for living, optimism, and hope in comparison to treatment as usual. "
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    ABSTRACT: Patients hospitalized for psychiatric reasons exhibit significantly elevated risk of suicide, yet the research literature contains very few outcome studies of interventions designed for suicidal inpatients. This pilot study examined the inpatient feasibility and effectiveness of The Collaborative Assessment and Management of Suicidality (CAMS), a structured evidence-based method for risk assessment and treatment planning (Jobes, 2006). The study used an open-trial, case-focused design to assess an inpatient adaptation of CAMS, spread over a period averaging 51 days. The intervention was provided via individual therapy to a convenience sample of 20 patients (16 females and four males, average age 36.9) who were hospitalized with recent histories of suicidal ideation and behavior. Results showed statistically and clinically significant reductions in depression, hopelessness, suicide cognitions, and suicidal ideation, as well as improvement on factors considered "drivers" of suicidality. Treatment effect sizes were in the large range (Cohen's d > .80) across several outcome measures, including suicidal ideation. Although these findings must be considered preliminary due to the lack of a randomized control group, they merit attention from clinicians working with patients at risk for suicide. This study also supports the feasibility of implementing a structured, suicide-specific intervention for at-risk patients in inpatient settings.
    Psychotherapy Theory Research Practice Training 03/2012; 49(1):72-80. DOI:10.1037/a0026746 · 3.01 Impact Factor
    • "Given the heterogeneity of suicidality, mental health practitioners may benefit from effective, efficient tools for discriminating between types of suicidal individuals. In turn, clinical treatment researchers may find that certain typologies of suicidality are better suited to different types of suicidal treatments, for example, dialectical behavioral therapy [7], cognitive therapy [8], and the Collaborative Assessment and Management of Suicidality [9] [10]. Both historical [11] and recent research [12] suggests that the notion of ambivalence about the wish to live and to die underlies much of the variability seen among people who contemplate suicide. "
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    ABSTRACT: The aim of this study was to determine the validity of assigning suicidal individuals into differing typologies of suicidality based on their reported wish to live and wish to die. One hundred five inpatients who reported suicidal ideation in the previous 48 hours completed a battery of assessments during inpatient psychiatric hospitalization. An algorithm was used to assign participants into 1 of 3 typologies of suicide: wish to live, ambivalent, or wish to die. Discriminant function analysis and group classification were used to predict group membership, followed by multiple analysis of variance and follow-up contrasts to measure between-group differences. Group classification resulted in 76% accuracy for predicting typology of suicidality based on scores from suicide-specific measures. Self-perceived risk of suicide and hopelessness were the strongest variables at differentiating between the 3 groups. Patients in the wish to die typology were less likely to report having never made a suicide attempt. Creating typologies of suicidality may prove useful to clinicians seeking to better differentiate among suicidal patients within a limited period of assessment.
    Comprehensive psychiatry 11/2011; 53(5):461-7. DOI:10.1016/j.comppsych.2011.09.007 · 2.25 Impact Factor
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