Suicide prevention training outside the mental health service system - Evaluation of a state-wide program in Australia for rehabilitation and disability staff in the field of traumatic brain injury
ABSTRACT The training needs of staff working in mainstream (i.e., noncrisis) health settings with client groups that have moderate levels of suicide risk have not been extensively addressed. An initiative to train rehabilitation and disability staff working in the field of traumatic brain injury (TBI) is described. A program was adapted from a generic state health department training program, and disseminated by means of established training networks within the brain injury field. Program efficacy was evaluated as the training was provided across the state of Victoria in a series of 1-day workshops. Participants (n = 86) completed two evaluation measures designed for this purpose (objective knowledge test, self-rating of knowledge and skills) on three occasions (pre- and postworkshop, 6-month follow-up). Compared to a control group of rehabilitation and disability workers who did not receive the training (n = 27), the workshop participants made significant gains in objective knowledge and reported skills, and maintained these gains at the 6-month follow-up. The Suicide Interview Response Inventory-2 (Neimeyer & Pfeiffer, 1994) was administered to a subgroup of participants as a validating measure, and correlated significantly with scores from the objective knowledge test. This process may provide a template for developing more fine-grained suicide prevention strategies among other health-related at-risk groups.
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ABSTRACT: A systematic search was conducted of the literature addressing suicidality after traumatic brain injury (TBI). Results from population-based studies found that people with TBI have an increased risk of death by suicide (3-4 times greater than for the general population), as well as significantly higher levels of suicide attempts and suicide ideation. Clinical studies have also reported high levels of suicide attempts (18%) and clinically significant suicide ideation (21-22%) in TBI samples. In reviewing risk factors, two prognostic studies using multivariate analysis were identified. Adjusted risk statistics from these studies found an elevated risk of suicide for people with severe TBI in comparison to concussion (hazard ratio 1.4, 95% CI 1.15-1.75) and an elevated risk of suicide attempts among people displaying post-injury suicide ideation (adjusted odds ratio 4.9, 95% CI 1.79-13.17) and psychiatric/emotional distress (adjusted odds ratio 7.8, 95% CI 2.11-29.04). To date, little evidence exists for the role of pre-morbid psychopathology, neuropathology, neuropsychological impairments or post-injury psychosocial factors as major risk factors for post-injury suicidality. Finally, there has been little empirical examination of approaches to suicide prevention. Therefore, current best practice is based on clinical judgement and the untested extrapolation of prevention approaches from other clinical populations.Brain Injury 01/2008; 21(13-14):1335-51. DOI:10.1080/02699050701785542 · 1.86 Impact Factor
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ABSTRACT: As part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative, the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff. In this study of the dissemination and implementation of STORM (Skills-based Training On Risk Management), we set out to explore not only the outcomes of training, but key factors involved in the processes of diffusion, dissemination and implementation of the educational intervention. Participants attending STORM training in Highland Region provided by 12 trained facilitators during the period March 2004 to February 2005 were recruited. Quantitative data collection from participants took place at three time points; immediately before training, immediately post-training and six months after training. Semi-structured telephone interviews were carried out with the training facilitators and with a sample of course participants 6 months after they had been trained. We have utilized the conceptual model described by Greenhalgh and colleagues in a Framework analysis of the data, for considering the determinants of diffusion, dissemination and implementation of interventions in health service delivery and organization. Some 203 individuals completed a series of questionnaire measures immediately pre (time 1) and immediately post (time 2) training and there were significant improvements in attitudes and confidence of participants. Key factors in the diffusion, dissemination and implementation process were the presence of a champion or local opinion leader who supported and directed the intervention, local adaptation of the materials, commissioning of a group of facilitators who were provided with financial and administrative support, dedicated time to provide the training and regular peer-support. Features that contributed to the success of STORM were related to both the context (the multi-dimensional support provided from the host organisation and the favourable policy environment) and the intervention (openness to local adaptation, clinical relevance and utility), and the dynamic interaction between context and the intervention.BMC Health Services Research 01/2009; 8(1):246. DOI:10.1186/1472-6963-8-246 · 1.66 Impact Factor
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ABSTRACT: People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.The Journal of head trauma rehabilitation 01/2011; 26(4):244-56. DOI:10.1097/HTR.0b013e3182225528 · 3.00 Impact Factor