Article

Suicide Intervention Training for K-12 Schools: A Quasi-Experimental Study on ASIST

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Abstract

This quasi-experimental study investigated differences between 104 school personnel who received a standardized suicide awareness and prevention training (i.e., Applied Suicide Intervention Skills Training) and 45 control group participants. Pre- and posttraining data included experimental and control group participants’ (a) suicide intervention skills; (b) attitudes toward suicide; (c) knowledge of suicide; and (d) comfort, competence, and confidence in responding to individuals at risk of suicide. Results indicated a significant positive effect for training on all measures. Implications for training of school personnel and future research are discussed.

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... ASIST (Lang et al., 2013) is a standardised, manualised 14-hour training that equips participants with the skills necessary to provide an evidence-based suicide intervention (e.g. Gould et al., 2013;Shannonhouse et al., 2017aShannonhouse et al., , 2017b. ASIST is grounded in the LivingWorks model of suicide prevention (LivingWorks, nd). ...
... asking directly about suicide, seeking reasons for living, noticing hesitation and ambivalence about dying, etc.) which resulted in reduced lethality and increased life promotion (Gould et al., 2013). ASIST has been adopted by the US Armed Forces, CDC (CDC et al., 2017), crisis centres across the USA (Gould et al., 2013), K-12 schools (Shannonhouse et al., 2017a) and college contexts (Shannonhouse et al., 2017b). ...
... Consistent with the skill acquisition in members of other helping groups (Tierney, 1994;Turley et al., 2000;Shannonhouse et al., 2017aShannonhouse et al., , 2017b, participants in this study appeared to acquire the ability to not just recognise risk but also follow up on their concerns. These results suggest HDM volunteers who receive the ASIST training apply their skills in the context of their HDM routes, as well as in other contexts, when they encounter a person-at-risk. ...
Article
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Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.
... Reis and Cornell (2008) compared the school counselors and teachers trained with the standardized training program Question, Persuade, and Refer (QPR; Quinnet, 2007) to a control group of school counselors and teachers. More recently, Shannonhouse, Lin, Shaw, and Porter (2017) conducted a quasi-experimental, pre-post study, which compared school personnel who were trained with the Applied Suicide Intervention Skills Training (ASSIST; Lang et al., 2013), a standardized training for suicide awareness and intervention, to a no-training control group. In both studies, results indicated statistically significant improvement in in suicide intervention ability for the training groups (Reis & Cornell, 2008;Shannonhouse et al., 2017) In an effort to address the need for evidence-based competency goals in graduate psychology programs, Cramer, Johnson, McLaughlin, Rausch, and Conroy (2013) proposed 10 literature-based competencies for suicide assessment. ...
... More recently, Shannonhouse, Lin, Shaw, and Porter (2017) conducted a quasi-experimental, pre-post study, which compared school personnel who were trained with the Applied Suicide Intervention Skills Training (ASSIST; Lang et al., 2013), a standardized training for suicide awareness and intervention, to a no-training control group. In both studies, results indicated statistically significant improvement in in suicide intervention ability for the training groups (Reis & Cornell, 2008;Shannonhouse et al., 2017) In an effort to address the need for evidence-based competency goals in graduate psychology programs, Cramer, Johnson, McLaughlin, Rausch, and Conroy (2013) proposed 10 literature-based competencies for suicide assessment. The competency goals proposed were distilled from the plethora of competencies from the suicide literature. ...
... Similar to previous research (Reis & Cornell, 2008;Shannonhouse et al., 2017), a significant positive effect was found for training with both suicide intervention skills, and determination of appropriate action. An unexpected finding, however, was that there were no significant differences between treatment and control groups. ...
Article
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An experimental design examining the efficacy of online suicide assessment training with counselor trainees was implemented to assess influence on a variety of related skills. Results from 2-factor mixed analyses of variance, Mann–Whitney U tests, and Wilcoxon signed rank tests partially supported the effectiveness of this method for improving suicide assessment skills, but challenged the use of online education for increasing trainees' suicide assessment skills. © 2018, © 2018 Association for Assessment and Research in Counseling (AARC).
... Gatekeeper training has been widely studied in the field of suicide prevention, and while most of these trainings were developed for the general population, several have been evaluated with teachers and other school personnel (Wyman et al., 2008;Shannonhouse, Lin, Shaw, & Porter, 2017). SAMHSA (2012) recommends that all adults within the school community be trained to identify an at-risk student, respond effectively, and refer the student to an appropriate staff member (e.g., school mental health professional) for follow-up. ...
... SAMHSA (2012) recommends that all adults within the school community be trained to identify an at-risk student, respond effectively, and refer the student to an appropriate staff member (e.g., school mental health professional) for follow-up. Most evaluations of gatekeeper training programs within school settings have focused on middle and high school teachers (Wyman et al., 2008), although some programs, such as Applied Suicide Intervention Skills Training (ASIST) have been implemented with a K-12 audience including teachers, administrators, and school mental health professionals (Shannonhouse et al., 2017). ...
... Most gatekeeper trainings provide information about common suicide myths, risk factors, and warning signs and provide a strategy or approach for responding effectively. For instance, Question, Persuade, Refer (QPR) teaches a 3-part strategy for intervening (Wyman et al., 2008), while ASIST teaches a 6-step, 3-phase approach (Ewell Foster et al., 2017), the "Pathway for Assisting Life" (PAL) model (Shannonhouse et al., 2017). Most gatekeeper trainings also provide an opportunity for behavioral rehearsal through role-play, which, while described as one of the more effective elements of these trainings (SAMHSA, 2012), has not consistently led to improved skills with regard to identification of suicidal youth (Wyman et al., 2008). ...
Article
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Suicide is the second leading cause of death among youth aged 10–25 years, and approximately one in six adolescents reported serious suicidal ideation in the past year (Centers for Disease Control and Prevention [CDC] in Web-based Injury Statistics Query and Reporting System (WISQARS). http://webappa.cdc.gov/cgi-bin/broker.exe, 2017). Schools are a unique environment in which to identify and respond to youth suicide risk, yet the research base for school-based suicide prevention programs is limited due to challenges with implementation and evaluation. The purpose of this article is to review best practice approaches and existing empirical support for school-based suicide prevention and to present a framework for how these efforts can be embedded within multi-tiered systems of support (MTSS). In line with the Substance Abuse and Mental Health Services Administration [SAMHSA] (Preventing suicide: a toolkit for high schools. https://store.samhsa.gov/shin/content//SMA12-4669/SMA12-4669.pdf, 2012) framework for suicide prevention in schools, the article overviews existing programs for student education, staff training, and screening, noting where these programs may be situated across tiers of intervention. This is followed by a review of school-related outcomes of existing suicide prevention programs, which highlights the limitations of existing research. Because there are only two school-based prevention programs with evidence for reducing suicide risk in students, the authors encourage school staff to implement best practice recommendations in collaboration with school mental health professionals who can provide ongoing evaluation of program effectiveness, as well as with researchers who are able to design and conduct outcome studies addressing the limitations of current research. Findings also underscore the need for greater integration of suicide prevention programming with existing school initiatives such as MTSS, which aligns with a growing focus in the field of suicide prevention on “upstream approaches.”
... A positive effect has also been found with adolescents in school environments. In fact, it has been observed that school staff (teachers, counselors and administrative staff) who receive training on the ASIST program are more able to detect cases of suicide and show better competence and greater confidence to respond appropriately to people at risk of taking their lives [16]. ...
... Thus, total scores range from 0 to 24. The authors [46] suggest five levels of severity: minimal (total score, 0-4); mild (total score, 5-9); moderate (total score, [10][11][12][13][14]; moderately severe (total score, [15][16][17][18][19]; and severe (total score, [20][21][22][23][24]. A score of 10 or above is frequently used as a cut-off point to identify patients with major depression. ...
Article
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The aim of the study was to carry out a pilot implementation and evaluation of the OverCome-AAI program, a pioneering program for the prevention of suicidal behavior through animal-assisted interventions for young people with high risk factors for suicidal behavior. The study sample consisted of 30 adolescents (11 boys and 19 girls) aged between 14 and 17 years (Mean age = 15.50, SD = 1.60) from the Basque Country (Northern Spain). After the intervention, subjects presented reductions in suicidal ideation, suicide plans, and non-suicidal self-harm, as well as a greater predisposition to seek help. A reduction in the intensity of mental pain was also found, although no differences were observed in indicators of hopelessness and depression. The preliminary results obtained in this pilot study suggest that the OverCome-AAI program may be effective in reducing suicidal behavior and non-suicidal self-harm in young people in residential care who present high risk factors for suicide.
... Next, with respect to suicide prevention specifically, school counselors engage in gatekeeper training, educating individuals (e.g., families, school staff, students) on signs and risk factors related to suicide. Gatekeeping can start with all students within the school and extend to individuals outside of the classroom (Briggs, 2015;Shannonhouse, 2017;Singer et al., 2019;Stutey, 2021). One example of an evidence-based program geared toward students includes Signs of Suicide (SOS), to identify and dispel common myths about suicide, and explore suicide risk factors and warning signs, approaches for responding effectively, community mental health resources, and coping strategies (Aseltine et al., 2007). ...
Article
Youth mental health concerns have reached crisis-level with the American Academy of Pediatrics (2021) reporting a 51% increase for reported suicide attempts for 12-17 year old youth. School counselors play a pivotal role within the conversation on mental health and suicide specifically (ASCA, 2016; ASCA, 2020). In this article we outline how school counselors can organize their suicide prevention and intervention efforts with Multi-Tiered Systems of Support (MTSS), grounded in a model by Dr. Rebecca Pianta, as well as prioritizing culturally sustaining, antiracist practices, data, prevention, and screening in all tiers. Specifically, at Tier 1, school counselors educate stakeholders, including students, on the warning signs. While at Tiers 2 and 3, school counselors identify and support students at risk of suicide. We highlight ethical considerations throughout, in the context of the article Suicide Intervention in Schools: If Not School Counselors, Then Who?
... School counselors receive the same training and have the same standards in assessment as mental health counselors. Numerous studies support the efficacy of suicide assessment trainings that have been conducted for school counselors or school counselors-in-training (Gallo et al., 2018(Gallo et al., , 2021Shannonhouse et al., 2017Shannonhouse et al., , 2018. The second part of this statement involves "level of risk." ...
Article
Youth suicide rates continue to rise each year. School counselors play an essential role in preventing suicide within K-12 schools. After the publication of the article, “Suicide Assessments: The Medical Profession Affirms School Counselors’ Truth,” in 2021 by Dr. Carolyn Stone, some confusion surfaced regarding professional school counselors’ responsibilities and liabilities around issues of suicide. To provide clarification, the role and training of school counselors are highlighted to provide evidence for their place in suicide risk assessment. Ethical implications and previous legal cases are provided to inform the profession. Training/supervision recommendations for counselor educators are also discussed.
... An extension of such shifts can be seen in a more recent debate that has emerged around school counselor preparation in assessing for crisis and suicide risk (Gallo, 2018;Shannonhouse et al., 2017Shannonhouse et al., , 2018Wachter Morris et al., 2021). Although counselor educators broadly train risk assessment techniques across specialties, the notion of risk assessment in schools has become a largely debated topic, given the philosophical differences of educators and counselors (Wachter Morris et al., 2021). ...
Article
Full-text available
This special section on school counselor preparation in assessing for crisis and suicide risk considers the impact of the perception of school counselor training and expertise related to suicide assessment and intervention. The collection of six articles focuses on considerations and best practices in assessing and intervening with PK-12 students experiencing suicidality, the unique considerations within a school setting, and corresponding implications for school counselor training.
... Tierney (1994) found those trained in ASIST were better able to ask directly about suicide thoughts and behaviors, assess risk, identify ambivalence about dying, and develop mutually agreed-upon safe plans than non-ASIST trained peers in a comparison group. More recently, natural helpers in K-12 schools (Shannonhouse et al., 2017a) and natural helpers in collegiate contexts (Shannonhouse et al., 2018) acquired significant increases in suicide intervention skill acquisition after having received the ASIST training. ...
Article
Older adults are at risk for mental health concerns, such as social isolation and suicide. Risk factors to suicide among older adults, such as loneliness and social isolation, may be impacted by the COVID-19 pandemic. Gatekeepers in the community are a significant source of identification and referral of older adults at risk of mental and physical health concerns. In this study, we sought to discover whether natural helpers in the Aging Service Network (ASN), including volunteers and providers (n = 93) obtain and utilize suicide-intervention skills with older adults who receive home-delivered meals (HDM) after being trained in a 14-hour evidenced based training. Paired-sample t-tests yielded significant results at pre- and post-test measures of suicide intervention response skill acquisition, and over 19% of trained participants reported using suicide intervention skills over six months. Implications for future training and research are discussed.
... Shannonhouse et al. (2017) stated that training is needed in school settings to respond to young people at risk of suicide. School counselors should be trained in suicide intervention skills to build the capacity of their school community and provide suicide rst aid to students in need.Cox et al. (2016) recommended that school staff should not use the terms 'committed suicide' or 'successful suicide' when discussing a death, because the word 'committed' is associated with an illegal or criminal act, and 'successful' implies that the individual reached a desirable outcome.Johnson and Parsons (2012) and Shannonhouse et al. (2017) recommended that suicide should be a training priority for school staff. ...
Preprint
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Suicide is the second leading cause of death in the 15–29 age group worldwide, and is a severe public health problem worldwide. Adolescent and young adult individuals primarily attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to examine the role that educational institutions play in suicide prevention. A systematic review was conducted to determine what educational institutions and agents are identified in the literature when addressing suicide. The systematic review yielded 58 articles published over the last 30 years. The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention between primary education and college. Overall, educational suicide initiatives report positive effects on participants’ understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution. The different types of programs and recommendations are discussed.
... In responding to the increasing need for evidence-based competency goals in suicide risk assessment training, an empirically based list of competencies has been proposed to assist mental health training programs in training mental health trainees for suicide risk assessment (Cramer, Johnson, McLaughlin, Rausch, & Conroy, 2013). A recent study (Shannonhouse, Lin, Shaw, & Porter, 2017) shows that trainees who receive suicide risk assessment and intervention training demonstrate greater competencies to address suicide crises. Hence, suicide risk assessment training will provide mental health trainees with opportunities to promote their competencies to work more effectively with clients at higher risk of suicide. ...
Chapter
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Suicidal thoughts and behaviors have increased significantly during the last decade. Suicide is among the leading cause of death for adolescents and adults. It is now the second cause of death for youngsters and young adults (10-34 years old). Furthermore, the suicide rate of adults (35-64 years old) have surpassed the suicide rates of older adults (65 or older). This observed trend reveals an increased likelihood for therapists to meet a suicidal client and highlights the need to assess suicidal risk of any new client or any client experiencing major negative mood changes or stressful life-challenging situations. Careful, sensitive and focused assessment of suicide risk can save lives. This moment of excellence provides a demonstration of suicide risk assessment.
... In total, 37.1% of the children had panic disorder, 45.5% had separation anxiety, 20% had social anxiety, and 36.5% had school avoidance. Developmental psychology research indicates that unaddressed anxiety and emotional problems in childhood and adolescence may persist into adulthood and affect well-being [9,10]. ...
Conference Paper
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Anxiety disorders are common among children and adolescents because of the nature of their developmental stage, which requires significant skill development and adaptation to many life transitions. A recent cross-sectional study conducted in the United Arab Emirates (UAE) with children aged 10-19 years (N=968) reported the overall prevalence was anxiety disorders of 28%. Of the whole sample, 37.1% had panic disorder, 45.5% had separation anxiety, 20% had social anxiety, and 36.5% had school avoidance. This highlights that age-appropriate initiatives are urgently needed to reduce the high rate of anxiety-related disorders. In the UAE, there are additional risk factors for the development of mental health problems, particularly among young people (i.e., consanguineous marriages, large families, and a large youth population in the active phase of development). This further reinforces the need to actively initiate intervention to address these issues among the youth population before they become entrenched in their adult personalities. According to World Health Organization reports, almost half of mental health conditions develop before age 14 years. The UAE healthcare system has identified a clear need to further develop existing mental health services.
... For example, insurance companies may legally deny coverage for death resulting from suicide [34]. Commonly-offered suicide prevention and intervention trainings such as Applied Suicide Intervention Skills Training (ASIST) typically focus on individuals rather than systemic or contextual factors (e.g., Evans & Price, 2012 [17]; Shannonhouse, et al., 2017 [42];). In some cases, institutionalized discomfort and/or lack of familiarity with the topic of suicide has led to avoidance of the topic by schoolbased counselors in conversations with students, potentially due to assumptions made in professional education curricula [3,23]. ...
Article
Full-text available
Suicide is among the 10 leading causes of death in the US and has the potential to suddenly change many lives. It often occurs when people are disproportionately affected by societal conditions, including inequities, discrimination, oppression, and historical trauma. We posit that a social justice framework can improve suicide prevention efforts when incorporated into existing strategies because it mandates that inequities be addressed. It does so through education, engagement, advocacy, and action, and can be especially effective in states and nations with high suicide rates and entrenched societal inequities.
... White and Sabarwal (2014:9) specified that single-difference impact estimates compare outcome from the intervention group with the same in the comparison groups at a single point in time following the intervention. Quasi-experimental designs have been used extensively to determine the effectiveness of training interventions (see, e.g., Brutus & Donia 2010;Fjuk & Kvale 2018;Shannonhouse et al. 2017). Elaborating on the stated designs, the fundamental assumption of an impact assessment is that an intervention has defined outcomes (Jonck et al. 2018). ...
Article
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Background: A paucity of evaluation studies could be identified that investigated the impact of training. The lacuna of research should be viewed in light of austerity measures as well as inability to measure return of investment on training expenditure, which is substantial year on year, especially in the context of public service.Objectives: This article reports on an impact evaluation of a research methodology skills capacity workshop.Method: A quasi-experimental evaluation design in which comparison groups were utilised to evaluate the impact of a research methodology skills development intervention. A paired-sample t-test was used to measure the knowledge increase whilst controlling for the influence of comparison groups by means of an analysis of variance. A hierarchical multiple regression analysis was performed to determine how much of the variance in research methodology knowledge could be contributed to the intervention whilst controlling for facilitator effect.Results: Results indicated that the intervention had a statistically significant impact on research methodology knowledge. Furthermore, the intervention group significantly differed statistically from the control and comparison groups with respect to research methodology knowledge. Facilitator effect was found to be a moderating variable. Hierarchical regression analysis performed to isolate the impact of intervention in the absence of facilitator effect revealed a statistically significant result.Conclusion: The study augments the corpus of knowledge by providing evidence of training impact within the South African public service, especially utilising a quasi-experimental pre-test–post-test research design and isolating the impact of facilitator effect from the intervention itself.
... Future research might interview faculty and site supervisors to understand their experiences and efficacy providing this information to students. Finally, specified suicide training models (Rigsbee & Goodrich, 2018;Schmitz et al., 2012;Shannonhouse, Lin, Shaw, & Porter, 2017) might be researched with preservice students to examine if they predict on-site skill utilization and efficacy related to suicide prevention and postvention practice. Conducting longitudinal outcome studies, such as extending Shannonhouse et al.'s (2017) findings on the ASIST training program, from preservice training to various points in school counselor practice may help determine the most effective trainings to provide to developing counselors. ...
Article
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Suicidality among children and adolescents is a growing public health concern (Osterman et al., 2015). CACREP (2016) and ASCA (2012) include crisis management in their standards and competencies for school counselor education; however, minimal research exists on the nature and perceptions of this training, particularly as it pertains to managing suicide in school communities. The current study shares the results of an exploratory Consensual Qualitative Research (CQR) investigation examining how (n = 10) school counseling students made meaning of their preparatory experiences surrounding suicide prevention, assessment, and postvention. Implications for counselor educators and supervisors will be discussed.
... While there have been quantitative studies examining the effect of ASIST in counselor preparation (Shannonhouse et al., 2018) and in K-12 schools with school counselors (Shannonhouse et al., 2017a), there has not been a qualitative study which explores CITs' acquisition of skills pre-to post-training and/or clinical use of the model. Therefore, our research questions included: (1) What was the impact of receiving ASIST training on CITs attitudes and beliefs towards suicide, knowledge about suicide, and comfortcompetence-confidence at responding to persons with thoughts of suicide? ...
Article
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The present study evaluates the impact of an evidence-based suicide intervention model and how pedagogical practices of counselor education programs may prepare counselors-in-training (CIT) to respond to clients considering suicide. Using content analysis to explore pre- and post-training data, the researchers examined the impact of the 14-hour evidence-based Applied Suicide Intervention Skills Training (ASIST) on 54 CITs (76% female, 24% male; 58% White, 20% African American, 11% Latinx/Hispanic, 11% other), with a mean age of 30 years (SD =8.6). Further data were collected six months later after CITs had the opportunity to utilize suicide intervention skills during their clinical experiences. Content analysis yielded several changes between pre- and post-training data that elucidate the process of suicide intervention skill acquisition. The CITs also reported frequently applying their skills during their clinical internships with clients considering suicide. The findings support the use of ASIST in the preparation of future counselors.
... Diversos programas han evaluado la efectividad de intervenciones específicas en niños, niñas y adolescentes con alto riesgo sucida (Hernández-Cervantes, 2007;Palencia, 2014;Reijas, Ferrer, González, e Iglesias, 2013;Shannonhouse, Lin, Shaw, y Porter, 2017), y han mostrado reducción de la ideación e intencionalidad suicida tras enfocarse en el desarrollo de habilidades socioemocionales en los niños, niñas y adolescentes, y en el fortalecimientos de habilidades en profesores, consejeros escolares y administrativos para prevenir el suicidio. ...
Article
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Effects of the CIPRES program on suicidal risk in adolescents. The objective of the study was to evaluate the specific changes generated by the CIPRES program on suicidal risk in adolescents. The sample comprised 106 adolescents aged between 13 and 18 years old (53 in the experimental group, 53 in the control group), of which 54.7% were women (n = 58). The study used a quasi-experimental design of repeated pretest-posttest measures with a control group. Two assessment instruments were administered before and after the program: The Scale of the Suicide Risk (ERS) and the Inventory of Positive and Negative Suicidal Ideation (PANSI). The pretest-posttest ANCOVAs showed that the program significantly reduced (p < .05) the scores of suicidal ideation, planning, self-harm, isolation/social support, lack of family support, and global suicide risk. In addition, it significantly increased positive ideation scores. The results support the relevance of this program to reduce suicidal risk in adolescents. Resumen: El estudio tuvo por objetivo evaluar los cambios específicos generados por el programa CIPRES sobre el riesgo suicida en adolescentes. La muestra se configuró con 106 adolescentes entre los 13 y 18 años (53 experimentales, 53 controles), de los cuales el 54.7% eran mujeres (n = 58). El estudio utilizó un diseño cuasi-experimental de medidas repetidas pretest-pos-test con grupo de control. Se administraron dos instrumentos de evaluación antes y después de la aplicación del programa: la Escala de Riesgo Suicida (ERS) y el Inventario de Ideación Suicida Positiva y Negativa (PANSI). Los ANCOVAs pretest-pos-test evidenciaron que el programa redujo significativamente (p < .05) las puntuaciones en ideación suicida, planificación, auto-lesión, aislamiento/soporte social, falta de apoyo familiar, y riesgo suicida global. Además, aumentó significativamente las puntuaciones en ideación positiva. Los resultados apuntan a la relevancia de este programa para reducir el riesgo suicida en adolescentes.
... Moreover, studies which conducted within-group analyses, comparing teachers to counsellors, consistently reported significant mean gains in knowledge and confidence literacy outcomes for teachers only (Cross et al., 2011;Lamis et al., 2017;Reis & Cornell, 2008;Shannonhouse, Lin, Shaw, & Porter, 2017;Wyman et al., 2008). Counsellors already had sufficiently strong knowledge of suicide risks and of how to intervene in suicidal youth, therefore, training had a null effect. ...
Article
Introduction: Suicide is a leading cause of death in young people, which may in part be because young people are notoriously poor help-seekers. Improving the identification of at-risk young people and connecting them to appropriate help is needed to prevent suicide in adolescents. The aim of this study is to examine the effectiveness of suicide prevention gatekeeper programs for parents and teachers, which are designed to improve their ability to recognise and respond to risks so that they may intervene before crisis occurs. Methods: Academic databases and reference lists were searched for gatekeeper training programs involving teachers and parents, and which aimed to prevent youth suicide, between journal inception and May 2018. Information directly reporting on suicide literacy (knowledge, confidence, attitudes) and/or gatekeeper behaviours (identification, referral) was extracted and a qualitative synthesis was conducted. Results: Thirteen studies fulfilled inclusion criteria. Significant moderate-to-large intervention effects were reported for suicide literacy outcomes among teachers and parents, with the largest gains among those with lowest baseline scores. No improvements in identification and referral behaviors among gatekeepers were noted. A need to improve evaluation research designs and outcome measurements was evident. Conclusions: While gatekeeper programs lead to increased suicide literacy, there is little evidence for behavioural change. There is need to increase the reach and uptake of gatekeeper training by offering digital versions, which may lead to improved behavioural outcomes, and to employ targeted strategies to engage parents in this training as one of the most trusted sources of support for vulnerable youth.
... 5,[16][17][18]20 This was the approach adopted by the Farm-Link project, which aimed to improve the mental well-being of people living and working on farms in New South Wales (NSW). 16 The usefulness of a brief education program compared to more intensive programs like Mental Health First Aid, 21,22 or Applied Suicide Intervention Skills, 23 has been highlighted by previous research. 24 The aim of the current research was to analyze the effectiveness of the SCARF (Suspect, Connect, Ask, Refer, Follow-Up) brief education workshop in improving suicide literacy, reducing stigmatizing attitudes, enhancing mental well-being, and increasing confidence to assist people at risk of suicide. ...
Article
Purpose Rural communities in Australia have an elevated risk of suicide. The aim of the current study was to evaluate a well‐being and suicide prevention education workshop, SCARF (Suspect, Connect, Ask, Refer, Follow‐Up) developed for Australian farming and rural communities. Methods The SCARF program was delivered to 14 groups, a convenience sample including frontline agricultural workers and farmers from New South Wales. The Literacy of Suicide Scale, Stigma of Suicide Scale, and items assessing confidence to assist others were administered immediately before and after the workshop, and at 3‐month follow‐up. The Warwick Edinburgh Mental Wellbeing Scale was given immediately before and at 3‐month follow‐up. In total, 255 agreed to participate in the study, with 127 completing 3‐month follow‐up. Data were analyzed using linear mixed‐effects regression. Findings There was a significant increase in suicide literacy and confidence to assist others immediately after the workshop, which remained significant at 3‐month follow‐up. Mental well‐being significantly improved at 3‐month follow‐up. Conclusion The SCARF program is unique for its brevity, cultural specificity, focus on health, and incorporation of the biopsycho‐ecological model and the Interpersonal Theory of Suicide. It represents a useful program for Australian farming and rural communities to improve mental well‐being, suicide literacy, and confidence to recognize and respond to suicidality.
... Six articles featured qualitative and quantitative evaluation of workshops, interventions, or course experiences offered to student or professional audiences. Features include strong quantitative evidence of effectiveness of the applied suicide intervention skills training model with practicing school personnel (Shannonhouse, Lin, Shaw, & Porter, 2017) and preliminary quantitative evidence supporting STORM suicide gatekeeper training in the United Kingdom (Gask, Coupe, McElvenny, & Green, 2017). Several researchers found mixed-methods evidence to support effectiveness of a responsive training intervention focused on needs of LGBT clients or students (Luke & Goodrich, 2017;Rivers & Swank, 2017). ...
Article
This article includes a review of 100 peer‐reviewed journal articles regarding counselor education and supervision published in 2017. Areas reviewed include supervision, understanding stakeholders, teaching and training, and professional issues. Publications featured a blend of research methodologies, attention to complexity in supervision and teaching, and incorporation of student experiences.
Article
School counselors provide comprehensive school counseling services related to prevention of school violence, but a critical step is to put those pieces together in an intentional and preventive evidence-based model. Several nationally recognized safe school initiatives neglect the significant role school counselors provide in mental health services to create a safe and connected school climate. School counselors and school counselors in training need an evidence-based approach that clearly defines their roles and responsibilities for prevention and intervention related to school shootings. Elevating and expanding school counselors’ role and responsibilities to address students’ mental health needs, creating safe and connected school environments, and providing thorough and effective threat assessments are essential and align with school counselor clinical training.
Article
This study examined the effects of a psycho-educational program (sessions on sending and catching SOS signals) for elementary school children on improving their help-seeking attitudes and skills as a protective factor in preventing suicide. Composed of two sessions, the program was administered to fifth-and sixth-grade elementary school children (N=111) on a class-by-class basis. We examined its effect using a self-administered questionnaire assessing help-seeking preferences toward friends and teachers, help-seeking skills, and skills in supporting friends. The responses to scales assessing help-seeking skills and support skills to friends indicated the program's positive effects. The results of specific subscale scores assessing help-seeking preferences toward friends also showed differential effects between boys and girls. Moreover, the program resulted in partially significant correlations between changes in help-seeking skills and support skills for friends and changes in help-seeking preferences toward friends and teachers, which were especially characteristic of girls. Based on these results, the potential for future developments in suicide prevention education research and practices for elementary school children are discussed.
Article
With increased suicide rates among youth during recent decades, the K–12 educational community still lacks a comprehensive model for suicide prevention that is tailorable for school systems. With this article, we present the Research-Informed Adaptable Model for the Prevention of Suicide in Schools (RAMPSS). A multitiered system of support, RAMPSS includes (a) all four major components of the American School Counselor Association National Model and (b) options for research-based responsive services at each tier level.
Article
Objectives The present study sought to understand the state of suicide risk assessment trainings in clinical psychology graduate programs. Methods We surveyed 167 clinical psychology doctoral students' behavioral competency in responding to suicidal clients and their attitudes, perceived behavioral control, subjective norms, and intentions related to suicide risk assessment. Hypotheses were tested using path analysis. Results Ninety six percent of participants reported receiving some type of suicide risk assessment training at their program. Results provided partial support for significant relationships between attitudes, perceived behavioral control, subjective norms, and intentions. Unexpectedly, amount of training in suicide risk assessments was not related to theory of planned behavior variables including behavioral competency. Conclusion These findings have implications regarding the effectiveness of current suicide risk assessment training practices and ways to improve trainings to help increase the number of clinical psychologists competent in suicide risk assessment and management.
Article
Background: The self-report measures used in evaluations of the Applied Suicide Intervention Skills Training (ASIST) program have tended not to detect an improvement in a broad range of suicide counseling skills from pre- to posttraining or among trainees with better skills at pretraining. Aims: The purpose of this study was to develop and validate the Suicide Counseling Skills Inventory (SCSI), which included ten brief counselor-client scenarios and three counselor responses to each scenario. Method: Data were collected from several samples to develop and evaluate the SCSI. Trainee scores were subtracted from criterion expert scores to create discrepancy scores. Results: The SCSI detected an improvement in skills from pre- to posttraining across samples, including among trainees with better skills at pretraining. Internal consistency and test-retest reliability were good. Limitations: The results may not generalize across different training models. Conclusion: Trainee scores were more like expert scores at posttraining. The SCSI may be useful in evaluating suicide counseling competency.
Article
This study evaluated the effectiveness of the Lithuanian translation of the Applied Suicide Interventions Skills Training (ASIST). In total 248 participants (45.7%) completed pre- and post-assessment and 146 (26.9%) had data at 3-month follow-up. Suicide Intervention Response Inventory (SIRI-2) was used to evaluate suicide intervention skills. The results indicated no change in the overall SIRI-2 score following training or at a 3-month follow-up. A more detailed analysis of the response pattern indicated that both following training and at 3-months follow up participants were better at identifying helpful responses but tended to overestimate their helpfulness.
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Suicide is an increasingly prevalent cause of death among adolescents across all demographics. Schools can be effective settings for identification and prevention of suicide due to the amount of time that students spend in school. This study presents a meta-analysis of school-based suicide prevention programs for students and school staff on the following outcomes: suicide awareness, helping skill, suicide behavior, psychological wellness, and psychological distress outcomes. A total of 27 studies were identified via 5 databases. Results suggest that suicide prevention programs have the largest impact on suicide awareness (k = 18, g = .72) and helping skill (k = 15, g = .43) compared to suicide behavior (k = 8, g = .17), psychological wellness (k = 7, g = .16), and psychological distress (k = 9, g = .16). However, results are limited by the availability of previous research. We conclude with a discussion of limitations, implications for practice, and directions for future research.
Article
Using a matched-control experimental design, this study explored the use of Applied Suicide Intervention Skills Training (ASIST) with fifty-four counselors in training (CIT). Over the course of 10 weeks CIT self-reported interactions with suicidal clients and their use of counseling skills. Trainees who completed ASIST were significantly more likely to report they had identified and used specific intervention strategies and counseling skills with suicidal clients during sessions. Implications for future training and research are provided.
Article
The objective of this study was to evaluate the changes in prospective helpline volunteers' suicide intervention skills throughout the training in Lithuania. In total, 90 participants of the Youth Line volunteer initial training course completed the Suicide Intervention Response Inventory (SIRI-2) before any training, before and after the suicide intervention module, and after all training. There was a steady and significant increase in the trainees’ suicide intervention competencies during the training. Younger and less skilled trainees benefited more from the training. These results indicate that helpline volunteers can be trained in suicide intervention skills in a relatively short time.
Article
Background: Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour are widely used, although little is known regarding the collective effectiveness of these interventions. Aim: We evaluated the existing evidence for the effectiveness of education interventions in the prevention of suicidal behaviour. Methods: In this systematic review and meta-analysis, we searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were combined in meta-analyses. Results: We identified 41 studies evaluating two different types of interventions: school-based education interventions and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary depending on subjects' personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the estimate, according to GRADE criteria, was rated as very low. Conclusion: The results of this study indicate that school-based education interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and implementation of educational interventions should focus on participants' individual characteristics.
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The authors used a quasi-experimental design to explore the effect of Applied Suicide Intervention Skills Training on 126 counselor trainees. Results showed that after 3 months, trainees had retained improvements in measured response skills and self-reported attitudes. The authors discuss the developmental benefits of incorporating similar training into counselor education. Implications for skill measurement are also considered. © 2018 by the American Counseling Association. All rights reserved.
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Objective: Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research. Method: Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken. Results: Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide. Conclusions: Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated.
Article
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Suicide and self-inflicted injuries represent a significant public health problem. For community-based suicide prevention programs, theory-driven research on Gatekeeper training and its effectiveness remains limited. This paper describes the QPR Gatekeeper Training program for Suicide Prevention, its theoretical basis, the three-step CPR-like intervention and implications for the detection of new, untreated at-risk cases in defined communities. QPR stands for how to Question, Persuade and Refer someone emitting suicide warning signs. The QPR intervention is contextualized within the published literature on brief but beneficial public health and clinical interventions. The program is available face-to-face or on-line or via a blended learning approach combining interactive online knowledge mastery with interpersonal Q&A and role-plays for community Gatekeepers. As a promising psychological and behavioral public health tool, QPR may prove a useful recognition-and-referral educational intervention in the prevention of suicide and suicide attempts and is currently being evaluated in a number of venues.
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Suicide rates have been increasing in some subgroups of Veteran populations, such as those who have experienced combat. Several initiatives are addressing this critical need and the Department of Veterans Affairs (VA) has been recognized for its leadership. This integrative review adopts the Research Impact Framework (RIM) to address suicide-specific prevention activities targeting Veterans. The RIM is a standardized approach for developing issue narratives using four broad areas: societal-related impacts, research-related impacts, policy-related impacts, and service-related impacts. The questions addressed in this review are: (1) What are the major initiatives in Veteran-specific suicide prevention in four areas of impact-society, research, policy, and services? (2) Are there gaps related in each impact area? and (3) What are the implications of this narrative for other strategies to address suicide prevention targeting Veterans? Systematic application of the RIM identifies exemplars, milestones, gaps, and health disparity issues.
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Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.
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Reporting effect sizes in scientific articles is increasingly widespread and encouraged by journals; however, choosing an effect size for analyses such as mixed-effects regression modeling and hierarchical linear modeling can be difficult. One relatively uncommon, but very informative, standardized measure of effect size is Cohen's f(2), which allows an evaluation of local effect size, i.e., one variable's effect size within the context of a multivariate regression model. Unfortunately, this measure is often not readily accessible from commonly used software for repeated-measures or hierarchical data analysis. In this guide, we illustrate how to extract Cohen's f(2) for two variables within a mixed-effects regression model using PROC MIXED in SAS(®) software. Two examples of calculating Cohen's f(2) for different research questions are shown, using data from a longitudinal cohort study of smoking development in adolescents. This tutorial is designed to facilitate the calculation and reporting of effect sizes for single variables within mixed-effects multiple regression models, and is relevant for analyses of repeated-measures or hierarchical/multilevel data that are common in experimental psychology, observational research, and clinical or intervention studies.
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Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.
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Health and community professionals have considerable exposure to suicidal people and need to be well skilled to deal with them. We assessed suicide intervention skills with a Dutch version of the SIRI in 980 health and community professionals and psychology students. Suicide intervention skills clearly differed among professional groups and were strongly related to experience, especially suicide-specific experience. Some community professionals scored below acceptable levels on their ability to respond appropriately to suicidal people they encounter, and tended to overestimate their skills level. Training is therefore indicated for these groups, and may be useful to more highly experienced groups too.
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Full-text available
Suicide prevention remains a challenge across communities in North America and abroad. We examine a suicide prevention effort that is widely used, termed gatekeeper training. There are 2 aims: review the state of the evidence on gatekeeper training for suicide prevention, and propose directions for further research. Studies were identified by searching MEDLINE (PubMed) and PsycINFO from inception to the present for the key words suicide, suicide prevention, and gatekeeper. In addition, a manual scan of relevant articles' bibliographies was undertaken. Gatekeeper training has been implemented and studied in many populations, including military personnel, public school staff, peer helpers, clinicians, and Aboriginal people. This type of training has been shown to positively affect the knowledge, skills, and attitudes of trainees regarding suicide prevention. Large-scale cohort studies in military personnel and physicians have reported promising results with a significant reduction in suicidal ideation, suicide attempts, and deaths by suicide. Gatekeeper training is successful at imparting knowledge, building skills, and molding the attitudes of trainees; however, more work needs to be done on longevity of these traits and referral patterns of gatekeepers. There is a need for randomized controlled trials. In addition, the unique effect of gatekeeper training on suicide rates needs to be fully elucidated.
Article
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Although the college years prove to be a vulnerable time for students and a critical period for suicide prevention, few school-based prevention strategies have been empirically evaluated. The current study examined the short-term effects of Question, Persuade, and Refer (QPR), a gatekeeper training program that teaches how to recognize warning signs, question suicidal intent, listen to problems, and refer for help. One hundred twenty-two residence advisers (RAs) who were trained in QPR demonstrated significant post-training gains across a variety of domains relevant to suicide and suicide prevention, with 60 who completed the follow-up assessment showing sustained knowledge and appraisals into the following semester. Although these gains were generally more substantial for RAs trained in QPR, 86 controls who completed both baseline and follow-up assessments also demonstrated changes in appraisals relevant to suicide and suicide prevention, despite having not received QPR training. Editors' Strategic Implications this study provides some promising evidence on gatekeeper training for RAs in terms of suicide prevention knowledge and attitudes. As the authors note, replication, rigorous evaluation, and studies of systemic efforts and behavioral outcomes are needed.
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Although physicians report spending a considerable amount of time in continuing medical education (CME) activities, studies have shown a sizable difference between real and ideal performance, suggesting a lack of effect of formal CME. To review, collate, and interpret the effect of formal CME interventions on physician performance and health care outcomes. Sources included searches of the complete Research and Development Resource Base in Continuing Medical Education and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group, supplemented by searches of MEDLINE from 1993 to January 1999. Studies were included in the analyses if they were randomized controlled trials of formal didactic and/or interactive CME interventions (conferences, courses, rounds, meetings, symposia, lectures, and other formats) in which at least 50% of the participants were practicing physicians. Fourteen of 64 studies identified met these criteria and were included in the analyses. Articles were reviewed independently by 3 of the authors. Determinations were made about the nature of the CME intervention (didactic, interactive, or mixed), its occurrence as a 1-time or sequenced event, and other information about its educational content and format. Two of 3 reviewers independently applied all inclusion/exclusion criteria. Data were then subjected to meta-analytic techniques. The 14 studies generated 17 interventions fitting our criteria. Nine generated positive changes in professional practice, and 3 of 4 interventions altered health care outcomes in 1 or more measures. In 7 studies, sufficient data were available for effect sizes to be calculated; overall, no significant effect of these educational methods was detected (standardized effect size, 0.34; 95% confidence interval [CI], -0.22 to 0.97). However, interactive and mixed educational sessions were associated with a significant effect on practice (standardized effect size, 0.67; 95% CI, 0.01-1.45). Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion, health care outcomes. Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.
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In 2002, an estimated 877,000 lives were lost worldwide through suicide. Some developed nations have implemented national suicide prevention plans. Although these plans generally propose multiple interventions, their effectiveness is rarely evaluated. To examine evidence for the effectiveness of specific suicide-preventive interventions and to make recommendations for future prevention programs and research. Relevant publications were identified via electronic searches of MEDLINE, the Cochrane Library, and PsychINFO databases using multiple search terms related to suicide prevention. Studies, published between 1966 and June 2005, included those that evaluated preventative interventions in major domains; education and awareness for the general public and for professionals; screening tools for at-risk individuals; treatment of psychiatric disorders; restricting access to lethal means; and responsible media reporting of suicide. Data were extracted on primary outcomes of interest: suicidal behavior (completion, attempt, ideation), intermediary or secondary outcomes (treatment seeking, identification of at-risk individuals, antidepressant prescription/use rates, referrals), or both. Experts from 15 countries reviewed all studies. Included articles were those that reported on completed and attempted suicide and suicidal ideation; or, where applicable, intermediate outcomes, including help-seeking behavior, identification of at-risk individuals, entry into treatment, and antidepressant prescription rates. We included 3 major types of studies for which the research question was clearly defined: systematic reviews and meta-analyses (n = 10); quantitative studies, either randomized controlled trials (n = 18) or cohort studies (n = 24); and ecological, or population- based studies (n = 41). Heterogeneity of study populations and methodology did not permit formal meta-analysis; thus, a narrative synthesis is presented. Education of physicians and restricting access to lethal means were found to prevent suicide. Other methods including public education, screening programs, and media education need more testing. Physician education in depression recognition and treatment and restricting access to lethal methods reduce suicide rates. Other interventions need more evidence of efficacy. Ascertaining which components of suicide prevention programs are effective in reducing rates of suicide and suicide attempt is essential in order to optimize use of limited resources.
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We evaluated the feasibility of a population-based approach to preventing adolescent suicide. A total of 1323 students in 10 high schools completed the Suicide Risk Screen. Screening results, student follow-up, staff feedback, and school responses were assessed. Overall, 29% of the participants were rated as at risk of suicide. As a result of this overwhelming percentage, school staffs chose to discontinue the screening after 2 semesters. In further analyses, about half of the students identified were deemed at high risk on the basis of high levels of depression, suicidal ideation, or suicidal behavior. Priority rankings evidenced good construct validity on correlates such as drug use, hopelessness, and perceived family support. A simpler, more specific screening instrument than the Suicide Risk Screen would identify approximately 11% of urban high school youths for assessment, offering high school officials an important opportunity to identify young people at the greatest levels of need and to target scarce health resources. Our experiences from this study show that lack of feasibility testing greatly contributes to the gap between science and practice.
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Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of Question, Persuade, Refer (QPR) training on a stratified random sample of 249 staff with 1-year average follow-up. To test QPR impact, the authors introduced and contrasted 2 models of gatekeeper-training effects in a population: gatekeeper surveillance and gatekeeper communication. Intent-to-treat analyses showed that training increased self-reported knowledge (effect size [ES] = 0.41), appraisals of efficacy (ES = 1.22), and service access (ES = 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behaviors. Also consistent with the communication model were results from 2,059 8th and 10th graders surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as "natural gatekeepers" plus interventions that modify students' help-seeking behaviors are recommended to supplement universal gatekeeper training.
Article
Using data from a national study of rural high school youth, the authors examined where students go to receive information about their futures and which sources are most helpful. Results indicated that students in rural and low‐income schools were more likely to report going to teachers and found teachers to be most helpful compared with students in small town and higher income schools. Patterns of differentiation were also found on the basis of gender, ethnicity, and grade level.
Article
We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008-2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST-trained counselors. Few significant changes in ASIST-trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST-related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.
Article
Examined 20 master's and doctoral students' perceptions of the helpful and hindering aspects of a beginning-level multicultural counseling course. The Guided Inquiry Protocol (GIP) by P. P. Heppner et al (1992) was completed at the end of each class session. 1,907 responses were collected and categorized around the 7 open-ended questions in the GIP. The text of the GIP is presented. An increased awareness was the change most often reported by the Ss. Interpersonal exchanges in class were seen as the most important factor in helping Ss achieve changes. Lack of time and personal biases were seen as hindering changes of their views of different cultures. The most immediate concern of the Ss was integrating classroom information into counseling practice. Findings indicate that a multicultural course will be most helpful if taken early in the Ss' training. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This article reports the development and validation of the Suicide Intervention Response Inventory, a self-administered questionnaire designed to assess the paraprofessional's ability to select an appropriate response to the self-destructive client. The Suicide Intervention Response Inventory demonstrated the ability to discriminate among three groups of 28 respondents known to differ in suicide counseling skills, and it detected enhancement of such skills in 127 volunteers over the course of crisis intervention training. As predicted, the Suicide Intervention Response Inventory also showed moderate convergence with the Counseling Skills Evaluation technique, an instrument devised to tap more general capacities for facilitative responding. These preliminary indications of the validity of the Suicide Intervention Response Inventory, coupled with its high internal consistency and test-retest reliability, suggest that it may be a useful adjunct to more general indices of counseling effectiveness in screening, evaluating, and researching paraprofessionals who deal with potentially suicidal clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This chapter provides an update of the growing body of empirically based knowledge about adolescent suicidal behavior. After reviewing findings on the incidence and prevalence of adolescent suicidal thoughts and behaviors, the author discusses information pertinent to the understanding of the continuum of adolescent suicidality. The links between adolescent suicidal behavior and psychopathology, particularly identifiable psychiatric disorders, as well as critical parental, family system, and life event influences are then discussed. An argument is made for the further integration of theory and empirical research. A developmental model is offered that suggests pathways in suicidal behavior among depressed adolescents with comorbid alcohol/substance abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide an attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior. The guidelines also present suggestions on how the clinician may interface with the community. Crisis hotlines, method restriction, educational programs, and screening case-finding suicide prevention strategies are examined, and the clinician is advised on media counseling. Intervention in the community after a suicide, minimization of suicide contagion or imitation, and the training of primary care physicians and other gatekeepers to recognize and refer the potentially suicidal child and adolescent are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.
Article
Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable. September 2010-December 2011. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9-12. Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥ 25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day. Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts. YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
Article
In social policy evaluations, the multiple testing problem occurs due to the many hypothesis tests that are typically conducted across multiple outcomes and subgroups, which can lead to spurious impact findings. This article discusses a framework for addressing this problem that balances Types I and II errors. The framework involves specifying confirmatory and exploratory analyses in study protocols, delineating confirmatory outcome domains, conducting t tests on composite domain outcomes, and applying multiplicity corrections to composites across domains to obtain summative impact evidence. The article presents statistical background and discusses multiplicity issues for subgroup analyses, designs with multiple treatments, and reporting.
Article
To date, very little work has been done on evaluating training in suicide intervention. This study developed and piloted a comprehensive method for evaluating suicide intervention training by applying three studies of immediate training effects on (a) suicide intervention abilities, (b) attitudes to suicide and suicide intervention, and (c) knowledge about suicide. The focus of the evaluation was a broadly used 2-day suicide intervention training program. Changes in suicide intervention abilities were measured by the Suicide Intervention Response Inventory (SIRI) and by performance in simulated suicide intervention situations, scored with the Suicide Intervention Protocol (SIP). Subjects consisted of 19 workshop participants in a pre-post condition and 17 participants in a post-test only condition. Results indicated significant increases in skills in suicide intervention situations. No significant effects were noted on the SIRI. Results from the attitudes and knowledge studies were very preliminary. They are reported here so that others may become aware of the methodology being used and the status of evaluation of the target program. Implications for further research are discussed.
Article
The Suicide Intervention Response Inventory (SIRI) was developed by Neimeyer and MacInnes (1981) to assess the ability of paraprofessional counselors to recognize appropriate responses to suicidal clients. Although several studies have supported the validity of the scale, concerns have been raised about its ceiling effect when administered to more highly trained counselors. Psychometric improvements were therefore attempted, and the original dichotomous scoring system was replaced with a Likert scale format, in the SIRI-2. Because respondents were required to make more subtle judgments concerning the appropriateness of each response as defined by a criterion group of highly expert suicidologists, the ceiling effect that limited the use of the original measure was eliminated. Construct and discriminant validity were demonstrated in both versions of the instrument. Internal consistency and test-retest reliability showed improvement with the SIRI-2. Overall, the SIRI-2 shows promise as an index of suicide counseling effectiveness, especially among more skilled counselors.
Article
Both before and after a 1-hour suicide prevention training module, 75 elementary teachers-in-training read a 4-sentence vignette about a suicidal student ("Pat"), then completed 8 questions about their responses. Compared with pretraining, at post-training these teachers were more likely to say that they would send or escort Pat to the counselor's office, use written or verbal no-suicide agreements, call Pat's parents, believe Pat to be serious rather than simply seeking attention, and feel comfortable handling a similar situation. Increased proactive attitudes after one hour of training imply that teachers would benefit from periodic suicide awareness and prevention training modules.
Article
The association between help-seeking and nearly lethal suicide attempts was evaluated using data from a population-based, case-control study of 153 13- to 34-year-old suicide attempt case-patients treated at emergency departments in Houston, Texas, and a random sample of 513 control-subjects. Measures of help-seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case-patients were less likely than control-subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3-0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95%CI = 0.29-0.8). Among those who sought help, case-patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2-5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2-43.2). Our findings suggest that efforts to better understand the role of help-seeking in suicide prevention, including help sought from family and friends, deserves further attention.
Article
To review critically the past 10 years of research on youth suicide. Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols. There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide. While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.
Article
Developing and implementing consistent methodology for suicide assessment and intervention is challenging, particularly in a large community hospital which provides both inpatient care and a wide range of ambulatory and community based mental health programs. Patients, families, staff, and ongoing evaluation contributed to the development of an initiative to determine what is best practice and in effecting changes in clinical and organizational practices. The Suicide Assessment project resulted in improved clinical outcomes for patients and clients. Staff report that they feel more supported in probing for suicidal ideation and have the skills required to effectively intervene with the 'suicidal' patient/client. This project advanced our knowledge of suicide assessment and risk management and provided new insights to assist professionals in the aftermath of a client's suicide when, as Valente describes, clinicians report 'feeling overwhelmed with feelings of guilt, self-blame, and responsibility (Valente S: Journal of Psychosocial Nursing 40:7 22-23, 2002).
Article
To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.
Article
In this pilot study we report on proximate outcomes of a 1-hour community gatekeeper training in-service for 76 nonclinical employees in a university hospital workplace setting. Pre-post analyses resulted in positive changes in participants' knowledge about suicide and attitudes (self-efficacy) about intervening with suicidal individuals. A subset of participants engaged in role play practice of gatekeeper skills following training and rated the experience positively. Fifty-five observations were rated using an observational measure developed for this study and approximately half of these demonstrated satisfactory skills post training. Participants in this workplace gatekeeper training reported sharing new knowledge and skills with family, friends, and coworkers.
Applied Suicide Intervention Skills Training: Trainee experiences, recommendations, and posttraining behavior
Substance Abuse and Mental Health Services Administration & ICF Macro. (2010). Applied Suicide Intervention Skills Training: Trainee experiences, recommendations, and posttraining behavior. Retrieved from https://www.livingworks. net/dmsdocument/273
Youth Risk Behavior Surveillance—United States Retrieved from https://www.cdc.gov/mmwr/ preview/mmwrhtml/ss6304a1 Who gets care? Mental health service use following a school-based suicide prevention program
  • L Kann
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Kann, L., Kinchen, S., Shanklin, S. L., Flint, K. H., Hawkins, J., Harris, W. A.,... Zaza, S. (2014). Youth Risk Behavior Surveillance—United States, 2013. Morbidity and Mortality Weekly Report, 63, 1–168. Retrieved from https://www.cdc.gov/mmwr/ preview/mmwrhtml/ss6304a1.htm Kataoka, S., Stein, B. D., Nadeem, E., & Wong, M. (2007). Who gets care? Mental health service use following a school-based suicide prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1341–1348. doi:10.1097/ chi.0b013e31813761fd
QPR: Ask a question, save a life
  • P Quinnett
Quinnett, P. (1995). QPR: Ask a question, save a life. Spokane, WA: QPR Institute.
ASIST trainer manual
  • W A Lang
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Lang, W. A., Ramsay, R. F., Tanney, B. L., Kinzel, T., Turley, B., & Tierney, R. J. (2013). ASIST trainer manual (11th ed.). Calgary, Alberta, Canada: LivingWorks Education.
Living-Works Applied Suicide Intervention Skills Training (ASIST): A competency-based evaluation
  • B Turley
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Turley, B., Pullen, L., Thomas, A., & Rolfe, A. (2000). Living-Works Applied Suicide Intervention Skills Training (ASIST): A competency-based evaluation. Melbourne, Victoria, Australia: LivingWorks Education.
Project Safety Net: CSU final report
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Chen, P. Y., Moore, J. T., & Gibbs, J. (2009). Project Safety Net: CSU final report, October 1, 2006–September 30, 2009. Retrieved from http://hermes.cde.state.co.us/drupal/islandora/object/ co%3A20731/datastream/OBJ/view
Suicide and suicidal behavior Youth Suicide Prevention Program: Annual evaluation report Evaluation of program training workshops. Retrieved from yspp Achieving the promise: Transforming mental health care in America
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Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30, 133–154. doi:10.1093/epirev/mxn002 Organizational Research Services. (2002). Youth Suicide Prevention Program: Annual evaluation report 2001–2002. Evaluation of program training workshops. Retrieved from yspp.org/down- loads/about_yspp/2001-2002Report.pdf President's New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: Author.
Suicide intervention training outcomes study: Summary report
  • P Illich
Illich, P. (2004). Suicide intervention training outcomes study: Summary report. Waco, TX: Research Consulting Services.
SafeTALK trainer manual
  • W Lang
  • R Ramsay
  • B Tanney
  • T Kinzel
Lang, W., Ramsay, R., Tanney, B., & Kinzel, T. (2007). SafeTALK trainer manual. Calgary, Alberta, Canada: LivingWorks Education.
Making it safer: A health centre's strategy for suicide prevention The Suicide Intervention Response Inventory: A revision and validation
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McAuliffe, N., & Perry, L. (2007). Making it safer: A health centre's strategy for suicide prevention. Psychiatric Quarterly, 78, 295–307. doi:10.1007/s11126-007-9047-x Neimeyer, R. A., & Bonnelle, K. (1997). The Suicide Intervention Response Inventory: A revision and validation. Death Studies, 21, 59–81. doi:10.1080/074811897202137
A review of experimentwise Type I error: Implications for univariate post hoc and for multivariate testing. Retrieved from ERIC database Help-seeking behavior prior to nearly lethal suicide attempts. Suicide and Life-Threatening Behavior
  • L S Barnes
  • R M Ikeda
  • M Kresnow
<.001*** <.001*** <.001*** <.001*** .032 <.001*** <.001*** <.001*** .90 <.001*** <.001*** <.001*** .001*** <.001*** <.001*** <.001*** References Altman, D. (2000). A review of experimentwise Type I error: Implications for univariate post hoc and for multivariate testing. Retrieved from ERIC database. (ED438322) Barnes, L. S., Ikeda, R. M., & Kresnow, M. (2001). Help-seeking behavior prior to nearly lethal suicide attempts. Suicide and Life-Threatening Behavior, 32, 68–75. doi:10.1521/ suli.32.1.5.68.24217
Review of suicidology
  • C. A. King
Førstehjelp ved selvmordsfare—En evaluering [Applied suicide intervention—An evaluation]
  • T. Guttormsen
  • T. S. Høifødt
  • K. Silvola
  • O. Burkeland