Toward Zero Suicide TRAIN Presented by: Jacqueline Awe, LMSW - Director, Department of Student Development Coordinator of the STAR Program at Savannah State University Becca Smith, LPC, CPCS – Assistant Director, Counseling Center at Valdosta State University

TRAIN Utilizing a Zero Suicide approach to training, in order to develop a confident, competent and caring campus community.

Train Why Train? Who Should be Trained? How are Staff Trained? What Trainings are Available? When Should Staff be Trained? Where Should Staff be Trained?

Train ZERO SUICIDE TOOLKIT WEBSITE http://zerosuicide.sprc.org/toolkit/train

WHY??

Why Train?? It is essential that all staff members have the necessary skills to provide excellent care, which in turn will help staff to feel more confident in their ability to provide caring and effective assistance to clients with suicide risk.

Competent: Caring: Confident: What does being confident, competent and caring look like? Confident: Competent: Caring:

WHO??

Who should be trained?? Non-Clinical Staff All non-clinical staff, including receptionists, administrative staff, and technicians, should be trained to identify patients who are at risk for suicide. People who are experiencing suicidal thoughts often disclose them to non-clinical staff, so all staff members should be on alert for someone who might be at risk from the moment the person first calls for an appointment or walks in the door. The trainings that would be appropriate for non-clinical staff are generally called gatekeeper training. Gatekeeper training provides an overview of suicide prevention. Participants learn how to recognize suicidal behavior, how to respond, and where to make a referral and find help. It does not teach how to do a clinical assessment of a person at risk for suicide.

Who Should Be trained?? All Professional Staff Members Anyone who will be asked to screen new patients at intake must be trained in how to conduct a screening, preferably using a tool that is informed by evidence of its ability to accurately identify those at risk. Those staff members may include paraprofessionals, nurses, nurse practitioners, and physician assistants in primary care settings or emergency department staff. In integrated or primarily behavioral health organizations, intake workers, case managers, or other professionals may be included in this category.

Who Should be Trained?? Clinical Staff- Behavior Health Professionals Those who work with patients or clients who may be at risk for suicide include social workers, psychologists, professional counselors, marriage and family therapists, psychiatric nurses, and psychiatrists.

Who should be trained? Training for Clinical Staff should teach these essential skills: An approach that acknowledges the ambivalence of the person considering suicide and affirms that alternatives to alleviating the patient’s pain do exist. The ability to gather patient information beyond suicide screening information that will inform a risk formulation. The ability to form and communicate to other clinicians, supervisors, and the patient a contextualized risk formulation to aid safety planning, counseling to reduce access to lethal means, crisis support, and treatment planning. The ability to write a clear risk formulation for the patient record. A commitment to collaborating with the patient and others who are significant in the patient’s life to create and record a safety plan and crisis support plan. Knowledge of the available treatment options and the ability to consider those options that are least restrictive to the patient whenever possible.

HOW??

How To Implement Zero Suicide Train Staff in Key Skills Provide staff training commensurate with their roles in providing safer suicide care. Repeat training at least every three years. Ensure that training contains the following elements: The fundamentals of the organization’s Zero Suicide philosophy. Policies and protocols relevant to the staff member’s role and responsibilities. Basic, research-informed training on suicide identification for all staff. Additional training to all clinical staff to ensure a basic level of skill in assessing, managing, and treatment planning for patients at risk of suicide, including safety planning and reduction of access to lethal means. Advanced training to deepen skills and increase confidence and effectiveness.

How To Implement Zero Suicide Assess Staff Skills Conduct an assessment of staff knowledge, practices, and confidence in providing safer suicide care. Repeat the assessment at least every three years.

Workforce Survey What is it? The Zero Suicide Workforce Survey takes an average of 10 minutes to complete, and the responses are confidential. Section 1 contains questions about the prevalence of suicide. Section 2 asks a series of questions designed to elicit whether staff members hold some specific beliefs about suicide and people at risk of suicide. Section 3 contains questions about the staff members current suicide care practices. Section 4 asks whether staff members believe they have the training, skills, confidence, and supervisory support to work effectively with suicidal patients. Sections 5 contains demographic items.

Why Use the Workforce Survey? The Zero Suicide Workforce Survey is one tool your organization can use to assess the level of knowledge and self-reported competence and confidence of your staff members. The Workforce Survey can be an integral part of your organization’s Zero Suicide launch to create organizational readiness for the Zero Suicide approach. The survey reinforces the idea that suicide care and prevention is the responsibility of every staff member. Sample Letter to Staff about Zero Suicide Workforce Survey

Workforce Survey Results The general findings from more than 35,000 responses to the Zero Suicide Workforce Survey across nine states and hundreds of organizations showed that a large number of staff at all levels do not have specific training in suicide care (D. Covington, personal communication, 2014). Between 35%-45% don’t feel they have the skills Between 40%-50% don’t feel they have the training Between 30%-40% don’t feel they have the supports

Workforce Survey Results For example, one organization administered the survey and had similar initial results. After providing staff with training and then administering the survey a second time, the organization found dramatic changes in staff responses: Number of all staff responding that they had the training, skills, and support increased by more than half, from just 36% on the first survey to 86% on the second. Number responding that they did not have the training, skills, and support decreased from 27% to 2%.

WHAT??

What to use to determine SUICIDE RISK Applied Suicide Intervention Skills Training (ASIST) (LivingWorks) www.livingworks.net/programs/asist 2 days (14 hours) In person Workshop emphasizes teaching suicide first aid to help a person at risk stay safe and seek further help as needed Standardized, customizable, and delivered by two trainers

What to use to determine SUICIDE RISK Question, Persuade, Refer: Gatekeeper Training for Suicide Prevention (QPR Institute) www.qprinstitute.com 1 to 2 hours In person or online Teaches lay and professional gatekeepers to recognize and respond positively to someone exhibiting suicide warning signs and behaviors

What to use to determine SUICIDE RISK Assessment of Suicidal Risk Using the Columbia Suicide Severity Rating Scale (C-SSRS) (NY State Office of Mental Health and Columbia University) http://zerosuicide.sprc.org/sites/zerosuicide.sprc.org/files/cssrs_we b/course.htm Connect Suicide Prevention/Intervention Training 45 minutes Online, self-paced Teaches how the C-SSRS is structured and how to administer the brief screening and full versions Videos show how to use the scale’s Suicidal Ideation and Suicidal Behavior sections in client

What to use to determine SUICIDE RISK Assessing & Managing Suicide Risk (AMSR) (Suicide Prevention Resource Center) www.sprc.org/training-institute/amsrSuicide Alertness 1 day In person Research-informed workshop Focuses on 24 core competencies clinicians need to be successful in working with suicidal clients Uses a mix of lecture, discussion, case review, video demonstrations, and written and paired practice exercises

What to use to determine SUICIDE RISK Counseling on Access to Lethal Means (CALM) (Suicide Prevention Resource Center) http://training.sprc.org/course/description.php#course3Assessing & Managing Suicide Risk 1.5–2 hours Online Workshop covers why reducing access to lethal means of self-harm saves lives Teaches practical skills on when and how to ask suicidal clients about their access to lethal means and how to work with them and their families to reduce that access

What to use to determine SUICIDE RISK Collaborative Assessment and Management of Suicidality (CAMS) http://cams-care.com/training Assessing & Managing Suicide Risk Varies In person, role-play, or consultation calls Teaches the Collaborative Assessment and Management of Suicidality (CAMS), an evidence-based, therapeutic framework emphasizing collaborative assessment and treatment planning. There are various CAMS training options to meet the needs and expectations of a wide range of clinicians and systems of care.

WHEN??

When is the best time to Train?? Summer months when clinical staff may be less busy September after the Housing crunch and move in is over December after finals and before winter break January before the beginning of the semester starts

WHERE??

Where are the trainings? On campus Bring a trainer to your campus Use Conference rooms Near ample parking Off campus Some trainings are held in locations that some staff are able to travel to Train the trainer

Questions???