1. Suicide Prevention Training Lloyd B. Potter PhD, MPH Director Suicide Prevention Resource Center November 2, 2006 Adelaide

2. Topics  A community approach to prevention  Training as one aspect of prevention  Gatekeeper training  Rationale and Logic  Common gatekeeper programs  Issues for gatekeeper programs

3. Society Community Family/Peers Spheres of influence on risk for suicidal behavior Individual

5. NAMI New Hampshire - Frameworks  Gatekeepers  Schools/Education  Mental Health and Substance Abuse Providers  Emergency Medical Services  Emergency Departments  Law Enforcement  Dispatch  Cultural Competence  Judiciary  Social Service Agencies  Teens/Students  Primary Care Providers  Community Coordinator  Funeral Directors  Clergy PROTOCOLS DEVELOPED FOR: www.NAMINH.org

6. Programs for the Prevention of Suicide Among Adolescents and Young Adults  School gatekeeper training  Community gatekeeper training  General suicide education  Screening programs  Peer support programs CDC. Youth Suicide Prevention Programs: A Resource Guide. 1992.

7. Programs for the Prevention of Suicide Among Adolescents and Young Adults (continued)  Crisis Centers and hotlines  Restriction of access to lethal means  Intervention after a suicide CDC. Youth Suicide Prevention Programs: A Resource Guide. 1992.

8. SPRC Training Institute  Strategic Planning for Suicide Prevention  Assessing and Managing Suicide Risk (3 versions)  First Responder Curriculum (forthcoming)  Online workshops  Locating, Understanding, and Presenting Youth Suicide Data  Planning and Evaluation for Youth Suicide Prevention  Youth Suicide Prevention: An Introduction to Gatekeeping  3 more forthcoming  Training for clergy (planned)

9. Rationale for Gatekeeper Training  Suicide does not usually occur spontaneously. There often is time to intervene.  Gatekeeping is a process in which caring individuals recognize the potential for risk behaviors in others and take action to insure that people at-risk receive the help they need.

10. Gatekeeper  Gatekeepers must have:  command of the basic facts about suicide and of suicidal behavior  the personal confidence and specific skills needed to recognize and respond to a person who may be at- risk of suicide  the ability to appropriately interact, support, and assist family and friends in the aftermath of an attempted or completed suicide

11. Program Logic Model Train Gatekeeper Trainers InputsActivitiesOutputsOutcomes Resources money staff volunteers facilities equipment &supplies Constraints laws regulations funding Services train trainers to train gatekeepers Products number trainers trained Results trainers train gatekeepers more persons at risk identified more referrals for MH care MH care results in reduced-risk fewer suicide attempts and completions

12. Program Logic Model Train Gatekeepers InputsActivitiesOutputsOutcomes Resources money staff volunteers facilities equipment &supplies Constraints laws regulations funding Services train gatekeepers Products number trained Results more persons at risk identified more referrals for MH care MH care results in reduced-risk fewer suicide attempts and completions

13. Valid program outcomes Evaluation to include measurable results:  Direct suicide factors-decrease in suicides & attempts  Suicide ideation  Related suicide factors- decrease in depression, stress & anger  Protective factors- increase in personal control, self- esteem, social support & problem solving Eggert L, Thompson E, Reducing Suicide Potential Among High Risk Youths: Tests of School-based Prevention Program

14. Gatekeeper Training  For school personnel:  Livingworks/ASSIST  Project SOAR (Suicide, Options, Awareness, Relief)  QPR (Question, Persuade, Refer)  Reconnecting Youth  For students:  Yellow Ribbon (uses QPR)  Natural Helpers Peer Navigators/New Mexico  SOS (Signs of Suicide )

15.  SuicideTALK: An exploration in suicide awareness (1.5–2 hours) provides a structure in which session members can safely explore some of the most challenging attitudinal issues about suicide, and encourages every member to find a part that they can play in preventing suicide.  safeTALK: suicide alertness for everyone (2.5–3 hours or full day 7 hours) ability to recognize a person with thoughts of suicide and know how to connect them with a person trained in suicide first aid intervention.  Applied Suicide Intervention Skills Training (ASIST) (14 hours) For caregivers who want to feel more comfortable, confident and competent in helping to prevent the immediate risk of suicide.  Training for Trainers (T4T) (Five days) Prepares local resource persons to be trainers of the ASIST workshop. Source: www.livingworks.org LivingWorks Programs

16.  As a QPR-trained Gatekeeper you will learn to:  recognize the warning signs of suicide  know how to offer hope  know how to get help and save a life WHAT YOU CAN DO… Become a Certified QPR Gatekeeper Instructor. On site training and through a self-study program. To locate a Certified QPR Gatekeeper Instructor in your area. Learn QPR through out web-enabled interactive CD-ROM program. Source: www.qprinstitute.com QPR

17. QPR Cornerstones  The four cornerstones of the theory upon which the QPR approach is derived are these:  Those who most need help in a suicidal crisis are the least likely to ask for it.  The person most likely to prevent you from dying by suicide is someone you already know.  Prior to making a suicide attempt, those in a suicidal crisis are likely to send warning signs of their distress and suicidal intent to those around them.  When we solve the problems people kill themselves to solve, the reasons for suicide disappear. Source: www.qprinstitute.com

18. YELLOW RIBBON INT'L SUICIDE PREVENTION PROGRAM  Promote and Raise awareness of suicide prevention in a community  Provide outreach to those at risk of suicide Educate people to be Gatekeepers, such as school staff (certified and classified), parents, peers, elders and the community to recognize suicidal behaviors in youth and adults.  Respond effectively and knowledgably in a suicidal crisis  Offer support to friends and family of suicide victims. Source: www.yellowribon.org

19. Maine Gatekeeper Training Program  Free materials  Background about risk and protective factors  Responding to a person at risk: 1. Show You Care 2. Ask About Suicide 3. Get Help  Support of family members  Building school readiness  Responding to a completed suicide Source: www.state.me.us/suicide

20. Gatekeeper training issues  Intensity, content, learning objectives  Skill building practice / role playing  Pre-post measures for persons trained  Expectations and record keeping for and about gatekeepers

21. Gatekeeper training issues  Exposure of gatekeepers to at-risk individuals  Subjective assessment of risk dependent on exposure to gatekeeper  Difficulty causally tying gatekeeper actions to therapeutic follow-through or prevention of suicidal behavior

22. Limitations in scope of programs  Inadequate links to mental health services  Programs for alcohol and drug abuse, HIV and other risk factors rarely make formal ties with suicide prevention  Reach youth not enrolled in school (CDC Youth Suicide Prevention Programs: A Resource Guide,1992)

23. Contact us at: www.sprc.org info@sprc.org 1-877-GET-SPRC www.sprc.org info@sprc.org