The LivingWorks suicideCare course is a one day training focused on advanced suicide risk and case management. According to LivingWorks, the following learning outcomes are expected:
- Building on the principles and practice of suicide first aid
- Understanding helper issues associated with ongoing care; and
- Demonstrating a working knowledge of intervention strategies
The training identifies a number of ‘tasks’, ‘tools’ and ‘traits’ that they feel are helpful, including describing risk, maintaining a helping alliance, working with ambivalence, living with uncertainty and showing courage to name a few.
The major categories (which will be reviewed in sequence below) are:
- Assumptions and Key Elements in Suicide Helping
- Suicide Process
- Suicide Helping Process: Three Helping Strategies
- Strategy 3: Tasks, Tools and Traits
- Helping Approaches: Suicide First Aid
- Task: Describe Risk
- Helping Approaches: Management
- Helping Approaches: Treatment
Table of Contents
Assumptions and Key Elements in Suicide Helping
This part of the seminar goes over the advantages from taking the course and what individuals will learn coming out of the seminar. I believe we discussed the Suicide Intervention Response Inventory at this point, which was part of our pre-reading for the seminar.
The suicide process discusses the interplay between protective factors and risk factors, and the idea of a “suicide zone” where increased suicidal risk exists, and how intervention before this point can help reduce future risk.
They also define the acronym PAR – person at risk.
Suicide Helping Process: Three Helping Strategies
In this section the three helping strategies are discussed. The first helping strategy is to focus on the person or the suicidal act. This involves dealing with the risk elements directly, including through potential hospitalization.
The second strategy is delivering an intervention. This could involve checklists, agency protocols or other procedures. For instance, the Distress Centre protocol involves using the CPR Risk Assessment followed by the ABC Model of Crisis Intervention.
There are some interesting studies consulted in this section that would be valuable to follow up with. I won’t spoil the fun but they involve suicide rates from various treatments and types of follow-up.
The final strategy is to focus on both the person/act and the intervention, which is essentially a combination of the first two strategies, tailored to the person involved, which takes advantage of the Tasks, Tools and Traits discussed earlier.
Additionally, unproductive reactions are covered, these include:
- Repressing the response
- Turning their anger inward
- Projecting on to the person at risk
As well, learning your “suicide baseline”, in terms of your optimism or pessimism to suicide, and your level of comfort with permissiveness or restrictiveness. A 1994 Neimeyer study about the most common error of suicide interventionists is also cited.
Helping Approaches: Suicide First Aid
This section is a review of the Suicide Intervention Model (SIM) from the ASIST training. ASIST has been updated to a new version, ASIST 11 which I have not taken yet, so this content may be different in the latest suicideCare. If anyone has taken it, please let me know.
The CPR Model is covered here, with a comprehensive case review. I found this one of the most valuable sections of the entire seminar.
It also briefly discusses a quantitative method of estimating risk, based on severity of risk equaling time multiplied by duration. I found this part less helpful, because there is no information provided on how to assess “severity.” An interesting thought, however, was the idea of the rules of 2: estimating risk at 2 minutes, 2 hours, 2 days, 2 weeks, 2 months and 2 years.
Helping Approaches: Management
This section again starts with a comprehensive case study. This case study focuses on case management, working to remove external barriers that cause a person’s suicidality.
This is most useful for non-therapists (and obviously, case managers.) Additional skills highlighted here that would be useful is the ability to perform a Mental Status Exam (MSE). The reading materials provided with the seminar (which I am basing this review off of) includes a good MSE as part of the case study.
Like the previous case study, the depth of the material covered makes this an extremely valuable reference.
Helping Approaches: Treatment
The treatment section of the seminar focuses on internal barriers that lead to suicidality. This is separate from external barriers that are treated by case management. Instead, internal issues are treated with counselling and psychotherapy.
Because of my lack of experience provide long-term counselling (as opposed to using counselling skills which happens quite frequently), I found this section less helpful. Of course therapists and counsellors would likely be very comfortable with this material.
The summary of the course offers a birds-eye view of the material covered, and summarized the resources that have been referred to during the course. Overall, I found the suicideCare a valuable resource for a suicide interventionist looking to develop more advanced skills and I would thoroughly recommend it.