Advanced Crisis Line Training

Introduction

A few years ago when I was working for Distress Centre Durham (DCD), I undertook a project to develop a new advanced training curriculum for telephone responder. Currently the Basic Training is 16 hours of in-class, plus another 16 hours of supervised phone shifts where a responder demonstrates that they have the active listening, empathy, suicide and crisis intervention skills we need for them to be on the phones independently.

After about 3 months or 50 hours they are required to undertake an Advanced Training session. This session helps consolidate some of the learning, revisit some of the classroom skills and then to build some additional skills going forward.

This training was turned into a PowerPoint that I won’t share because it contains some copyrighted Distress Centre Durham material – but you can read below for information that you could use as the foundation of your own advanced crisis line training. I’ve since made some updates so this training goes beyond the original that I developed for DCD.

Session Information

The length of the session was usually about 3 hours. The content covered was as follows:

  • Introduction
  • Burnout and Stress Management
  • Handling Difficult Calls
  • Advanced Suicide Intervention
  • Advanced Crisis Intervention
  • Discussion of Difficult Situations
  • Conclusion

Five Step Limit Setting Process

For more information on this limit-setting process, you can see my article Setting Limits and Boundaries with Callers. Briefly, the five steps are:

  1. Identify the inappropriate behaviour
  2. Identify what correct behaviour is
  3. Indicate the consequences for failing to change behaviour
  4. Give the caller an opportunity to change their behaviour
  5. Follow through on consequences (e.g. hanging up) if behaviour does not change

Active Listening Process (ALP)

For more information on the active listening process, you can see my article Active Listening Process on Crisis Lines. As a quick reminder, the different skills in the ALP include:

  • Voice Tone
  • Pace
  • Setting the Climate
  • Open Ended Questions
  • Close Ended Questions
  • Empathy Statements
  • Clarifying
  • Paraphrasing
  • Summarizing
  • Referrals
  • Winding Up

Burnout and Stress Management

What is Burnout?

Burnout is a “state of physical, emotional, or spiritual exhaustion.” It occurs when we give too much of ourselves for too long and don’t take appropriate steps to recover. Symptoms of burnout can include:

  • Becoming cynical or critical of callers
  • Being irritable or impatient
  • Feeling responsible for the outcome of calls
  • Having unexplained headaches or other physical complaints

An example of a situation I knew a responder was feeling burned out was when they took a 20 minute call with a regular caller who was dealing with relationship issues. While their on-the-phone work was good, when the call was over, they were very upset that the caller was not in crisis and just wanted to bounce ideas off the responder.

This responder felt like their time was being wasted by this caller, when we could be taking crisis calls instead. It’s clear that responder cared a lot for our callers – but they were not treating all of our callers like they were important to us. For this reason, we had a discussion about how our service is preventative and designed to both provide emotional support and crisis intervention. The responder took a leave of absence and when they returned several weeks later they were recharged and ready to support all of our callers.

Emotions on the Helpline

We can experience a range of emotions on the helpline. Some of these are positive and some of these are negative.

Positive Helpline Emotions

  • Excited
  • Grateful
  • Happiness
  • Hopeful
  • Meaningful
  • Optimistic

Negative Helpline Emotions

  • Anger
  • Frustration
  • Guilt
  • Confusion
  • Physical fatigue
  • Nightmares
  • Intrusive thoughts

What Causes Burnout?

There are a number of causes of burnout. These include working too many hours on the helpline – feeling like you’re a martyr or you always have to be there. Having your expectations set too high and expecting clients to change or improve (they call us because we’re a source of support that don’t ask them to change.)

Being isolated or having a lack of social support can increase burnout, as can a failure to debrief either with peers or supervisors after your calls. Feeling disconnected from the day-to-day events and other things happening at the crisis line can also cause increase your fatigue and burnout.

Overall, if you feel ineffective in your work you’ll be at greater risk for burnout.

Preventing Burnout

To prevent burnout, it’s important that you always debrief after tough calls. You can talk to your peer in the call room, you can talk to your supervisor. You can work fewer shifts or even take a Leave of Absence away from the Centre for a while, to recharge. Adjusting your personal life so you have a better work/life balance, and coming to Team Meetings and other social events can help you.

Finally, stress management techniques and having a strong support network will help you prevent burnout.

Relaxation and Stress Management Techniques

  • Bubble Bath
  • Hot Shower
  • Meditation
  • Physical Exercise
  • Sleep
  • Yoga
  • Others…?

Handling Difficult Calls

There are a range of difficult callers that responders can be confronted with. These include individuals with significant mental health issues, “chronic” or repeat callers who are calling for social maintenance reasons and sexual fantasizers or abusive callers who are trying to misuse the service.

Seriously Mentally Ill Callers

These individuals have significant struggles or may be actively in a mental health crisis. They might speak very quickly and not let you get a word in edge-wise, or they may be very impatient. Winding up the call be difficult and these calls can make you feel ineffective or frustrated.

Remember to keep an open mind, and remember why we support these callers. They often have few resources other than us that are non-judgemental and empathic. Let the caller vent their fears, anxieties and frustrations, but always remember the Active Listening Process (ALP).

If a caller is having delusions, we must not feed into those delusions but instead empathize with the underlying emotion. Rather than saying “Yes, there could be vans outside your house monitoring your thoughts”, say something like, “That would be really scary if it were happening.”

Social Maintenance Callers

These individuals are calling because they’re lonely. While our service provides support to them we must make sure that they do not monopolize the lines, or push boundaries in trying to collect personal information on our callers.

We will use our 5-Step Limit Setting Process if the caller wants identifying information, and try to engage the caller openly in things that they can do, or that you and them can talk about, to reduce their loneliness. When the call starts going in circles (they’re repeating themselves and not moving on to anything new), we can begin to wind up the call.

They should call us back tomorrow if they’d like to speak again, and you can discuss with staff the setting of a time limit or other restrictions.

Sexual Fantasizer Callers

These can be some of the most frustrating calls for us to deal with, because they make us question what we’re doing on the helpline. These callers are often difficult to determine as sexual fantasizers at first – they drag it out as long as possible.

When we begin to suspect that we’re speaking with a sexual fantasizer, we must remind them to stick to the discussion of the emotions of their problem. For example, sometimes we get legitimate callers who want to talk about cross-dressing, sexual orientation, or sexual fetishes. If these callers are genuine, they will prefer to speak about the emotions of those elements and how they impact those around them, rather than discussing the specific activities of cross-dressing, having sex with men, or engaging in a sexual fetish.

You might feel angry or used when the call ends if you don’t figure it out early enough. You’ll need to make sure that you debrief and put your stress management techniques into practice.

Angry or Abusive Callers

These callers are those who are calling to take emotions out on you. This can be challenging and is not an appropriate use of our service. Using your Five Step Limit Setting Process, you’ll need to let the caller know that you are here to listen if they are upset but that they cannot direct language at you.

If they would like to make a complaint, they should call the office line. Set the boundary, and if they continue then you’ll end the call. And make sure you follow through!

Suicide/Crisis Intervention

Suicide intervention is the process of assessing and intervening with someone who is at high-risk of suicide. Once you’ve done some risk assessments on the phone you’ll have a better sense of how to weave these questions into your exploration of the caller’s issues.

By starting each suicide assessment with “Have you done anything tonight to kill yourself or end your life?” you’ll be able to move smoothly into the safety planning questions. Your goal is to make sure that you have a sense of whether the caller will be safe tonight. If they will, you don’t have to worry. If they won’t, you can begin building a safety plan or support network collaboratively with the caller to make sure they will be safe.

You’ll want to conduct a suicide risk assessment:

  • Any time you suspect a caller is suicidal
  • When they tell you they’re having suicidal thoughts
  • Even if the person denies current suicidal thoughts

In an emergency, when the caller has already taken steps to end their life, you must:

  1. Change your voice tone. Become assertive, to let that caller know that they need to cooperate with you so you can get them help
  2. Collect their location, and other identifying information
  3. Tell them to unlock their door, open the door if they can, so that emergency personnel can reach them
  4. Debrief after the call with your supervisor

Example of Suicide Intervention

  • Caller explains they have self-injured today
  • Responder assesses suicide risk, they come up medium on the CPR or DCIB Suicide Risk Assessment
  • Responder explores coping strategies but they say there’s nothing they can do, they’ve tried it all and they can’t guarantee their own safety
  • Responder arranges for a taxi to take them to hospital or mental health crisis bed

Discussion of Difficult Situations

During the discussion of difficult situations, responders would talk about situations that they personally found challenging – whether or not they were covered on the above. A group discussion would help responders get a better sense of how their peers would handle those situations, and the facilitators would share their own thoughts. This helped to increase the confidence of the responders in dealing with those situations in the future.

Conclusion

We would wrap the session by thanking everyone for coming out and presenting them with an Advanced Training certificate. Completion of both Basic and Advanced Training was required for a responder to be considered a Certified Volunteer Helpline Worker.

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Suicide to Hope Workshop Review

Introduction

Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.

Conclusion

I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on May 27, 2019 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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SIMPLE STEPS Model for Suicide Risk Assessment

Introduction

The SIMPLE STEPS Model (McGlothlin, 2008) for suicide risk assessment provides a simple mnemonic similar to others like SADPERSONS (Patterson, et. al., 1983) or IS PATH WARM (from the American Association of Suicidology). Each of these is correlated with increasing suicide lethality and so this can be a useful short-hand to remember these items.

Suicide risk assessment on the crisis line is mostly concerned with imminent risk, and many suicide screeners designed for lay people may miss important variables in a goal to be simplistic; the SIMPLE STEPS model appears to avoid both of these traps, by providing an assessment tool simple enough to be used in the crisis line environment but comprehensive enough to be used by counsellors or therapists for ongoing monitoring of suicide risk.

Items in the SIMPLE STEPS Model

  • Suicidal – Is the individual expressing suicidal ideation?
  • Ideation – What is their suicidal intent?
  • Method – How detailed and accessible is their suicidal method?
  • Perturbation – How strong is their emotional pain
  • Loss – Have they experienced actual or perceived losses? (Relationships, material objects)
  • Earlier Attempts – What previous attempts has the individual experienced, what happened after those attempts?
  • Substance Use – Is the individual abusing drugs, alcohol, or other substances?
  • (Lack of) Troubleshooting Skills – Are they able to see alternatives or options other than suicide?
  • Emotions / Diagnosis – “Assessment of emotional attributes (hopelessness, helplessness, worthlessness, loneliness, agitation, depression, and impulsivity) and diagnoses commonly associated with completed suicide (e.g., substance abuse, mood disorders, personality disorders, etc.)” (McGlothlin, et. al., 2016)
  • (Lack of) Protective Factors – What is keeping this person safe from suicide? Who are their supports (internal such as personal values and external like people), resources and agencies
  • Stressors and Life Events – What has happened in their life to lead them to suicide?

Sharp readers will identify that these elements map very neatly onto the DCIB Model of Suicide Risk Assessment, but perhaps provide a better mnemonic in order to make sure that clinicians who do not have the DCIB in front of them are able to perform that assessment.

Validation of the SIMPLE STEPS Model

McGlothlin, et. al. (2016) used 13,000 calls over six years to a crisis line and correlated the SIMPLE STEPS items with the lethality risk present in that call. One limitation of this study is that it used self-reported (by the helpline worker taking the call) lethality rather than using another evidence-based risk assessment in order to compare with. I am satisfied that McGlothlin addressed this in his limitations section, where he noted the difficulty with using data collected in this manner.

References

McGlothlin, J. (2008). Developing clinical skills in suicide assessment, prevention and treatment.
Alexandria, VA: American Counseling Association

McGlothlin, J., Page, B., & Jager, K. (2016). Validation of the SIMPLE STEPS Model of Suicide Assessment. Journal Of Mental Health Counseling, 38(4), 298-307. doi:10.17744/mehc.38.4.02

Patterson, W.M., Dohn, H.H., Patterson, J. & Patterson, G.A. (1983). “Evaluation of suicidal patients: the SAD PERSONS scale.” Psychosomatics 24(4): 343–5, 348–9. doi:10.1016/S0033-3182(83)73213-5. PMID 6867245

Cite this article as: MacDonald, D.K., (2017), "SIMPLE STEPS Model for Suicide Risk Assessment," retrieved on May 27, 2019 from http://dustinkmacdonald.com/simple-steps-model-suicide-risk-assessment/.

 

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Level of Care Utilization System (LOCUS)

Introduction

The Level of Care Utilization System or LOCUS tool has been designed by the American Association of Community Psychiatrists (2009) to allow staff who work on inpatient hospital environments with patients with psychiatric problems (such as emergency departments, psychiatric sections of general hospitals or in psychiatric hospitals) to determine the level of care that an individual should receive.

The LOCUS provides for six levels, ranging from the least intense (recovery maintenance, such as seeing a case manager once a month and having access to a 24-hour crisis line if needed) to the most intense (medically managed residential services such as being a hospital inpatient.)

Parameters

The LOCUS is based on a set of parameters that an individual is scored along. The level of care is determined based on the mix of parameters that each client has. These parameters are:

  1. Risk of Harm
  2. Functional Status
  3. Medical, Addictive and Psychiatric Co-morbidity
  4. Recovery Environment
  5. Treatment and Recovery History
  6. Engagement and Recovery Status

In most of these domains there are a number of states that are used to code the domain. For instance, “Risk of Harm” has five potential states from Minimal Risk of Harm to Extreme Risk of Harm. The exception is 4. Recovery Environment which has two subcomponents, Level of Stress and Level of Support.

The LOCUS manual provides detailed coding instructions to allow an individual to be assessed in a reliable, repeatable way.

Levels of Care

For each Level of Care, the manual provides for four categories, Care Environment, Clinical Services, Supportive Systems, and Crisis Stabilization and Prevention Services.

Care Environment describes where services are delivered and what facilities might need to be available. Clinical Services describes the type and number of clinical employees (nurses, etc.) and the types of therapies or treatments available. Supportive Services includes client access to things like case management, outreach and financial support, while Prevention Services include mobile crisis, crisis lines, and other access to services.

Scoring

Each of the levels includes specific individual scores required for a level, and also a composite score. The Composite Score overrides the individual scores to determine which level an individual is placed at if the Composite Score results in a more intense level of care.

Composite Scores

  • Level 1 – 10-13
  • Level 2 – 14-16
  • Level 3 – 17-19
  • Level 4 – 20-22
  • Level 5 – 23 – 27
  • Level 6 – 28+

Level 1 – Recovery Maintenance and Health Management

  • Risk of Harm: 2 or less
  • Functional Status: 2 or less
  • Co-morbidity: 2 or less
  • Level of Stress: Sum of Stress and Support less than 4
  • Level of Support: Sum of Stress and Support less than 4
  • Treatment & Recovery History: 2 or less
  • Engagement & Recovery Status: 2 or less

Level 2 – Low Intensity Community Based Services

  • Risk of Harm: 2 or less
  • Functional Status: 2 or less
  • Co-morbidity: 2 or less
  • Level of Stress: Sum of Stress and Support less than 5
  • Level of Support: Sum of Stress and Support less than 5
  • Treatment & Recovery History: 2 or less
  • Engagement & Recovery Status: 2 or less

Level 3 – High Intensity Community Based Services

  • Risk of Harm: 3 or less
  • Functional Status: 3 or less
  • Co-morbidity: 3 or less
  • Level of Stress: Sum of Stress and Support less than 5
  • Level of Support: Sum of Stress and Support less than 5
  • Treatment & Recovery History: 3 or less
  • Engagement & Recovery Status: 3 or less

Level 4 – Medically Monitored Non-Residential Services

  • Risk of Harm: 3 or less
  • Functional Status: 3 or less
  • Co-morbidity: 3 or less
  • Level of Stress: 3 or 4
  • Level of Support: 3 or less
  • Treatment & Recovery History: 3 or 4
  • Engagement & Recovery Status: 3 or 4

Level 5 – Medically Monitored Residential Services

  • Risk of Harm: If the score is 4 or higher – the client is automatically Level 5
  • Functional Status: If the score is 4 or higher – most clients are automatically Level 5
  • Co-morbidity: If the score is 4 or higher – most clients are automatically Level 5
  • Level of Stress: 4 or more in combination with a rating of 3 or higher on Risk of Harm, Functional Status or Co-morbidity
  • Level of Support: 4 or more in combination with a rating of 3 or higher on Risk of Harm, Functional Status or Co-morbidity
  • Treatment & Recovery History: 3 or more in combination with a rating of 3 or higher on Risk of Harm, Functional Status or Co-morbidity
  • Engagement & Recovery Status: 3 or more in combination with a rating of 3 or higher on Risk of Harm, Functional Status or Co-morbidity

Level 6 – Medically Managed Residential Services

  • Risk of Harm: If the score is 5 or higher – the client is automatically Level 6
  • Functional Status: If the score is 5 or higher – the client is automatically Level 6
  • Co-morbidity: If the score is 5 or higher the client is automatically Level 6
  • Level of Stress: 4 or more
  • Level of Support: 4 or more
  • Treatment & Recovery History: 4 or more
  • Engagement & Recovery Status: 4 or more

Given that there are a number of nuances in the exact scoring it’s recommended that an individual read or receive structured training in administration of the LOCUS. The LOCUS manual also provides a decision tree (not shown) to assist in making your determinations and a determination grid (shown below.)

Level of Care Determination Grid

LOCUS Level of Care Determination Grid

Research

Although the LOCUS is widely used, research is surprisingly limited.

The initial study validating the LOCUS was Sowers, George & Thomson (1999). Their study examined scores on the LOCUS and correlated them to expert decisions to see if the LOCUS matched that decision-making; their results indicated that it performed well in this function.

Kimura, Yagi & Toshizumi (2013) reviewed the LOCUS by comparing scores on it to the Global Assessment Scale (GAS) scores, a similar tool and examining the change of scores from admission to discharge. They found it a sensitive and effective tool for clinical use in Japan.

Ontario Shores, a large mental hospital in Whitby, ON implements the LOCUS along with the RAI tools as well.

References

American Association of Community Psychiatrists. (2009) LOCUS Level of Care Utilization System for Psychiatric and Addictions Services, Adult Version 2010. Retrieved on January 18, 2017 from http://cchealth.org/mentalhealth/pdf/LOCUS.pdf

Kimura, T., Yagi, F., & Yoshizumi, A. (2013). Application of Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) to Psychiatric Practice in Japan: A Preliminary Assessment of Validity and Sensitivity to Change. Community Mental Health Journal, 49(4), 477-491. doi:10.1007/s10597-012-9562-6

Sowers, W., George, C., & Thomson, K. R. (1999). Level of care utilization system for psychiatric and addiction services (LOCUS): a preliminary assessment of reliability and validity. Community Mental Health Journal, (6), 545.

Cite this article as: MacDonald, D.K., (2017), "Level of Care Utilization System (LOCUS)," retrieved on May 27, 2019 from http://dustinkmacdonald.com/level-care-utilization-system-locus/.
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Interprofessional Education in Suicide Prevention

Introduction to Interprofessional Education

This is an essay I wrote in 2015 for the course HSRV 306 Critical Reflection for Practice at Athabasca University.

Interprofessional education (IPE) is defined as “the process, through which two or more professions learn, with, from and about each other to improve collaboration and the quality of service” (CAIPE, 1997) IPE has been practiced in various forms for decades (Smith & Clouder, 2010) but is most commonly associated with healthcare and the social sciences.

The advantage of interprofessional education is that it allows allied fields to benefit from “pooling together of expertise in teams [that] would make them more effective and efficient” (Illingworth & Cheivanayagam, 2007) than those professions working on their own. As there is much overlap in the work provided by professionals in social work, psychology and psychiatry this pooling together of resources has the potential to improve their skills and competencies.

One competency required by these professions is the ability to prevent suicide, which involves the interrelated skills of risk assessment and suicide intervention. How much an individual may need to intervene will differ depending on their role, with some professionals needing only to recognize the signs and refer them on, while others may be required to perform regular and comprehensive suicide risk assessment and intervention.

Suicide and Mental Health Professionals

The suicide rate in Canada has remained relatively steady in Canada for several years, with more than 3,000 individuals dying by suicide in Canada each year. (Statistics Canada, 2014) A 2002 meta-review demonstrated that many of these people visited physicians or nurses for physical health complaints before their death. (Luoma, Martin & Pearson, 2002) Whether or not these physical complaints were related to their mental health issues or not, an opportunity for suicide screening and subsequent referral was missed.

One study on suicide screening, focused on Emergency Departments in the United States found that when universal screening was implemented, requiring all patients to be screened for suicide regardless of their presenting problem, the rate of detected suicidal thoughts doubled. (Boudreaux, et. al., 2015) This demonstrates the importance of all healthcare professionals being competent in the basics of suicide screening.

Mental health professionals regularly treat suicidal clients, with Feldman & Freedmanthal’s 2006 study reporting 78% of social workers had provided service to a suicidal client in the previous year. While mental health professionals regularly work with suicidal clients they may lack the skills or confidence to respond appropriately.

Ruth et. al. (2006) conducted interviews with social work students, faculty and Deans and discovered that the majority of programs provided their social worker students less than 4 hours of education on suicide assessment during their graduate programs. This resulting lack of coverage left social work students feeling unconfident working with suicidal clients, and indeed scared of the possibility that a client will reveal suicidality, a fact noted by other researchers as well. (Osteen, Jacobson & Sharpe, 2014) This paralyzing fear may contribute to burnout or other negative professional consequences and ultimately make them less effective practitioners.

Interprofessional education has the potential to improve the care of suicidal clients by allowing professionals to take advantage of the best practices in education present in allied fields. By borrowing best practices from other helping professions the number of competent professionals may ultimately be increased and the number of suicides or potential suicides that are undetected may be reduced.

Potential drawbacks to adopting interprofessional education that have been documented in the literature include the costs of implementation (such as redesigning curriculums) and the possible loss of professional identity among different groups who learn the same skills (Smith & Clouder, 2010) Given that mental health care is already well-diffused (with each professional area like social work, psychology and psychiatry having specialties but ultimately all being able to provide counselling or therapy with training), this may be less of an issue in suicide prevention, which is currently practiced by volunteers all the way up to Psychiatrists and Psychologists holding doctorates.

Interprofessional Education in Physical and Mental Health

There are a number of approaches to education in mental health fields (social work and psychology) and physical health fields (nursing and non-psychiatric medicine), including best practices that have demonstrated improved knowledge transfer, satisfaction and skill within their respective professional programs.

Physical health professions include general medicine practiced by physicians as well as nurses, who are recognized as professionals in their own right (College of Registered Nurses of Manitoba, n.d.). Professional schools of nursing have a long history, stretching back to the early 1900s (Schekel, 2009), while the first medical school opened in Italy in the 9th century. (de Divitiis, Cappabianca, & de Divitiis, 2004)

Education of physicians and nurses has always emphasized hands-on treatment and “learning by doing”, but especially since the 15th century when the first cadaver dissections were performed for medical students. (Rath & Garg, 2006)

Current techniques used in medical and nursing education include case studies, where the signs and symptoms of an illness and a patient’s history are described in detail and a diagnosis or treatment is sought (Raurell-Torreda, et. al., 2015), and simulated patients who are specially trained actors that medical students interact with in order to experience conducting clinical interviews, assessment and diagnosis (Uys & Treadwell, 2014).

Both case studies and simulated patients have shown utility in general nursing and medicine according to Luebbert & Popkess (2015). Some studies have specifically explored their utility with suicidal patients, such as Norrish (2009) who used cases to teach suicide risk assessment skills to Omani medical students.

Techniques that have demonstrated effectiveness with Psychology and Social Work students on the other hand, include role-playing (Murdoch, Bottorff & McCullough, 2013) where students practice simulated complaints with each other in order to develop the skills of recognizing and responding to suicidal statements, and evidence-based lecture. (Scott, 2015)

Gate-keeper training programs that are designed to teach lay people the basic skills of recognizing the signs of suicide and referring individuals to trained professionals, for instance, QPR (Lancaster, et. al., 2014) have demonstrated effectiveness in increasing confidence and skill in both nursing (Bolster, Holliday, Oneal & Shaw, 2015) and social work students. (Sharpe, Frey, Osteen & Bernes, 2014)

While domain-specific education for nurses and physicians has begun to be developed, it lacks the exploration of knowledge-transfer and rigorous methodology necessary for it to be as effective as possible. One example of beginning nurses education is Kishi et. al. (2014), who had emergency room nurses in Japan completing a 1 day workshop. The workshop covered suicide risk assessment, management of the immediate suicidal crisis, referring patients to long-term resources, and attitudes towards suicidal patients. This workshop was taught using lectures and case studies, with a pre and post-test design on a scale measuring attitudes towards suicide (but not knowledge transfer or skill acquisition.) The lack of a knowledge-transfer component means these nurses are unable to demonstrate whether they learned anything or if they apply their training to their patients.

Other exercises in integrating suicide prevention into social work including Scott (2015) who developed a full-semester course for MSW students that taught suicide risk assessment, intervention, and public health interventions such as media guidelines around suicide. Luebbert & Popkess (2015) had students complete either a video-taped lecture or speak to a standardized patient after being exposed to material on suicide assessment and found that the group that worked with the standardized patient felt much more confident.

What is lacking in nursing and medical education is a focus on evidence-based practice in suicide prevention, an issue noted by nursing faculty (Kalb et. al., 2015) Additionally providing opportunities for hands-on practice through exercises like case studies, simulated patients, and roleplaying will allow for necessary deep knowledge transfer.

Conclusion

Suicide prevention is a field ripe for improvement by integrating the best practices from a variety of allied fields. Most notably, from nursing and general medicine the case study and simulated/standard patients may help social workers and psychologists reduce their fear of working with suicidal clients, while the strong evidence-based lecture, roleplaying and gate-keeeper training may give busy nurses and physicians an opportunity to develop suicide awareness and referral skills that will allow them to intervene to prevent death.

References

Bolster, C., Holliday, C., Oneal, G., & Shaw, M. (2015). Suicide Assessment and Nurses: What Does the Evidence Show?. Online Journal Of Issues In Nursing, 20(1), 1-1 1p. doi:10.3912/OJIN.Vol20No01Man02

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Cite this article as: MacDonald, D.K., (2016), "Interprofessional Education in Suicide Prevention," retrieved on May 27, 2019 from http://dustinkmacdonald.com/interprofessional-education-suicide-prevention/.
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