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:
- Explore Stuckness
- Describe Issues
- Formulate Goals
- Develop Plan
- Monitor Work
- 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.
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:
- Safety First
- 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.
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.
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
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.