Section I: Evidence-Based Programs

American Indian Life Skills Development/Zuni Life Skills Development is a school-based curriculum that has demonstrated increased suicide prevention skills and decreased hopelessness, among other positive outcomes, in American Indian youth. The curriculum is 28-56 lessons long. The curriculum manual is available from the University of Washington Press for a fee.

Brief Psychological Intervention after Deliberate Self-Poisoning has demonstrated decreased suicidal ideation in those who received the four 50-minute treatments compared to those who received regular treatment. Information about the program has been published in the academic journal literature.

CARE (Care, Assess, Respond, Empower) is a school-based and community-based computerized assessment and counseling program that has demonstrated decreased suicide risk factors for at-risk adolescents and young adults. The four-hour program (two hours for assessment, two hours for counseling) is for use by mental healthcare providers, including psychologists, counselors, and social workers. Training is required. CARE is available from Reconnecting Youth, Inc. for a fee.

CAST (Coping and Support Training) is a school-based small group counseling program for at-risk youth that has demonstrated decreased suicide risk factors among other positive outcomes in adolescents. CAST is conducted over 12 55-minute sessions. It can be delivered by trained teachers, counselors, social workers, or others with similar experience. It is available from Reconnecting Youth, Inc. for a fee.

Dialectical Behavior Therapy (DBT) is a psychological treatment program that has demonstrated decreased suicide attempts and other positive outcomes in young adults. Generally, mental health professionals will need additional training to implement DBT. Training and training materials are available from Behavioral Tech, LLC for a fee.

Dynamic Deconstructive Psychotherapy (DDP) is a 12- to 18-month, manual-driven treatment for adults with borderline personality disorder and other complex behavior problems, such as alcohol or drug dependence, self-harm, eating disorders, and recurrent suicide attempts. DDP combines elements of translational neuroscience, object relations theory, and deconstruction philosophy in an effort to help clients heal from a negative self-image and maladaptive processing of emotionally charged experiences. Neuroscience research suggests that individuals having complex behavior problems deactivate the regions of the brain responsible for verbalizing emotional experiences, attaining a sense of self, and differentiating self from other, and instead activate the regions of the brain contributing to hyperarousal and impulsivity.

DDP helps clients connect with their experiences and develop authentic and fulfilling connections with others. During weekly, 1-hour individually adapted sessions, clients discuss recent interpersonal experiences and label their emotions, while also reflecting upon their experiences in increasingly complex and realistic ways, to start the longer-term process of self-acceptance. Therapists must learn to recognize, understand, and make use of their own intense emotional reactions elicited by clients in order to foster recovery, avoid burnout, and provide novel experiences in the client-therapist relationship that support individuation and challenge clients' basic assumptions about themselves and others.

Implementers should be licensed therapists (i.e., psychologists, clinical social workers, psychiatrists, marriage and family therapists). Training is required to implement the full model.

Emergency Department Means Restriction Education increased the safe storage of firearms, among other positive outcomes, in homes of adolescent suicide attempters. Program information is available from published studies.

Emergency Room Intervention for Adolescent Females is an emergency room based intervention for female suicide attempters and adult caregivers that has demonstrated decreased suicidal ideation, among other positive outcomes, for adolescent female suicide attempters and their adult caregivers. It is available from UCLA. The training manual is free; the training video and the program video are available for a fee.

Kognito At-Risk for College Students is a 30-minute, online, interactive training simulation that prepares college students and student leaders, including resident assistants, to provide support to peers who are exhibiting signs of psychological distress such as depression, anxiety, substance abuse, and suicidal ideation. Through a self-paced, narrative-driven experience, participants build knowledge, skills, and confidence to identify, approach, and refer an at-risk student to counseling, mental health, or crisis support services.

LEADS: For Youth (Linking Education and Awareness of Depression and Suicide) is a curriculum for high school students in grades 9-12 that is designed to increase knowledge of depression and suicide, modify perceptions of depression and suicide, increase knowledge of suicide prevention resources, and improve intentions to engage in help-seeking behaviors. The curriculum addresses such topics as depression and its symptoms, the link between depression and suicide, the risk and protective factors associated with suicide, the warning signs of suicide, seeking help and overcoming barriers to seeking help, and school and community suicide prevention resources. By educating students about seeking help and the resources available to them, the intervention aims to empower students to get help for themselves or others. LEADS is available from Suicide Awareness Voices of Education (SAVE) for a fee.

Lifelines is a school-based curriculum that has demonstrated increased positive attitudes about preventing suicide, among other positive outcomes, in adolescents. Lifelines can be taught in four 45-minute lessons. The program manual and materials are available from Hazelden Publishing and Educational Services for a fee.

The Model Adolescent Suicide Prevention Program (MASPP) is a public health-oriented suicidal-behavior prevention and intervention program originally developed for a small American Indian tribe in rural New Mexico to target high rates of suicide among its adolescents and young adults. The goals of the program are to reduce the incidence of adolescent suicides and suicide attempts through community education about suicide and related behavioral issues, such as child abuse and neglect, family violence, trauma, and alcohol and substance abuse. As a community-wide initiative, the MASPP incorporates universal, selective, and indicated interventions and emphasizes community involvement, ownership, and culturally framed public health approaches appropriate for an American Indian population.

Central features of the program include formalized surveillance of suicide-related behaviors; a school-based suicide prevention curriculum; community education; enhanced screening and clinical services; and extensive outreach provided through health clinics, social services programs, schools, and community gatherings and events. In addition, neighborhood volunteers of various ages are recruited to serve as "natural helpers." These individuals engage in personal and program advocacy, provide referrals to community mental health services, and offer peer counseling (with guidance from professional mental health staff) to youth who may prefer to seek assistance from trusted laypersons in a less formal setting.

Multisystemic Therapy with Psychiatric Supports (MST-Psychiatric) is a psychological treatment program for children and adolescents that has demonstrated reductions in suicide attempts, among other positive outcomes, in children and adolescents. It is available from MST Services for a fee.

PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) is a multi-faceted primary care intervention that has demonstrated reductions in suicidal ideation and depression in older adults. It is available Weill Medical College of Cornell University for a fee.

QPR (Question, Persuade, and Refer) Gatekeeper Training for Suicide Prevention is a 1-2 hour educational program designed to teach "gatekeepers"--those who are strategically positioned to recognize and refer someone at risk of suicide (e.g., parents, friends, neighbors, teachers, coaches, caseworkers, police officers)--the warning signs of a suicide crisis and how to respond by following three steps: (1) Question the individual's desire or intent regarding suicide, (2) Persuade the person to seek and accept help, and (3) Refer the person to appropriate resources. It is available from the QPR Institute for a fee.

Reconnecting Youth: A Peer Group Approach to Building Life Skills (RY) is a classroom-based intervention that has demonstrated decreased suicidal behaviors in at-risk adolescents. RY is conducted by teachers or other qualified individuals in classes dedicated to at-risk students. Training is required. RY is available from Reconnecting Youth for a fee.

Limits on Analgesic Packaging demonstrated decreased self-poisoning deaths, among other positive outcomes, in citizens of selected communities in Great Britain. Information about the program has been published in the academic journal literature.

SOS Signs of Suicide is a school-based curriculum and screening program that has demonstrated decreased suicide attempts, among other positive outcomes, in adolescents. SOS can be taught in two one-hour lessons. The program manual and materials are available from Screening for Mental Health for a fee.

Sources of Strength, a universal suicide prevention program, is designed to build socioecological protective influences among youth to reduce the likelihood that vulnerable high school students will become suicidal. The program trains students as peer leaders and connects them with adult advisors at school and in the community. With support from the advisors, the peer leaders conduct well-defined messaging activities intended to change peer group norms influencing coping practices and problem behaviors (e.g., self-harm, drug use, unhealthy sexual practices). Specifically, these activities are designed to reduce the acceptability of suicide as a response to distress, increase the acceptability of seeking help, improve communication between youth and adults, and develop healthy coping attitudes among youth. Sources of Strength is also designed to positively modify the knowledge, attitudes, and behaviors of the peer leaders themselves.

Depending on the size of the high school, 10-50 students are recruited through staff and student nominations to form a team of peer leaders, who are mentored by 2-5 adult advisors. Certified Sources of Strength trainers provide the peer leaders with an initial 4-hour interactive training, which the adult advisors also must attend. Adult advisors facilitate peer leader meetings over 3-4 months to plan, design, and practice messaging activities, including individual messaging, classroom presentations, and media messaging. The peer leaders have one-on-one conversations within their network of friends; develop posters and public service announcements with local faces and voices; give peer-to-peer presentations; and develop messages to be delivered via video, the Internet, or text messages.

The program is often initiated as a 3- to 6-month project, but it is designed as a multiyear project with ongoing peer messaging and contacts growing over time. Adult advisors receive monthly teleconference support meetings with Sources of Strength staff.

United States Air Force Suicide Prevention Program is a multi-faceted public health program that demonstrated decreased suicide deaths, among other positive outcomes, in young adults and adults. The program manual is available from the SPRC online library at no charge.