The BPR is designed to support program planners in creating effective suicide prevention programs. This section defines the term “evidence-based” and its relationship to effective prevention, explains how the BPR incorporates the best available research evidence, and provides specific suggestions for using the BPR as a resource for developing effective prevention programs.
What does the term “evidence-based” mean? Is it the same as “effective prevention?”
Simply put, evidence-based means “based on scientific research.” A common use of this term is in the phrase evidence-based programs, which are interventions that have been rigorously evaluated and demonstrated positive outcomes. For suicide prevention, positive outcomes are reductions in suicidal behaviors or changes in suicide-related risk and protective factors. It is accurate to say that evidence-based programs are “effective” for the populations and settings in which they were tested.
In addition to evidence-based programs, the research literature also offers broad principles and processes for creating and implementing prevention efforts that are more likely to be effective (sometimes also referred to as science-based as well as effective prevention.) Examples include using a data-driven planning process; addressing identified risk and protective factors; setting clear goals and objectives; tailoring programs to the geography, culture, and language of the target audience; and combining multiple strategies into an integrated comprehensive program.
Effective prevention practice includes both choosing evidence-based programs and adhering to principles and processes based on research.
How does the BPR incorporate the best available research evidence?
- By listing evidence-based suicide interventions in Section I. The source for these interventions is SAMHSA's National Registry of Evidence-Based Programs and Practices (NREPP). At minimum, all Section I programs must demonstrate one or more positive outcomes relevant to suicide prevention to qualify for NREPP review. For more information, see Section I.
- By basing Section II and III review criteria on current research and expertise. The design of the BPR recognizes that the suicide prevention field can benefit from dissemination of other information in addition to evaluated programs. These include (1) guidance and recommendations created by experts or consensus processes (Section II listings); and (2) programs, practices, and policies that have undergone review to assess whether the content is accurate, safe, likely to meet specified objectives, and consistent with standards of program design (Section III listings.) While the practices listed in Sections II and III are not evidence-based programs, the criteria used to review these programs are based on the best available research and expertise. For example, the statements in Section II are based on literature reviews and expert consensus. Similarly, the content of materials in Section III has been reviewed for adherence to standards that are based on research and expert consensus.
While the BPR is a useful resource for identifying programs and materials, selecting programs from the BPR is not a substitute for engaging in effective planning processes and adhering to principles of effective prevention. In other words, planners should not simply "pick from the list," but rather should engage in a systematic planning effort and use the BPR to help identify programs or materials that address local needs and circumstances. The next section provides recommendations for using the BPR within the context of an effective planning process.
How can I use the BPR as a resource for developing effective suicide prevention programs?
(1) Engage in a systematic planning process. Program planners are encouraged to use the BPR in the context of a systematic strategic planning process (this example is broadly applicable to community planning, although the surrounding text describes its use in a campus context). In this type of planning process, multiple stakeholders typically work together to assess local needs, assets, and readiness, set goals, choose or create interventions that match local problems and circumstances, and evaluate efforts and use the results for improvement.
BPR listings can be used in several ways during this planning process. For example, planners can search Section I for evidence-based suicide prevention programs that match their identified needs, resources, and audiences. Since the BPR is not a comprehensive list of all evaluated programs, planners are encouraged to conduct a literature search as well. If no evidence-based programs exist that match local needs, planners may consider adapting one of the programs listed in Section I or found in the literature, making revisions based on theory, local assessment, and an understanding of the audience, while retaining key intervention ingredients. Resources about “program fidelity and adaptation” can be helpful in guiding these types of program revisions. A detailed synthesis of the literature on factors that influence program implementation can also inform decisions about local implementation of evidence-based programs.
Whether creating a new program or using an existing one, planners should consult Section II of the BPR to determine whether there are expert or consensus guidelines relevant to their planning efforts.
Program planners can consult Section III to find examples of resource materials, trainings, protocols and policies for suicide prevention that include accurate information, are likely to meet program objectives, follow safe messaging guidelines, and adhere to recommendations for suicide prevention program design. While the programs and materials in Section III have not been reviewed for effectiveness, they are examples of program content that meet specified standards and may be suitable for addressing identified program needs. Finally, by applying the Section III content standards to programs they create or implement, prevention professionals can increase the likelihood that their programs and practices will be effective.
(2) Follow principles of effective prevention practice. Suicide prevention practitioners can benefit from the large body of research about what works in the prevention of other health and safety problems such as injury and substance abuse. For example,
- One review of prevention efforts across four areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence) identified nine characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff.
- Recognizing that best practice principles exist for specific kinds of efforts, this summary provides principles of effective substance abuse prevention divided into six domains: Individual, Family, Peer, School, Community, and Society/Environmental.
- The broader public health literature also emphasizes the need to undertake environmental and systems change efforts that complement and work in sync with individually-focused interventions. Injury prevention expresses this concept through the Three Es of Prevention: Education, Enforcement, and Environment.
Once interventions are selected to meet local needs, planners are encouraged to visit Section II of the BPR and to conduct a targeted search of the broader literature to determine whether there are science-based or best practice principles documented for that type of program, policy, or service (e.g., gatekeeper training, media campaigns, professional training programs, policy development.)
(3) Conduct program evaluation and disseminate the findings. Planners are encouraged to build evaluation into their efforts to assess the effectiveness of their programs and build the knowledge base in the field.
For more information about effective planning and evaluation, see
- About Suicide Prevention
- A Strategic Planning Approach to Suicide Prevention (free online workshop)
- Locating and Understanding Data for Suicide Prevention (free online workshop)
- Colleges & Universities: Developing a Campus Program
- American Indian / Alaska Native Suicide Prevention: Basics of Getting Started
- Evaluation Resources in the SPRC Library
- Planning Resources in the SPRC Library