Suicide Prevention Consultation Design: CASE, Suicide Prevention Triangle, and Individual-Family-School-Work-Community Links for Effectiveness
The objective of this study is to design a suicide prevention consultation. The student will describe the consultation model and level of intervention based on current research. Suicide is described as the "ultimate mental health crisis" and one that is all too common among children and youth. There are approaches designed based on proven scientific methods that best deal with the individual who is contemplating suicide.
The CASE Approach
One of these is the CASE approach which holds that the "art of suicide assessment is composed of three tasks and the first two of which are information gathering, first in terms of information related to the risk factors for suicide in the client and secondly, in regards to the suicidal ideation and planning of the patient. The third task relates to clinical decision making applied to these two areas in which information informs the clinician of how to proceed. It is reported that there is little doubt that two clinicians can walk away from assessing the suicidal patient with different impressions based upon the elicitation of suicidal ideation from the patient "depending on how the questions were phrased and the degree with which the patient felt comfortable discussing his or her suicidal ideation." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) There are various approaches for how to best design a suicide prevention consultation. This study endeavors to examine and disseminate knowledge on what is empirically shown to be of critical importance in such a design.
The CASE approach is described as being "flexible, practical, and easily learned" for interviewing and eliciting suicidal ideation, planning, and intent." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) The CASE approach is designed for increasing validity and decreasing errors of omission and increasing the patient level of safety with the interviewer. The techniques and strategies of the CASE approach are reported as "concretely behaviorally defined." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) It can consequently be taught easily and the clinician's skill testing and documented for purposes of quality assurance. The CASE Approach is based upon the idea that the approach should be one that is "easily learned" and "easily remembered" and one that "should not require written prompts." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) The approach should be such that ensures that the "large database regarding suicidal ideation is comprehensively covered and the approach should furthermore "increase the validity of the information elicited from the patient whether this information be a denial of suicidal ideation or an explication of the extent of ideation and planning." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) The approach should be one that can be taught easily and the clinician's skill level tested and should as well be an approach "that is behaviorally concrete enough that it subsequently lend itself to empirical research." (Training Institute for Suicide Assessment and Clinical Interviewing, 2012, p.1) The CASE approach is reported as "one such method. It is not presented as the 'right way' to elicit suicidal ideation.
II. Suicide Prevention Triangle
The Psychiatric Times articles entitled "Uncovering Suicidal Intent: A Sophisticated Art" reports that a suicide assessment protocol is comprised by three primary elements which should sound familiar as they are, just as in the CASE approach cited as information gathering on risk factors and the client's "suicidal ideation, planning, behaviors and intent." (Shea, 2009, p.1) The third element is the "clinical formulation of risk based on these 2 databases." (Shea, 2009, p.1) Shea states as well, that three primary considerations include that: (1) clients most intent to commit suicide might not reveal this fact; (2) the client's actual intent "may be a combination of what the patient tells the interview is his or her intent, and (3) what plans and actions may reflect the patient's actual intent, and what intent the patient or unconsciously withholds" (Shea, 2009, p.1); and (3) it is suggested by motivational theory that "…in some instances, reflect intent- amount of ideation, extent of planning, and actions taken on planning may be a more accurate indicator of actual intent than what a patient states is his intent. (Shea, 2009, p.1) The Suicide Prevention Triangle Model and Theory is one that has been adapted from the Fire Prevention Model and is based on necessary and sufficient causes of self-injurious behavior including; (1) intensity of wish to die; (2) degree of planning; and (3) kind of amount of distress. (Cutter, nd, p.1) The model as conceptualized is shown in the following illustration labeled Figure 1 in this study.
Figure 1 -- Suicide Prevention Model
Source: Shea (2009)
Assessment of the client's perspective on the value of life can be conducted by asking the client questions including open-ended questions to assess the severity and intensity of the client's desire and likelihood to commit suicide. The intensity of the client's wish to die must also be assessed and this is addressed as well with the base for assessment being rooted in three specific intensities as shown in the following illustration labeled Figure 2.
Figure 2 -- Intensity of Wish to Die
Source: Shea (2009)
The degree of planning the client has taken to move towards the commission of suicide. For example there is what is known as deliberate planning which is thought about and premeditated and envisioned by the client and other clients are more prone to impulsive planning with no preset plan of how they will proceed with the act of suicide. There are cries for helps both implicit and explicit, all which must be considered when conducting a suicide consultation. The following illustration labeled Figure 4 shows this aspect of the model.
Figure 3 -- Degree of Planning
Source: Shea (2009)
This model further emphasizes the need to assess for the degree of stress of the client which ranges from acute anxiety to toxic reaction to substances as shown in the following illustration on 'kinds and amount of distress' that must be assessed in the client in alignment with this specific suicide prevention consultation model.
Figure 4 -- Kind and Amounts of Stress
Source: Shea (2009)
Prevention programs are required to be designed to enhance the protective factors of individuals and should as well work with reducing or eliminating known risk factors. Prevention programs should be long-term with repeat interventions to reinforce the original prevention goals. Prevention should be family-focused and should be inclusive of community programs that are inclusive of media campaigns and change in policy along with individual and family interventions to enhance effectiveness. Prevention programming to should be adapted to specific communities in which norms are strengthened in the supporting of help-seeking behaviors in family, work, school, and community settings. The higher risk target populations should have more intensive prevention programs. Prevention programs should be "…age-specific, developmentally appropriate, and culturally sensitive…" and should be such that are "…implemented with no or minimal differences from how they were designed and tested." (Potter, L, et al. (1998) Potter, et al. (1998) bases their model upon the models approved by the following:
(1) American Evaluation Association (2012) Retrieved from: http://www.eval.org/
(2) CDC Evaluation Working Group (2012) Retrieved from: http://www.cdc.gov/eval
III. Combination of the CASE Approach and the Extensive Family-Work-School-Community Links for Effectiveness
What these and the two models described in this order have in common is the need for assessment of the client's risk and likelihood to commit the act of suicide. These two models however, fail to include the extending of these elements of the program to those noted in the above-stated program requirements. That extension is such that goes beyond the initial consultation and treatment of the client in that linked are the community, family, and individual in a preventative existence in the home, at work, at school and in the family and community-at-large as well.
American Evaluation Association (2012) Retrieved from: http://www.eval.org/
CDC Evaluation Working Group (2012) Retrieved from: http://www.cdc.gov/eval
W.K. Kellogg Foundation Evaluation Handbook (2012) Retrieved from: http://www.wkkf.org/Documents/WKKF/Evaluation Handbook/default.asp
National Mental Health Association -- Effective Prevention Programs (2012) Retrieved from: http://www.nmha.org/children/prevent/effective.cfm
Prevention First -- Online Course on Basics of Prevention (2012) Retrieved from: http://www.onlinesyllabus.com/prevention/