CAMS: Suicide Prevention Evidence-Based Practice

The CAMS Suicide Prevention Assessment, Intervention & Treatment Is Backed By 30 Years Of On-Going Clinical Research

Replicated data across various clinical research studies show the CAMS approach to suicidal risk:

  • Quickly reduces suicidal ideation in 6-8 sessions;
  • Reduces overall symptom distress, depression, changes suicidal cognitions, and decreases hopelessness;
  • Increases hope and improves clinical retention to care;
  • Is liked by patients who use it;
  • May be optimal for suicidal ideators;
  • The best proven treatment for randomized trials
  • Decreases Emergency Department (ED) visits among certain subgroups;
  • Appears to have a promising impact on self-harm behavior and suicide attempts;
  • Is relatively easy to learn, and become adherent.

Explore the various research studies to learn how CAMS is being utilized effectively

RANDOMIZED CONTROLLED TRIALS (RCT’s)
Gold Standard of Proven Treatment

RESEARCH

Four Randomized Controlled Trials (RCT’s) have been published proving its effectiveness for treating suicidal risk.

Because causality is a central goal in treatment development scientific research, current CAMS research is heavily focused on randomized controlled trial (RCT) designs. To date, there are four published RCT’s of CAMS with several other RCT’s in various stages of completion.

  1. CAMS-Next Day Appointment (NDA) Study:
    The CAMS-NDA RCT was funded by the American Foundation for Suicide Prevention (AFSP). This was a small feasibility-oriented RCT comparing CAMS to Enhanced Care as Usual (E-CAU) with a community-based sample of suicidal outpatients. In this study, 32 suicidal outpatients were randomly assigned to the respective treatment arms in an outpatient mental health treatment clinic housed within a large urban medical center. Despite limited statistical power given the small sample, there were statistically significant experimental findings on all our primary and secondary measures including between-group differences in suicidal ideation, overall symptom distress, and optimism/hope. Importantly, the experimental between-group differences were most robust at the most distal assessment time point (12 months after the index treatment assessment) showing the possible enduring causal impact of CAMS long after the treatment ended (on average around eight sessions). Finally, CAMS patient satisfaction ratings were significantly higher than control patient ratings and the patients receiving CAMS care demonstrated superior treatment retention in comparison to control patients. Access a copy of the journal article: Comtois, Jobes, O’Connor et al 2011
  2. DBT vs. CAMS RCT (the DIAS RCT):
    Researchers in Copenhagen Denmark conducted a well-powered RCT using a parallel group superiority design in which 108 suicide attempters with Borderline Personality Disorder traits were randomly assigned to either Dialectical Behavior Therapy (DBT) or “CAMS-Informed Supportive Psychotherapy.” Data from this study showed no significant differences between DBT and CAMS for the treatment of self-harm and suicide attempts. As DBT is a proven and highly effective treatment for self-harm and suicide attempts this finding was encouraging particularly because patients received significantly less clinical contact (1X/week of CAMS for an average of 10 sessions vs. 2Xweek of DBT for 16 weeks). Access a copy of the journal article: Andreasson, Krogh, Wenneberg et al 2016
  3. Operation Worth Living (OWL) Study:
    The “Operation Worth Living” (OWL) study funded by the US Department of Defense was a well-powered RCT of CAMS vs. Enhanced Care as Usual with an “intent-to-treat” sample of 148 suicidal U.S. Army Soldiers at an outpatient military treatment facility. In this study, CAMS significantly eliminated suicidal ideation in 6-8 sessions significantly more quickly than control care at 3 months follow up and this reduction in ideation was maintained at 6 and 12 months. There are “moderator” data showing that CAMS was significantly better than control care for 6 of 8 significant findings showing that subgroups of CAMS patients had decreased visits to the emergency department, decreases in overall symptom distress, and increases in resilience. Access a copy of the journal articles: Jobes, Comtois, Gutierrez, Brenner et al 2017, Huh, Jobes, Comtois, et al 2018
  4. Managing suicidality within specialized care: A randomized controlled trial
    Researchers in Oslo Norway, conducted a rigorous RCT comparing CAMS to TAU for 80 suicidal patients across 4 different treatment settings. After 6 months, the results demonstrated a significant impact for CAMS on suicidal ideation and overall symptom distress compared to TAU. Access a copy of the journal article: Ryberg et al 2019.

Additional supportive RCT data from two unpublished RCT’s in the US and abroad

A NIMH R-34 grant has funded a small randomized controlled trial at the University of Nevada-Reno Counseling Center comparing CAMS vs. TAU vs. DBT using a sequential multiple assignment randomized trial (a “SMART” design) research methodology where 62 suicidal college students were randomized to 8 sessions of CAMS vs. TAU in Stage 1; for those who do not respond, there is a second randomization to Stage 2 which is 16 weeks of CAMS or 16 weeks of DBT. Within the SMART design, there is the potential to investigate possible dosing effects of different treatments with the prospect of effectively matching different treatments to different suicidal states.

Four on-going RCT’s (Aftercare Focus Study (AFS), Rapid Referral to Suicide Specific Intervention in Psychiatric Emergency Care, Virtual CAMS for Suicidal Patients in the Emergency Department and Suicidal Inpatients (Santel et al)) are presently being conducted in Seattle, Washington, San Diego, and Germany with other RCT’s in the planning stages. Several RCT’s of CAMS with children and teenagers are currently being developed for funding.

RELEVANT CITATIONS
Randomized Controlled Trials of CAMS
Principal Investigator Setting & Population Design & Method Sample Size Status Update
Comtois
(Jobes)
Harborview/Seattle
CMH Patients
CAMS vs.VTAU
Next Day Appts.
32 blue_star_icon 2011 published article
Andreasson
(Nordentoft)
Danish Centers
CMH patients
DBT vs. CAMS
superiority trial
108 blue_star_icon 2016 published article
Jobes
(Comtois et al)
Ft. Stewart, GA
US Army Soldiers
CAMS vs. E-CAU 148 blue_star_icon 2017 published article
Ryberg
(Fosse)
Norwegian Centers
Outpatient/inpatient
CAMS vs. TAU 78 blue_star_icon 2019 published article
Pistorello
(Jobes)
Univ. Nevada (Reno)
College Students
SMART Design
CAMS/TAU/DBT
62 Manuscript under review
Comtois
(Jobes)
Harborview/Seattle
Suicide attempters
CAMS vs. TAU
Post-Hospital D/C
150 ITT Complete; on-going assess
Santel et al German Crisis Unit
Inpatients
CAMS vs. TAU 110 ITT Complete; on-going assess
Depp et al San Diego VAMC
Walk In Veterans
CAMS vs. Outreach
Same Day Services
176 RTC preparation on-going

RELEVANT CITATIONS

  • Comtois, K. A., Jobes, D. A., O’Connor, S., Atkins, D. C., Janis, K., Chessen, C., Landes, S. J., Holen, A., & Yuodelis Flores, C. (2011). Collaborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety, 28, 963-972. Access the DOI.
    AFSP-Funded CAMS vs.TAU RCT; Full description appears after image.

    AFSP-Funded CAMS vs.TAU RCT (Comtois & Jobes et al., 2011). Significantly higher patient satisfaction ratings and better clinical retention…

  • Andreasson, K, Krogh, J., Wenneberg, C., Jessen, H. L. K., Krakauer, K., Gluud, C., Thomsen, R. R., Randers, L., & Nordentoft, M. (2016). Effectiveness of Dialectical Behavior Therapy Versus Collaborative Assessment and Management of Suicidality Treatment for Reduction of Self-Harm in Adults with Borderline Personality Traits and Disorder–A Randomized Observer-Blinded Clinical Trial. Depression and Anxiety. Access the DOI.
  • Wenche, R., Fosse, R., Zahl, P. H., Brorson, I. W., Moller, P., Landro, N. I., & Jobes, D. (2016). Collaborative assessment and management of suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: Study protocol for a randomized controlled trial. Trials Journal. Access the DOI.
  • Jobes, D. A., Comtois, K.A., Gutierrez, P. M., Brenner, L. A., Huh, D., Chalker, S. A., Ruhe, G., Kerbrat, A. H., Atkins, D. C., Jennings, K., Crumlish, J., Corona, C. D., O’Connor, S., Hendricks, K. E., Schembari, B., Singer, B., & Crow, B. (2017). A randomized controlled trial of the collaborative assessment and management of suicidality versus enhanced care as usual with suicidal soldiers. Psychiatry: Interpersonal and Biological Processes, 80, 339–356. Access the DOI.
  • David Huh, David A. Jobes, Katherine Anne Comtois, Amanda H. Kerbrat, Samantha A. Chalker, Peter M. Gutierrez & Keith W. Jennings (2018) The collaborative assessment and management of suicidality (CAMS) versus enhanced care as usual (E-CAU) with suicidal soldiers: Moderator analyses from a randomized controlled trial, Military Psychology, 30:6, 495-506. Access a copy of the article.
  • Pistorello, J., Jobes, D. A., Compton, S., Locey, N. S., Walloch, J. C., Gallop, R., Au, J., Noose, S. K., Young, M., Johnson, J., Dicken, Y., Chatham, P., Jeffcoat, T., Dalto, G., & Goswami, S. (2017). Developing adaptive treatment strategies to address suicidal risk in college students: A pilot Sequential Multiple Assignment Randomized Trial (SMART). Archives of Suicide Research. Access the DOI.
    College Student Client Flow Through SMART; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 1. College Student Client Flow through the SMART. Significant Stage 1 findings for CAMS on suicidal ideation and depression.

    Figure 1. CCAPS Depression; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 1. CCAPS Depression.

    Figure 2. CCAPS Suicidal Ideation Question; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 2. CCAPS Suicidal Ideation Question.

    Figure 3. Hopelessness Moderated by Borderline Features; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 3. Hopelessness Moderated by Borderline Features.

  • Dimeff et al., (2018). DA novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. Access a copy of the article.
    Fig. 1. “Dr. Dave” avatar—graphic representation of scale anchors.; Full description appears after image.

    Fig. 1. “Dr. Dave” avatar—graphic representation of scale anchors.

    Fig. 2. Peer specialist video.; Full description appears after image.

    Fig. 2. Peer specialist video.

    Fig. 3. V-CAMS SSI template.; Full description appears after image.

    FFig. 3. V-CAMS SSI template.

RESEARCH

Four Randomized Controlled Trials (RCT’s) have been published proving its effectiveness for treating suicidal risk.

Because causality is a central goal in treatment development scientific research, current CAMS research is heavily focused on randomized controlled trial (RCT) designs. To date, there are four published RCT’s of CAMS with several other RCT’s in various stages of completion.

  1. CAMS-Next Day Appointment (NDA) Study:
    The CAMS-NDA RCT was funded by the American Foundation for Suicide Prevention (AFSP). This was a small feasibility-oriented RCT comparing CAMS to Enhanced Care as Usual (E-CAU) with a community-based sample of suicidal outpatients. In this study, 32 suicidal outpatients were randomly assigned to the respective treatment arms in an outpatient mental health treatment clinic housed within a large urban medical center. Despite limited statistical power given the small sample, there were statistically significant experimental findings on all our primary and secondary measures including between-group differences in suicidal ideation, overall symptom distress, and optimism/hope. Importantly, the experimental between-group differences were most robust at the most distal assessment time point (12 months after the index treatment assessment) showing the possible enduring causal impact of CAMS long after the treatment ended (on average around eight sessions). Finally, CAMS patient satisfaction ratings were significantly higher than control patient ratings and the patients receiving CAMS care demonstrated superior treatment retention in comparison to control patients. Access a copy of the journal article: Comtois, Jobes, O’Connor et al 2011
  2. DBT vs. CAMS RCT (the DIAS RCT):
    Researchers in Copenhagen Denmark conducted a well-powered RCT using a parallel group superiority design in which 108 suicide attempters with Borderline Personality Disorder traits were randomly assigned to either Dialectical Behavior Therapy (DBT) or “CAMS-Informed Supportive Psychotherapy.” Data from this study showed no significant differences between DBT and CAMS for the treatment of self-harm and suicide attempts. As DBT is a proven and highly effective treatment for self-harm and suicide attempts this finding was encouraging particularly because patients received significantly less clinical contact (1X/week of CAMS for an average of 10 sessions vs. 2Xweek of DBT for 16 weeks). Access a copy of the journal article: Andreasson, Krogh, Wenneberg et al 2016
  3. Operation Worth Living (OWL) Study:
    The “Operation Worth Living” (OWL) study funded by the US Department of Defense was a well-powered RCT of CAMS vs. Enhanced Care as Usual with an “intent-to-treat” sample of 148 suicidal U.S. Army Soldiers at an outpatient military treatment facility. In this study, CAMS significantly eliminated suicidal ideation in 6-8 sessions significantly more quickly than control care at 3 months follow up and this reduction in ideation was maintained at 6 and 12 months. There are “moderator” data showing that CAMS was significantly better than control care for 6 of 8 significant findings showing that subgroups of CAMS patients had decreased visits to the emergency department, decreases in overall symptom distress, and increases in resilience. Access a copy of the journal articles: Jobes, Comtois, Gutierrez, Brenner et al 2017, Huh, Jobes, Comtois, et al 2018
  4. Managing suicidality within specialized care: A randomized controlled trial
    Researchers in Oslo Norway, conducted a rigorous RCT comparing CAMS to TAU for 80 suicidal patients across 4 different treatment settings. After 6 months, the results demonstrated a significant impact for CAMS on suicidal ideation and overall symptom distress compared to TAU. Access a copy of the journal article: Ryberg et al 2019.

Additional supportive RCT data from two unpublished RCT’s in the US and abroad

A NIMH R-34 grant has funded a small randomized controlled trial at the University of Nevada-Reno Counseling Center comparing CAMS vs. TAU vs. DBT using a sequential multiple assignment randomized trial (a “SMART” design) research methodology where 62 suicidal college students were randomized to 8 sessions of CAMS vs. TAU in Stage 1; for those who do not respond, there is a second randomization to Stage 2 which is 16 weeks of CAMS or 16 weeks of DBT. Within the SMART design, there is the potential to investigate possible dosing effects of different treatments with the prospect of effectively matching different treatments to different suicidal states.

Four on-going RCT’s (Aftercare Focus Study (AFS), Rapid Referral to Suicide Specific Intervention in Psychiatric Emergency Care, Virtual CAMS for Suicidal Patients in the Emergency Department and Suicidal Inpatients (Santel et al)) are presently being conducted in Seattle, Washington, San Diego, and Germany with other RCT’s in the planning stages. Several RCT’s of CAMS with children and teenagers are currently being developed for funding.

RELEVANT CITATIONS

Randomized Controlled Trials of CAMS

Comtois (Jobes)

  • Setting & Population: Harborview/Seattle CMH Patients
  • Design & Method: CAMS vs.VTAU Next Day Appts.
  • Sample Size: 32
  • Status Update: 2011 published article

Andreasson (Nordentoft)

  • Setting & Population: Danish Centers CMH patients
  • Design & Method: DBT vs. CAMS superiority trial
  • Sample Size: 108
  • Status Update: 2016 published article

Jobes (Comtois et al)

  • Setting & Population: Ft. Stewart, GA US Army Soldiers
  • Design & Method: CAMS vs. E-CAU
  • Sample Size: 148
  • Status Update: 2017 published article

Ryberg (Fosse)

  • Setting & Population: Norwegian Centers Outpatient/inpatient
  • Design & Method: CAMS vs. TAU
  • Sample Size: 78
  • Status Update: 2019 published article

Pistorello (Jobes)

  • Setting & Population: Univ. Nevada (Reno) College Students
  • Design & Method: SMART Design CAMS/TAU/DBT
  • Sample Size: 62
  • Status Update: Manuscript under review

Comtois (Jobes)

  • Setting & Population: Harborview/Seattle Suicide attempters
  • Design & Method: CAMS vs. TAU Post-Hospital D/C
  • Sample Size: 150
  • Status Update: ITT Complete; on-going assess

Santel et al

  • Setting & Population: German Crisis Unit Inpatients
  • Design & Method: CAMS vs. TAU
  • Sample Size: 110
  • Status Update: ITT Complete; on-going assess

Depp et al

  • Setting & Population: San Diego VAMC Walk In Veterans
  • Design & Method: CAMS vs. Outreach Same Day Services
  • Sample Size: 176
  • Status Update: RTC preparation on-going

RELEVANT CITATIONS

  • Comtois, K. A., Jobes, D. A., O’Connor, S., Atkins, D. C., Janis, K., Chessen, C., Landes, S. J., Holen, A., & Yuodelis Flores, C. (2011). Collaborative assessment and management of suicidality (CAMS): Feasibility trial for next-day appointment services. Depression and Anxiety, 28, 963-972. Access the DOI.
    AFSP-Funded CAMS vs.TAU RCT; Full description appears after image.

    AFSP-Funded CAMS vs.TAU RCT (Comtois & Jobes et al., 2011). Significantly higher patient satisfaction ratings and better clinical retention…

  • Andreasson, K, Krogh, J., Wenneberg, C., Jessen, H. L. K., Krakauer, K., Gluud, C., Thomsen, R. R., Randers, L., & Nordentoft, M. (2016). Effectiveness of Dialectical Behavior Therapy Versus Collaborative Assessment and Management of Suicidality Treatment for Reduction of Self-Harm in Adults with Borderline Personality Traits and Disorder–A Randomized Observer-Blinded Clinical Trial. Depression and Anxiety. Access the DOI.
  • Wenche, R., Fosse, R., Zahl, P. H., Brorson, I. W., Moller, P., Landro, N. I., & Jobes, D. (2016). Collaborative assessment and management of suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: Study protocol for a randomized controlled trial. Trials Journal. Access the DOI.
  • Jobes, D. A., Comtois, K.A., Gutierrez, P. M., Brenner, L. A., Huh, D., Chalker, S. A., Ruhe, G., Kerbrat, A. H., Atkins, D. C., Jennings, K., Crumlish, J., Corona, C. D., O’Connor, S., Hendricks, K. E., Schembari, B., Singer, B., & Crow, B. (2017). A randomized controlled trial of the collaborative assessment and management of suicidality versus enhanced care as usual with suicidal soldiers. Psychiatry: Interpersonal and Biological Processes, 80, 339–356. Access the DOI.
  • David Huh, David A. Jobes, Katherine Anne Comtois, Amanda H. Kerbrat, Samantha A. Chalker, Peter M. Gutierrez & Keith W. Jennings (2018) The collaborative assessment and management of suicidality (CAMS) versus enhanced care as usual (E-CAU) with suicidal soldiers: Moderator analyses from a randomized controlled trial, Military Psychology, 30:6, 495-506. Access a copy of the article.
  • Pistorello, J., Jobes, D. A., Compton, S., Locey, N. S., Walloch, J. C., Gallop, R., Au, J., Noose, S. K., Young, M., Johnson, J., Dicken, Y., Chatham, P., Jeffcoat, T., Dalto, G., & Goswami, S. (2017). Developing adaptive treatment strategies to address suicidal risk in college students: A pilot Sequential Multiple Assignment Randomized Trial (SMART). Archives of Suicide Research. Access the DOI.
    College Student Client Flow Through SMART; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 1. College Student Client Flow through the SMART. Significant Stage 1 findings for CAMS on suicidal ideation and depression.

    Figure 1. CCAPS Depression; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 1. CCAPS Depression.

    Figure 2. CCAPS Suicidal Ideation Question; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 2. CCAPS Suicidal Ideation Question.

    Figure 3. Hopelessness Moderated by Borderline Features; Full description appears after image.

    NIMH-Funded R-34; Pl: Jacque Pistorello, Ph.D.; Co-I: David Jobes, Ph.D. (n=62). Figure 3. Hopelessness Moderated by Borderline Features.

  • Dimeff et al., (2018). DA novel engagement of suicidality in the emergency department: Virtual Collaborative Assessment and Management of Suicidality. Access a copy of the article.
    Fig. 1. “Dr. Dave” avatar—graphic representation of scale anchors.; Full description appears after image.

    Fig. 1. “Dr. Dave” avatar—graphic representation of scale anchors.

    Fig. 2. Peer specialist video.; Full description appears after image.

    Fig. 2. Peer specialist video.

    Fig. 3. V-CAMS SSI template.; Full description appears after image.

    FFig. 3. V-CAMS SSI template.

CORRELATIONAL / OPEN CLINICAL TRIALS &
NON-RANDOMIZED, CASE-CONTROLLED STUDIES

RESEARCH

Eight published correlational/open clinical trials of CAMS in real-world clinics and hospitals around the world provide further support for the efficacy of CAMS.

RELEVANT CITATIONS
Correlational and Open Clinical Trial Support for SSF / CAMS
Authors Sample / Setting n = Significant Results
Jobes et al., 1997 College Students
Univ. Counseling Ctr.
106 Pre/Post Distress
Pre/Post Core SSF
Jobes et al., 2005 blue_star_icon Air Force Personnel Outpatient Clinic 56 Between Group Suicide
Ideation, ED/PC Appts.
Arkov et al., 2008 Danish Outpatients
CMH Clinic
27 Pre/Post Core SSF
Qualitative findings
Jobes et al., 2009 College Students
Univ. Counseling Ctr.
55 Linear reductions
Distress/Ideation
Nielsen et al., 2011 Danish Outpatients
CMH Clinic
42 Pre/Post Distress
Ellis et al., 2012 Psychiatric Inpatients 20 Pre/Post Distress
Suicidal Ideation, depression, hopelessness
Ellis et al., 2015 blue_star_icon Psychiatric Inpatients 52 Suicide ideation and cognitions
Ellis et al., 2017 blue_star_icon Inpatients (& post-discharge) 104 SI, cognitions, depression, hopelessness, funct. impare, well-being, psych flexibility
RESEARCH

Eight published correlational/open clinical trials of CAMS in real-world clinics and hospitals around the world provide further support for the efficacy of CAMS.

RELEVANT CITATIONS

Correlational and Open Clinical Trial Support for SSF / CAMS

Jobes et al., 1997

  • Sample / Setting: College Students Univ. Counseling Ctr.
  • n = 106
  • Significant Results: Pre/Post Distress Pre/Post Core SSF

Jobes et al., 2005

  • Sample / Setting: Air Force Personnel Outpatient Clinic
  • n = 56
  • Significant Results: Between Group Suicide Ideation, ED/PC Appts.

Arkov et al., 2008

  • Sample / Setting: Danish Outpatients CMH Clinic
  • n = 27
  • Significant Results: Pre/Post Core SSF Qualitative findings

Jobes et al., 2009

  • Sample / Setting: College Students Univ. Counseling Ctr.
  • n = 55
  • Significant Results: Linear reductions Distress/Ideation

Nielsen et al., 2011

  • Sample / Setting: Danish Outpatients CMH Clinic
  • n = 42
  • Significant Results: Pre/Post Distress

Ellis et al., 2012

  • Sample / Setting: Psychiatric Inpatients
  • n = 20
  • Significant Results: Pre/Post Distress Suicidal Ideation, depression, hopelessness

Ellis et al., 2015

  • Sample / Setting: Psychiatric Inpatients
  • n = 52
  • Significant Results: Suicide ideation and cognitions

Ellis et al., 2017

  • Sample / Setting: Inpatients (& post-discharge)
  • n = 104
  • Significant Results: SI, cognitions, depression, hopelessness, funct. impare, well-being, psych flexibility

COUNSELING CENTER STUDIES

RESEARCH

There have been several studies with counseling center samples over the years. In replicated non-randomized clinical trials CAMS is associated with decreases in suicidal ideation and overall symptom distress. The intervention was originally developed for use in counseling center settings so it is well-suited to these settings and this population.

RELEVANT CITATIONS
  • Jobes, D. A., Jacoby, A. M., Cimbolic, P., & Hustead, L. A. T. (1997). The assessment and treatment of suicidal clients in a university counseling center. Journal of Counseling Psychology, 44, 368-377. Access the DOI.
  • Jobes, D. A., Kahn-Greene, E., Greene, J., & Goeke-Morey, M. (2009). Clinical improvements suicidal outpatients: Examining suicide status form responses as predictors and moderators. Archives of Suicide Research,13, 147-159. Access the DOI.
  • Jobes, D. A., & Mann, R. E. (1999). Reasons for living versus reasons for dying: Examining the internal debate of suicide. Suicide and Life-Threatening Behavior, 29, 97-104. Access the DOI.
  • Jobes, D. A., Nelson, K. N., Peterson, E. M., Pentiuc, D., Downing, V., Francini, K., & Kiernan, A. (2004). Describing suicidality: An investigation of qualitative SSF responses. Suicide and Life-Threatening Behavior, 34, 99-112. DOI.
  • Jobes, D. A., & Jennings, K. W. (2011). The Collaborative Assessment and Management of Suicidality (CAMS) with College Students (pp 236-254). In D. Lamis and D. Lester (Eds.), Understanding and preventing college student suicide. Springfield, IL: Charles C. Thomas Press.
  • Brancu, M., Jobes, D.A., Wagner, B.A., Greene, J.A., & Fratto, T.A. (2015) Are there linguistic markers of suicidal writing that can predict the course of treatment? A repeated measures longitudinal analysis. Archives of Suicide Research, E-pub ahead of print. Access the DOI.
  • Pistorello, J., Jobes, D. A., Compton, S., Locey, N. S., Walloch, J. C., Gallop, R., Au, J., Noose, S. K., Young, M., Johnson, J., Dicken, Y., Chatham, P., Jeffcoat, T., Dalto, G., & Goswami, S. (2017). Developing adaptive treatment strategies to address suicidal risk in college students: A pilot Sequential Multiple Assignment Randomized Trial (SMART). Archives of Suicide Research. Access the DOI.

INTERNATIONAL STUDIES

RESEARCH

The cross-cultural utility of CAMS has been established through international studies. Particularly studied in Denmark, the SSF has been translated into many languages and CAMS is used around the world including Ireland, England, Poland, Germany, Lithuania, China, Uruguay, and Australia. The CAMS book, “Managing Suicidal Risk: A Collaborative Approach” is or will be translated into the following languages: Latvian, Korean, Polish, Lithuanian, and three dialects of Chinese. Across the various studies, CAMS decreases suicidal ideation and the SSF Core Assessment variables. There is promising evidence for CAMS also having an impact on self-harm and suicide attempts (in comparison to DBT).

RELEVANT CITATIONS
  • Arkov, K., Rosenbaum, B., Christiansen, L, Jonsson, H., Munchowm M. (2008). Treatment of suicidal patients: The collaborative assessment and management of suicidality. Ugeskr Laeger, 170, 149-153.
  • Corona, C. D., Jobes, D. A., Nielsen, A. C., Pedersen, C. M., Jennings, K. W., Lento, R. M., & Brazaitis, K. A. (2013). Assessing and treating different suicidal states in a Danish outpatient sample. Archives of Suicide Research, 17, 302-312. Access the DOI.
  • Jobes, D. A. (2009). The CAMS approach to suicide risk: Philosophy and clinical procedures. Suicidology, 14, 3-7. Access the DOI. Nielsen, A. C., Alberdi, F., & Rosenbaum, B. (2011). Collaborative assessment and management of suicidality method shows effect. Danish Medical Bulletin, 58, A4300. Access the article.
  • Andreasson, K., Krogh, K., Rosenbaum, B., Gluud, C., Jobes, D., & Nordentoft (2014). The DiaS trial: Dialectical behaviour therapy vs. collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits, study protocol for a randomized controlled trial. Trials Journal, 15, 194. Access the DOI.
  • Andreasson, K., Krogh, J., Wenneberg, C., Jessen, H. K., Krakauer, K., Gluud, C.,  & Nordentoft, M. (2016). Effectiveness of dialectical behavior therapy versus collaborative assessment and management of suicidality treatment for reduction of self-harm in adults with borderline —A randomized observer-blinded clinical trial. Depression and Anxiety, 33, 520-530. DOI.
  • Wenche, R., Fosse, R., Zahl, P. H., Brorson, I. W., Moller, P., Landro, N. I., & Jobes, D. (2016). Collaborative assessment and management of suicidality (CAMS) compared to treatment as usual (TAU) for suicidal patients: Study protocol for a randomized controlled trial. Trials Journal. Access the DOI.

INPATIENT STUDIES

RESEARCH

The SSF has been used extensively within inpatient settings. Most notably there has been research at the Mayo Clinic and the Menninger Clinic where a modified version of CAMS (called CAMS-M) has been used for many years. The SSF has been shown to have robust validity and reliability among inpatients; replicated inpatient data has shown the CAMS rapidly decreases suicidal ideation and changes suicidal cognitions over the course of care.

RELEVANT CITATIONS
  • Conrad, A. K., Jacoby, A. M., Jobes, D. A., Lineberry, T. Jobes, D., Shea, C., Fritsche, K., Schmid, P., Ellenbecker, S., Grenell, J., & Arnold-Ewing, T. (2009). A psychometric investigation of the suicide status form with suicidal inpatients. Suicide and Life-Threatening Behavior, 39, 307-320. Access a copy of the article.
  • Ellis, T. E., Allen, J. G., Woodson, H., Frueh, B. C., & Jobes, D. A. (2010). Implementing an evidence-based approach to working with suicidal inpatients. Bulletin of the Menninger Clinic, 73, 339-354. Access the DOI.
  • O’Connor, S., Jobes, D. A., Lineberry, T., & Bostwick, J. M. (2010). An investigation of emotional upset in suicide ideation. Archives of Suicide Research, 14, 35-43. Access the DOI.
  • Kraft, T. L., Jobes, D. A., Lineberry, T. L., & Conrad, A. K. (2010). Brief report: Why suicide? Perceptions of suicidal inpatients and reflections of clinical researchers. Archives of Suicide Research, 14, 375-382. Access the DOI.
  • O’Connor, S.S., Beebe, T.J., Jobes, D. A., Lineberry, T.W., & Conrad, A.K. (2012). The association between the K10 and suicidality: A cross-sectional analysis. Comprehensive Psychiatry, 53, 48-53. Access the DOI.
  • Ellis, T. E., Green, K. L., Allen, J. G., Jobes, D. A., & Nadorff, M. R. (2012). Use of the collaborative assessment and management of suicidality in an inpatient setting: Results of a pilot study. Psychotherapy, 49, 72-80. Access the DOI.
  • O’Connor, S. S., Jobes, D. A., Yeargin, M. K., Fitzgerald, M., Rodriguez, V., Conrad, A. K., & Lineberry, T. W. (2012). A cross-sectional investigation of the suicidal spectrum: Typologies of suicidality based upon ambivalence about living and dying. Comprehensive Psychiatry, 53, 461-467. Access the DOI.
  • Lento, R. M., Ellis, T. E., Hinnant, B. J., & Jobes, D. A. (2013). Using the suicide index score to predict treatment outcomes among psychiatric inpatients. Suicide and Life-Threatening Behavior, 43, 547-561. Access the DOI.
  • Ellis, T. E., Rufino, K. A., Allen, J. G., Fowler, J. C., & Jobes, D. A. (2015). Impact of a suicide-specific intervention within inpatient psychiatric Care: The collaborative assessment and management of suicidality (CAMS). Suicide and Life-Threatening Behavior. Access a copy of the article.
  • Ellis, T. E., Rufino, K. A., & Allen, J. G. (2017). A controlled comparison trial of the collaborative assessment and management of suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six months follow up. Psychiatry Research, 249, 252-260. Access the DOI.
  • Corona, C. D., Ellis, T. E., & Jobes, D. A. (in press). Word count as an indicator of suicide risk in an inpatient setting. Bulletin of the Menninger Clinic. Access the DOI.

RESEARCH ON CAMS TRAINING

RESEARCH

Training in CAMS has been recognized as one of only a handful of national-level suicide-specific professional training approaches. There is compelling unpublished evidence that CAMS training can be effective in changing clinician’s knowledge and attitudes about working with suicidal risk.

In a recent study by LoParo et al (2018), the results suggest that CAMS followed by DBT training are superior at impacting implementation of evidence-based practices of suicide care. These trainings are well known for providing clinicians with novel and specific tools for the 1152 SUICIDE PREVENTION TRAINING treatment of at-risk individuals who experience suicidality that go beyond basic training on best practices related to suicide prevention (Jobes, 2012; Landes et al., 2016; Tørmoen et al., 2014). CAMS, in particular, was specifically created to target suicidality by identifying distal and proximal risk factors and drivers of suicidal intention. One of the advantages of CAMS is that treatment is designed to be a collaborative process in which both the clinician and the client decide the focus of intervention to reduce suicidality (Ellis, Rufino, & Allen, 2017; Jobes, 2012). The empirical evidence on the effectiveness of CAMS to target suicidality is continuing to grow; for example, CAMS demonstrates effectiveness in reducing suicide ideation, overall distress, and increasing hope (Ellis, Rufino, Allen, Fowler, & Jobes, 2015; Jobes, Lento, & Brazaitis, 2012; Ryberg et al., 2016).

In an unpublished study conducted by Schuberg et al (2009) of a range of CAMS-trained Veterans Affairs mental health providers (n=165), the investigators observed significant pre-post training differences related to decreasing clinician anxiety about working with suicidal risk in general, while specifically increasing clinician confidence in assessing and treating suicidal risk. There were further significant pre-post positive training findings related to clinicians’ perceptions about forming an alliance with a suicidal patient, increasing patient motivation, and conducting safety-planning. Importantly, most of these significant CAMS-training pre-post effects were sustained in a 3-month follow up assessment with a subset of the original sample (n=36).

In an online survey of 120 mental health practitioners self-reported adherence to the CAMS therapeutic philosophy was found to be moderate to high, which was comparable to other studies gauging the impact of suicide-focused training (Crowley et al., 2014). Participants further reported relatively high adherence to CAMS practice which was higher than findings on adherence to interventions for other psychiatric issues. Overall adherence to CAMS philosophy and practice did not vary consistently as a function of any contextual variable. For example, a range of clinicians in a range of different settings receiving different training modalities can successfully subscribe to the CAMS therapeutic philosophy and implement CAMS-specific practices.

Data on the positive impact of CAMS training delivered within an e-learning training modality has also been published (Marshall et al., 2014). In this study, a total of n=215 Veterans Affairs mental health providers across five sites were randomized to three conditions: n=69 to CAMS e-learning, n=70 to in-person CAMS training, and n=76 to the control no-training group. We observed in this study that both the CAMS live training and e-learning training were favorably received and no major significant differences between clinician ratings between the live training and e-learning training showing the potential value of an accessible broad-based e-learning training in CAMS to a wide range of mental health providers.

While these studies have some limitations (e.g., their self-report nature), it does seem that clinicians can quickly learn key CAMS concepts and with support and guidance can become CAMS-adherent often with their first case. Further training research is underway going beyond the limits of clinician self-report to more specifically investigate training that results in actual clinician behavior-change by becoming a competent CAMS-adherent clinical provider. A major research project on CAMS Integrated Training (CAMS-IT) offered by CAMS-care is now being developed.

RELEVANT CITATIONS
  • LoParo, D., Florez, I.A., Valentine, N., Lamis, D.A. (2018, August). Associations of Suicide Prevention Trainings with Practices and Confidence among Clinicians at Community Mental Health Centers. Suicide and Life-Threatening Behavior, 49, 1148-1156. Access a copy of the article.
  • Crowley, K. J., Arnkoff, D. B., Glass, C. R., & Jobes, D. A. (2014, April). Collaborative assessment and management of suicidality (CAMS): Adherence to a flexible clinical framework. In J. Crumlish (Chair), The collaborative assessment and management of suicidality: Perspectives from the Catholic University suicide prevention lab. American Association of Suicidology, Los Angeles, CA. Access the DOI.
  • Pisani, A. R., Cross, W. F., Gould, M. S., (2011). The assessment and management of suicide risk: State of workshop education. Suicide and Life-Threatening Behavior, 41, 255-276. Access the DOI.
  • Schuberg, K., Jobes, D. A., Ballard, E., Kraft, T. L., Kerr, N. A., Hyland, C. A., Freimuth, J.Seaman, K., & Guidry, E. (2009, April). Pre/post/post evaluations of CAMS-trained VA clinicians. Poster presented at the annual meeting of the American Association of Suicidology, San Francisco, CA.
  • Marshall, E., York, J., Magruder, K., Yeager, D., Knapp, R., De Santis, M., Burriss, L., Mauldin, M., Sulkowski, S., Pope, C., & Jobes, D. (2014). Implementation of online suicide-specific training for VA providers. Academic Psychiatry. Access the DOI.

CAMS RESEARCH AND WORK WITH SUICIDAL SERVICE MEMBERS AND VETERANS

RESEARCH

CAMS has been used across all US military service branches and throughout VA mental health care across the country. Dr. Jobes and CAMS-care consultants routinely provide expert consultation, process improvement, and on-going research with both the US Department of Defense and Veterans Affairs. This work has led to various professional publications and on-going as well as future research projects with these significantly at-risk populations.

RELEVANT CITATIONS
  • Oordt, M., Jobes, D., Rudd, M., Fonseca, V., Russ, C., Stea, J., Campise, R., & Talcott, W. (2005). Development of a clinical guide to enhance care for suicidal patients. Professional Psychology: Research and Practice. 36, 208-218. Access the DOI.
  • Jobes, D. A., Wong, S. A., Conrad, A., Drozd, J. F., & Neal-Walden, T. (2005). The Collaborative assessment and management of suicidality vs. treatment as usual: A retrospective study with suicidal outpatients. Suicide and Life-Threatening Behavior, 35, 483-497. Access the DOI.
  • Nademin, E., Jobes, D. A., Pflanz, S. E., Jacoby, A. M., Ghahramanlou-Holloway, M., Campise, R., Joiner, T. E., Wagner, B, M, & Johnson, L. (2008). An investigation of interpersonal-psychological variables in air force suicides: A controlled comparison study. Archives of Suicide Research, 12, 309-326. Access the DOI.
  • Oordt, M. S., Jobes, D. A., Fonseca, V. P., & Schmidt, S. M. (2009). Training mental health professionals to assess and manage suicidal behavior: Can provider confidence and practice behaviors be altered? Suicide and Life-Threatening Behavior, 39, 21-37. Access the DOI.
  • Jobes, D. A., Bryan, C. J., & Neal-Walden, T. A. (2009). Conducting suicide research in naturalistic clinical settings. Journal of Clinical Psychology, 65, 382-395. Access the DOI.
  • Cox, D.W., Ghahramanlou-Holloway, M., Greene, F. N., Bakalar, J. L., Schendel, C. L., Nademin, E., Jobes, D., Englert, D., & Kindt, M. (2011). Suicide in the United States Air Force: Risk factors communicated before and at death. Journal of Affective Disorders, 133, 398-405. Access the DOI.
  • Bryan, C. J., Jennings, K. W., Jobes, D. A., & Bradley, J. C. (2012). Understanding and preventing military suicide. Archives of Suicide Research, 16, 95-110. Access the DOI.
  • Jobes, D. A., Lento, R., & Brazaitis, K. (2012). An evidence-based clinical approach to suicide prevention in the department of defense: The collaborative assessment and management of suicidality (CAMS). Military Psychology, 24, 604-623. Access the DOI.
  • Martin, J.S., Ghahramanlou-Holloway, M., Englert, D., Bakalar, J.L., Olsen, C., Nademin, E., Jobes, D., & Branlund, S. (2013). Marital status, life stressor precipitants, and communications of distress and suicide intent in a sample of United States Air Force suicide decedents. Archives of Suicide Research, 17(2). Access the DOI.
  • Jobes, D. A. (2013). Reflections on suicide among soldiers. Psychiatry, 76, 126-131. Access the DOI.
  • Marshall, E., York, J., Magruder, K., Yeager, D., Knapp, R., De Santis, M., Burriss, L., Mauldin, M., Sulkowski, S., Pope, C., & Jobes, D. (2014). Implementation of online suicide-specific training for VA providers. Academic Psychiatry. Access the DOI.
  • Johnson, L. L., O’Connor, S. S., Kaminer, B., Jobes, D. A., & Gutierrez, P. M. (2014). Suicide-focused group therapy for veterans. Military Behavioral Health, 2, 327–336. Access the DOI.
  • Archuleta, D., Jobes, D. A., Pujol, L., Jennings, K., Crumlish, J., Lento, R. M., Brazaitis, K., Moore, B. A., & Crow, B. (2014). Raising the Clinical Standard of Care for Suicidal Soldiers: An Army Process Improvement Initiative. Army Medical Department Journal, Oct-Dec, 55-66. Access a copy of the article article.
  • O’Connor, S. S., Carney, E., Jennings, K. W., Johnson, L. L. Gutierrez, P. M., & Jobes, D. A. (2016). Relative impact of risk factors, thwarted belongingness, and perceived burdensomeness on suicidal ideation in veteran service members. Journal of Clinical Psychology. [Epub ahead of print] Access the DOI.
  • Jobes, D. A., Comtois, K.A., Gutierrez, P. M., Brenner, L. A., Huh, D., Chalker, S. A., Ruhe, G., Kerbrat, A. H., Atkins, D. C., Jennings, K., Crumlish, J., Corona, C. D., O’Connor, S., Hendricks, K. E., Schembari, B., Singer, B., & Crow, B. (2017). A randomized controlled trial of the collaborative assessment and management of suicidality versus enhanced care as usual with suicidal soldiers. Psychiatry: Interpersonal and Biological Processes, 80, 339–356. Access the DOI.
  • Johnson, L.L., O’Connor, S.S., Kaminer, B., Gutierrez, P.M., Carney, E., Groh, B., & Jobes, D.A. (in press). Evaluation of structured assessment and mediating factors of suicide focused group therapy for Veterans recently discharged from inpatient psychiatry. Archives of Suicide Research. Access the DOI.

DELIVERING CAMS VIA TELEPSYCHOLOGY

RESEARCH

Telepsychology is a method for delivering mental health care to clients and patients in underserved communities, such as remote areas and post-disaster settings. Research studies have shown that evidence-based psychotherapies can be delivered effectively through telepsychology.

Some of the benefits of telepsychology include: flexible scheduling, access to therapy in native languages, saving time from driving long distances, and increased availability of quality evidence-based treatment interventions.

While there are limitations to this long-distance method of care, in a recent paper, Scott Waltman, Julie Landry, Lynette Pujol, and Bret Moore describe workable solutions, including the effectiveness of using the CAMS Framework via teleconferencing.

Traditionally the CAMS Framework is performed with the clinician sitting side by side with the patient, and the Suicide Status Form (a highly interactive assessment process) is handed back and forth between the patient and clinician during the assessment. In this study, the initial SSF was sent to the patient at the remote site prior to the intake session. According to the paper, “[f]ollowing introductions and consents, CAMS was introduced to the patient. The traditional protocol was discussed as well as the necessary adaptations to conduct the treatment through telepsychology. Specifically, the patient was told a single SSF was meant to be shared and coauthored by the patient and clinician but would be completed together on two separate copies by each participant during the session.

“Information gleaned from the qualitative responses on the SSF was used to inform treatment interventions in subsequent sessions. The treatment plan and crisis response plan were similarly updated as necessary. At the conclusion of each session, [the patient] and the provider kept their own copy of the form, and the therapist’s worksheet was uploaded into the soldier’s electronic medical record for documentation purposes. The first several sessions were marked by significant declines in severity ratings on the tracking sheets. After five sessions, [the patient] was no longer reporting suicidal thoughts. The subsequent session focused on understanding warning signs for possible future episodes of suicidal ideation and additional coping skills to address inevitable life stressors. During the final session, the final SSF was compared side by side with the initial SSF to serve as a visual aid of the patient’s treatment progress.”

This paper illustrates how to modify existing research-supported treatment protocols for use with video-teleconferencing based telepsychology. This helps ensure that people in remote areas or areas with provider shortages can have access to quality mental health care.

RELEVANT CITATIONS

Waltman, S. H., Landry, J. M., Pujol, L. A., & Moore, B. A. (2019, October 3). Delivering Evidence-Based Practices via Telepsychology: Illustrative Case Series From Military Treatment Facilities. Professional Psychology: Research and Practice. Advance online publication. Access the paper.