Applications of the CAMS Framework® to Different Settings and Populations
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THE CAMS FRAMEWORK®
At CAMS-care we are passionate about treating each person’s specific suicidal risk with empathy, collaboration, and honesty. The Collaborative Assessment and Management of Suicidality (CAMS) is backed by 30 years of clinical research. Within the CAMS Framework we never shame or blame, we strive to understand the patient’s suffering through their eyes in an empathic, non-judgmental way. CAMS targets and treats patient-defined problems that make them suicidal. The CAMS Framework is flexible, can be learned quickly, and can be adapted to a range of theoretical approaches and the spectrum of clinical settings.
Active Duty Service Members
CAMS has been successfully used across military service branches, both in garrison and within combat environments abroad. There is proven support for CAMS rapidly decreasing suicidal ideation in military samples and replicated evidence for decreasing emergency department visits.
Selected Publications:
Jobes, D. A., Comtois, K.A., Gutierrez, P. M., Brenner, L. A., Huh, D…..& 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.
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.
Adolescents
There has been extensive use of CAMS with suicidal teenagers and this is now a major focus of on-going CAMS research. There are a few projects that will lead to randomized controlled trial studies of “CAMS-4Teens” as researcher are considering adaptations of CAMS for teenagers and working constructively with their parents as well.
Selected Publications:
Anderson, A. R., Keyes, G. M. & Jobes, D. A. (2016). Understanding and treating suicidal risk in young children. Practice Innovations, 1, 3-19.
Jobes, D. A., Vergara, G., Lanzillo, E., & Ridge-Anderson, A. (in press). The potential use of CAMS for suicidal youth: Building on epidemiology and clinical interventions. Children’s Health Care.
Adults
There is overwhelming evidence supporting the effective use of the CAMS framework with suicidal adults supported by eight correlational/open clinical trials, four published randomized controlled trials, and one unpublished randomized controlled trial.
Selected Publications:
Jobes, D. A. (2012). The collaborative assessment and management of suicidality (CAMS): An evolving evidence-based clinical approach to suicidal risk. Suicide and Life-Threatening Behavior, 42, 640-653.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Children
CAMS research is now underway to modify the framework for suicidal children 4-12 with a particular emphasis on the best way to engage parental/family support. There are major adaptations needed to work with suicidal children, including drawings and developmental modification of terms and language used. Feasibility clinical use suggests that “CAMS-4Kids” can be effective but extensive clinical research is needed to fully understand its best use.
Selected Publications:
Anderson, A. R., Keyes, G. M. & Jobes, D. A. (2016). Understanding and treating suicidal risk in young children. Practice Innovations, 1, 3-19.
Jobes, D. A., Vergara, G., Lanzillo, E., & Ridge-Anderson, A. (in press). The potential use of CAMS for suicidal youth: Building on epidemiology and clinical interventions. Children’s Health Care.
Community Mental Health Settings
The CAMS Framework has been extensively used around the work with community mental health treatment settings. Indeed, much of the empirical work supporting the use of CAMS has been conducted in such settings in the United States as well as abroad.
Selected Publications:
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.
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.
Crisis Centers
CAMS has been used extensively in crisis center settings in the United States and around the world. Its flexibility and adaptability ensures its effective use for suicidal crisis patients.
Selected Publications:
Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach 2nd edition. New York: Guilford Press.
Ryberg, W., Zahl, P-H., Diep, D. M., Landro, N. I., & Fosse, R. (2019). Managing suicidality within specialized care: A randomized controlled trial. Journal of Affective Disorders, 249, 112-120.
Employee Assistance Program (EAP)
The assessment aspect of CAMS can be used within relatively short-term employee assistance programs to assess and even briefly treat suicidal risk in employees. Meta-analytic research has shown that the assessment approach used within CAMS functions as a therapeutic assessment.
Selected Publications:
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Poston, J. M. & Hanson, W. E. (2010). Meta-analysis of psychological assessment as a therapeutic intervention. Psychological Assessment, 22, 203-212.
Forensic Settings
There has been extensive clinical use of CAMS in prison settings with suicidal inmates in the California penal system and within the Georgia juvenile justice system for suicidal incarcerated youth. There has been some feasibility research and there is now further interest in conducting a randomized controlled trial with suicidal inmates. The possible use of CAMS through telehealth is also under consideration.
Selected Publications:
Jobes, D. A. (2016).Managing suicidal risk: A collaborative approach 2nd edition. New York: Guilford Press.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Inpatients
While standard CAMS is most widely used in outpatient settings, there have been inpatient adaptations of the framework that has been proven effective in a randomized controlled trial conducted in Oslo Norway for quickly decreasing suicidal ideation and overall symptom distress.
Selected Publications:
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250. http://dx.doi.org/10.1037/ser0000229
Ryberg, W., Zahl, P-H., Diep, D. M., Landro, N. I., & Fosse, R. (2019). Managing suicidality within specialized care: A randomized controlled trial. Journal of Affective Disorders, 249, 112-120.
Native Americans
The CAMS framework has been trained and used within a half-dozen different tribal nations in the United States. One of the compelling virtues of the model is its cross-cultural flexibility and the fact that native medicine and ritual can be integrated into the treatment framework. As CAMS has literally been used around that world with success, there is evidence of cultural adaptation that is unusual and welcomed within Native American use of the approach.
Selected Publications:
Jobes, D. A. (2016).Managing suicidal risk: A collaborative approach 2nd edition. New York: Guilford Press.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Outpatients
“Standard” use of the CAMS framework primarily focuses on working with suicidal people on an outpatient basis. A major goal of using CAMS within outpatient care is potentially keeping a suicidal patient out of the hospital if at all possible. Our research has shown that this can be done safely through stabilization planning and the treatment of patient-defined suicidal drivers with sufficient documentation to decrease the risk of malpractice liability. There are five correlational clinical trial studies and four randomized controlled trials supporting outpatient CAMS.
Selected Publications:
Jobes, D. A. (2012). The collaborative assessment and management of suicidality (CAMS): An evolving evidence-based clinical approach to suicidal risk. Suicide and Life-Threatening Behavior, 42, 640-653.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250. http://dx.doi.org/10.1037/ser0000229
Primary Care/Behavioral Health
CAMS has been clinically used within primary care across behavioral healthcare systems. Because CAMS is a flexible clinical framework, it can be adapted and tailored to different systems and different needs.
Selected Publications:
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.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Private Practice
Private practitioners oftentimes feel isolated and vulnerable in their work with suicidal patients. The CAMS framework provides a structured approach and creates extensive documentation that helps decrease exposure to malpractice liability. The robust evidence base supporting CAMS provides reassurance that one is using a proven approach for effectively treating suicidality.
Selected Publications:
Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach 2nd edition. New York: Guilford Press.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
School Settings
There is growing interest in using CAMS within school settings—some exploratory work in this area shows promise for effectively using CAMS within a school-based system of care.
Selected Publication:
Capps, R. E., Michael, K.D., & Jameson, J. P. (2019). Lethal means and adolescent suicidal risk: An expansion of the PEACE protocol. Journal of Rural Mental Health, 43, 3-16
Telehealth
The CAMS Framework has been adapted in various settings for use within telehealth care. There has been some preliminary use of telehealth CAMS within the U.S. Military; the feasibility of using telehealth CAMS within forensic and rural/frontier environments is also being explored.
Selected Publications:
Jobes, D. A. (2016). Managing suicidal risk: A collaborative approach 2nd edition. New York: Guilford Press.
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250.
Veterans
CAMS has been trained across dozens of Veterans Affairs Medical Centers and across various networks of VA healthcare systems (VISN’s). The framework has been used within both VA outpatient and inpatient care. Veterans Affairs (HSR&D) is now funding a randomized controlled trial of CAMS for suicidal walk-in veterans at the San Diego VAMC.
Selected Publication:
Jobes, D. A., Gregorian, M. J., & Colborn, V. A. (2018). A stepped care approach to clinical suicide prevention. Psychological Services, 15, 243-250. http://dx.doi.org/10.1037/ser0000229
University Counseling Center Settings
The CAMS Framework was originally developed for working with suicidal students in a university counseling center. Given this history, it is wonderfully well-suited for treating suicide risk on an outpatient basis among students struggling with suicidal thoughts. There is an extensive literature about the effective use of CAMS over decades of clinical use and research.
Selected Publications:
Jobes, D. A., Jacoby, A. M., Cimbolic, P., & Hustead, L. A. T., (1997). The assessment and treatment of suicidal clients in a university center. Journal of Counseling Psychology, 44, 368-377.
Pistorello, J., Jobes, D. A., Compton, S., Locey, N. S., Walloch, J. C…..& 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.
Zero Suicide Policy Initiative
As a flexible therapeutic framework, CAMS is ideally suited for integration into the Zero Suicide policy approach to systems-level suicide prevention. While the Zero Suicide approach has been transformative for the field around the world, the full embrace of effective suicide-specific care has often lagged behind. CAMS can be readily adapted into the model to provide effective evidence-based care for suicidal risk across treatment settings and populations.
Suggested resource:
Zero Suicide Video