Authors: David A. Jobes Ph.D. ABPP

David Jobes, PhD, ABPP, is the founder of CAMS-care, LLC. He began his career in 1987 in the Counseling Center of the Catholic University of America, where he developed a suicide risk assessment tool for college students that evolved into CAMS. Dr. Jobes is now a Professor of Psychology and Associate Director of Clinical Training at Catholic; he has trained thousands of mental health professionals in the United States and abroad in evidence-based assessment and treatment of suicide risk and the use of CAMS.

Zero Suicide – Outcomes and Opportunities

Zero Suicide - Outcomes and Opportunities

The Zero Suicide model was launched in 2012 as part of the National Action Alliance for Suicide Prevention. Consistent with the National Strategy for Suicide Prevention, Zero Suicide called for improved suicide identification and care in health care systems and promoted use of evidence-based practices by health care providers. Seven core elements comprise the model: “Lead”, “Train”, and “Improve” are the structural components embedded throughout the system and necessary for change success, fidelity, and continuous quality improvement. “Identify”, “Engage”, “Treat”, and “Transition” are clinical components of the model and define the care patients should receive. Despite evidence supporting each component, use of the full model within systems of care varies.

Over 38% of individuals have made a healthcare visit (e.g., primary care, emergency department, specialty care, etc.) within the week before their suicide attempt and 95% have had a healthcare visit within the preceding year. While this varies across race and ethnicity, these are clearly missed opportunities to identify and care for people at risk for suicide.

Seeing suicide as a never event forces the organization to use best practices, apply continuous quality improvement, and emphasize reducing errors while holding the system to account, not the individual. The clinical science of treating suicidality has evolved such that we now have several proven suicide-specific treatments with additional promising treatments in development. However, graduate programs, professional certification, and continuing education rarely focus on suicide-specific treatments as a competency for graduation or licensure and clinicians report a lack of comfort, confidence, and skill in delivering suicide care.

The Zero Suicide approach has demonstrated notable reductions in suicide and suicide behaviors as well as improvements to using evidenced-based practices. This webinar will describe the Zero Suicide model, discuss challenges, disparities, and opportunities regarding uptake of the unique components of the model, and share how organizations can get started on their Zero Suicide implementation efforts.

Julie Goldstein Grumet, PhD

Julie Goldstein Grumet, PhD

Julie is Vice President for Suicide Prevention Strategy and the Director of the Zero Suicide Institute at the Education Development Center. She provides strategic direction to health care systems to improve the identification and treatment for people at risk for suicide. She has collaborated on numerous grants and publications about systems-based approaches to suicide prevention. Julie’s primary responsibility is to advance the development, dissemination, and effective implementation of comprehensive suicide care practices in various settings. She has expertise in behavioral health transformation, state and local community suicide prevention, quality improvement, and the use of evidence-based practices for suicide care in clinical settings. Julie has a Ph.D. in Clinical Psychology from The George Washington University and lives in Silver Spring, MD.

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Improving Outpatient Suicide Treatment, a Better Alternative to EDs and Hospitals

Improving Outpatient Suicide Treatment, a Better Alternative to EDs and Hospitals

In a 2021 proclamation, President Biden stated “My Administration is committed to advancing suicide prevention best practices and improving non-punitive crisis response.” This and other mandates for suicide care have come from the Joint Commission and system change recommendations from national Zero Suicide programs. Because of these efforts there has been substantial expansion of suicide screening and assessment as well as safety planning, but treatment has lagged behind. As a result, patients and families are often referred to the emergency department even when an outpatient intervention is better suited to their immediate needs. This approach results in overwhelmed systems and negative experiences for patients and providers. The new Suicide Care Research Center at the University of Washington is working to improve the design and delivery of suicide specific care in outpatient medical settings, so they are effective, feasible in busy clinic environments and supportive of adolescent and young adult (AYA) patients, their providers, and their families. This presentation will highlight the need for a paradigm shift in suicide care, describe our innovative integration of human centered design and optimization in the development of new interventions, and showcase some example interventions and interventions under development.

Kate Comtois, PhD, MPH

Kate Comtois, PhD, MPH

Kate Comtois, PhD, MPH is a professor and clinical psychologist in the University of Washington Department of Psychiatry and Behavioral Sciences and director of the UW Center for Suicide Prevention and Recovery (CSPAR) and the Suicide Care Research Center (SCRC) – an NIMH-funded practice-based research center. Dr. Comtois’ career is dedicated to promoting the recovery of individuals experiencing suicidal thoughts and behavior and the effectiveness and resilience of the clinical staff and families who care for them. This is the focus of her clinical work and training as well as her health services, treatment development, clinical trials, and implementation research.

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Using Advances in Technology to Advance the Understanding, Prediction, and Prevention of Suicide

Using Advances in Technology to Advance the Understanding, Prediction, and Prevention of Suicide On-Demand Webinar

Suicide is a leading cause of death in the US and worldwide. Whereas the mortality rate associated with many leading causes of death (cancer, pneumonia, HIV/AIDS) has declined dramatically over the past decades, the suicide rate is the same now as it was 100 years ago. Recent advances in technology and computing are providing tools that have been used to advance the understanding, prediction, and prevention of suicidal behaviors in recent years. This presentation will review some of these advances and the ways in which they could be incorporated into clinical practice in a range of different hospital- and community-based settings.

Matthew K. Nock, Ph.D.

Matthew K. Nock, Ph.D.

Matthew K. Nock, Ph.D. is the Edgar Pierce Professor of Psychology, Harvard College Professor (2019-2024), and Chair of the Department of Psychology at Harvard University. Professor Nock received his Ph.D. in psychology from Yale University (2003) and completed his clinical internship at Bellevue Hospital and the New York University Child Study Center (2003). Nock’s research is aimed at advancing the understanding why people behave in ways that are harmful to themselves, with an emphasis on suicide and other forms of self-harm. His research is multi-disciplinary in nature and uses a range of methodological approaches (e.g., epidemiologic surveys, laboratory-based experiments, clinic-based studies, digital monitoring via smartphones and biosensors, and web- and social-media-based experiments) to better understand how these behaviors develop, how to predict them, and how to prevent their occurrence. This work is funded by grants from the US National Institutes of Health, US Department of Defense, US Army, and private foundations and has been published in over 350 scientific papers. Nock’s work has been recognized through the receipt of career awards from the American Psychological Association, the Association for Behavioral and Cognitive Therapies, and the American Association of Suicidology; and in 2011 he received a MacArthur Fellowship (aka “Genius Grant”). At Harvard, Professor Nock has taught courses on statistics, research methods, self-destructive behaviors, developmental psychopathology, and cultural diversity—for which he has received teaching and mentoring awards including the Roslyn Abramson Teaching Award, the Petra Shattuck Prize, and the Lawrence H. Cohen Outstanding Mentor Award.

 

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Stigma, Shame, and Suicide Webinar

Stigma, Shame, and Suicide On-Demand Webinar

The connection between stigma, shame, and suicide will be discussed, with a focus on not just understanding the importance of these challenges in clinical care, but what available empirical evidence suggests are the most effective ways to target stigma and shame in treatment. Simple, strategic, and effective interventions will be shared.

M. David Rudd, Ph.D., ABPP

About M. David Rudd, Ph.D., ABPP

M. David Rudd, Ph.D., ABPP is Distinguished University Professor of Psychology and President Emeritus at the University of Memphis. His undergraduate degree is from Princeton University and his doctoral degree from the University of Texas. As one of the developers of brief cognitive behavioral therapy for suicide prevention (BCBT-SP), he has published and cited extensively on the assessment, clinical management, and treatment of suicide risk. A recently completed RCT demonstrated the effectiveness of a modified BCBT-SP protocol with suicidal inpatients.

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Innovations in Clinical Suicide Prevention: CAMS Update and the 3rd Edition of “Managing Suicidal Risk”

Innovations in Clinical Suicide Prevention: CAMS Update and the 3rd Edition of "Managing Suicidal Risk” On-Demand Webinar

This webinar provides a major update on the use of CAMS focused on the third and final edition of “Managing Suicidal Risk: A Collaborative Approach” published by Guilford Press. This webinar delves into the latest research and tools presented in the new book, written for mental health clinicians dedicated to treating their patients experiencing serious thoughts of suicide.
Explore the key highlights of the new book, including the:

  • Updated Suicide Status Form (SSF-5) for comprehensive risk assessment and suicide-focused treatment
  • CAMS-4Teens®: Engaging parents and families in adolescent care using the new Stabilization Support Plan (SSP)
  • Exploration of post-suicidal life and the optional Living Status Form (LSF)
  • Further insights on CAMS driver-oriented treatment planning
  • Major revision of the CAMS Therapeutic Worksheet
  • Suicide Status Form is available digitally for telehealth and electronic health records

Don’t miss this opportunity to hear directly from Dr. Jobes during Suicide Prevention Awareness Month. Hosted by Dr. Kevin Crowley, clinical psychologist, private practitioner and CAMS Consultant.

 

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Big Ideas for Advancing Suicide Prevention

Posted on by erics

The recent end of the Spring 2023 semester marked my 40th year of working in the field of suicide prevention. During my first year in graduate school at American University, I took a remarkable class with Dr. Lanny Berman in the Spring of 1983. Lanny would soon become my major professor and the person who steered me into the world of suicidology. His course was entitled “Suicide, Death, and Life-Threatening Behavior,” and it was an eye-opening immersion into this important area of study. During that memorable semester, Lanny and I began a productive collaboration that led to my master’s thesis, my doctoral dissertation, many journal articles, book chapters, and a couple of books. Through my work with Lanny I had the good fortune to meet and work with many of the founders and heroes of the field, including Ed Shneidman, Bob Litman, Norman Farberow, Jerry Motto, and Marsha Linehan. Little did I know sitting in Lanny’s class all those years ago that my nascent interest in suicidology would evolve into a remarkably rewarding career that has been singularly dedicated to this important cause.

My Final Decade of Suicide Research

As I enter into my final decade of work in this field, I find myself at the ripe old age of 64 reflecting on the many challenges, abject failures, and dead ends that are inherent to the study of suicide. But through a lot of hard work, perseverance, and good fortune, there have been noteworthy successes. Chief among these has been the creation of CAMS and a rigorous line of clinical research to prove its effectiveness. And now with ten published open trials, seven published randomized controlled trials (RCTs), and two supportive meta-analyses, the question of whether CAMS works has been answered. The replicated and independent clinical trial data show that CAMS reliably reduces suicidal ideation (SI) and overall symptom distress, while it also consistently increases hope and decreases hopelessness. Of course, additional research questions still linger. For example, does CAMS reliably reduce suicide attempts and self-harm? And what exactly is the “secret sauce” of CAMS—the moderators, mediators, and mechanisms that make it work like it does? As for suicidal behaviors, I am delighted to note the publication of a new inpatient RCT of CAMS that was conducted in Germany showing that CAMS significantly reduced suicide attempts during the high-risk post-discharge period. Moderators, mediators, and mechanisms of CAMS are being further investigated within five ongoing RCTs of CAMS (and additional clinical trials of CAMS are now being developed). Building on this robust foundation of clinical evidence, our professional training company, CAMS-care, has trained thousands of clinicians across the nation and around the world. But from my perspective, perhaps the most exciting developments of all is the publication of the 3rd—and final—edition of the Guilford Press book, Managing Suicidal Risk: A Collaborative Approach. After two years of exhaustive work, this definitive source book on CAMS will prove to be a fitting capstone to the Guilford Press book series.

A Lack of Progress in Reducing Suicidal Suffering

While all these CAMS-related developments are exciting, I nevertheless find myself feeling frustrated and frankly impatient about the relative lack of progress overall within the larger field of suicidology. After 40 years of hammering away, I find myself craving more impactful changes and innovations to meaningfully reduce suicide-related suffering that can ultimately prevent this leading cause of death. So to this end, I would like to note and explore four particularly compelling big ideas that could make a meaningful impact as I further reflect on this field to which I have dedicated my professional life.

Focusing on Suicidal Ideation

Several years ago I found myself ruminating over the rejection of a manuscript from a peer review scientific journal. One particular reviewer pointedly dismissed various significant findings from a CAMS RCT because the intervention had failed to reduce suicide attempts. On the heels of this rejection, I began musing about the issue of “only” reducing suicidal ideation as a major criticism of CAMS. I then started to look at this critique differently. I began to question the behavioral bias that has dominated the field and I started to formulate an argument for the importance of suicidal ideation in and of itself. In fact, I have come to believe that reducing suicidal ideation may actually be a more important outcome vs. solely focusing on suicide attempt and self-harm behaviors. This train of thought was something that I had memorably discussed with my friend and colleague Dr. Thomas Joiner. I thus emailed Thomas and we ultimately wrote a well-received editorial entitled “Reflections on Suicidal Ideation” that was published in the journal Crisis—The Journal of Crisis Intervention and Suicide Prevention . In this piece, we argued that from a population perspective, that the biggest challenge we face in suicide prevention (by far) is the population of people who report “serious thoughts of suicide” in a given year. According to a recent SAMHSA (2022 ) survey, the population with serious SI included 15,600,000 American adults and adolescents in 2021 (the most recent year of data collection). Mind you, this number dwarfs the population that attempt suicide (1.7 adults in 2021) and is well over 300 times greater than the number of those who die by suicide. As Thomas thoughtfully noted, this is a profound level of human suffering. We argued that identifying and helping this enormous population upstream, could result in fewer attempts and suicides downstream. We consequently asserted that a shift in the field was needed to more fully appreciate and investigate the importance of SI as a means of decreasing this pervasive form of human suffering. Importantly, while there are excellent treatments that reduce suicidal behaviors (e.g., DBT, CT-SP, BCBT, and ASSIP) they do NOT reliably reduce suicidal ideation. Since this piece, we have endeavored to shift thinking within the field to meaningfully increase a focus on suicidal ideation within our collective research, clinical practices, prevention programming, and policy-related work.

Jaspr Health – Providing Hope during ED Visits

One summer day some years ago I was on a call with my colleagues Drs. Linda Dimeff and Kelly Koerner who were telling me about the successful use of an avatar named “Nurse Louis” and how this avatar-based technology demonstrated success related to discharge orders with medical surgical patients in a study conducted by Boston College investigators. The conversation evolved as we talked about the experiences of patients who are suicidal within emergency departments (ED) and I noted an extensive literature about how negative the ED experience can be for such people. This call became the genesis of a whole new avatar intervention that led to a NIMH-funded Small Business Innovation Research (SBIR) grant and the creation of an avatar based on my likeness named “Dr. Dave” that would be used to engage patients who were suicidal in the ED . Our novel tablet-based digital intervention integrated key elements of CAMS (among other related interventions from DBT and elsewhere). The striking initial success of this intervention was also in part due to the input of people with lived experience (of having been suicidal) which led to the integration of this important voice in developing the application and in the form of video testimonial stories of recovery and hope. Further NIMH SBIR funding led to an evolved intervention named “Jaspr Health” which was further shaped and refined based on input from a panel of people with lived experiences (and Dr. Dave was “retired” to my relief). Even though our RCT of Jaspr was cut short by EDs being overrun by Covid-19 patients, the obvious success within our underpowered clinical trial nevertheless provided ample and convincing evidence of the effectiveness of this novel intervention . Importantly, across my travels I have never heard of any ED experiences for patients who are suicidal being characterized as positive—not in the US, China, Uruguay, Australia, or throughout Europe. And yet with Jaspr, patients in the ED were having notably positive experiences and their Jaspr “favorites” could be downloaded to their smart phone for later use. Doctors get full reports based on CAMS aspects of the app which also ensures that certain Joint Commission institutional requirements are met as well. This remarkable line of innovation and clinical research is ongoing and reflects a fresh and exciting solution for a particularly infamous worldwide need—providing effective suicide-focused care in emergency departments for those patients who struggle with suicidal thoughts and behaviors.

The Hope Institute – Keeping Suicidal Patients out of the Hospital

Another undeniably compelling and recent development in suicide-focused clinical care is The Hope Institute that has been developed by my colleague Derek Lee in Perrysburg Ohio. The Hope Institute is an outpatient crisis setting that employs the use of both CAMS and DBT to stabilize patients who are suicidal using next day appointments (NDAs) and frequent visits (up to four times/week in some cases) to reliably stabilize patients in 5-7 weeks. The key within this model is that all care is suicide-focused and fundamentally evidence-based with proven clinical interventions. Perhaps most importantly, The Hope Institute singularly aspires to achieve stabilization as a worthy and valuable clinical goal in and of itself. Staff morale is high as clinicians do remarkable life-saving work. We are now in the process of standing up additional Hope Institutes in multiple different locations. The field needs this kind of model that emphasizes evidence-based, least-restrictive, cost-effective, suicide-focused clinical care to help people who struggle so that they can become stable and able to manage their suicidal thoughts, feelings, and behaviors. In my view, The Hope Institute is proving to be an exciting and notable clinical game-changer.

Mental Health Service Corp

Finally, I have been preoccupied with the idea of a “Mental Health Service Corp” since 2016. Given that 15.6M Americans wrestle with serious thoughts of suicide, we will frankly never have a sufficiently large and trained clinical workforce to begin to deal with the obvious and pressing needs of this considerable population (and research shows that many in this group do not want conventional mental health care). Given these considerations, a Mental Health Service Corp reflects one of my favorite pie in the sky big ideas that could significantly change the field. To have a Peace Corp-level national initiative to create a substantial paraprofessional workforce that could person the 988 Suicide & Crisis Lifeline, provide peer-support, work at respite and retreat centers for suicide stabilization, and with proper training and supervision even provide various evidence-based resources (e.g., safety planning, lethal means safety, and caring contacts) could have a profound impact. This concept was potentially under consideration by team members of the losing 2016 Presidential candidate. And while the concept did not play out then, it is nevertheless a compelling big idea that could be transformative if the political stars and will of the people were ever to align to make a significant difference in the larger suicide prevention workforce.

* * * * *

So, after 40 years, these are some of the big ideas to which I am drawn. I believe these ideas could make a meaningful difference for those who struggle in the most profound manner possible—considering suicide as an alternative to suffering. While progress is clearly being made, I am impatient. Far too many people continue to suffer, and too many people get hospitalized and medicated in ways that may not be helpful and might in fact be harmful. If we aspire to make a lifesaving difference, we must endeavor to think outside the box and fully embrace compelling big ideas to advance the field of suicide prevention.

Empirical, Clinical, and Conceptual Evidence Converges to Indicate Good Support for the Interpersonal Theory of Suicide

Empirical, Clinical, and Conceptual Evidence Converges to Indicate Good Support for the Interpersonal Theory of Suicide On-Demand Webinar

In this webinar, Thomas Joiner, Ph.D. discusses the topic of Empirical, Clinical, and Conceptual Evidence Converges to Indicate Good Support for the Interpersonal Theory of Suicide.

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Essential DBT Skills for Individuals Who are Suicidal and the People that Care for Them

Essential DBT Skills for Individuals Who are Suicidal and the People that Care for Them On-Demand Webinar

Dialectical Behavior Therapy (DBT) is a comprehensive psychological treatment that was originally developed for borderline personality disorder but has been expanded to a variety of problems, many of which have been experienced by people during the historical events of the past few years. Dozens of randomized trials of DBT have been conducted including studies evaluating the efficacy of only the skills portion of the treatment. Results support the use of DBT skills to increase emotion regulation capabilities and decrease negative mental health outcomes such as depression and anxiety. In this presentation, Dr. Rizvi reviews the DBT skills modules, the proposed mechanisms of change within DBT, and will highlight specific skills that may be especially useful to the majority of clients who experience suicidal thoughts and behaviors. In addition, skills that therapists and family members can use themselves to manage stress and burnout will be reviewed.

Shireen L. Rizvi, PhD, ABPP

About Shireen L. Rizvi, PhD, ABPP

Shireen L. Rizvi, PhD, ABPP is Professor of Clinical Psychology at the Graduate School of Applied and Professional Psychology (GSAPP) at Rutgers University, where she also holds affiliate appointments in the psychology department, School of Public Health, and the Department of Psychiatry. Her research interests include improving outcomes, training, and dissemination of Dialectical Behavior Therapy (DBT) for the treatment of complex and severe populations. Dr. Rizvi has received funding from the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), Rutgers University, and the American Foundation for Suicide Prevention (AFSP) for her research. Her work has resulted in dozens of peer-reviewed articles and book chapters, as well as a sole-authored book entitled Chain Analysis in Dialectical Behavior Therapy and a co-edited volume, DBT in Clinical Practice (2nd edition). Dr. Rizvi is board certified in Behavioral and Cognitive Psychology and in Dialectical Behavior Therapy. Dr. Rizvi has trained hundreds of students and practitioners from around the world in DBT. She has received the Spotlight on a Mentor Award from the Association of Cognitive and Behavioral Therapies (2017), the International Society for the Improvement and Teaching of DBT (ISITDBT) Perry Hoffman Service Award (2020), and Professor of the Year for Excellence in Teaching, Graduate School of Applied and Professional Psychology (2022).

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Attachment-Based Family Therapy: a family safety net approach to suicide treatment

Attachment-Based Family Therapy: a family safety net approach to suicide treatment On-Demand Webinar

For adolescent and young adults, family conflict can drive a suicidal crisis and family support can buffer against it. ABFT aims to identify and address the family events (e.g. divorce) and processes (e.g. high demand, low warmth) that may exacerbate the distress and prohibit the family serving as a safety net. Individual sessions with the patient and the parents prepare them for conversations that address attachment ruptures and disappointment. Not only do these conjoint sessions resolve problems but server as in vivo change events where parents practice  new parenting skills and the young person practices new emotion regulation skills. This brief talk will  present the essential theory and elements of this well researched empirically supported therapy.

Guy Diamond, Ph.D.

About Guy Diamond, Ph.D.

Guy Diamond Ph.D. is Professor Emeritus at the University of Pennsylvania School of Medicine and Associate Professor at Drexel University in the College of Nursing and Health Professions. At Drexel, he is the Director of the Center for Family Intervention Science (CFIS). His primary work has been in the area of youth suicide prevention and treatment research. On the prevention side, he has created a program focused on training, screening and triage to be implemented in non-behavioral health settings. On the treatment side, he has focused on the development and testing of attachment-based family therapy, especially for teens struggling with depression and suicide. Much of this work has focused on inner city low income families.

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10 Tips for Using CAMS with Adherence

Posted on by erics

For a proven intervention to be effective in the field, clinicians must use the intervention with adherence, meaning it is used as designed, based on extensive support from clinical trial research. Clinical adherence challenges are particularly prominent when conducting a randomized controlled trial (RCT)—which is the gold standard methodology for proving an intervention is effective.

The Importance of Adherence in Randomized Controlled Trials

Within RCTs, researchers must ensure that an experimental treatment is reliably provided with adherence and that there is fidelity between experimental treatment arms (i.e., that in fact the targeted treatment and control treatment were administered as intended). There are currently six published and four active CAMS RCTs — three funded by the National Institute of Mental Health and a fourth funded by Veterans Affairs.

Across these RCTs, members of The Catholic University Suicide Prevention Laboratory (SPL) that I direct take the lead in training CAMS to RCT study providers. In turn, we are also responsible for watching digital recordings (on secure platforms) of clinicians endeavoring to provide CAMS with adherence with patients who are suicidal.

The Role of Adherence Feedback in RCTs

To do this with scientific rigor, we use two expert SPL coders rating each session using the CAMS Rating Scale (CRS) with high inter-rater reliability. In addition, SPL graduate students also watch comparison control sessions (e.g., clinicians providing “treatment as usual”—TAU) to ensure that these clinicians are doing the comparison control treatment—and not doing CAMS—confirming experimental fidelity.

To this end, over the fall semester of 2022, the SPL has been working hard to support the three NIMH-funded CAMS RCTs which means beyond the initial CAMS trainings that I lead, we all watch a lot of digital recordings of clinicians working diligently to provide CAMS with adherence.

This means SPL members watch dozens of sessions each week. I personally watched 15 recordings over the past few weeks. It’s a busy time for members of the SPL supporting providers across three RCTs to fully meet our criteria for adherence to CAMS. Once study providers are determined to be adherent, our workload decreases significantly as we do random spot checks to confirm that clinicians do not fall out of adherence (which can require training remediation work with providers if this occurs).

10 Tips for Becoming Adherent to CAMS

With this immersion of training and adherence it is inevitable that we encounter common challenges when providers are learning to use CAMS. With a bit of constructive CRS feedback and consultation coaching with our teams of providers, many of these issues quickly become a one-trial learning experience. Moreover, other providers on our consultation calls benefit from hearing about our constructive adherence feedback with their colleagues.

Within a matter of weeks, we usually get most of our clinical providers to meet adherence criteria to effectively provide CAMS. I would note that learning to use CAMS is not as challenging as learning other proven approaches in mental health. Dialectical Behavior Therapy, for example requires labor intensive training that may take months to achieve. But while CAMS is typically learned in fairly short order, there are still common mistakes when first using CAMS that can delay achieving adherence to the framework.

This blog is intended to help other beginning CAMS providers avoid some mistakes that we see among clinicians learning this model. Based on this adherence work let us thus consider 10 of the best tips for becoming adherent to CAMS.

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1. Dive Right into CAMS

We often see a hesitancy on the provider’s part to dive right into using the Suicide Status Form (SSF) at the start of each session, especially with clinicians unfamiliar with CAMS. From the first session through interim care, there is too often unnecessary small talk or avoidance of starting into the SSF assessment using up valuable session time (particularly in the labor-intensive first meeting). The feedback we get is that clinicians feel that they have to form some sort of relationship with the patient before they can broach the sensitive topic of suicide. However, our extensive clinical trial research and one meta-analysis show that patients welcome SSF engagement getting to the heart of their struggle with suicide.

Indeed, when clinicians experience the patient feeling validated and understood by the SSF assessment, the temptation to avoid getting into the SSF assessment at the start of each session of CAMS quickly dissipates. Bottom line, suicide is serious business and there is no need for chit-chat at the start of each session of CAMS—let’s get down to business!

2. Interact During Suicide Status Form Core Assessment

The SSF Core Assessment is used at the start of every session of CAMS. Too often we see the clinician have the patient complete their SSF ratings of pain, stress, agitation, hopelessness, self-hate, and overall risk of suicide in silence. Using this approach, providers then typically review patient’s ratings and have some observations or some comments after the ratings are made.

In contrast, the completion of the SSF Core Assessment ratings offers a superb opportunity to discuss the patient’s ratings as they complete each SSF rating scale. This approach creates more of an ongoing dialogue about the ups and downs of suicidality and underscores the importance of candid and collaborative discussion of what the patient is experiencing as they complete these ratings.

3. First Session—Focus on Reasons for Dying (Instead of Reasons for Living)

Ever since I created the Reasons for Living (RFL) versus the Reasons for Dying (RFD) assessment as a major focus in the first session of CAMS, I have observed that clinicians often enthusiastically focus on the patient’s RFL responses. Understandably clinicians focus on RFLs as potential protective factors that might mitigate the patient’s suicide risk. However, based on two studies that we did with a large clinical trial sample in Switzerland, I have now come to see RFLs as a clinician assessment because patients we have studied are actually more focused on their RFDs in their first session!

When I train the model I therefore discourage RFL “cheerleading” because for some patients emphasizing their RFLs can invalidate their current struggle. At its worst, pushing RFLs can even be shaming! It is not uncommon to see inexperienced CAMS clinicians pointing out possible RFLs that the patient has not spontaneously generated — “What about your kids?” or “Isn’t your wonderful wife a reason to live?” Given the clinical trial research findings, we do not want clinicians pointing out RFLs that the patient has not listed.

For example, perhaps a patient sincerely believes they are a burden to their kids or their spouse and that their death may actually be a “gift” to these people. Denying this perspective prematurely can be dismissive of something that the patient may feel deeply. However, within CAMS we absolutely do emphasize RFLs, but we wait to do it later in the course of care when potential clinical progress has been made and the patient is more open to such considerations. Remember, the capstone of successful CAMS-guided care is a focus on the pursuit of a life that the patient actually wants to live. But to push a RFL agenda prematurely risks overriding the patient’s experience and may invalidate what they are going through at the start of care.

4. First Session—Move on Through Section B

Within the first session of CAMS, providers often get bogged down in Section B (which should take only 10 minutes) at the expense of completing the CAMS Stabilization Plan (CSP) and the CAMS Treatment® Plan. We advise in the RCTs that if a first session provider is falling behind, Section B does not need to be fully completed (as it can be completed later). That said, within Section B, it helps to get through the patient’s suicide attempt history, but then move on to the CAMS Treatment Plan focusing on the CSP and the two problem drivers in the remaining time.

5. First Session—CAMS Treatment Planning Always Begins with the CAMS Stabilization Plan

A huge error that even experienced CAMS providers make in the first session, is addressing Problems 2 and 3 before completing the CAMS Stabilization Plan! For adherence to the proven model, the CSP is always addressed first, then Problems 2 and 3 are completed as the final steps at the end of the first session of CAMS.

The reason that the CSP is the first step in the CAMS Treatment Plan is that establishing a sound CSP is the foundation for the entire treatment plan. An ability to satisfactorily complete the CSP may be an indication of imminent danger that might warrant an inpatient admission. However, if we can establish a solid CSP then the goal of CAMS to keep someone out of the hospital can be realized as we then shift the focus to problems/drivers that are usually quite treatable.

6. Have the Patient Identify Their Own Drivers for Suicide

Beyond the initial establishment of the CSP, all CAMS Treatment planning should center on the patient’s identification of their problem/drivers for suicide. In other words, the clinician should not point out the patient’s problem/drivers for them. In turn, the clinician should help the patient identify treatment goals and objectives before taking the lead identifying the full spectrum of interventions to address each respective problem/driver.

Ideally, we like to have more than one intervention for any one problem/driver of suicide. The more interventions we have to offer, the more hope we instill in the patient. Bottom line, the message to the patient is that there are many potential ways for effectively addressing the issues that compel the patient to consider suicide as a solution for their struggles.

7. Interim Sessions—CAMS Treatment Focuses on Crafting the Stabilization Plan and the Patient’s Suicidal Drivers

Across CAMS-guided interim care, all sessions begin promptly with Section A, the SSF Core Assessment. There should then be a check-in about the previous week in terms of the presence of suicidal thoughts, feelings, and behaviors. The clinician should always ask about the CSP sometime during the course of each interim session (often at the start but it can be at the end as well). The focus of all CAMS interim care centers on patient’s problems/drivers and possible updates or revisions to the CSP.

8. Interim Sessions—Treatment Plan Updating

Across CAMS-guided interim care, every session ends with updating the CAMS Treatment Plan. The treatment plan update should be done from scratch and potentially change in each interim session depending on what is happening in the course of care. But too often inexperienced clinicians complete Section A and Section B at the start of the session.
Section A should always be completed at the start of each interim session and Section B at the end of each interim session of CAMS. Moreover, we know from our clinical trial research that CAMS Treatment Plans that change across clinical care lead to better outcomes (in contrast to CAMS Treatment Plans that basically do not change from session to session).

9. You Can Delay Resolving CAMS if Needed

A patient may continue to be engaged in CAMS even when CAMS resolution criteria are technically met. To clarify, just because criteria are met, does not mean that you must necessarily move to the outcome-disposition session. Sometimes deferring the final session can help reassure both members of the clinical dyad that the patient’s apparent recovery is holding up and feels well-established.

10. Emphasize the Goal of Managing Suicidal Thoughts and Feelings to Achieve Behavioral Stability

As a clinical intervention, CAMS can be resolved even when some suicidal thoughts are present. In other words, the treatment difference that CAMS often enables a patient to better and more reliably manage suicidal thoughts and feelings while achieving behavioral stability.

From clinical trial research, we know that CAMS reliably increases hope while reducing hopelessness and overall symptom distress (i.e., general misery and despair). We thus know that CAMS significantly reduces suicide-related suffering and in so doing it can open the door to hope and the pursuit of life that the patient wants to live.
How to Use CAMS in a Clinical Setting

Working with patients who are suicidal is invariably challenging and can be daunting. Frankly, far too many clinicians endeavor to simply avoid such patients. Given this, we in the CatholicU SPL are humbled by and grateful to the clinicians across clinical trials who aspire to use CAMS with adherence.

Imagine having your clinical works viewed and rated with patients that many providers seek to avoid. It is not easy. It requires being open to constructive feedback and inevitable tweaks and suggestions to help one master CAMS. As clinicians in our trials courageously work to learn the intervention, members of the SPL do everything we can to be positive, supportive, validating, and reassuring as we give our constructive CRS feedback. In truth, we deeply admire these providers and clinical trials of CAMS could not be conducted without them. Consequently, the adherence work that we do inspires constructive tips like the ones described in this blog to help other providers achieve adherence to the framework.

The adherence work we do is challenging but worth it. Seeing clinicians quickly master the intervention is incredibly rewarding. When we provide thoughtful guidance on common mistake and provide instructive tips, we will have done our part in helping providers deliver a potentially life-saving course of care that has been proven to decrease suicidal suffering and overall misery. In turn, each RCT we publish increases the evidence base which we hope will may inspire more providers to learn and master this proven suicide-focused clinical intervention.

Learn more about how you can get started with CAMS Training and Certification to help identify suicidal drivers in patients in as little as six sessions.