The word “sabbatical” derives from the Greek sabatikos, meaning “of the Sabbath Day”—a period of rest that occurs every seventh day. A sabbatical generally means a break from work, and within a university professor’s life it is a period of paid leave for the purpose of study, travel, and pursuit of special projects. Academic sabbaticals for full-time tenured professors may occur every seven years and can be one semester at full-time pay or two semesters at half salary. Research grants can then be used to “buyout” a full academic year salary.
At Catholic University I am a tenured full professor employed with a yearly renewed 8.5-month contract, and I have two NIMH CAMS clinical trial research grants that enable me to buyout my full salary. Within my current sabbatical this means that I wrapped up my classes in April of 2021 and I will not return to the classroom until August of 2022 (15-months). A pretty sweet chunk of time.
For every sabbatical to be granted, a professor must propose how they are going to use their leave and how this experience will enhance their program of research and/or enrich their teaching. Sabbatical proposals are submitted to the department chair and then to the university provost for their approval. In previous sabbaticals I wrote research grant proposals, I trained over a hundred VA clinicians across three southern states, and I have written books.
My current sabbatical centers on writing the third (and final) edition of my Guilford Press book, Managing Suicidal Risk: A Collaborative Approach and focusing on four randomized controlled trials (RCT’s) of CAMS. As of this writing, I am about half way through this sabbatical. I have been diligently writing the third edition manuscript and have immersed myself in the RCT’s. And by design, given the space and time that a sabbatical affords, there are various insights, thoughts, and reflections to share.
Reflections on Writing
First of all, book writing is a joy to do. I would note that writing a third edition of a successful book is markedly easier than writing the original. But across follow up editions that I have done for two of my books, I have endeavored to not merely write a “retread” and this new edition is no exception. The key to a successful follow up edition is to embrace a proven format while creating novel content to improve the book in a meaningful way. This has not been hard for me in terms of writing the subsequent editions of Managing Suicidal Risk, because of the explosion in funded clinical trial research of CAMS over the past 20 years. In fact, with so much new clinical trial data it is actually a relief to update and write new portions at a chapter/month pace. The three editions of the book reveal the evolution and maturation of CAMS and each has a different focus. The first edition was an argument for readers to consider CAMS as a novel suicide-focused approach, and I appealed for its acceptance and use. The original edition introduced the Suicide Status Form (SSF) and primarily emphasized the assessment aspects of CAMS.
With empirical support from RCT’s, the second edition was less of an appeal and more of a presentation of a full-blown clinical intervention for suicidal risk through the treatment of patient-identified “drivers” of suicide. A significant turning point in the story of CAMS was recently realized with the publication of an independently conducted nine-study meta-analysis of CAMS. Hence, there is no longer a need to argue whether CAMS works. Instead, our current research centers on the who, what, when, where, and how related to the efficacy of CAMS across different settings and with different patient populations.
Accordingly, the third edition that I am now writing further centers on the RCT research and emphasizes clinical outcomes and dispositions related to using CAMS. A related research interest centers on understanding what makes life worth living and how can we help successfully treated patients who have benefitted from CAMS to realize a “post-suicidal life”—a life brimming with hard-earned hope and meaning. Given the development and overall success of CAMS, including its broad dissemination and use, writing this third edition is extraordinarily gratifying and I am relishing the gift of the experience.
Reflections on Treatment Research
As noted, my other major sabbatical focus centers on CAMS RCT’s. The “Rapid Referral Study” at the San Diego VA Medical Center (and funded by VA HSR&D) is one of the smoothest RCT’s in which I have been involved. We are gradually closing in our target sample of veterans who are suicidal and our sudden flip to using CAMS via telehealth (driven out of necessity by Covid-19) has been seamless and successful.
The “CAMPUS” trial is being conducted at four university counseling centers across the U.S. This ambitious and massive study is comparing CAMS to usual care and Dialectical Behavior Therapy (DBT) for 700 college students who are suicidal, and it has been directly impacted by the Covid-19 pandemic. But to their credit, NIMH program staff have been wonderful in supporting an extended feasibility trial of this study to investigate the use of online training and telehealth delivery of the study treatments. Along with members of my lab, I have been watching dozens of hours of digitally recorded counseling center sessions of CAMS for adherence and fidelity purposes. And with every session, I learn more about treating suicidal risk with CAMS. For example, within CAMPUS we are treating many more clients of color and also have clinicians of color, and watching these sessions has been meaningful because so much scientific clinical research overlooks marginalized populations and providers.
Another NIMH-funded trial is exploring the potential synergistic effects of using CAMS with inpatients who have received intravenous Ketamine. I am collaborating with a superb team of psychiatrists at Mass General Hospital and the Cleveland Clinic as we work our way through the ethical considerations and clinical challenges of conducting this study with teens and young adults who are acutely suicidal.
Finally, there is a new NIMH-funded multisite RCT with teens who are suicidal comparing “CAMS-4Teens” versus Safety Planning Plus versus usual care at Seattle Children’s Hospital and Nationwide Hospital in Columbus Ohio. The “ASSIST” study is ramping up with a crack team of clinical treatment researchers. On the heels of this RCT we are also initiating a feasibility trial of “CAMS-4 Kids” at Nationwide—which feels exciting and daunting—seeing children who are suicidal (4-12 years old) using a significantly modified and adapted version of CAMS.
Obviously, my sabbatical is not exactly a 15-month vacation! In truth, my sabbatical days are full with lots of writing and an immersive involvement within our clinical trials. But I am not complaining—I am blessed for the chance to become engrossed in these rewarding projects, while living through a worldwide pandemic like everyone else. Even though I am busy, there is still ample unscheduled time and plenty of intellectual wiggle room to read, muse, nurture deeper insights, and of course reflect.
So, my key sabbatical reflections? Writing is great. It is an amazing medium for generating, crafting, realizing ideas, and making dreams come true. Randomized controlled clinical trials with patients who are suicidal are incredibly hard! But I am nevertheless deeply moved by the dedicated clinicians in these trials who work so hard to learn/master CAMS to make it their own. They do this not because they have idle time or because it is easy. Instead, each of them aspires providing the best possible care for the brave patients who struggle with suicide and yet are also willing to participate in our clinical trials.
It is remarkable and humbling to watch hour after hour of fidelity sessions. So much struggle with suicide, tempered by setbacks, but balanced by flickers of hope and clinical improvements. My research collaborators across these trials are simply amazing. The students in my lab who work tirelessly to learn CAMS to perform fidelity ratings across these trials are similarly awesome. Life is challenging; life is good. In sum, the singular virtues of work, love, purpose, and meaning are central to and fully grace virtually all of my sabbatical reflections. Needless to say, the septennial gift of such a “break” always prompts me to appreciate all that makes life so worth living.