Today I feel silly: And other moods that make my day, by Jamie Lee Curtis. This book normalizes the day-to-day moment-to-moment fluctuations in mood, including low mood. It is very appropriate for young children and is a common feature of many Social Emotional Learning (SEL) programs.
NeuroFlow and CAMS-care partner to offer an evidence based therapeutic framework for suicide-specific assessment and treatment on electronic medical records.
Enhancing an already unique partnership, CAMS-care and NeuroFlow are once again teaming up to help create a happier and healthier world. The latest element of the partnership now gives clinicians using NeuroFlow access to the CAMS evidence based Suicide Status Form to treat patients with serious thoughts of suicide.
According to the Substance Abuse and Mental Health Services Administration, there are 12.2 million adults and 3 million adolescents in the United States who are thinking of ending their lives. The Joint Commission, the Surgeon General, the CDC and Zero Suicide all reference the Collaborative Assessment and Management of Suicidality (CAMS) as one of a handful of evidence-based treatments that clinicians should use to reduce suicidal ideation.
Most clinicians today either don’t know that evidence-based treatments exist, have not been trained, or lack access to them in their electronic medical records. Building on an already existing, mission-aligned partnership between the two organizations, this development addresses these issues directly by getting evidence-based resources to care providers when it matters most.
“NeuroFlow is committed to integrating technology with evidence-based practices. Our partnership with CAMS-care provides a solution for the Treat step in Zero Suicide, putting clinicians on the NeuroFlow platform at the forefront of suicide prevention with access to tools that properly Identify, Engage and Treat the patient,” noted Matt Miclette, Head of Clinical Operations.
NeuroFlow provides best-in-class technology and care services for the effective integration of behavioral health. NeuroFlow’s HIPAA-compliant platform supports over 14 million users across 300 health systems, payors, and organizations, helping them capture behavioral health insights and take action to proactively manage individuals and populations holistically.
Developed by David A. Jobes, Ph.D., ABPP, the Collaborative Assessment and Management of Suicidality (CAMS) Framework is a both a clinical philosophy of care and a therapeutic framework for suicide-specific assessment, management, and treatment of a patient’s suicidal risk. With an evidence base supported by multiple randomized controlled trials (RCTs) from around the world, CAMS focuses on empathy, honesty, and collaboration to form a strong alliance between the caregiver and patient to motivate the patient to save their life instead of ending it.
Our mission is to save lives through effective care by training clinicians to treat suicidal patients. We have developed CAMS Trained™ and CAMS Certified™ designations, which licensed clinicians can achieve through completing training and gaining hands-on experience in the CAMS Framework. Never again feel unprepared when working with a person with serious thoughts of sucide.
In 2020, suicide became the second leading cause of death among teens and young adults (ages 15 to 24) in the U.S., according to the CDC. And the risk of suicide has only increased for teens, especially among girls and young women.
One recent nationwide study found that 37% of young Americans aged 18-24 report having thoughts of death and suicide and nearly half (47%) showed at least moderate symptoms of depression — a major indicator of suicidal thoughts and ideation among teens.
Another extensive survey of students from almost 100 college campuses from the American College Health Association found that:
It’s clear that teens and young adults are experiencing suicidal thoughts at increasing rates. In order to reverse this trend, effective suicide prevention programs and procedures need to be put in place for at-risk teens so they can get the professional help and support they desperately need.
Fortunately, there is a solution to help identify and treat the primary drivers of teen suicide. Preliminary data shows promise for using CAMS (Collaborative Assessment and Management of Suicidality) in conjunction with the SSF (Suicide Status Form) with suicidal teens, young adults, and even children, and clinical trial research is being pursued to confirm and formalize that data.
Here’s how to adapt the CAMS Framework® to treat and prevent suicidal thoughts and ideation in children, teens, and young adults.
CAMS is an evidence-based therapeutic assessment and treatment framework that places concerted emphasis on the word “collaborative.”
In this framework, therapists work hand-in-hand with each patient, discussing the patient’s experience in a non-judgmental fashion using the Suicide Status Form (SSF) as a guide to gather information about the patient’s current experience and suicide risk. This framework helps them identify triggers together then work collaboratively to devise treatment and stabilization plans — all while building trust through collaboration and transparency throughout the treatment process.
Generally speaking, the CAMS Framework works very well with adolescents. In fact, in a recent study, the SSF has been found to work as well with teens, especially older teens, as it does with adults with just a few adjustments.
Here are 9 tips and adjustments to help achieve better results when using the CAMS Framework with teens:
The CAMS Assessment® provides a guided walk-through of the teen’s life at that moment. If a particular stressor or issue that relates to the current suicidal thoughts is uncovered early enough, it can be addressed quickly in treatment. Remember however, that it is particularly easy for teens to become overwhelmed and feel that their situation is unsurmountable.
If any teen is in an acute suicidal state, try to work with them to identify the problem first. CAMS has been found to be very useful in breaking down these factors into manageable pieces that the teen is able to recognize as treatable.
Dr. Jobes, the creator and developer of CAMS, recently held a webinar on Adolescent Suicide Prevention with Dr. Cheryl King. In the webinar, available on demand at the CAMS website, Dr. King talks about her extensive expertise in youth suicide prevention, focusing on risk factors for youth suicide, screen, and assessment, and discusses clinical prevention work including her YST approach.
CAMS-care offers training for CAMS-4Teens: Working with Parents through a three-hour, on-demand video course that discusses research and a recommended approach for optimally involving parents to support the CAMS treatment of their child using the Stabilization Support Plan. The video provides vivid and unscripted clinical demonstrations of using CAMS with four different adolescent clients and their parents. The demonstrations show clinicians engaging parent(s) before the first session of CAMS, aspects of the first session of CAMS with teen clients, followed by a post-session re-engagement involving the whole family.
Continuing Education credits are available for this course.
Learn more about how you can become CAMS Trained™ and CAMS Certified™to provide an evidence-based suicide treatment framework with all of your patients, no matter their age.
Dr. Cheryl King shares her extensive expertise on youth suicide prevention. Highlights of her presentation center on risk factors for youth suicide, screening, and assessment. In addition, Dr. King discusses clinical prevention work including her YST approach.
Cheryl King, Ph.D., ABPP, is a Professor in the Departments of Psychiatry and Psychology and Director of the Youth Depression and Suicide Prevention Program at the University of Michigan. Her research focuses on the development of evidence-based practices for suicide risk screening, assessment, and intervention. She has provided leadership for multiple NIMH-funded projects, including Emergency Department Screen for Teens at Risk for Suicide, 24-Hour Risk for Suicide Attempts in a National Cohort of Adolescents, the Youth-Nominated Support Team Intervention for Suicidal Adolescents, and Electronic Bridge to Mental Health for College Students. A clinical psychologist, educator, and research mentor, Dr. King has served as Director of Psychology Training and Chief Psychologist in the Department of Psychiatry and has twice received the Teacher of the Year Award in Child and Adolescent Psychiatry. She is the lead author of Teen Suicide Risk: A Practitioner Guide to Screening, Assessment, and Management. In addition, Dr. King has provided testimony in the U.S. Senate on youth suicide prevention and is a Past President of the American Association of Suicidology, the Association of Psychologists in Academic Health Centers, and the Society for Clinical Child and Adolescent Psychology. She is a current member of the National Advisory Mental Health Council.
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On our journey of enlightenment and understanding the mechanisms of Black suicidality, we have explored the socio-historical context, current literature, and treatments available towards mental health care. By utilizing an intersectional lens, we began to unravel the complexities of systemic racism and how those processes influence and trigger suicidal behavior among Black Americans. It illustrates the erasure of methodology and treatment centered towards the Black experience within the U.S. Like a worn-out washing machine, it continues to perpetrate the cycle of institutionalized violence.
Now what? It is important to articulate the discourse around Black suicidology, but discourse by itself is an empty vessel. Even more relevant is the ability to apply knowledge to practice. In this final part of this series, we will conceptualize the implementation of effective treatment on suicidal Black youth, which has been alarmingly on the rise these past few years. Although we have been taken a macro analysis of Black suicide, I think it is important to center our lens towards the current crises: Black adolescents.1
As we have discussed in the previous parts of this series, there is a magnitude of risk factors that influence Black youth suicidality. I have compiled a list of internal and external risk factors that possibly influence suicidal behavior among Black adolescents:
While working with Black clients, I have established three main goals that I think are essential to the therapeutic process. These objectives can be implemented across your therapeutic style, whether CBT, psychoanalyses, or a mix-treatment. The aim is to build a foundation of trust between the client and the provider. The initial process of therapy should include the following steps:
I try to implement these objectives in both my academic and clinical work. They can be generalized to every patient; however, I find that keeping these three objectives in mind helps me to provide a more holistic approach when working with Black adolescents.
Tiffany
Tiffany is six years old. She lives in the suburbs of Northern Virginia with her parents. She attends a predominately White primary school and is the only Black student in her classroom. Tiffany is often bullied by her peers due to her physical appearance. She is beginning to feel isolated from her classmates. Tiffany informs her teacher about the bullying. The teacher assures her that if she ignores the bullies, the bullying will stop.
The bullying does not stop. It continues and begins to affect her academic performance. Tiffany, a recently high achiever, has not been completing her assignments and is not engaged in class discussions. Her teacher remarks to her parents that Tiffany’s behavior has become detached and rude towards others. Tiffany’s mother has also noticed negative changes in her behavior. She labels Tiffany’s behavior as lazy and disrespectful.
Tiffany attempts to avoid school by stating she feels sick during the weekdays, and on the weekends, she sleeps the whole day. Tiffany also spends a lot of time on the computer. Her mother has discovered her recent search history includes “how to kill yourself” and “how to hang a rope”. Her parents have found a Black, female therapist in the region because they are worried about her wellbeing.
When providing therapy for Tiffany, the therapist might find it helpful to:
Omar
Omar is a thirteen-year-old who lives in the Bronx with his parents, who are working class and sometimes struggle with finances. Omar has always been perceived as “troubled”. Since a toddler, he has displayed emotional outburst whenever he is frustrated or annoyed. He struggles with academics and continues to display a lack of emotional regulation. When confronted by an authority figure, Omar erupts into explosive outbursts. His teachers classify his behavior as disruptive and aggressive, however he is viewed as a class clown by his classmates. Omar has an extensive history of suspensions and has recently been expelled from his current school due to a physical altercation with a teacher.
At the age of nine, Omar was diagnosed with Oppositional Defiant Disorder (ODD). Omar is very active on social media and follows a politically motivated group that shares information about police brutality and systemic racism in the NYC area. Omar shares with the group his negative experiences with “the system”. On these sites, Omar has been increasingly exposed to visual media of images of Black people being brutalized on camera. These images have psychologically impacted Omar and influence his feelings of isolation and trauma.
Omar has a history of hospitalization due to self-mutilation and suicide attempts. Recently, Omar has been hospitalized after threatening suicide with his father’s handgun. He has been referred by his social worker to a White, male therapist who specializes in suicidal behavior and multicultural therapy.
When providing therapy for Omar, the therapist might find it helpful to:
Tiffany and Omar are examples of the complexities of treating Black youth and express the importance of encompassing a critical theory lens when addressing suicidal behavior among minority groups. To address their suicidality a mental health provider should contextualize the social, cultural, and historical oppositions that they endure. This is their positionality within society. Identify their risk factors. Affirm their experiences. Speak truth to their power.
There are numerous risk factors impacting the phenomena of suicidal behavior among Black adolescents in the U.S. These internal and external factors possibly underscore the undercurrent of institutionalized racism. Addressing the context of this marginalization may help build the therapeutic relationship between mental health providers and Black clients—extending to the larger Black community.
I appreciate your willingness to journey with me in this series through the complex dynamics of systemic racism and its impact on the suicidality of Black youth. These things are messy and uncomfortable. Yet we must sit with our discomfort and acknowledge the social-historical context of medical biases, racial civil unrest, and political engagement. If we can ask our clients to enter our spaces and share their personal experiences, then it is our responsibility to reciprocate, we can make a difference in this vulnerable population. The mental health of Black children depends on it.
Footnotes:
I was recently reviewing some literature for a current study and happened to come across a newly published conceptual article by a scholar named Édua Holmström, who is at the University of Helsinki in Finland. The article was a marvel to me as Holmström’s paper uses the “Self Determination Theory” (SDT) to conceptually explain how the CAMS Framework of suicide prevention motivates suicidal individuals to choose life.
Those who use the CAMS framework with suicidal patients already know that it first and foremost is based on empathy & honesty, and encourages your clients to work collaboratively with you to develop their unique suicide-focused treatment plans. This paper shines a light on this important element of the CAMS approach to treatment, and theorizes that this autonomy and acknowledgment of the client’s ability to make decisions about their own treatment plan is the key to the effectiveness of CAMS to clinically help save lives.
It turns out that SDT elegantly describes certain key aspects of this spirit and embodies the essence of doing CAMS as a collaborative and empathic therapeutic patient-centered framework. Within CAMS there is a clear and overt emphasis on respecting and validating the suicidal patient’s autonomy, a central construct within SDT. Writing about CAMS, Holmström notes “…many suicidal individuals make informed decisions about treatment with the support of an empathetic clinician.”
I could not agree more. And it is exhilarating to read the reflections of an unmet scholar in a faraway land applying a novel theory (at least to me) as explanatory for this evidence-based approach to suicide intervention that has consumed me over my entire professional career. Even after 35+ years in the field I cannot begin to describe the unabashed excitement I felt discovering this beautifully written paper about something that is so near and dear to my life’s work, and it got me thinking…
I often say to my students, “There are no new ideas, just repackaged old ones that capture enduring truths.” Over the years I have heard variations on this notion as it relates to CAMS. A seasoned and savvy inpatient nurse during a training session once told me that CAMS was nothing new, it was simply good nursing! She was delighted when I agreed and shared that I began my professional career on inpatient nursing staff as a psych tech. Her response? Of course, you did, I knew it! Some years later I had a similar conversation with a sophisticated clinical social worker who insisted that the essence of CAMS was merely doing good clinical social work!
Over decades I have come to relish many such conversations with clinicians across disciplines who have said in some way or another that they have been “doing CAMS” for years without realizing it. I think of my friend Kevin Briggs, who was a CHiPS highway patrolman for many years. His beat was the Golden Gate Bridge, and in his book, Guardian of the Golden Gate Bridge, Kevin recounts incredible experiences of talking suicidal of people out of jumping to their deaths from the iconic bridge. He could not save them all, but he literally did help save hundreds of lives. Over coffee, Kevin once told me that he used to lie down on the pavement to be at the same level with certain prospective jumpers sitting on a pipe on the other side of the railing so he could talk to them at their level. He asked me: So, was I doing CAMS? My response: Kevin, you are a natural!
Many of my days are consumed with randomized controlled trials (RCTs), interpreting data, and writing scientific papers in my determined effort to prove that CAMS works through replicated RCTs with the highest rigor of science possible. It is my passion and my goal to well establish a solid place for CAMS within systems of care as a means of clinically saving lives for people on the brink of life.
But when I read this article from a faraway land explaining to me how my intervention works, it gave me pause to think. I reflected on many conversations over decades with clinicians about how to help save lives. And I reflected on some simple and enduring truths about life. Most people want to live a life with purpose and meaning; most do not desire death by suicide. But for those who do, simple ideas about autonomy, empathy, collaboration, and truth go a long way toward creating the possibility of saving a life, even in the face of suicidal despair. “Good nursing” or “good social work” can help transform lives and help people self-determine whether they live or die.
It is gratifying and humbling to see an outside source confirming the importance of self-determination concepts as potential cornerstones of CAMS.
The alarming rise of teen and adolescent suicide rates over the last decade is prompting researchers and mental health professionals to search for causes and devise new methods and programs for preventing and treating younger suicidal patients, despite existing barriers.
| 2007 | 6.8 suicide deaths per 100,000 people aged 10 to 24 |
| 2017 | 10.6 suicide deaths per 100,000 people aged 10 to 24 |
| (56% increase over 10-year span) | |
| People ages 15-19: 76% increase | |
| People ages 10-14: 16% increase |
Curtin, S. C., & Heron, M. (2019). Death rates due to suicide and homicide among persons aged 10–24: United States, 2000–2017. NCHS Data Brief, no 352. Hyattsville, MD: National Center for Health Statistics.
| 2018 | 6,211 suicides nationwide, aged 15-24 – 14.5 deaths per 100,000 people |
| Suicide is the second-leading cause of death for 15- to 24-year-olds (Motor vehicle accident deaths is first) |
Drapeau, C. W., & McIntosh, J. L. (for the American Association of Suicidology). (2020). U.S.A. suicide: 2018 Official final data. Washington, DC: American Association of Suicidology, dated February 12, 2020, downloaded from http://www.suicidology.org.
| # of states with policies mandating and encouraging suicide prevention education for healthcare professionals | 2 |
| # of states with a policy mandating suicide prevention education | 8 |
| # of states with a policy encouraging suicide prevention education | 5 |
| # of states with a policy mandating or encouraging training for the treatment for suicidal patients | 0 |
Graves, J. M., Mackelprang, J. L., Van Natta, S. E., & Holiday, C. (2018). Suicide prevention training: Policies for health care professionals across the United States as of October 2017. American Journal of Public Health, 108(6), 760–768.”
The news of rising teen suicide rates is difficult to ignore. Every few months, the media reports on another study that documents how much teen suicide rates have increased in the past 20 years. Rates jumped from 6.8 deaths per 100,000 people in 2000 to 10.6 deaths per 100,000 people in 2017.1 Suicide is now the second-leading cause of death for 15- to 24-year-olds, with only motor vehicle accident deaths outnumbering it. Researchers have noticed trends in suicide rates among girls and young women increasing, as well as for young black men.1,2
Researchers and mental health professionals are struggling to identify causes for these trends and to quickly identify effective prevention and treatment strategies to address this major public health concern. While many research studies report on trends in rates among certain gender and ethnic groups, it is extremely difficult to identify causes for rising suicide rates. Our best educated guesses about this alarming trend relate to added stress caused by:
All of these issues combined with easier access of searching, finding, and being exposed to media that depict or offer information on suicide may be impacting the increase.
A major obstacle to reducing the rise of suicide rates across all age groups is the lack of evidenced-based care available for individuals who are suicidal5. Funding for research on suicide treatment lags far behind other health issues. For decades, researchers and mental health professionals did not include suicidal individuals in studies that tested promising new treatments because it was considered too risky. These barriers have brought us to our current state of feeling far behind in terms of knowing what works best for treating suicide. The National Institute of Mental Health has identified research on suicide as an area of priority, and more studies are being funded to help evaluate what methods work best for prevention, screening youth for suicide risk, and finding the best possible treatments.6
There are many layers of prevention and treatment that can be implemented for youth suicide. Many states have suicide prevention centers within their public health departments, which are tasked with implementing prevention programs in communities and schools and training mental health professionals in their state on best practices for working with suicidal patients. Within schools, Signs of Suicide has been found to be an effective gatekeeper training program that teaches teens about recognizing suicide risk in their peers and the steps they should take to connect their friends with resources.7 The Good Behavior Game is a classroom-management system that is used for second-graders and focuses on minimizing aggressive and disruptive behavior, and amazingly has shown long-term reductions in suicidal behavior as kids move through adolescence.8
From a treatment standpoint, few treatments specific to suicide exist that have been shown to provide best clinical care for suicidal teens. Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are both used for teens with suicide risk. CBT works well as a treatment for depression and anxiety-related disorders, and it can also be used to help someone understand their thoughts about suicide and their feelings of hopelessness.9 DBT specifically addresses self-harming behavior and teaches teens important coping skills to use in place of self-harm.10
Safety-planning interventions and crisis response plans are useful when used in conjunction with DBT or CBT, as they provide concrete steps for teens and their families to follow when the teen is in crisis or thinking seriously about suicide.11,12
Collaborative Assessment and Management of Suicidality (CAMS) is a therapeutic assessment and treatment framework that combines all elements from these treatments into one approach. First, CAMS provides a thorough risk assessment in the first session and uses the Suicide Status Form (SSF) to gather valuable information about a teen’s current experience and overall suicide risk.
With CAMS, the entire assessment approach is collaborative. The therapist sits next to the teen (if they are comfortable with it), encouraging the feeling that they are literally on the same page. Because many adolescents may be hesitant or suspicious of the treatment process, CAMS emphasizes transparency and empathy. Instead of a therapist sitting across from the teen with a clipboard and taking notes (that the teen can’t see) while asking questions, the teen is either writing their responses on the Suicide Status Form themselves (first page), or they are watching the therapist write down their responses (second page). The therapist and the teen write the treatment plan together, identify the top two drivers together, and create the stabilization plan together.
We have seen the CAMS approach work very well with teens (CAMS-4Teens), both in our own practices and with consultation and case presentations from other clinicians, as well as in research. A recent study found that the Suicide Status Form works just as well for assessing teen’s suicide risk as it does with adults. Teens in the study were able to understand and rate constructs like psychological pain, hopelessness, and self-hate in a way that was helpful to determining their overall level of distress and suicide risk.13
Once the therapist and teen identify the top two drivers for the treatment plan, the therapist explains what the goals and objectives will be, and which interventions they will use to help achieve those goals. Many teens have some version of self-hate as a driver for suicide. Therapists can make simple goals of decreasing self-hate and identify interventions to target that driver. Examples of interventions may be CBT interventions for increasing self-esteem or behavioral activation for getting teens out of the house and connected to the community and causes they care about (e.g., mentoring younger kids, animal shelters, volunteer work). Furthermore, elements from CBT, DBT skills, problem-solving, interpersonal therapy, and many other methods can be integrated into the CAMS Treatment® plan to target and treat drivers.
Especially for teens in an acute suicidal state, sometimes it is extremely helpful to first identify the problem. The CAMS Assessment® provides a guided walk-through of the teen’s life at that moment, and if a particular stressor or issue is uncovered as being related to the current suicidal thoughts, it can be addressed quickly in treatment. Teens can be overwhelmed with situational factors that feel unsurmountable. We have observed CAMS to be very useful in breaking down these factors into more manageable pieces that the teen can then recognize as treatable.
We have assembled some general tips for using CAMS with teens that may be helpful. Before making any major modifications to the Suicide Status Form (SSF) for use with teens, we decided to test it in its existing form. Our hunches were correct: we discovered that CAMS does not need to be radically changed for use with youth (ages 12-17).13
However, other slight procedural recommendations are helpful to keep in mind. First, some youth may need slower pacing for the assessment. It may take more time to explain concepts like psychological pain and agitation. Also, it may take some time to think about how to explain these concepts in a variety of ways.
Second, if the assessment is taking longer than usual, it is beneficial to prioritize getting the stabilization plan completed and in place. As much as possible and practical, intensive outpatient treatment is the goal of CAMS. This is largely achieved by having a solid stabilization plan/safety plan in place. It is very helpful to identify any supportive adults in the teen’s life that they can list on their stabilization plan as someone they can contact in a crisis. You may need to be creative in identifying these adults (e.g., parents, older siblings, other relatives, coaches, pastors, school counselors, etc.).
Third, some youth may respond better with a “parallel assessment” in which you are still gathering the information for the SSF while they are engaging in some other activity (coloring, fidget toys, etc.).
The last tip is focused on how to work with parents and caregivers during the course of CAMS Treatment. It is essential that other adults in the teen’s life are aware of the stabilization plan, understand how to respond to the child in a crisis, and can help assure access to lethal means are limited. We recommend completing the SSF with just the teen present, and then inviting the caregivers into the session at the end to review the stabilization plan. Caregivers may have a wide variety of emotional reactions to their suicidal teen, and it’s important to provide education on suicide in general, and the process of CAMS. Parents and caregivers may need their own support via therapy or community support groups.
Thus far we have confidence from recent research results that the SSF is appropriate for teens,13 and that CAMS is a promising evidence-based treatment for suicidal teens.14,15 We know that CAMS is an effective treatment for adults,16 and that many clinicians are using CAMS with youth ages 12+ with success.
Our consultants provide on-going support to clinicians using CAMS with teens, and the overwhelming response from clinicians has been positive. They describe CAMS as useful with all types of teens – from those who are very expressive and talkative as CAMS helps organize their thoughts and feelings, to those who may be more reserved as CAMS allows them to express themselves through the SSF without needing to verbalize everything.
The next phase of CAMS-4Teens research includes randomized clinical trials (RCT), which are the gold standard in treatment research, to gather more evidence for the effectiveness of using CAMS with youth. We see a bright future in which CAMS will be available as an evidenced-base intervention for suicidal youth, a group for which having effective treatment will make a big impact and save lives.
http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/Agenda.pdf
