Who You Treat: University & Graduate Students / Campus Life

The Rollins College Wellness Center focused on reducing student hospitalizations using the CAMS Framework®

All across the country college wellness and counseling centers are dealing with an increasing number of students with suicidal thoughts.  Rollins College in Winter Park, Florida is no exception. The Counseling and Psychological Services (“CAPS”) at Rollins Wellness Center adapted the CAMS protocol as the assessment and treatment method for suicidal clients in May of 2016.

Prior to May 2016 counselors and trainees were trained to utilize a thorough clinical interview and suicide assessment scale to evaluate the severity of the client’s suicidal thoughts. Focus of the session was to assess the degree of risk, stabilize, create a safety plan, and engage clients’ personal resources.  If the client could not commit to safety and become stabilized, the client would be encouraged to go to a crisis stabilization and receiving unit (hospital). If the client would not voluntarily go to the hospital, a decision would be made to hospitalize the client through the Baker Act, a Florida law that allows people with mental illnesses to be held involuntarily for up to 72 hours in a mental health treatment facility if they meet certain criteria.

Research shows that clients are more at risk for completing suicide after involuntary hospitalization. Additionally, the Baker Act requires the client to be restrained in handcuffs during the transport to the hospital. This can be a traumatic experience for an 18-25-year-old whose mental health is already compromised.

Connie Briscoe became the Director of the Wellness Center in 2014.  Connie is a psychologist and certified QPR (Question, Persuade, and Refer) trainer. Connie believed in a more structured, peer-reviewed, and researched instrument to be the standard way for counselors to determine the level of risk with students with suicide ideation.  Connie and Nadine Clarke, Assistant Director of Counseling/Clinical Coordinator chose the CAMS (Collaborative Assessment and Management of Suicidality) Framework and presented the instrument to counselors at CAPS. Nadine purchased Dr. Jobes first book on CAMS for all counselors and incoming interns in May of 2015. All full-time counselors were individually trained through Dr. Jobes’ training videos. Nadine trained incoming interns at their orientation in August and CAMS became the official assessment and treatment method for elevated, high-risk suicide ideation.

Nadine attended the American Association of Suicidality Conference in May of 2016 and met Dr. Jobes. She had the opportunity to ask him specific questions on the use of CAMS with Cluster B diagnosis and other difficult situations. Upon her return to the college, Nadine worked with Connie and the college’s risk management office to secure more in-depth live training. Dr. Kevin Crowley trained the staff in the use of CAMS on January 17, 2017. CAPS also purchased 12-one-hour phone consultations with Kevin. Kevin provided those consultations on an as-needed basis during the clinical group supervision period. This proved helpful in deepening the understanding of CAMS as a treatment in working with clients.

All full-time permanent counseling staff have a copy of Dr. Jobes 2nd Edition Managing Suicidal Risk, a Collaborative Approach, and incoming interns and temporary or part-time counselors are trained in the proper use of CAMS. They are also provided with a copy of Dr. Jobes’ book.

Nadine says, “CAMS provides a common language and framework for talking about suicide with students. The Student Affairs division and student leaders understand that students are getting help if that student mentions CAMS. The off-site 24-hour auxiliary counselors have been trained to ask if someone has a “Stabilization Plan” if that student talks about working with a CAPS counselor.” Through the use of CAMS the need to initiate the Baker Act is significantly reduced, and the process is well documented with the entire Suicide Status Form CAMS package.  The Rollins Wellness Center has avoided hospitalization for all but the most severe cases, and almost all who have been hospitalized have done so voluntarily.

If you would like to learn more about implementing CAMS in your College or University Counseling Center, please contact Dr. Kevin Crowley at kevin.crowley@cams-care.com

Supporting Clients Between Sessions: Peer Support and New Data from NowMattersNow

When clients are struggling most, support often needs to extend beyond the therapy hour. This webinar introduces Now Matters Now’s (NMN) three free programs, with a focused look at NMN Peer Support Meetings and new engagement and outcomes data, highlighting how peer support can complement CAMS-informed care between sessions.

Ursula Whiteside, PhD

About Ursula Whiteside Ph.D.

Dr. Ursula Whiteside is a licensed psychologist, certified DBT clinician, and founder/CEO of NowMattersNow.org. She trained for over a decade directly with Dr. Marsha Linehan, the creator of Dialectical Behavior Therapy. Today, NowMattersNow.org hosts the world’s largest lived-experience DBT skills library, offers free weekly DBT Peer Support Meetings, and provides a brief intervention for overwhelming suicidal urges.

Dr. Whiteside serves as Clinical Faculty at the University of Washington and as national faculty for the Zero Suicide initiative. She is co-founder of United Suicide Survivors International and advises on AI chatbot development, centering the lived experience, preferences, and safety of suicidal users. Dr. Whiteside is open about her experiences with intense emotions and suicidal thoughts.

 

David A. Jobes, PhD

About David A. Jobes, Ph.D. ABPP

David A. Jobes, Ph.D., ABPP, is a Professor of Psychology, Director of the Suicide Prevention Laboratory, and Associate Director of Clinical Training at The Catholic University of America. Dr. Jobes is also an Adjunct Professor of Psychiatry, School of Medicine, at Uniformed Services University. He is the author of seven books and hundreds of articles and book chapters. He is the creator of the Collaborative Assessment and Management of Suicidality (CAMS) and one of the founders of CAMS-care, LLC (a professional training and consultation company). Dr Jobes is the recipient of many awards such as the 2022 Alfred M. Wellner Award for Lifetime Achievement (for research excellence) from the National Register of Health Service Psychologists and the 2025 “Erwin Ringel Service Award” for contributions to suicide prevention from the International Association of Suicide Prevention (IASP). He is a Fellow of the American Psychological Association and is board certified in clinical psychology (American Board of Professional Psychology). Dr. Jobes maintains a private clinical and consulting practice in Washington DC and in Maryland.

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The Network Effect: Turning Connection into Protection in Suicide Prevention

Communities are made up of relationship networks, but we rarely consider how the structure of these networks—and the interaction between them—shapes suicide prevention. Prof. Tony Pisani reveals how shared trusted connections promote protection, why even small changes in networks make a difference, and how organizations can strengthen these networks to better serve people in their communities. Drawing on research and case examples from high schools, healthcare, and the military, Tony highlights innovative, network-informed approaches. Through reflective exercises, attendees will explore how these insights apply to their life, team, and work, leaving with actionable strategies to build networks that promote connection and wellbeing.

Holly Wilcox, PhD

About Tony Pisani, Ph.D.

Tony Pisani is a Professor of Psychiatry and Pediatrics at the University of Rochester Center for the Study and Prevention of Suicide and the founder of SafeSide Prevention has devoted his career to preventing suicide and promoting wellbeing, combining research at University of Rochester with practical implementation as the founder of SafeSide Prevention. Author of more than 40 peer-reviewed papers and host of the Never the Same Podcast, his work spans research, education, and real-world implementation across healthcare, military, and community settings in the US, Australia, and New Zealand.

 

David A. Jobes, PhD

About David A. Jobes, Ph.D. ABPP

David A. Jobes, Ph.D., ABPP, is a Professor of Psychology, Director of the Suicide Prevention Laboratory, and Associate Director of Clinical Training at The Catholic University of America. Dr. Jobes is also an Adjunct Professor of Psychiatry, School of Medicine, at Uniformed Services University. He is the author of seven books and hundreds of articles and book chapters. He is the creator of the Collaborative Assessment and Management of Suicidality (CAMS) and one of the founders of CAMS-care, LLC (a professional training and consultation company). Dr Jobes is the recipient of many awards such as the 2022 Alfred M. Wellner Award for Lifetime Achievement (for research excellence) from the National Register of Health Service Psychologists and the 2025 “Erwin Ringel Service Award” for contributions to suicide prevention from the International Association of Suicide Prevention (IASP). He is a Fellow of the American Psychological Association and is board certified in clinical psychology (American Board of Professional Psychology). Dr. Jobes maintains a private clinical and consulting practice in Washington DC and in Maryland.

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Cultural Perspectives on Suicide: How Different Societies Approach Prevention

Posted on by STOLBER Digital

Cultural Perspectives on Suicide

When it comes to suicide prevention, cultural awareness is extremely important. Every culture has their own views of suicide, stemming from their histories and belief systems. Therefore, not everyone addresses suicide prevention efforts in the same ways. Here is a look at how various cultures from around the world have historically viewed suicide and how some of them approach prevention.

Eastern Views and Approaches to Suicide


Historically, countries in Eastern cultures have had a more positive view of suicide than those in Western cultures. For example, in some Asian countries, suicide used to be viewed as a noble or honorable act. China is one example of an Eastern country that has shifted its view on suicide over time. Suicide was seen as honorable when it was done for social or political causes. It was even viewed highly when Confucianism was the main philosophy throughout the country. China saw their worst rates of suicide in the 1990s. [1] However, the rates dramatically declined in the decades to follow. There may be several factors at play. One possibility is fast economic growth. Another factor could be surveillance-based monitoring of students on college campuses. [2] China has also been working to reduce air pollution, as some studies have shown a connection between air pollution and suicide rates. [3] 

Japan is another Eastern country that has shifted its perceptions of suicide. Its general attitude toward suicide has been described as “tolerant.” [4] Similar to China, Japanese cultures have historically viewed suicide as honorable or “morally responsible” when it’s performed as a ritual. Also similar to China, Japan experienced a spike in suicide rates in the 1990s when they experienced an economic crisis. However, unlike China, Japan’s rates have not recovered to the extent that China has seen. Japan has, though, been working toward getting its rates down. In 2006, the government initiated a national suicide prevention strategy that helped reduce suicide rates by 35% by the year 2022. [5] This strategy along with other prevention efforts have helped the topic of suicide to be less of a taboo in Japanese culture. Instead, it is starting to be seen as a legitimate health concern.

 

Western Views and Approaches to Suicide


Western cultures have historically had a much more negative view of suicide compared to Eastern cultures. In these cultures, suicide is often seen as shameful and cowardly. It is also considered illegal in some places. In fact, the term “commit suicide” comes from when suicide was a crime and those who survived suicide could be imprisoned. [6] Much of the stigma surrounding suicide stemmed from Judeo-Christian beliefs and teachings that have been prominent in Western cultures. These teachings considered suicide immoral and punishable. While these religious overtones may no longer be as prominent, the stigma has lingered. This has caused many to struggle in silence, feeling ashamed and hesitant to get help. 

Historically, Western cultures have had a more clinical approach to suicide. They focus on identifying and treating mental illness that may be associated with it. This differs from other cultures. In more recent years, however, the topic of mental health has been more openly talked about. Wider prevention strategies started being put into place. For example, the 2024 National Strategy for Suicide Prevention was developed in the U.S. as a 10-year, whole-of-society approach to preventing suicide. Rather than only focusing on the clinical aspect, this strategy addressed health equity and community-based prevention methods.

 

African Views and Approaches to Suicide


Cultures in African countries also have their own unique perspectives when it comes to how they view and handle the topic of suicide. The cultures and belief systems throughout Africa vary greatly depending on the region. Many cultures view suicide as a taboo topic. This is often due to fear and unknowns surrounding mental health and illness in these cultures. Belief systems play into this, as well, with some cultures viewing suicide as the result of evil spirits or inherited curses. In some countries, such as Ghana and Uganda, suicide is punishable by law and can have severe consequences for the person’s family and community. [7]

Historically, there was an assumption that countries in Africa had low suicide rates. However, this was likely due to a lack of reporting and studies on suicide deaths in African countries. It has since been found that suicide is a public health concern. [8] Due to the vast diversity of culture and lack of data, suicide prevention strategies for African regions have been difficult to implement and research. However, many African cultures highly value community-based efforts. Traditional healers are important in many countries. One example is in South Africa. They have played a crucial role in helping people at risk of suicide. [9] 

 

Indigenous Views and Approaches to Suicide 

 

Indigenous cultures have struggled with significantly higher rates of suicide than non-Indigenous cultures, specifically in North America. [10] There are many factors that play a role in this, including generational trauma, loss of cultural identity, and issues related to poverty. Many Indigenous communities see suicide as a symptom of their broader collective trauma. However, many of these cultures have had stigmatized views of suicide for generations, making it difficult to approach the subject and receive help.

Because community is at the heart of Indigenous culture, Indigenous-specific approaches to suicide prevention often prioritize community-based and culturally grounded practices. This might include performing ceremonies, storytelling, connecting with the land, and finding ways to celebrate and honor their culture. [11] Elders also play a central role in supporting youth and restoring these generational and cultural ties. Rather than focusing on the individual, Indigenous strategies aim to heal the collective spirit and restore harmony within the entire community.

Suicide occurs in all countries and cultures. However, there are different ways to approach it. These methods should specifically resonate with the people who are affected. Learning about cultural differences helps us understand and stay aware that some forms of prevention may be more appropriate than others. The overarching theme, though, appears to be the need for community and meaning. Even though this may be found and approached in different ways, everyone needs to know that they matter to others and that their life has significance. 

Sources:

[1] https://www.sciencedirect.com/science/article/pii/S2352827323000071 

[2] https://www.healthdisgroup.us/articles/APM-5-125.php 

[3] https://news.ucsb.edu/2024/021373/clearing-air-reduces-suicide-rates 

[4] https://www.suicidecleanup.com/culture-and-suicidal-behavior/  

[5] https://www.who.int/news-room/feature-stories/detail/suicide-prevention-in-japan–a-public-health-priority 

[6] https://learning.nspcc.org.uk/news/why-language-matters/rethinking-language-suicide

[7] https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.549404/full  

[8] https://www.sciencedirect.com/science/article/abs/pii/S1876201823004355  

[9] https://www.madinamerica.com/2018/05/traditional-south-african-healers-use-social-bonds-connection-suicide-prevention/

[10] https://pmc.ncbi.nlm.nih.gov/articles/PMC3483901/ 

[11] https://pmc.ncbi.nlm.nih.gov/articles/PMC9588522/ 

How CAMS Empowers Families to Support Suicidal Loved Ones

Posted on by STOLBER Digital

Youth mental health remains a growing concern in the U.S. According to the Centers for Disease Control and Prevention (CDC), suicide is the second-leading cause of death for teens and young adults between the ages of 10–34 in the U.S. [1] Additionally, 36.7% of young adults ages 18–25 have mental health needs that are not being treated. [2] 

It is common for family members, especially caregivers, to feel overwhelmed. They may wonder what to do when a loved one talks about suicide. CAMS (Collaborative Assessment and Management of Suicidality) is an evidence-based treatment for suicide that allows family members to be a part of the process. It puts emphasis on the “collaborative” aspect. Rather than teaching and handing off the tools to the at-risk person to manage themselves, CAMS strives to involve parents and caregivers. The Stabilization Support Plan is one way that CAMS does this. This plan provides guidance to family members to help support their child’s treatment moving forward. This helps create a bigger system of support for the person who is struggling.  

The Role that Family Plays

Family members and caregivers play crucial roles in helping support their child’s mental health. Adolescence is often a time of instability and change—from changes in friendships to increased demands at school and other activities. Children and teens who are close with their family members have positive, built-in relationships with people they can rely on for help and support through the ups and downs. Here are a few specific ways that family members can help each other when it comes to mental health and suicide prevention. 

Offering emotional support

In a healthy dynamic, family members can provide emotional support to one another. They provide safe spaces for each other to open up and share about their struggles. Families often have deep bonds from shared experiences, good and bad. They know each other’s history, struggles, and triumphs. They are often the first place that people go to with those struggles and triumphs. Having people available to lean on during these times can be extremely helpful.  

Detecting early warning signs of suicide

Family members may be more in-tune and aware of certain warning signs, sensing when things seem “off.” They can easily detect abnormal behavior since they’re familiar with what normal behavior looks like. They are often able to be on alert for signs of distress. Being able to identify warning signs and abnormal behaviors in someone is a key first step to suicide prevention.

Being involved with treatment

When it comes to treatment, family members and caregivers are able to be more easily and seamlessly involved than those on the outside. Parents and caregivers can help their child stay healthy. They can manage logistics like scheduling and driving to appointments. They can also encourage their child to follow treatment plans. 

Family: A Protective Factor 

When talking about suicide, risk factors and protective factors are important to discuss. Risk factors are things that make suicide more likely. Protective factors are things that make suicide less likely. Some people are naturally more at risk than others depending on their background and living situation. According to the Suicide Prevention Resource Center, social isolation can be a big risk factor. Connectedness to other individuals, community, and family is a protective factor. [3] Therefore, it’s important for families to be present and know how to help their child or adolescent through their struggles.

Ways CAMS Supports Family Involvement

Unlike many other types of treatment methods, CAMS puts a large emphasis on collaboration when it comes to working with and supporting the at-risk individual. CAMS is set up to help family members be involved and take an active role in their loved one’s treatment, especially when dealing with parents and children. One way is through CAMS-4Teens®. CAMS-4Teens is a specific method of using the CAMS Framework® to treat children, teens, and young adults who are struggling with thoughts of suicide. Parents and caregivers are engaged in this process, as well. They are given expectations and information up front about the treatment. They are updated regularly as the treatment goes on. They join sessions to learn about their child’s “suicidal drivers.” They also discuss stabilization and support plans, among other topics.

Allowing parents to have a more active role in their child’s treatment allows for open communication and helps reduce the stigma about mental health and suicide. Parents and caregivers can learn about what leads to thoughts of suicide. They can also understand the CAMS therapy approach. This knowledge helps them better understand their child’s mind. 

Benefits of CAMS for Families

CAMS not only benefits the person at risk, but it can help families as a whole grow closer and move forward together in confidence. Here are a few of the specific areas in which families can benefit when working with CAMS.  

Insight into the issues

Many young people, especially teenagers, struggle with issues related to friendships, insecurity, and comparing themselves to their peers. In CAMS, the patient is always listened to first. This helps the therapist see the person’s suicidal thoughts from their point of view. This makes it easier to share these thoughts with family members who can then gain a better understanding.  

Greater sense of control and direction

CAMS allows parents and caregivers the opportunity to get a glimpse into what is going on

and what their role is in helping their child. This is helpful for the children but also helpful for the parents. It gives them a greater understanding and knowledge about what tools and techniques their child is learning to deal with their difficult thoughts and feelings. 

Strengthening trust and relationships

When mental health is openly talked about, trust is more easily built. Family members of any age can benefit from these open conversations around mental health and struggles. When parents and caregivers see how serious the issue is, it helps their child. They also learn what is being done to help. This way, the child can trust that their parents care about what is happening. 

Increased confidence in dealing with a crisis

A common fear that many parents and caregivers have is that they will make a situation worse by saying or doing the wrong thing, particularly in a moment of crisis. CAMS works with parents to put a plan in place for dealing with emergencies. That way, if a crisis happens, parents and caregivers will know how to respond appropriately.

Warning Signs to Watch For

It’s always important to stay aware of the warning signs of suicide, especially because they may look different for people of different ages. Here are some warning signs to watch for from the Substance Abuse and Mental Health Services Administration (SAMHSA): [4]

Warning signs in adults:

  • Talking about or making a plan for suicide
  • Behaving recklessly or acting agitated
  • Talking about feeling trapped or like a burden
  • Increased use of alcohol or drugs
  • Withdrawing or isolating from others
  • Changes in sleep (increased or decreased)
  • Showing signs of rage 
  • Displaying extreme mood swings

Warning signs in youth and children:

  • Expressing hopelessness about the future
  • Displaying severe or overwhelming emotional distress
  • Withdrawing or isolating from others
  • Changes in sleep (increased or decreased)
  • Sudden anger or hostility that seems out of character
  • Increased irritability 

Supporting a loved one who is struggling with suicidal ideation can feel overwhelming and even scary, especially those who feel ill equipped. CAMS aims to help families by offering them a lifeline and including them on the healing journey. CAMS helps parents and caregivers by encouraging open talks about struggles. It focuses on what matters most to the person at risk. This way, they gain the tools and confidence to support their loved one on the path to recovery.  

Curious to learn more about CAMS-4Teens? See more information in this article here: Proven CAMS-4Teens Strategies to Treat Adolescent Suicide. For those interested in or pursuing CAMS-Trained™ designation, check out our on-demand video CAMS-4Teens: Working with Parents. This 3-hour video training covers how therapists can work with parents to support the use of CAMS treatment with their child using the Stabilization Support Plan. 

For more help and tips on supporting a loved one, see this guide from the Center for Suicide Research and Prevention with resources.

Remember, if you or someone you know is in crisis, reach out to the 988 Suicide & Crisis Lifeline via call, text, or online chat.

 

Sources:

[1] https://www.cdc.gov/nchs/data/vsrr/vsrr024.pdf
[2] https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.pdf
[3] https://sprc.org/risk-and-protective-factors/
[4] https://www.samhsa.gov/mental-health/suicidal-behavior/warning-signs

2024 CAMS Update and Introducing CAMS Brief Intervention

2024 CAMS Update and Introducing CAMS Brief Intervention

In this suicide prevention month webinar, Dr. Jobes will discuss recent updates based on clinical trial research, clinical use of CAMS, and training developments related to CAMS. With five on-going randomized controlled trials and a series of recent publications, there is much news to report on all things CAMS. Dr. Jobes will then be joined by Dr. Ray Tucker who will present on the emerging use of CAMS as a single-session brief inpatient and/or emergency department intervention with promising preliminary evidence. There are now several new research efforts to replicate and extend early CAMS-BI™ findings. Join us for this exciting update and introduction to CAMS BI as a novel and much needed suicide-focused brief intervention.

David A. Jobes, PhD

About 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.

Dr Raymond Tucker Headshot

About Dr. Raymond P. Tucker

Associate Professor of Psychology, Louisiana State University (LSU)
Clinical Assistant Professor of Psychiatry, Louisiana State University Health Sciences Center (LSUHSC)/Our Lady of the Lake (OLOL),
Raymond P. Tucker is a licensed clinical psychologist and associate professor of psychology at Louisiana State University. There he teaches undergraduate courses in psychology, graduate courses in clinical psychology, and founded the LSU Mitigation of Suicidal Behavior research laboratory. As a clinical assistant professor of psychology at LSUHSC/OLOL, he trains medical staff/students in suicide-specific evidence-based assessment and intervention protocols.

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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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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.

What Future? How People Who Are Suicidal Look Beyond the Present Moment

What future? How People Who Are Suicidal Look Beyond The Present Moment On-Demand Webinar

The consideration of suicide involves the contemplation of not only death, but also of life and what it can offer. This presentation explores cognitive underpinnings of life-oriented thoughts, with a particular focus on how people who are suicidal envision their future. Dr. Cha will introduce various ways to assess future thinking among individuals who are suicidal, and present an emerging profile of future thinking abilities that are characteristic of this population.

Christine Cha, PhD

About Christine Cha, PhD

Dr. Christine Cha is an Associate Professor of Clinical Psychology at Teachers College, Columbia University, and Director of the Laboratory for Clinical and Developmental Studies. Her research focuses on thought patterns that may contribute to suicidal thoughts and behaviors, and pertain to concepts proximal to suicide (e.g., death) as well as alternatives to suicide (e.g., future). Dr. Cha’s work has been funded by the American Foundation for Suicide Prevention and the National Institute of Mental Health (NIMH). She serves on the editorial boards of the Journal of Clinical Child and Adolescent Psychology, Journal of Abnormal Psychology, and General Hospital Psychiatry, and has received the Rising Star Award from the Association for Psychological Science.

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