The R&D of LivingWorks: From idea to world dissemination

Using research in suicide intervention training

LivingWorks uses developmental research to build its programs. Rothman’s social R&D is the knowledge transformation method of choice (Rothman, 1980). Developmental research is one of three major research methods: basic research to generate knowledge; developmental research to transform generated knowledge into program applications; and evaluation research to measure outcome and impact results.

Suicidology research had generated a core body of knowledge by the 1970s. Several reports recommended the need to transform this knowledge into widely disseminated training programs (Maris, 1973; Boldt, 1976). By the 1980s no one had used developmental research to do this until it was started in Alberta as part of a government initiative to develop a comprehensive, coordinated approach to suicide prevention focused on education and training, information dissemination, community outreach services and a suicide research centre (Ramsay, Cooke, Lang, 1990).

Problem

The education and training component was challenged with the task of developing suicide intervention training for a diverse range of community caregivers likely to be in contact with persons at risk of suicidal behaviors. Two kinds of caregivers were defined: ‘designated’—those professionally trained and expected to have skills to help someone at risk of suicide, and ‘emergent’—those who are accessible and often selected by persons at risk but not specifically expected to be suicide intervention helpers.

Three core questions addressed the challenge of transforming existing knowledge to meet the training needs of individuals in these caregiver groups:

1. Could a standardized curriculum be developed to meet the needs of all caregivers?
2. Could a standardized curriculum be widely accepted and disseminated?
3. Would large numbers of program disseminators adhere to quality control standards?

Methodology

Rothman’s four (4) phase, six (6) stage social R&D method was used to build and disseminate the program.

Research/retrieval

1. Basic research and peripheral knowledge content is retrieved, assessed, and codified.

Conversion and design

2. Consensus findings are gathered and initial design is formulated.
3. Design is pilot tested as a ‘dress rehearsal’ to spot limitations and barriers. Evaluation feedback from potential users is essential.

Development

4. Pilot test revisions are subjected to rigorous field trials.
5. Refined program is finalized. Operational manuals, audiovisual aids, and other materials are professionally packaged in user-ready form. Once the program is widely disseminated, developers must be open to reapplying the development phase.

Diffusion

6. Broad practice use in which ‘product advocacy’ is carried out. Implementation requires sufficient flexibility to be broadly utilized, while demanding a high degree of standardization to meet quality control expectations.

Outcomes

The experiment to transform core suicide knowledge into a standardized widely used suicide intervention program (ASIST) succeeded with positive outcomes for each of three developmental research question. Since 1985, ASIST has been delivered to over 500,000 caregivers in more than ten countries. Today 3,000 Registered Trainers deliver ASIST around the world. ASIST is a recognized exemplary program (CDC, 1992), now widely disseminated in Australia, Canada, Ireland, Northern Ireland, Norway, Scotland and the United States. It has been adopted statewide in California, Washington, Colorado, Tennessee, Oregon, Virginia and region/county-wide in Alaska, Louisiana, North and South Carolina, Oklahoma, and Texas. It is the approved training program for the Army and extensively used by the Air Force. The program has been evaluated by more than 15 independent evaluation studies, including two Ph.D. studies (e.g. Farrell and Maniprize, 1992; Tierney, 1994; Turley and Tanney, 1998; Eggert et al, 1999, MacDonald, 1999; Guttormsen et al, 2003).

LivingWorks received the 2002 Canadian Policy Research Knowledge Broker Award, designed to celebrate excellence by Canadian individuals, groups or organizations in the policy research field whose work helped facilitate and improve the transfer of knowledge.

 

References

Boldt, M. (chair) (1976). Report of the Task Force on Suicides to the Minister of Social Services and Community Health. Edmonton: Government of the Province of Alberta.
CDC (Centers for Disease Control). (1992). Youth suicide prevention programs: a resource guide. Atlanta: USDHHS, Public Health Service.
Eggert, L, Pike, K., and P. Karovsky. (1999). WA State Youth Suicide Prevention Program: Final Report, 1999. Seattle, WA: U of W School of Nursing.
Farrell, G. & Mainprize, B. (1990). Update on suicide prevention training: Correctional Service of Canada. Ottawa: CSC, Comm. & Corp. Develop., Program & Information Analysis.
Guttormsen T., Hoifodt T., Silvola K., Burkeland O. (2003). Applied suicide intervention: an evaluation. Tidsskr Nor Laegeforen, 123(16), 2284-6.
MacDonald, M. (1999). Suicide intervention training evaluation: A study of immediate and long term training effects. Unpublished doctoral dissertation, Calgary, Alberta: The University of Calgary.
Maris, R. (1973). Education and training in suicidology for the 70s. In H.L.P Resnick & B.C. Hathorne (eds.), Suicide prevention in the seventies (DHEW, HSM 72-9054). Washington: US GPO.
Ramsay, R., Cooke, M. and Lang, W. (1990). Alberta’s suicide prevention programs. SLTB, 20, 335-351.
Rothman, J. (1980). Social R&D: Research and development in the human services. Englewood Cliffs: Prentice-Hall.
Tierney, R.J. (1994). Suicide intervention training evaluation: A preliminary report. Crisis 15(2), 70-76
Turley, B and Tanney, B. (1998). SIFTA Evaluation Report. Melbourne: Lifeline Australia