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LivingWorks’ Dr. Trena Anastasia on suicide prevention: collective impact, public health, and hope for the future


Feb 8, 2019

"My dream is that one day soon it's going to become common for a 16-year-old kid writing their first resume to put that they're trained in suicide prevention, right there alongside CPR."

From J
une 19 to 21, Dr. Trena Anastasia, LivingWorks’ Executive Vice President of Program Innovation, Impact and Improvement attended the Research Training Institute (RTI) as a group mentor. Sponsored by the Centers for Disease Control and Prevention (CDC), RTI conferences bring together researchers and practitioners to discuss training, treatment, and evaluation on a variety of issues under the CDC’s mandate, including addictions and suicide prevention. Held in Denver, Colorado, the June RTI session focused exclusively on suicide, and Trena was honored to share her expertise and insight with the participants. She joined us for an interview afterward to talk about the experience, LivingWorks’ thought leadership, and future directions for suicide prevention.


Before this interview you described being a mentor at RTI as a lifetime highlight. How did it feel, and what was the experience like?

Trena Anastasia:

In a single word, it was an honor. I had attended in 2014 as a participant when I was doing work on collective impact theory, which is a key research area for me. This year, many of the researchers were doing work on collective impact, logic model design, training development and evaluation, and other areas I’m specialized in, so the organizers asked if I would return as a mentor, and I was only too happy to be involved.

Throughout the three days I worked with a group of researchers to provide suggestions and feedback on their projects relating to suicide prevention. There was also a strong focus on the use and evaluation of LivingWorks programs, including LivingWorks safeTALK and LivingWorks ASIST, so I was able to provide insight there as well.

Part of what made it so special was that Dr. Phil Rodgers, who previously held my role at LivingWorks and who passed away three years ago, was one of my mentors at the RTI conference I attended in 2014. He contributed so much to suicide prevention, so having this opportunity to walk in his footsteps and mentor other researchers was a tremendous moment for me.

LW: Can you explain collective impact?

TA: It’s the idea that people can take on and solve complex, intersecting problems when they use a concerted, integrated approach. There are many issues out there that a single group or vocation can’t address on its own, no matter how many of them there are or how well-resourced they are. But when you add other groups who have other ways of thinking and who bring synergistic means of addressing those problems, it becomes possible.

LW: Like suicide?

TA: Exactly like suicide. What members of the suicide prevention field have increasingly realized is that no single approach is going to address this issue alone. It takes many stakeholders playing a broad range of roles. This is one of the most important calls that has come out of the American Association of Suicidology conference over the past two years. People in the field know that if we want to make a meaningful difference in suicide rates, we have to do something different. We have to make it possible for more groups and people to engage.

So what LivingWorks did in response to this call was take a step back and say, “Alright, we know that some of the components that we’re providing are making a difference—there’s published evidence, there are programs on national registries. But if it’s not sustainable, and we’re not building out a network of safety in these communities where we’re training, that difference isn’t going to spread, and it isn’t going to last.”

If you think of a single LivingWorks ASIST participant out in a community, they have these amazing skills to help someone stay alive, but they have to be in the right place at the right time. They’re like an island, and someone has to come to that island to get help. So how do we make that possible? We have to build bridges. Those are the connections throughout that community: people trained to play a connector role with LivingWorks safeTALK and LivingWorks Start, or other LivingWorks ASIST trainees who are aware of each other to offer help and support.

The more these interconnections are being built, the more we’re creating this self-sustaining network that provides support, resources, and hope to keep going. People may play different roles in saving lives, but they have this common vision and philosophy about how to make it possible throughout that community. They have this network that spans the places where they live, work, and play so that people have access to these skills in all facets of their lives.

Part of why it’s such an exciting time to be with LivingWorks is that we’re leading this charge. We’re emphasizing the importance of integrated training programs that allow everyone in the community to be part of that collective impact. And we aren’t alone. Increasingly we’re seeing other leading organizations in health and wellness fields—the CDC, the Department of Veterans Affairs, the Education Development Center—calling for the same kind of paradigm. In effect, it’s a public health approach to suicide prevention.

LW: Tell us more about public health approaches.

TA: The CDC and WHO have acknowledged that suicide is a public health problem, so it needs a public health solution. There’s actually a correlation to how safety networks are built out in other fields using the same methodology. If we think of the public health approach that’s been the most successful in another field, the one that most readily comes to mind is preventing loss of life from heart attacks.

Death from heart disease has dropped dramatically since we’ve been able to identify a continuum of safety skills around heart disease. We now know that everyone in a community has a role to play in responding to heart attacks. Everyone in a community knows to dial 911, most people know how to recognize the basic warning signs of a heart attack, and there’s a high percentage of people who know how to do CPR. If you’re on an airplane or in a restaurant, you can be pretty certain that there’s someone there who knows CPR.

If you’re having a heart attack, that CPR trainee’s responsibility is not to be your heart surgeon, their responsibility is to keep you “safe for now” until an EMT or paramedic can arrive and provide a full intervention to save your life, and even as they are saving your life, they still may be connecting you to a surgeon for further treatment, and after that surgery is done, there’s opportunity for recovery and growth post-treatment. That could be with physical therapy, and providing information to you and your family around exercise and diet, and what you can do to not only recover, but to thrive.

You can see where I’m going with this. There’s a similar continuum of safety skills to be learned and applied in suicide prevention, and this is the model that we used in developing our integrated community training solution. Not everyone has to play every role, but everyone has a role that they can play, and all of those roles are part of the answer—that’s how collective impact works. We’ve recently launched LivingWorks Start, our online training, and that’s critical because it empowers large numbers of people to play that connector-type role at the beginning of the continuum, which will help build out that impact on a large scale.


LW: It’s interesting that you chose the example of heart disease, given that you’re statistically much more likely to encounter someone who needs a suicide intervention that someone who needs CPR.

TA: It’s true! And yet we have so many people trained in CPR around the world, and comparatively few people trained in suicide prevention. That’s not to say that preventing heart disease fatalities isn’t important—of course it is! But it would be wonderful to see more organizations, families, and communities taking up the call of being ready to prevent suicide as well.

Just like with a heart attack, you can learn to recognize the signs and help connect someone to further safety—you don’t have to be the heart surgeon. You don’t even have to necessarily learn the skills yourself. Maybe your role is to encourage someone else in your family or workplace to do so, but at the end of the day, there is a role for everyone. My challenge to everyone reading this would be to think about what their role is on that continuum of safety, and how they can leverage that role to be part of the collective impact in their community.

The exciting thing is that we’re starting to get there. We’re seeing more and more organizations focusing on an integrated, public health approach to suicide prevention where everyone has a way to get involved. LivingWorks is ready to go with this: we have the curriculum and we have the approach. We can get skills and support into the hands of every household, every family, and every industry. My dream is that one day soon it’s going to become common for a 16-year-old kid writing their first resume to put that they’re trained in suicide prevention, right there alongside CPR.

LW: Were you able to share these concepts with your fellow researchers at RTI?

TA: I was, and I think it made a real difference. A lot of the work we’ve been doing at LivingWorks lately is directly applicable to the prevention efforts that are going on at RTI and other organizations around the country. It’s exciting because it really feels like we’re doing the right thing at the right time.

LW: What was the feeling in the air as RTI came to an end?

TA: There’s a lot more work to be done in so many different fields, but I think we all left inspired by what we’d seen and with renewed energy to keep going. There are some powerful new ideas coming to the fore, and that brings a real sense of hope.