Design & Development

Using research in suicide intervention training

There are three major types of research methods: basic research (which generates knowledge), developmental research (which transforms generated knowledge into programs and processes), and evaluation research (which measures outcomes and impacts). LivingWorks uses developmental research to build our programs. The social research and development technique developed by Jack Rothman is our knowledge transformation method of choice (Rothman, 1980). 

By the 1970s, basic research in suicidology had generated a core body of knowledge. Several reports recommended the need to transform this knowledge into widely disseminated training programs (Maris, 1973; Boldt, 1976). As of the 1980s, no one had undertaken the necessary developmental research until a government initiative in Alberta began to develop a comprehensive, coordinated approach to suicide prevention. Key components of this approach included education and training, information dissemination, community outreach services, and a suicide research center (Ramsay, Cooke, Lang, 1990).

The challenge of transforming knowledge

The education and training component was tasked with developing suicide intervention training for a diverse range of community caregivers likely to be in contact with persons at risk of suicide. 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 were 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 six-stage social research and development method was used to build and disseminate the program.

Research & Retrieval

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

Conversion & Design

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

Development

  • Stage 4: Pilot test revisions are subjected to rigorous field trials.
  • Stage 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 (stages 4 and 5).

Diffusion

  • Stage 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 questions. Since 1985, ASIST has been delivered to over one million caregivers in more than 15 countries, and today more than 6,500 registered trainers provide the program on a regular basis. ASIST has also been evaluated by more than 15 independent evaluation studies (e.g. Farrell and Maniprize, 1992; Tierney, 1994; Turley and Tanney, 1998; Eggert et al, 1999, MacDonald, 1999; Guttormsen et al, 2003). LivingWorks also 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—ASIST

  • Australian Institute for Suicide Research and Prevention. (2012). A review of the Operation Life suicide awareness workshops: Report to the Department of Veterans' Affairs. Brisbane, QLD: Author.
  • 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.
  • Chen, P. Y., Moore, J. T., & Gibbs, J. (2009). Project Safety Net: CSU final report October 1, 2006 – September 30, 2009. Fort Collins, CO: Colorado State University, Project Safety Net Evaluation Team.
  • Demmler, J. (2007). Gatekeepers: Helping to prevent suicide in Colorado. An evaluation report on the Preventing Suicide in Colorado Initiative. Denver, CO: The Colorado Trust.
  • 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.
  • Evans, R. E., & Price, S. (2013). Exploring organisational influences on the implementation of gatekeeper training: A qualitative study of the Applied Suicide Intervention Skills Training (ASIST) programme in Wales. Critical Public Health, 23(2), 213-224.
  • Farrell, G. & Mainprize, B. (1990). Update on suicide prevention training: Correctional Service of Canada. Ottawa: CSC, Comm. & Corp. Develop., Program & Information Analysis.
  • Gould, M. S., Cross, W., Pisani, A. R., Munfakh, J. L., & Kleinman, M. (2013). Impact of Applied Suicide Intervention Skills Training (ASIST) on National Suicide Prevention Lifeline counselor interventions and suicidal caller outcomes. Suicide and Life-Threatening Behavior, 43(6), 676-691.
  • Guttormsen T., Hoifodt T., Silvola K., Burkeland O. (2003). Applied suicide intervention: an evaluation. Tidsskr Nor Laegeforen, 123(16), 2284-6.
  • ICF Macro. (2010). Applied Suicide Intervention Skills Training: Trainee experiences, recommendations, and post-training behavior [Cross-site evaluation of the Garrett Lee Smith Suicide Prevention and Early Intervention Program]. Calverton, MD: ICF Macro, & Rockville, MD: SAMHSA.
  • Lander, H., & Tallaksen, D. W. (2007). Long-term efforts yield results:  Positive evaluation of the Vivat education programme. Suicidologi, 12(2).
  • 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.
  • McAuliffe, N., & Perry, L. (2007). Making it safer: A health centre’s strategy for suicide prevention. Psychiatric Quarterly, 78, 295-307.
  • Moore, J. T. (2011). Training individuals in suicide prevention: Individual and organizational characteristics of effective gatekeepers. (Doctoral dissertation, Colorado State University). 
  • Price, S. & Briscoe, A. (2012). Applied Suicide Intervention Skills Training (ASIST) in Wales: Impact and effectiveness. Cardiff, Wales: Mind Cymru.
  • Public Health Agency. (2011). All Island evaluation of Applied Suicide Intervention Skills Training (ASIST): Summary report. Belfast, Northern Ireland: Author.
  • Ramsay, R., Cooke, M. and Lang, W. (1990). Alberta’s suicide prevention programs. SLTB, 20, 335-351.
  • Rodgers, P. (2010). Review of the Applied Suicide Intervention Skills Training Program (ASIST): Rationale, evaluation results, and directions for future research. Calgary, AB: LivingWorks Education.
  • Rothman, J. (1980). Social R&D: Research and development in the human services. Englewood Cliffs: Prentice-Hall.
  • Tallaksen, D. W., Bråten, K., & Tveiten, S. (2013). “You are not particularly helpful as a helper when you are helpless”. A qualitative study of public health nurses and their professional competence related to suicidal adolescents. Vård i Norden, 33(1), 46-50.
  • Tierney, R.J. (1994). Suicide intervention training evaluation: A preliminary report. Crisis 15(2), 70-76
  • Turley, B., Pullen, L., Thomas, A., & Rolfe, A. (2000). LivingWorks Applied Suicide Intervention Skills Training (ASIST): A competency-based evaluation. Melbourne, Australia: LivingWorks.
  • Turley, B and Tanney, B. (1998). SIFTA Evaluation Report. Melbourne: Lifeline Australia 

  

References—safeTALK

  • Braswell, W. J. (2011). Does safeTALK equip airmen to intervene when a fellow military member is having suicidal thoughts? [Thesis – Columbia International University, Columbia, SC].
  • Eynan, R. (2011). Preventing suicides in the Toronto Subway System: A program evaluation. [Thesis – University of Toronto, Toronto, Ontario].
  • Forward for Life & Common Unity. (2014). Suicide prevention training in Hertfordshire: An overview of delivery of the combined approach for suicide prevention implemented on behalf of Hertfordshire County Council Public Health Service 2014.
  • Gullestrup, J., Lequertier, B., & Martin, G. (2011). MATES in construction: Impact of a multimodal, community-based program for suicide prevention in the construction industry. International Journal of Environmental Research and Public Health, 8, 4180-4196.
  • McLean, J., Schinkel, M., et al. (2007). Evaluation of the Scottish safeTALK pilot. Edinburgh, Scotland: Scottish Development Centre for Mental Health.
  • Mellanby, R., Hundson, N. P. H., et al. (2010). Evaluation of suicide awareness programmes delivered to veterinary undergraduates and academic staff. Veterinary Record, 167, 730-734.