j.kennedy handout

a suicide-safer community

Bendruomenė saugesnė nuo savižudybių

John Kennedy - LivingWorksConsulting Trainer Support Person

International Quality Assurance Reader Team ASIST Senior Team Leader/ safeTALK Instructor

Sveiki atvykę į LivingWorks Education

Lithuania

Progressing to a national strategy through safeTALK

and ASIST

Strategy- The Art of Fishtail Movement

Key Stakeholders

Lithuania and LivingWorks Unite

TimelineDate Activity

20062011

ASIST workshop conducted in Vilnius, Lithuania by Norwegian VIVAT LivingWorks trainers Dag Willy Tallaksen/Kirsti Silvola

Scotland StudyIreland Study

May -June 2014

Communication with University of Vilnius – Professor Danute Gailiene and Paulius Skruibis regarding interest in implementing ASIST; Discussions revealed great passion and interest though implementation was not feasible at the time due to funding constraints and lack of infrastructure to support a suicide prevention plan

February 2016

Reconnected with Paulius indicating new initiative and Memorandum in Vilnius for suicide prevention addressing infrastructure and funding

Norway says ‘HELLO’ again!

TimelineDate Activity

March –May 2016

Discussions with the Vilnius Municipality Public Health Bureau regarding strategic planning and preparation for implementation of safeTALK and ASIST LivingWorks training programs including application process of potential trainer candidates

June 2016 safeTALK and ASIST trainer candidates selected and notified by Public Health Bureau

August 2016

safeTALK and ASIST Training for TrainersLivingWorks welcomes 10 new safeTALK and 6 new ASIST trainersTranslation process begins in consultation with LivingWorks

October 2016

Suicide Prevention Conference Vilnius

Introductions before safeTALK

Questions after safeTALK

Lithuania’s New ASIST Caregivers

Lithuania’s First safeTALK and ASIST Trainers

2 Suicide Alert and ASIST helpersBecoming a suicide-safer community

Suicide Alertness for Everyone

safeTALK: suicide alertness for everyone

safeTALK is a half-day training in suicide alertness.

It helps participants recognize a person with thoughts of suicideand connect them with resources who can help them to keepsafe.

Participants don’t need any formal preparation to attend thetraining.

FOCUS: Suicide alertness training for the community

DURATION: 3 hours - 4 hours (half a day)

LANGUAGES: English and French (and soon Norwegian and Lithuanian!)

PARTICIPANTS: Anyone 15 years or older

TRAINERS: 1 Trainer and 1 Community Resource Person for 15-30 participants

12 countries have onsite Trainers with 2,500+ safeTALK Trainers worldwide

273,000+ safeTALK participants trained since 2006

safeTALK is listed in the Suicide Prevention Resource Center Best Practices

Registry (USA)

Goals and objectives

Over the course of their training, safeTALK participants will learn to:

•Notice and respond to situations where suicide thoughts may be present

•Recognize that invitations for help are often overlooked,

•Move beyond the common tendency to miss, dismiss, and avoid suicide

•Apply the TALK steps: Tell, Ask, Listen, KeepSafe

•Know community resources and how to connect someone with thoughts of suicide to them for further suicide-safer help.

Why is safeTALK important?

Suicide is a community health problem that affects us all.

In each community, suicides we hearabout are only the tip of the iceberg. There are also...

•Unreported suicides (5% to 25% more)•Non-fatal suicide behaviors (40 to 100 times greater than the number of suicides)•People with thoughts of suicide (3% to 5% of the population)•People affected whenever someone dies by suicide

LTA KTell, Ask, Listen and KeepSafe

Tell (Pasakyti)

Ask (Paklausti)

Listen (Klausyti)

KeepSafe (Uztikrinti

sauguma)

safe LTA K

16.1 Connecting with an intervention resource

Co-Trainer 2.7.2 and slide 21

safeTALK in Vilnius

Testimonials

“As a taxi driver, I speak to a surprising number of people who have thoughts of suicide. safeTALK has given me and other drivers in Kilkenny a way to help them stay safe.”

—Derek Devoy, Taxi Driver, Kilkenny, Ireland

(Derek also went on to encourage safeTALK training for all the drivers in Kilkenny)

2 Suicide Alert and ASIST helpersBecoming a suicide-safer community

Applied Suicide Intervention Skills Training

FOCUS: Suicide intervention training

DURATION: Two days (15 hours)

PARTICIPANTS: Anyone 16 or older

TRAINERS: Two registered trainers per 15 – 30 participants

LANGUAGES: English, French, Spanish, Inuktitut, and Norwegian (and soon Lithuanian); Large print and Braille also available

11 Updated editions since 1983 for continued growth and improvement

6,300+ ASIST trainers offer workshops in over 30 countries

1,000,000+ people have taken ASIST worldwide

• 2-day suicide First aid gatekeeper training workshop

• Standardized core curriculum

• Pioneered integration of upstream Attitude antecedents with Knowledge and Skills

• Facilitates a safety-challenge learning environment

• Developed unique suicide intervention model (PAL)

• Multiple safeplan options – including safety for now

• Common language communication

Goals and objectives

In the course of the two-day workshop, ASIST participants learn to:

•Understand the ways personal and societal attitudes affect views on suicide and interventions

•Provide guidance and suicide first-aid to a person at risk in ways that meet their individual safety needs

•Identify the key elements of an effective suicide safety plan and the actions required to implement it

•Appreciate the value of improving and integrating suicide prevention resources in the community at large

•Recognize other important aspects of suicide prevention including life-promotion and self-care

4.3.1 PAL - Bičiulis

Pathway for Assisting Life (PAL)

3.10.2 Actions to Confirm

Safety Framework (Right now, what will keep you safe?)

Workbook Page 16

Available ASIST Caregiver

Psychological subdivision in

the Vilnius County Police

Headquarters

Common

qualities

Highly evolved

For all types of

caregivers

Training for

Trainers

LivingWo

Programs

Country and Number of Evaluations

Country ASIST sTALK

Australia 4 3

Canada 6 3

Ireland 1 -

Norway 4 -

Scotland 4 2

USA 16 1

Wales 2 -

Totals 37 9

Evaluations range from 1986 to

2015 Include findings on:

✓Satisfaction

✓Utilization

✓Learning

✓Portability

✓Suicide behavior Impact

✓Broader impact

✓Investment Benefit

Kirkpatrick-Phillips Model

Did participants like the trainings?

Summary of Satisfaction

Based on multiple evaluations, satisfaction has generally been high.

ASIST Participants:

• Good use of their time

• High quality

• Benefits were long lasting

• Better prepared them to address suicide directly

safeTALK Participants:

• Training enjoyable and worthwhile, relevant to role

• Content well received

• Acceptable to young people

• Appreciated trainer knowledge and preparedness

ASIST: Canada (2000, 2007), Norway (2003), Scotland (2005, 2007, 2008)

safeTALK: UK (2014) Australia (2015), Scotland (2007),

Did participants learn from the trainings?

Summary of Learning

ASIST Participants:

• Greater knowledge about suicide, prevention and intervention

• Greater confidence in their ability to intervene

• Readiness to intervene increased

• Increase in knowledge of intervention skills

• Improved ability of medical students to detect suicide vs TAU

• More willing to talk openly about suicide and help

• More positive attitudes toward suicide and prevention

• Better prepared to recognize suicide, ask directly, connect with help

• More likely to seek help

ASIST: Australia (2000), Canada (1994, 2015), Scotland (2008), Washington (2003)

safeTALK: Scotland (2007; 2010), Australia (2015), Canada (2011)

Did participants use the trainings?Summary of Utilization Impact

ASIST Participants:

• Increased Interventions

√ 99% applied at least one aspect of intervention model

√ More identification (18%) & risk assessment (13%) in medical setting

• Use in Garrett Lee Smith Youth Suicide Prevention Grants

√ Most used programs by GLS grantees: ASIST (longer), QPR (shorter)

√ People in longer programs had proportionately more interventions

√ Counties with Gatekeeper trainings had reductions in suicide

behaviours compared with counties without training

• Use with serious mental illness population

√ Reduced suicide by 38% in year 1, increasing to 42% in year 2

• increased case management referrals

ASIST: Australia (2000), Canada (2007), Scotland (2008), USA. (2010, 2015)safeTALK: Australia (2011)

Did ASIST and safeTALK Impact results?Summary of Results

ASIST Impact:

• National vehicle

√ raising public awareness; building longer term community capacity √ Reducing reliance on specialized professionals; sustainable resource (Scotland 2006)

• Intervention changes

√ Raised layperson Attitude/Knowledge/ Skills & interventions to level of MH professionals√ Increased networking and sense of community empowerment (Ireland 2011)

• Organization managers

√ Better able to understand and support staff experiences (Wales 2011)

• Common language

√ Better inter-agency working relationships (Wales 2011)

• Intervention outcomes

√ Less suicidal, less overwhelmed, more hopeful (Mattie Gould study 2013)

safeTALK Impact

• Established preparedness for connections with help

• Identified & connected young people at risk who had not come forward before

• Safe - no iatrogenic effects for young participants (Australia 2011/2015)

ASIST: Canada (2007), Ireland (2011), Scotland (2006, 2008), USA (2013), Wales (2011)safeTALK: Australia (2011, 2015)

Did trainings have an investment benefit?

Summary of Return on Investment (ROI)

ASIST Benefit:

• Scotland (Choose Life, 2006)

√ Cost saving (direct & indirect costs) benefit: needed 17 fewer suicides (1.9% reduction)

on $5.5m annual investment

√ Achieved 19.5 % reduction over 10 years against 20% goal

• California (Rand, 2015)√ State gain: $50 for each $1 invested in ASIST -averted health care costs; increased

income tax revenue.

√ Individual-family gain: $1100 for each $1 invested in ASIST – medical care savings;

increased lifetime earnings.

safeTALK Benefit:• no investment benefit studies to date

ASIST: Scotland (2006), USA. (2015)safeTALK:

Template

National Task Force Guidelines 1998

Reach Out- Suicide Prevention Strategy

National Strategy for

Action on Suicide Prevention

2005-2014

Connecting for Life Strategy

2015-2020

Numbers Trained in ASIST and

SafeTALKYear SafeTALK

Workshops

SafeTALK

Participant

Workshops

Participants

2004 0 0 30 641

2005 0 0 80 1724

2006 11 200 150 3184

2007 30 473 151 3219

2008 31 443 152 3279

2009 58 915 159 3348

2010 199 3439 158 3461

2011 282 5100 162 3525

2012 326 6921 156 3444

2013 379 6982 154 3406

2014 319 5891 114 2509

2015 343 6353 106 2501

Total 1,978 36,717 1,572 34,241

Template

ASIST/SafeTALK Lithuania

2 Suicide Alert and ASIST helpers

Becoming a suicide-safer community

Suicide Safer Lithuania

Vilnius Lithuania August 26th 2016 First safeTALK and ASIST Trainers

along with Translators, Municipality, Public Health, University of

Lithuania, Suicide Prevention Bureau, local Politicians and LivingWorks

Lithuania

Progressing to a national strategy through safeTALK

and ASIST

a suicide-safer community

Bendruomenė saugesnė nuo savižudybių

www.livingworks.net

ASIST References (Partial)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.

Bolton S-L, (2015). Evaluation of a gatekeeper training program as suicide intervention training for medical

students: A randomized controlled trial. Retrieved from University of Manitoba DSpace,

http://hdl.handle.net/1993/30725

Gould MS, Cross W, Pisani AR, Munfakh JL, 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.

Griesbach and Associates (2008). The use and impact of Applied Suicide Intervention Skills Training (ASIST) in

Scotland: An evaluation. Edinburgh, Scotland: The Scottish Government, Health and Community Care.

Høifødt TS, Talseth A-G, Olstad R (2007). A qualitative study of the learning processes in young physicians

treating suicidal patients: from insecurity to personal pattern knowledge and self-confidence. BMC Medical

Education, 7:21 doi:10.1186/1472-6920-7-21

McAuliffe N, Perry L (2007). Making it safer: A health centre’s strategy for suicide prevention. Psychiatric

Quarterly, 78, 295-307.

Public Health Agency (2011). All Island evaluation of Applied Suicide Intervention Skills Training (ASIST):

Summary report. Belfast, Northern Ireland: Author.

Evans RE, 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.

safeTALK ReferencesEynan 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, Hudson NPH, et al (2010). Evaluation of suicide awareness programmes delivered to veterinary

undergraduates and academic staff. Veterinary Record, 167, 730-734.

Robinson J Evaluation of the safeTALK program in the Northern Territory. Poster session presented at: American

Association of Suicidology Annual Conference; 2016 Mar 30–Apr 2; Chicago, IL.

Martin G, Swannell S, Milner A, Gullestrup (2016). Mates in Construction Suicide Prevention Program: A Five Year

Review. J Community Med Health Educ 6:465. doi:10.4172/2161-0711.1000465

Questions?

If you have further questions

Please contact:

Richard Ramsay (President LivingWorks) richard.ramsay@livingworks.net

Heather Stokes (Vice President Strategic Development) heather.stokes@livingworks.net

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