Suicide Executive Bulletin

Suicide Executive Bulletin SAMPLE

CONTINUING EDUCATION CREDIT FOR THIS MONTH S BULLETIN Training Description The assessment of self-harm and suicide risk has become routine practice in mental health and criminal justice systems around the globe. With so many studies being published each year on these important topics, staying up-to-date on the research literature can be a challenge. The Global Institute of Forensic Research Executive Bulletin is a monthly resource that provides one-page summaries of all articles published on these important topics, as well as exclusive interviews and trainings. The present reading is a Sample Edition, which features four sample summaries as well as an exclusive interview with Dr. Robert Canning as well as a training on suicide risk assessment in children and adolescents with Dr. Tyler Black. The intended audience for the Executive Bulletin is mental health, correctional, and legal professionals with advanced degrees. Editor Biography CE Credit: Length: Level: Accreditation: Training Style: Category: Dr. Robert Canning is currently Senior Psychologist with the Statewide Mental Health Program of the California Department of Corrections and Rehabilitation (CDCR) in Sacramento, California. As CDCR s suicide prevention coordinator, he is the department s subject matter expert on correctional suicide prevention and has designed trainings for clinicians and prevention programs throughout the state. He received his Doctorate in Clinical Psychology from Pacific Graduate School of Psychology in Palo Alto, California. After finishing his clinical training, Dr. Canning completed a post-doctoral fellowship in Psychiatric Epidemiology at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. He is currently a member of the American Association of Suicidology and has been a trainer of the Association s Recognizing and Responding to Suicide Risk task force since 2007. Dr. Canning has trained hundreds of community and correctional clinicians in multiple settings in the United States and Canada. X Credits X Hours Introductory APA, CPA, ANCC Reading Risk Assessment & Management Learning Objectives This training is designed to help you: 1 Identify key strengths and limitations of available methods for self-harm and suicide risk assessment as discussed in peer-reviewed articles published in the preceding month. 2 Discuss key clinical implications of self-harm and suicide risk assessment research literature published in the preceding month such that findings may be applied in practice. 3 Learn how to effectively both defend and question the practical utility of self-harm and suicide risk assessment when applied in legal settings in accordance with research findings from peer-reviewed articles published in the preceding month. Sponsorship: The Global Institute of Forensic Research, LLC is approved by the American Psychological Association and Canadian Psychological Association to sponsor continuing education trainings. The American Nurses Credentialing Center accepts American Psychological Association credits. The Global Institute of Forensic Research, LLC maintains responsibility for this program and its contents. Refund/Cancellation Policy: If you wish to request a refund on account of technical difficulties, please contact services@gifrinc.com. Commerical Supports: The Global Institute of Forensic Research, LLC reports no conflicts of interest in the development and sponsorship of this training. The Global Institute of Forensic Research, LLC receives no commercial support for its Continuing Education programs or from its presenters.

TABLE OF CONTENTS 1. This Month s Articles 2. Monthly Interview 3. Quarterly Training 4. Continuing Education Quiz Q 5. Evaluation Form

Silverman, M. M., & Berman, A. L. (2014). Training for suicide risk assessment and suicide risk formulation. Academic Psychiatry, 38(5), 526-537. http://tinyurl.com/kajgnuw QUALITY RATING EXECUTIVE SUMMARY Silverman and Berman conducted a narrative review on the current state of suicide risk assessments (SRA) and suicide risk formulations (SRF) conducted by psychiatrists in the United States, with a particular focus on the training received in such practices by psychiatric residents. SRA involves the gathering of information about a patient s observed and reported symptoms, behaviors, and background that are associated with an increase or decrease in suicide risk. SRF involves the process through which gathered information is used to categorize a patient s suicide risk level. The authors described current SRA and SRF practices in the United States and suggested areas for improvement. There were four principal conclusions: CLINICAL IMPLICATIONS Comprehensive educational programs in suicide risk assessment and formulation are needed as part of the training received by psychiatrists during residency. The lack of a gold standard for suicide risk assessment and formulation may result in unreliable evaluations that result in false positive or false negative predictions. To improve the quality of unstructured clinical judgments, the clinical work of psychiatric residents should be supervised by experienced mentors. (4) Although most psychiatry residency programs provide some form of training on the care of suicidal patients, comprehensive educational programs on SRA and SRF are rare. There is currently no gold standard for either SRA or SRF, in part due to the lack of research on available methods predictive validity or reliability. Clinical judgment is used more often than risk assessment tools to determine a patient s suicide risk level, although there is little evidence to suggest that such unstructured judgments can predict suicide more accurately than chance. As clinical judgment is commonly used for the purposes of suicide risk assessment, psychiatric residents should be exposed to repeated case practice under the supervision of a competent mentor. RELEVANT LEGAL QUESTIONS Can you please describe the training you received in suicide risk assessment and formulation as part of your psychiatric residency? And were you supervised by a mentor when handling any cases of suicidal ideation or behavior during that residency? Can you please describe why you assessed my client s suicide risk using the approach that you did, as there is no gold standard instrument available to guide such evaluations?

Warden, S., Spiwak, R., Sareen, J., & Bolton, J. M. (2014). The SAD PERSONS scale for suicide risk assessment: A systematic review. Archives of Suicide Research, 18(4), 313-326. http://tinyurl.com/q4m9d75 QUALITY RATING EXECUTIVE SUMMARY Warden and colleagues conducted a systematic review of the predictive validity of the SAD PERSONS Scale (SPS) and the Modified SAD PERSONS Scale (MSPS) in clinical settings. The SPS is a 10-item actuarial scheme designed to aid in the prediction of suicide risk in clinical and educational settings. The MSPS contains the same 10 items as the SPS with a modified scoring procedure, in which four of the items are weighted more heavily. Total scores on both schemes are used to classify people into one of three risk categories (Low, Medium, High), with higher scores indicating higher risk. The review included nine studies between 1983 and 2012 that reported original data, evaluated the SPS or MSPS in clinical settings, and were written in English. There were three principal findings: SPS assessments of suicide risk underestimate the risk of suicide and suicidal behaviors. SPS assessments of suicide risk do not differentiate between patients at different suicide risk levels. MSPS assessments of suicide risk demonstrate the ability to predict future suicide attempts as well as the need for psychiatric admission; however, suicide risk assessment tools demonstrate better levels of predictive validity than MSPS assessments. CLINICAL IMPLICATIONS There is limited empirical research supporting the use of the SPS or MSPS in clinical samples. Caution is warranted when using the SPS or MSPS to make medicolegal decisions concerning suicide risk. Suicide risk assessment tools may produce more accurate predictions of the likelihood of suicide than the SPS or MSPS. RELEVANT LEGAL QUESTIONS Is it true that my client s score on the SPS may not accurately reflect his suicide risk? Is it true that risk assessment tools other than the SPS and MSPS may produce more accurate predictions of the likelihood of suicide? Why were additional tools not administered? Can you please describe the role your MSPS assessment played in your clinical decision-making process for my client's treatment? The authors advised caution in interpreting their findings because the SPS and MSPS were administered for a variety of purposes across articles, with few studies investigating predictive validity. When predictive validity was assessed, inconsistent scoring procedures were used for both the SPS and MSPS.

Tran, T., Luo, W., Phung, D., Harvey, R., Berk, M., Kennedy, R. L., & Venkatesh, S. (2014). Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments. BMC Psychiatry, 14(76), 1-9. http://tinyurl.com/mgyban3 QUALITY RATING EXECUTIVE SUMMARY Tran and colleagues investigated the predictive validity of a suicide risk assessment tool developed by Barwon Health compared to that produced by suicide risk assessments derived from electronic medical records (EMR) in 7,399 patients in community health centers and emergency departments in Australia. The clinician risk assessment tool developed by Barwon Health is an 18-item instrument designed to aid in the prediction of suicide risk. Total scores on the instrument are used to classify patients into one of three risk categories (Low, Moderate, High), with higher scores indicating higher risk. The EMR assessments of suicide risk were based on 202 available variables that were used to classify patients into one of three risk categories (Low, Moderate, High). The study authors followed the sample for 180 days to see who had at least one suicide attempt. There were four principal findings: The clinician risk assessment tool developed by Barwon Health produced poor to fair levels of predictive validity, whereas EMR assessments produced excellent levels. Patients who were admitted to the emergency department and had a high-lethality diagnosis had higher scores on most of the 18 risk factors on the clinical risk assessment compared to patients who were admitted to the emergency department with either a moderate- or low-lethality diagnosis. CLINICAL IMPLICATIONS Risk assessments made using information contained in electronic medical records may produce more accurate predictions of suicide than the clinical risk assessment tool developed by Barwon Health. Which risk factors are most predictive of suicide may differ across risk categories. RELEVANT LEGAL QUESTIONS Is it true that the information contained in my client s electronic medical records may produce a more accurate prediction of his suicide risk than this risk assessment tool developed by Barwon Health? Is it true that the risk factors most predictive of suicide for my client may depend on his risk level? The authors advised caution in interpreting their findings because all risk assessments were conducted in a single location, potentially limiting generalizability to other settings. (4) The most predictive variables on EMR assessments amongst patients judged to be at high risk were the participation in high risk events (e.g., alcohol abuse, intentional self-harm, asphyxiation) in the past three months as well as injuries in the past three to six months. The most predictive variables on EMR assessments amongst patients judged to be at moderate risk were emergency department visits in the past three months and number of mental health diagnoses.

Large, M., & Ryan, C. (2014). Suicide risk assessment: Myth and reality. International Journal of Clinical Practice, 68(6), 679-681. http://tinyurl.com/mh8vuwa QUALITY RATING EXECUTIVE SUMMARY Large and Ryan provided a critical commentary on the usefulness of suicide risk assessment in psychological and psychiatric practice through the discussion of relevant research findings. The authors made three principal arguments: A patient s communication of suicidal ideation is a poor predictor of future suicide, as the majority of people who express suicidal ideation do not commit suicide. Combinations of risk factors including past suicide attempts, suicidal ideation, depression, and being widowed or divorced have been unable to identify individuals who commit suicide. Classifying patients into high and low suicide risk groups does not provide a useful categorization for predicting which patients may or may not commit suicide, as half of all suicides occur in patients who are judged to be at low risk. CLINICAL IMPLICATIONS Factors that are often thought to be positively associated with suicide risk may not be empirically predictive of future suicide. Because suicide rates are indistinguishable between high and low risk patients, providing risk management interventions to only patients judged to be at high risk may not be advisable. RELEVANT LEGAL QUESTIONS Is it true that my client s history of suicidal ideation is likely not indicative of his likelihood of committing suicide? My client has been assessed to be at 'low risk' of committing suicide. Is it true that people classified as 'low risk' are just as likely to commit suicide as those classified as 'high risk'?

EXCLUSIVE INTERVIEW PLEASE CLICK HERE TO WATCH THE VIDEO ON OUR CHANNEL EXCLUSIVE INTERVIEW WITH DR. ROBERT CANNING Robert Canning, Ph.D., is Senior Psychologist with the Statewide Mental Health Program of the California Department of Corrections and Rehabilitation (CDCR) in Sacramento, California. In 1993 Dr. Canning received a doctoral degree in Clinical Psychology from Pacific Graduate School of Psychology in Palo Alto, CA. After clinical training he completed a post-doctoral fellowship in Psychiatric Epidemiology at the Western Psychiatric Institute and Clinic at the University of Pittsburgh Medical Center. Since 2005 Dr. Canning has acted as the CDCR s suicide prevention coordinator. In this position he has been the department s subject matter expert on correctional suicide prevention and has designed trainings for clinicians and prevention programs throughout the state. He is a member of the American Association of Suicidology and has been a trainer of the Association s Recognizing and Responding to Suicide Risk task force since 2007. He has trained hundreds of community and correctional clinicians in multiple settings in the United States and Canada.

EXCLUSIVE TRAINING LEARNING OBJECTIVES: PLEASE CLICK HERE TO WATCH THE VIDEO ON OUR CHANNEL 1 2 3 This training is designed to help you: Explore the epidemiology of suicide risk in children and adolescents in North America. Examine the relationship between mental illness and suicide. Distinguish between static and dynamic risk factors for suicide. EXCLUSIVE TRAINING WITH DR. TYLER BLACK Dr. Tyler Black received his Medical Doctorate at the University of Alberta and his residency training in psychiatry at Dalhousie University and the University of British Columbia. Dr. Black is currently the clinical head of the Child and Adolescent Psychiatric Emergency (CAPE) Unit at British Columbia Children s Hospital. He is also a Clinical Instructor in the Department of Psychiatry at the University of British Columbia. Dr. Black's primary research and clinical interests include suicidology, emergency psychiatry, violence in video games, and cross-cultural psychiatry. His recent research has been published in leading journals including the Journal of the American Medical Association and the Journal of the Canadian Academy of Adolescent Psychiatry. He frequently presents findings of his research at both national and international conferences and is on the Executive Board of both the Canadian Association for Suicide Prevention as well as the Crisis Line Association of British Columbia.

CONTINUING EDUCATION QUIZ Full Name License Number (if applicable) Today's Date INSTRUCTIONS First, identify whether the statements below are true or false, and complete the evaluation form on the following two pages. Second, save this PDF onto your computer. Third, send an e-mail to services@gifrinc.com with a subject line of March 2015 CE Quiz and your PDF attached. A representative from the Global Institute of Forensic Research will grade your quiz and respond to your e-mail with a Continuing Education Certificate within one calendar week, provided a passing grade of 70% or higher was achieved. QUESTION 1 Comprehensive education on suicide risk assessment and formulation is rarely received during psychiatric residencies in the United States. QUESTION 2 Information contained within electronic medical records may predict the likelihood of future suicide more accurately than clinician assessments. QUESTION 3 SAD PERSONS Scale assessments overestimate suicide risk. QUESTION 4 Suicidal ideation is a poor predictor of future suicide, since the majority of people who express suicidal ideation do not commit suicide. QUESTION 5 The prevalence of suicide in the United States is higher during late adolescence compared to early adolescence. QUESTION 6 Approximately 75% of suicide victims met criteria for a mental illness. QUESTION 7 Non-response to medication is a dynamic risk factor for suicide.

CONTINUING EDUCATION EVALUATION FORM Strongly Disagree Disagree Neutral Agree Strongly Agree Not Applicable The Following Learning Objectives Were Met 1 2 3 4 5 6 Identify key strengths and limitations of available methods for self-harm and suicide risk assessment as discussed in peer-reviewed articles published in March 2015. Discuss key clinical implications of the March 2015 suicide and self-harm risk assessment research literature such that findings may be applied in practice. Learn how to effectively both defend and question the practical utility of self-harm and suicide risk assessment when applied in legal settings in accordance with research findings from peer-reviewed articles published in March 2015. Explore the epidemiology of suicide risk in children and adolescents in North America. Examine the relationship between mental illness and suicide. Distinguish between static and dynamic risk factors for suicide. Overall Presentation Accuracy and utility of content were discussed Content was appropriate for postdoctoral level training Instruction at a level appropriate to postdoctoral level training Presentation of information was effective My special needs were met (if applicable) Level of Learning Information could be applied to my practice (if applicable) Information could contribute to achieving personal/professional goals Cultural, racial, ethnic, socioeconomic, and gender differences were considered (if applicable) I learned a great deal as a result of this CE program This CE program enhanced my professional expertise I would recommend this CE program to others Executive Bulletin Editor (Dr. Robert Canning) Knew the subject matter Discussed the subject competently Elaborated upon the stated learning objectives (1-6 above) Presented content in an organized manner Materials maintained my interest Answered questions effectively (if applicable) Was responsive to questions, comments, and opinions (if applicable)

Please confirm that you have read and understand each of the following I confirm that I am an individual subscriber (or my institution has a group subscription) to the Executive Bulletin. To receive CE credit for this month s Executive Bulletin, a passing grade of 70% or higher must be achieved on the quiz and submitted electronically with a completed Evaluation Form to services@gifrinc.com GIFR receives no commercial support or benefits for its CE programs or from its presenters. GIFR reports no conflicts of interest in the development and sponsorship of this CE program. GIFR interviewees and trainers receive a free annual subscription to the GIFR Executive Bulletin. GIFR holds responsibility for the accuracy and utility of the materials presented in this month s Executive Bulletin, which is based on peer-reviewed research as well as the professional opinions of doctoral-level GIFR staff members. No risks are foreseen associated with these materials. For details on limitations of liability, please see the Terms & Conditions. Your Profession (check all that apply) Psychologist Nurse Masters Level Licensed Therapist Social Worker University Faculty Administrator Student Other Specify: Years in Your Profession Student <1-5 6-10 11-20 20+ What was your overall impression of this month s GIFR Executive Bulletin? What went well? What could have been improved? What did you learn in this month s GIFR Executive Bulletin that was new or different? How and/or will this information change how you practice (if applicable)? Additional Comments or Suggestions for Future Editions of the GIFR Executive Bulletin? Contact the GIFR Continuing Education Administrator at services@gifrinc.com