Course Summary

This registered best practice training program teaches the core competencies required of professionals responsible for the care and safety of consumers detected to be at elevated risk for suicidal behaviors (not violence). Following foundational lectures on epidemiology, clinical risk patterns, and the current status of suicide risk assessment, clinicians learn how to conduct a standardized, evidence-based guided interview designed to elicit perceived burdensomeness, suicidal desire, intent, capability and buffers against suicide. Data collected is then contextualized within the patient’s current personal crisis to better understand, anticipate, and implement risk mitigation strategies, including evidence-based treatments.

Based on the quality of the relationship, the difficulty of the interview, and the reliability of the data collected, participants learn to make informed risk stratification decisions to determine the level of care recommended or required. Training includes modules on means reduction, collaborative crisis safety planning, managing/monitoring risk over time, documentation, and a skills practice sessions.

In 2022 10 upgrades were made to this training program:

1. Basic QPR training is now included to enhance suicide risk detection in friends, family members, colleagues and co-workers
2. A tutorial on official terms and language use and orientation to Zero Suicide
3. A verbal screener to detect suicide risk in care settings
4. Skills training in three additional interventions; means reduction, safety planning, and continuity of care/caring contacts
5. A new e-learning software enabling scenario-based simulation training is included, enhancing learner engagement and improving content and skills mastery
6. Tutorial on how to avoid claims of suicide malpractice (taught by an expert attorney)
7. Training in postvention best practices in the aftermath of a death by suicide
8. Late-life suicide prevention, burden of suffering, and current clinical best practice
9. Copyright free use of QPRT risk assessment documents for pediatrics, adults, inpatient and outpatient are now included
10. Orientation to trauma-informed care

Skills-based training

Competencies taught in this course are based on emerging recommendations and descriptions of the knowledge and skills required for working with people at risk of suicide as described by the National Suicide Prevention Lifeline, the American Psychological Association competency movement, and as adapted from the Substance abuse and Mental Health Services Administration, Center for Substance Abuse Treatment’s Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, Technical Assistance Publication series #21 and #50.

This training program includes knowledge-based competencies (knowledge of) and application-based competencies (able to), following the “cube model” of the professional psychology competency development movement, and in which both “foundational” and “functional” competencies are addressed (Rodolfa, et al., 2005).

Major Learning Objective

Participants earning a certificate will have knowledge of and be able to:

• Explain suicide as a major global public health problem
• Describe the US National Strategy for Suicide Prevention and the scope of the problem of suicide in America. (If from another country, describe national and regional suicide prevention efforts)
• Describe the relationship of mental illness, by diagnosis, to suicide risk
• Critique the current challenges in suicide risk assessment
• Recite clinically relevant risk and protective factors for suicidal behavior
• Explain the current limitations in suicide risk assessment
• Recite three reasons why suicide risk often goes undetected
• Describe at least five risk factors for suicide
• Describe at least five protective factors for suicid
• Describe the rationale for the QPRT Suicide Risk Management Inventory©
• Demonstrate use the 7 QPRT protocol stem questions and the reasons each
• Employ a proven risk assessment interview protocol
• Conduct and document a comprehensive suicide risk assessment
• Describe when and why reassessment of suicide risk is indicated
• Apply common terms about suicidal behavior and communicate effectively with other clinicians about suicidal patients
• Avoid claims of suicide malpractice
• Pass a nationally standardized exam on suicide risk assessment and management

Participants should ALSO be able to:

• Describe/discuss personal discomfort comfort with suicide
• Establish rapport, engagement strategies, and apply initial probes for suicidal ideation
• Demonstrate how to gather data related to suicidal ideation and history from the patient and other available collateral sources
• Assess current and historic suicidal ideations, plans and attempts
• Explain how to collect and integrate health, mental health and substance related treatment history, mental status examination, and current social, environmental, and/or economic constraints into a treatment plan for a suicidal consumer
• Probe for, discuss, and reduce access to any means of suicide under consideration
• Assess the patient’s readiness for acceptance of a safety plan and/or treatment as well as the needs of others involved in the current situation
• Demonstrate and document a collaborative patient safety and shared risk management plan in a concise and competent manner
• Prepare and formulate a risk stratification decision to guide “next steps” toward enhanced patient safety, crisis mitigation and/or treatment disposition
• State that I had the opportunity to practice the QPRT assessment interview during the workshop, or as directed in the online course using the downloadable role-play and instructions

Continuing Education Credits Application Information

(Edit as needed for application to sponsoring CE organizations)

The following course description of the QPRT Suicide Risk Assessment and Risk Management training program and it’s derivative QPR for Primary Care Providers can be used to complete CEU applications.

Brief best practice description @ www.sprc.org/sites/sprc.org/files/bpr/QPRT.pdf

Course Description

The QPRT training program is the first, systematic training program ever developed for the standardized detection, assessment, and management of suicidal consumers of mental health and chemical dependency services. It was designed and developed to improve the clinical core competencies of healthcare professionals to work with suicide-at-risk patients and thereby improve patient safety.

First developed in 1999 in collaboration between Spokane Mental Health and the Washington Institute for Mental Health Research and Training, the QPRT training program and interview protocol was designed to reduce consumer suicide-related morbidity and mortality by standardizing the detection, assessment, documentation and management of patients at elevated risk for suicidal behaviors in all settings and across the age span.

The QPRT assessment protocols (adult, pediatric and hospital versions) are guided clinical interviews developed through expert consensus opinion from surveys conducted with members of the American Association of Suicidology.

The training content is sourced and anchored in existing scientific literature on suicide risk assessment, treatment, and risk management, as well as emerging best practices as registered in the American Foundation for Suicide Prevention/Suicide Prevention Resource Center registry.

The structured interview assessment questions are logically reasoned, flexible, and produce a standardized suicide risk assessment data set which includes documentation of risk and protective factors, dynamic and contextual information, current suicidal ideation, desire, intent, planning, past attempts and other reports of suicide capability.

Data gathered from the QPRT interview protocol by a trained practitioner leads to the development of a collaborative crisis management safety plan which, in turn, is integrated into the treatment or referral plan.

The QPRT Suicide Risk Management Inventory© was developed by a multidisciplinary team of psychiatrists, psychologists, nurses, and social workers at Spokane Mental Health in response to a comprehensive medical records review of all known consumer fatalities by suicide for the years 1978 through 1998. The detailed review found that a lack of training, standardization of detection and assessment of suicide risk, and poor documentation of risk management likely contributed to preventable consumer deaths. (The history of these developments is summarized below.)

In addition to providing a medical record documentation system for patients at elevated risk of suicide, the purpose of the training is to enhance clinical competence as defined by the capacity to conduct:

“[A] one-to-one assessment/intervention interview between a suicidal respondent in a telephonic or face-to-face setting in which the distressed person is thoroughly interviewed regarding current suicidal desire/ideation, capability, intent, reasons for dying, reasons for living, and especially suicide attempt plans, past attempts and protective factors. The interview leads to a risk stratification decision, risk mitigation intervention and a collaborative risk management/safety plan, inclusive of documentation of the assessment and interventions made and/or recommended.” (Quinnett, 2010)

Learner Experiences and Expectations

Learning how to conduct a best practice suicide risk assessment requires participants to address areas of personal knowledge, values, and attitudes that often require self-reflection regarding one’s competence to work with known at risk individuals. This course is not designed to fully address these participant concerns or issues but does make room for optional disclosures of personal or professional experiences with suicide. The overall aim of the training is to enhance suicide risk assessment/diagnostic competencies by addressing both potential knowledge and application or skill deficits in keeping with emergent competency expectations. *

Training Time Requirements

This course is offered only online and requires 14+ hours to complete. Face-to-face role-play practice sessions are recommended.

This course explores the theoretical foundation in suicide risk assessment and management with a special emphasis on the Surgeon General’s National Strategy for Suicide Prevention 2012. It covers the epidemiology of suicide in America and evidenced-based risk and protective factors. Emphasis is placed on the relationship of mental illness and substance use to suicide with focus on suicide risk mitigation through the employment of intervention best practices, e.g., means reduction, safety planning and caring letters follow up. The roles of resiliency, shared responsibility, connectivity to reduce and mitigate suicide risk are also developed. This course provides detailed instruction on interviewing suicide-at-risk patients and includes scenario-based interactive practice challenges, simulations, and role-play exercises followed by immediate learner feedback.

Course Rationale

Developing social policy emphasizing the importance of training for all health professionals and human services professionals concerning suicide recognition, the need for treatment, risk assessment and management has arrived. The Zero Suicide initiative has emerged from the culmination of decades of recommendations to address the training deficit.

Course Content

The QPRT online training program is divided into 25+ lessons covering the following highlighted topics:

• Orientation to the challenge of patient safety
• QPR Theory, Research and Practice
• QPR Gatekeeper Training for Suicide Prevention
• QPR as a Suicide Risk Screener
• Suicide Terms and Definitions
• The epidemiology of suicide in America and beyond
• Mental Health and Suicide
• LGTBQ and Suicide
• Foundations in Serious Mental Illness, SUDs, and Suicide
• The relationship of mental illness to suicide, e.g., risk by DSM IV diagnostic category – major depression, TBI, PSTD, etc.
• Co-occurring disorders and suicide
• Introduction to the neurobiology of suicide
• Overview of environmental and circumstantial risk factors, proximal, distal, developmental, trauma-related, and protective factors
• Review of environmental and circumstantial risk factors, proximal, distal, developmental, trauma-related, and protective factors
• Overview of intimate partner violence and murder-suicide
• Current status of suicide risk assessment, screens verses assessments, status of current practices
• Suicide risk detection and assessment. (formulating risk)
• Suicide risk management and risk mitigation
• Limitations of the clinical interview in suicide risk assessment
• Introduction to the QPRT Suicide Risk Management Inventory ©
• Instructions for interviewing suicidal patients, protocol, documentation, and safety planning
• Interactive simulations and role-play sessions/Q&A/feedback
• Risk assessment documentation instructions
• Avoiding claims of suicide malpractice with mock trial
• Instructions for what to do if a patient dies by suicide.
• Late-life suicide prevention, scope of problem and best practices
• Veteran-specific approach to preventing suicide
• Brief review of survivors of suicide and resources to assist
• Clinician self-care and surviving patient suicide, resources and referrals

Course Competencies and Objectives

Competencies taught in these courses are based on emerging recommendations and descriptions of the knowledge and skills required for working with suicidal people as described by the National Suicide Prevention Lifeline, the American Psychological Association competency movement*, and as adapted from the Substance abuse and Mental Health Services Administration, Center for Substance Abuse Treatment’s Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice, Technical Assistance Publication series #21 and #50.

These competencies were selected because the training is suited for mental health professionals, substance abuse treatment professionals, as well as counselors, medical professionals, and case managers at every level of service – whether in a screen, assess, and refer role, or in a full treatment role.

Following developments in the practice competency movement, these training programs are broken down into knowledge-based competencies (knowledge of) and application-based competencies (able to), following the “cube model” of the professional psychology competency development movement, and in which both “foundational” and “functional” competencies are addressed (Rodolfa, et al., 2005). Thus, the learning objectives are defined as follows:

Knowledge-based Learning Objectives

The person conducting a suicide risk assessment will have knowledge of and be able to:

• Describe the National Strategy for Suicide Prevention and the scope of the problem of suicide in America
• Critique the current challenges in suicide risk assessment
• Recite clinically relevant, evidence-based risk and protective factors for suicidal behavior
• Explain the current limitations in suicide risk assessment
• Recite three reasons why suicide risk often goes undetected
• Describe the rationale for the QPRT Suicide Risk Management Inventory©
• Demonstrate use the 7 QPRT protocol stem questions and the reasons each
• Employ a guided suicide risk assessment interview protocol to elicit risk and protective factor information
• Conduct and document a comprehensive suicide risk assessment interview using the QPRT interview protocol
• Demonstrate and document a collaborative patient safety and shared risk management plan in a concise and competent manner
• Describe when and why reassessment of suicide risk is indicated

Application-based Learning Objectives (skills)

The person conducting a suicide risk assessment will be able to:

• Describe/discuss personal comfort with suicide
• Establish rapport, engagement strategies, and apply initial probes for suicidality
• Demonstrate how to gather data related to suicidal ideation and history from the patient and other available collateral sources, using key stem questions sensitive to age, developmental level, culture, and gender
• Assess current and historic suicidal ideations, plans and attempts
• Explain collection for health, mental health and substance related treatment history, mental status, and current social, environmental, and/or economic constraints (QPRT only, skills usually established)
• Assess the patient’s readiness for acceptance of a safety plan and/or treatment as well as the needs of others involved in the current situation
• Prepare and formulate a risk stratification decision to guide “next steps” toward enhanced patient safety, crisis mitigation and/or treatment disposition
• Describe an appropriate level of monitoring in an inpatient or residential setting, e.g., line of sight vs. routine monitoring
• Write a clear, detailed, collaborative, documented safety plan and take specific steps to initiate an appropriate admission or referral and ensure follow-through (emphasis strong in QPR Suicide Triage Training)
• Prepare a collaborative plan with the patient and others to gather and interpret information necessary for treatment and evaluating patient progress (QPRT only)
• Explain how to integrate the suicide risk assessment into a treatment plan, set up reassessment windows, and review schedules and document model risk monitoring and management plan (QPRT only, inpatient/residential option available in training modules and documentation systems)
• State that I had the opportunity to practice the QPRT assessment interview during the workshop, or as directed in the online course using the downloadable role-play and instructions

Class Format/Methodology

Online training consists of brief lectures, videos, case studies, class discussions, role-plays, practice challenges, simulations and role-plays, short quizzes, and interactive text game maze challenges. Following the APA recommendations on establishing competencies, both knowledge and skills are emphasized*

Evaluation Methods

Online students complete pre-post knowledge and self-efficacy surveys and must pass a nationally standardized exam to earn a certificate. The online courses include multiple interactive practice challenges. Contact and interaction with an expert instructor is available (additional fee required).

Competencies taught in QPR Institute courses are based upon recommendations from the US Department of Education, National Center for Education Statistics and follow recommendations found in "Defining and Assessing Learning: Exploring Competency-Based Initiatives," NCES 2002-159R, prepared by Elizabeth A. Jones and Richard A. Voorhees, with Karen Paulson, for the Council of the National Postsecondary Education Cooperative Working Group on Competency-Based Initiatives. Washington, DC: 2002.

Developmental History Current Status of the QPRT Training Program

Since the QPRT training program was first developed in 1998 it has been taught in a wide spectrum of clinical settings across the United States, including mental health centers, state hospitals, substance abuse treatment programs and residential programs. It is constantly evolving and being updated to reflect the latest research.

Since 2001 the following highlights are noted:

• 2002. The QPRT, as part of a systems approach to suicide risk reduction, was presented at the request of the American Psychiatric Association’s Special Task Force on Patient Safety, held in Chantilly, Virginia.
• 2002-2003. The QPRT and its training program were adopted for use by a variety of mental health and substance abuse treatment organizations. More than 1,100 professional trainees from several states provide pre-post testing outcomes for a multi-site evaluation of QPRT training.
• 2004. The Devereux Foundation reported favorable outcomes from its five-year implementation of the QPR Institute’s Suicide Risk Reduction Program (featuring the QPRT training and documentation system) to the Joint Commission. The Devereux Foundation consists of over 50 facilities located in 11 states and employs more than 5,000 staff.
• 2004. In partnership with Eastern Washington University and its division of Educational Outreach, the QPRT course was offered in a blended online version for continuing education and college credit for all healthcare students and working professionals. The core content and methodology of this online course are also incorporated into a 3-credit college course from the Department of Social Work and Human Services.
• 2005. The QPRT was highlighted in the U.S. Department of Health and Human Services (SAMHSA) Treatment Improvement Protocol Tip 42, as an example of best practices in suicide risk assessment.
• 2005. As part of a state-wide suicide risk reduction effort for consumers, and on contract to the University of Georgia via the Georgia Division of Mental Health, Addiction Services and Developmental Disabilities, the QPRT was taught to a wide variety of providers in five locations throughout the state. Overall training satisfaction ratings from 378 diverse professionals finds that 98% of participants found the program “good to excellent” (good N = 118, excellent N = 251) on a 5-point Likert scale.
• 2006. The QPRT online course offered through Eastern Washington University was approved for 6.5 hours of CE for psychologists by the American Psychological Association.
• 2006. In collaboration with the University of Northern Illinois a comparison study of the impact of QPRT training on suicide risk assessment and management knowledge was conducted using the 25-item standardized SRMI© (Suicide Risk Management Inventory ©). This multi-site (N=28), multi-instructor study found knowledge gains averaged more than 50% across multiple mental health and medical disciplines (N=1,136).
• 2007. A pilot research project to enhance the QPRT Suicide Risk Management Inventory© by using third party informants was completed with Comprehensive Mental Health, a three-county mental health system in Central Washington State.
• 2007. The Devereux Foundation reported favorable outcomes from its ten-year implementation and use of the QPRT and its training program to the Joint Commission.
• 2009. All QPRT training manuals, teaching slides, user materials and related content is provided to the American Foundation for Suicide Prevention/Suicide Prevention Resource Center Best Practice Registry for peer review.
• 2010. The US Substance Abuse Mental Health Services Administration published the QPRT in the Best Practice Registry. See at: http://www2.sprc.org/sites/sprc.org/files/QPRTrev.pdf
• 2012. The QPRT training program is undergoing a formal external evaluation by an independent research team at the University of South Florida.

Used in more than 150 inpatient and outpatient mental health service provider sites around the United States the QPRT has been used to assess more than 950,000 mental health, substance abuse and medical consumers of care to date. No adverse events have been reported in association with the use of the QPRT protocol.

Research/evaluation summary

The QPRT Suicide Risk Management and Risk Assessment protocol and training program was originally developed in 1996 by a multidisciplinary team of mental health professionals at Spokane Mental Health, in Spokane, Washington, USA.

Working with the Washington Institute for Mental Illness Research and Training, and after surveying senior members of the American Association of Suicidology for “most recommended” suicide risk assessment questions, teaching content was selected, tested, and evaluated using an objective 27-item test developed to assess the training effect of the eight hour QPRT Suicide Risk Management and Risk Management course. The exam questions were divided into four sub-scales intended to tap information in the following areas: Epidemiology and Statistics (8 items), Suicide Risk Factors (5 items), Suicide Risk Assessment (6 items), and Suicide Risk Management (8 items). Treatment content items were included in the assessment and management subsets. Since the initial 1996 evaluation of the QPRT training program, the following groups or organizations have conducted training and content evaluations.

Published research on the QPRT can be found at: https://scholar.google.com/scholar?q=research+on+the+QPRT+Risk+Assessment&hl=en&as_sdt=0&as_vis=1&oi=scholart

References

Practice Definition Reference:

Quinnett, P. (2010). Suicide risk assessment competency certification examination. Retrieved from: http://www.qprinstitute.com/Joomla/index.php?product_id=3&page=shop.product_detail s&category_id=1&flypage=flypage-ask.tpl&option=com_virtuemart&Itemid=112

Competency Movement:

Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L. Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36, 347‐354.