QPRT Version 2.0

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.