Practical Approaches to the Infusion of Culture and Diversity into Downstream Suicide Prevention Work

Body of Abstract: Part 1: A Diversity- and Culturally-Infused Framework for Downstream Suicide Prevention
Though standard approaches to suicide prevention and management clinical care have been applied similarly for all culturally diverse clients for years, researchers and the recent National Strategy for Suicide Prevention have noted a need for more attention to culture, diversity, and equity in downstream suicide prevention efforts. Recent research has identified key theoretically- and empirically-based cultural considerations for suicide prevention, but translation is needed to infuse this guidance into clinical trainings and organizational systems. This first talk presents core theoretical frameworks and empirical findings that provide the foundation needed to transform culturally-responsive clinical practice. First, presenters will discuss the core principles of the Cultural Theory and Model of Suicide and the Cultural Assessment of Risk for Suicide clinical measure which provides guidance for the integration of cultural considerations and risk and protective factors into screening, assessment, safety planning, and treatment (e.g., Chu et al., 2010, 2017a, 2017, 2022). Second, results are shared from a study that addresses a need to identify culturally responsive ways to ask about suicide (Berman & Silverman, 2017; Shea, 2009). Results will be shared from a study that utilized the expertise and lived experience of 58 community members and 46 mental health providers to assist in generating a cross-cultural list of ways to ask about suicide, named the Cross Cultural List of Questions about Suicide (CCSQ) - a definitive list of six major types and ways to ask about suicide across different cultural groups and identities.

Part 2: A Diversity- and Culturally-Infused Downstream Suicide Prevention and Management Training: “Suicide Prevention 201”
Existing trainings for behavioral health or other crisis care providers or stakeholders have lacked comprehensive attention to culture and diversity in ways that would increase service access for marginalized and under-resourced populations. The current session (part 2) presents the approach and evidence-basis for “Suicide Prevention 201 (SP201),” a culture and diversity-infused workshop for clinicians, school counselors, crisis response staff, and other suicide crisis care providers (along with a purely case-practice follow-up course titled “Suicide Prevention 202”). SP201 provides instruction and a forum for clinical discussion and case practice on the current standards for suicide prevention and management, using evidence-based frameworks and accessible guidelines that ensure its participants are able to competently manage suicide risk, incorporating the latest standards in suicide science and practice. In SP201, crisis care stakeholders learn to account for cultural influences on suicide risk and infuse key evidence-based cultural considerations (i.e., the Cultural Theory and Model of Suicide, CARS, and CCSQ discussed in part 1 of this session) throughout their suicide management activities. Aims are to provide guidance to advance culturally responsive suicide practice. Curricular lessons and data from over 600 SP201 participants will be discussed, along with ways that organizational partners have utilized SP201 as a key resource in culturally-infusing and transforming their clinical practices and procedures, system-wide.

Part 3: Implementing Best Practices in Culturally Responsive Suicide Clinical Care Systems
In order to effectively prevent suicide, there is a need to pair upstream community-level efforts with downstream focus on improving clinical systems of care. This session’s part 3 will discuss recommendations for creation of sustainable suicide safety nets within clinical systems, through a model of systematic organizational change. In this approach, consultation and resources can be provided to behavioral health and health systems interested in improving their suicide assessment and management for diverse clientele. From conceptualization and throughout the project to date, the work is grounded in a foundation in culture/diversity and community-based participatory approaches. Guiding principles of the consultation work are to help shoulder existing organizational barriers around suicide risk management, particularly among diverse communities and stakeholders. This discussion will overview the process of organizational change with several clinical site examples, as examples of how to implement similar transformations in other organizations and inspire critical thinking and planning around downstream transformation.
1. Participants will learn new theoretical and empirical advancements for the infusion of culture, diversity, and equity into downstream suicide prevention work.
2. Participants will learn cross-cultural ways to ask about suicide with six different types of suicide questions.
3. Participants will learn about a culturally-infused approach to suicide prevention training for crisis care stakeholders and providers.
4. Describe ways to integrate culture and diversity concepts and principles into clinical systems (i.e., documentation systems, policies and procedures, clinical resource systems, onboarding and training systems).

References
Berman, A. L., & Silverman, M. M. (2017). How to ask about suicide? A question in need of an empirical answer. Crisis, 38(4), 213–216.

Chu, J.P., Goldblum, P., Floyd, R., & Bongar, B. (2010). The cultural theory and model of suicide. Applied and Preventive Psychology, 14, 25-40.

Chu, J., Hoeflein, B.T.R., Goldblum, P., Bongar, B., Heyne, G.M., Gadinsky, N., & Skinta, M. (2017a). Innovations in culturally competent suicide management practice. Practice Innovations, 2(2), 66-79.

Chu, J., Hoeflein, B., Goldblum, P., Espelage, D., Davis, J., & Bongar, B. (2017b). A shortened screener version of the Cultural Assessment of Risk for Suicide. Archives of Suicide Research, 22(4), 679-687.

Chu, J., O’Neill, J., Ng, J., & Khoury, O. (2022). The Cultural Theory and Model of Suicide for Youth. In J. Ackerman & L. Horowitz (Eds.), Advances in Child and Family Policy and Practice: Youth Suicide Prevention and Intervention: Best Practices and Policy Implications. Springer: Cham.

Shea, S. C. (2009). Suicide assessment: Part 1: Uncovering suicidal intent, a sophisticated art. Psychiatric Times, 26(12), 17–19.

Learning Objectives:

• Describe new theoretical and empirical advancements for the infusion of culture, diversity, and equity into downstream suicide prevention work.
• Identify cross-cultural ways to ask about suicide with six different types of suicide questions.
• Describe a culturally-infused approach to suicide prevention training for crisis care stakeholders and providers.
• Describe ways to integrate culture and diversity concepts and principles into clinical systems (i.e., documentation systems, policies and procedures, clinical resource systems, onboarding and training systems).