• Concurrent complementary universal, selected and indicated interventions.

  • Collaboration among all parties.

  • Fidelity of program implementation.

  • The program must be designed to be sustained over a long period of time in order to evaluate its effectiveness.

  • Program evaluation must be mandatory, planned at the outset including proximal and distal outcome measures, and sufficiently funded.

  • A “Program Champion” is essential. A paid, dedicated staff position works best.

  • Everyone is trained to be competent to provide appropriate initial response, at minimum.

The workshop attendees asked Dr. Kalafat if there is any evidence of additional benefits from suicide prevention programs. He stated that they also show promise in reducing interpersonal violence.

No single type of intervention is likely to be universally effective, we can turn our attention to a more appropriate question: which combination of the many poten tial interventions is likely to be the most effective as well as feasible in prevent ing violent injuries?

John Kalafat

In a discussion of dissemination of successful models, Dr. Brown suggested three stages of development and dissemination. First, efficacy and effectiveness studies must be done, followed by small-scale implementation studies, and finally broad dissemination can start, with continued evaluations at each step.

Dr. Kalafat listed 10 priorities for effective prevention of suicide. (1) Suicide assessment and intervention training in graduate programs in all clinical disciplines. (2) Study of individual treatment efficacy, since it remains unproven. (3) Program efficacy assessment to formulate data-based methods for all groups. (4) Improved continuity of care from hospital and/or emergency settings to outpatient treatment. (5) Enhanced case identification and referral of at risk individuals. (6) Improved accessibility and delivery of services, as exemplified by the “full service school” movement. (7) Decreased access to means. (8) Improved media reporting to reduce imitation and contagion. (9) Promotion of protective factors. (10) Complementary approaches incorporating universal, selected, and indicated interventions are paramount.



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