Behavioral health professionals, Tribal leaders, teachers, first responders, and others in American Indian and Alaska Native communities can peruse the descriptions below to find best and promising practices, culturally relevant programs, training opportunities, and more about suicide prevention, intervention, assessment, and aftercare. You can use this information to create, improve, or adapt your own programs. (This isn’t a comprehensive list of programs and resources, and a listing on this page doesn’t mean an endorsement.)
American Indian Life Skills Development is a school-based suicide prevention curriculum designed to reduce suicide risk and improve protective factors among American Indian adolescents 14 to 19 years old. The curriculum includes anywhere from 28 to 56 lesson plans, covering such topics as building self-esteem, identifying emotions and stress, increasing communication and problem-solving skills, recognizing and eliminating self-destructive behavior, learning about suicide, role-playing around suicide prevention, and setting personal and community goals. The Zuni Life Skills Development curriculum was developed with cultural components relevant to the people of the Zuni Pueblo in New Mexico. The Zuni curriculum is the basis for the broader American Indian Life Skills Development curriculum, which can be used with other American Indian populations when implemented with appropriate and culturally specific modifications. The two programs are reviewed by the National Registry of Evidence-Based Programs and Practices
and by Suicide and Life-Threatening Behavior
, the journal of the American Association of Suicidology
. The American Indian Life Skills Development Curriculum is available from the University of Wisconsin Press
Assessing and Managing Suicide Risk: Core Competencies for Mental Health Professionals
is a two-day, practice-oriented workshop created by LivingWorks
for caregivers who want to feel more confident in preventing the immediate risk of suicide. According to LivingWorks, more than one million caregivers have participated in this workshop. ASIST requires instruction by a qualified trainer, and training is available from LivingWorks or qualified trainers for a fee. ASIST is considered a best practice[PDF – 36 KB] by the Suicide Prevention Resource Center
The Center for Native American Youth
is committed to improving the health, safety, and well-being of Native American youth and, in particular, to preventing youth suicide. Founded by former U.S. Senator Byron Dorgan, the center aspires to develop meaningful partnerships with Tribal governments and organizations. The Center holds youth summits and roundtables throughout Indian Country to bring together youth, Tribal leaders, key partners, and experts to discuss the challenges these young people face and best practices on how to respond to those challenges.
The Community Readiness Model
provides communities, organizations, and social networks with the stages of readiness for the development of appropriate strategies that are more successful and cost effective. The Model has nine stages of readiness, and it measures six dimensions (or aspects) of a community. Each dimension has a stage of readiness associated with it, and each readiness stage has specific interventions that work most effectively for that stage. Culture is integrated into the prevention process. Over the past 18 years, the Community Readiness Model has been used in more than 2,500 communities to prevent suicide, substance abuse, intimate partner violence, and other problems.
—a prevention, intervention, and postvention training program for professionals, community stakeholders, and youth—uses a holistic, public health approach that views suicide in the context of the individual, family, clan, Tribe, community, and society. Building on Tribal strengths
, Connect collaboratively creates a safety net for people at risk and provides a comprehensive postvention response after a suicide. Connect has worked with a number of Tribes, and the training program can be customized to meet Tribal customs. The Suicide Prevention Resource Center
has placed Connect’s prevention[PDF – 47 KB], postvention[PDF – 47 KB], and youth[PDF – 36 KB] programs in its Best Practices Registry.
CARE (Care, Assess, Respond, Empower)—formerly called C-CARE and MAPS—is a high school-based suicide prevention program for high-risk youth. CARE includes a suicide assessment interview followed by motivational counseling and social support intervention. The counseling session is designed to deliver empathy and support, provide a safe context for sharing personal information, and reinforce positive coping skills and help-seeking behaviors. The program includes a follow-up reassessment of suicide risk and protective factors and offers a booster motivational counseling session nine weeks after the initial session. Although CARE was developed for high schoolers, its scope has been expanded to include young adults. CARE is reviewed at the National Registry of Evidence-Based Programs and Practices
is a school-based suicide prevention program for 14–19 year olds. CAST delivers life-skills training and social support to groups of 6–8 students. Twelve group sessions are given over six weeks. CAST serves as a follow-up program for youth who have been identified through screening as being at significant risk for suicide. In the original trials, identification of youth was done through CARE, but other evidence-based suicide risk screening instruments can be used. CAST’s skills training aims to increase mood management, improve school performance, and decrease drug involvement. Group sessions incorporate key concepts, objectives, and skills that inform a group-generated implementation plan for the CAST leader. Each session helps the youths apply newly acquired skills and increase support from family and other trusted adults. Lesson plans specify the type of motivational preparation, teaching, skills practice, and coaching activities. CAST is reviewed at NREPP
Dialectical behavior therapy is a cognitive-behavioral treatment approach with two key characteristics: a behavioral, problem-solving focus blended with acceptance-based strategies and an emphasis on dialectical processes. “Dialectical” refers to the issues involved in treating patients with multiple disorders and to the type of thought processes and behavioral styles used in the treatment strategies. Dialectical behavior therapy is reveiwed at the National Registry of Evidence-Based Programs and Practices
Youths treated at hospital emergency rooms for suicidal behavior remain at very high risk for future suicide attempts. Research
in Los Angeles shows that a family-based intervention conducted while troubled youths are still being treated in the emergency room leads to improvements in linking these youths to outpatient treatment following their discharge. Youths in the study received an enhanced mental health intervention that involved a family-based crisis-therapy session designed to increase motivation for outpatient follow-up treatment and improve the youths’ safety.
Most efforts to prevent suicide focus on why people take their lives. But, how a person attempts suicide—the means he or she uses—can determine life or death. “Means reduction” is the goal of a project of the Harvard School of Public Health called Means Matter
. The Center argues that reducing teen access to more lethal means of suicide, such as firearms, saves lives.
The Native HOPE
program creates a safe, sacred place through culture, spirituality, and humor for participants to address suicide, depression, trauma, violence, and substance abuse. Participants share the challenges in their lives; they commit to effect positive changes in their attitude and behavior and to support each other. This peer-counseling approach has proven to be highly effective for Native youth to break the “code of silence.” This process allows Native youth to help their peers get through crises and make the necessary referrals for support. Native HOPE also trains community members in facilitation and group process skills to continue ongoing “booster” prevention and leadership activities. Native HOPE is a program of Native PRIDE
(Prevention, Research, Intervention, Development, and Education), which provides cultural- and spiritual-based programs to inspire wellness and healing, leadership development, and positive changes.
A project of the Montana-Wyoming Tribal Leaders Council, Planting Seeds of Hope
builds resilience in Native American youth and capacity for suicide prevention on reservations by: promoting awareness; training gatekeepers; implementing screening and brief intervention; building protective factors for youth and veterans; implementing interventions for youth who have attempted suicide; helping families who have lost someone to suicide; and strengthening coordination and collaboration across sectors.
Question, Persuade, and Refer: three simple steps that anyone can learn to help save a life from suicide. Just as people trained in CPR and the Heimlich maneuver help save thousands of lives each year, people trained in QPR learn how to recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to help. QPR-trained “gatekeepers” are parents, friends, neighbors, teachers, religious leaders, doctors, nurses, coworkers, police, counselors, firefighters, or others who are in a position to recognize and refer someone at risk of suicide. QPR was developed, and is taught, by the QPR Institute
. Several QPR Institute trainings are listed in the Adherence to Standards section of the Best Practices Registry
of the Suicide Prevention Resource Center
is a school-based prevention program for students ages 14–19 years that teaches skills to build resiliency against risk factors and control early signs of substance abuse and emotional distress. Reconnecting Youth targets youth who demonstrate poor school achievement and high potential for school dropout. Eligible students may show signs of multiple problem behaviors, such as substance abuse, aggression, depression, or suicidal ideation. Reconnecting Youth has been reviewed by the National Registry of Evidence-Based Programs and Practices
is an evidence-based, suicide prevention training program that teaches participants to recognize and engage individuals who might be having thoughts of suicide and connect them with community resources trained in suicide intervention. “Safe” stands for “suicide alertness for everyone.” “TALK” stands for “tell, ask, listen, and keep safe,” which are the actions one takes to help someone with thoughts of suicide. Created by LivingWorks
, safeTALK stresses safety and challenges taboos that inhibit open talk about suicide. safeTALK is universal and appropriate for a variety of audiences—formal or informal caregivers—and it has been tested cross-culturally, including with Native, First Nations, and aboriginal communities. safeTALK is considered a best practice[PDF – 36 KB] by the Suicide Prevention Resource Center
SOS Signs of Suicide
is a two-day secondary school-based intervention that includes screening and education. Students are screened for depression and suicide risk and referred for professional help as indicated. Students learn to recognize signs of depression and suicide in others. They are taught that the appropriate response to these signs is to Acknowledge them, let the person know you Care, and Tell a responsible adult (ACT). Students participate in guided classroom discussions about suicide and depression. The intervention attempts to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes toward suicide and depression, and increase help-seeking behavior. SOS Signs of Suicide is listed as an evidence-based practice in the Best Practices Registry
of the Suicide Prevention Resource Center, and it has been reviewed by the National Registry of Evidence-Based Programs and Practices
and the BMC Public Health
Sources of Strength
is a comprehensive wellness program that uses young peer leaders to change norms around codes of silence and help seeking. The program is designed to increase help-seeking behaviors and connections between peers and caring adults. Tribal communities, especially in the Northern Plains, have been long-term partners of Sources of Strength. There have been a wide range of adaptations of Sources of Strength blended with local Tribal traditions of wellness and strength. For example, schools have developed peer leaders using traditional stories from elders, the teaching of traditional language, arts, crafts, and more. According to the American Journal of Public Health
, “Sources of Strength is the first suicide prevention program involving peer leaders to enhance protective factors associated with reducing suicide at the school population level.” Sources of Strength is listed as an evidence-based program in the Best Practices Registry
of the Suicide Prevention Resource Center and has been reviewed by the National Registry of Evidence-Based Practices
The Suicide Prevention Resource Center
provides technical assistance, training, and materials to increase the knowledge and expertise of suicide prevention practitioners and other professionals serving people at risk for suicide. The Center promotes collaboration among organizations that play a role in developing the field of suicide prevention. The Center offers workshops and webinars, and its website has 250 library resources and a best practices registry. The Center’s website also has a section for professionals serving American Indian and Alaska Native communities
To Live to See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults
To Live to See the Great Day That Dawns[PDF – 6.9 MB] is a 170-page guide from the Substance Abuse and Mental Health Administration
that lays the groundwork for comprehensive suicide prevention planning. The guide explores some of the cultural issues around prevention and describes respectful approaches. It provides practical tools and resources that a community can use for assessment, program selection, coalition building, and implementation of a comprehensive plan. The guide also covers actions a community can take in response to a suicide to help the community heal and prevent suicide contagion.
Serving the youth of the Spirit Lake Tribe, the Wiconi Ohitika (Strong Life) Project
is a culturally enriched approach to youth suicide prevention based on the culture, language, values, and history of the Spirit Lake Dakota. The project promotes positive self-identity, increases self-esteem, and increases knowledge of the Dakota way of life. Cultural strengthening undergirds the suicide prevention program, which has implemented many different prevention activities throughout the community.