CSPAR has led or collaborated with a number of clinical initiatives to improve suicide care through clinical service, research, training, or consultation.

Building a Suicide Care Pathway:

Practical Guidelines and Clinical Tools

Explore CSPAR-Affiliated Evidence-Based Interventions for Suicide Care

Practical Approaches to Implement EBPs and Studying Implementation

Building a Suicide Care Pathway: Practical Guidelines and Clinical Tools

National organizations such as The Joint Commission, the National Institutes of Mental Health, Zero Suicide, and the Veterans Health Administration have issued recommendations for caring for people at risk for suicide in clinical settings. These recommendations often specify clinical tools and point to training resources. Selecting clinical tools and trainings from the large range of options, however, can prove challenging even for those with broad experience in suicide prevention – something which we faced in our efforts to implement suicide care pathways in our health care system.

To support health care organizations and individual clinicians in understanding and implementing best practices for suicide prevention, we have organized Suicide Care into an overall pathway and describe each component of care. We then select evidence-based clinical tools to support clinical work across this suicide care pathway.

Explore Evidence-Based Interventions for Suicide Care

CSPAR faculty members have led and partnered with other investigators on clinical trials and training initiatives using a number of Evidence-Based Interventions for Suicide Care.

CAMS (Collaborative Assessment and Management of Suicidality)

CAMS is a 4-12 session, outpatient, evidence based, suicide-focused treatment framework. This model can be integrated as an intervention in itself or integrated with other suicide prevention or behavioral health interventions. As its name implies, CAMS has two primary foci – establishing and maintaining a therapeutic alliance and keeping the focus on suicidality until it resolves. CAMS is liked by patients and clinicians and results in carefully crafted documentation.

Caring Contacts

Caring Contacts is a simple but powerful suicide prevention intervention. Instead of waiting for clients to reach out in distress, Caring Contacts clinicians reach out to clients repeatedly over time, leading to moments of connection and providing opportunities to offer help when it is needed. Caring Contacts is recommended by the VA/DoD Clinical Practice guidelines.

DBT (Dialectical Behavior Therapy)

Dialectical behavior therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders. As such, DBT is a transdiagnostic, modular treatment. DBT is recommended by the VA/DoD Clinical Practice guidelines.


Dialectical Behavior Therapy – Accepting the Challenges of Employment and Self Sufficiency

DBT-ACES is an expansion and adaptation of Standard DBT featuring a second year of treatment designed to meet the needs of DBT graduates who want to increase self-sufficiency and maintain living wage employment. The goal by the end of the DBT-ACES year is for clients to have mastered skills and to have created environmental contingencies to provide sufficient momentum that is close to inevitable that they will achieve their employment, social, and independence goals. A recent paper by Carmel & Comtois explains how DBT-ACES strategies can be integrated into CBT.

PARS (Preventing Addiction Related Suicide)

PARS is an interactive psycho-educational suicide prevention training program to be used within community addiction group therapy treatment. It was designed with input from addiction patients, counselors, administrators, and suicide experts to fit easily into Intensive Outpatient Programs, the most common form of addiction treatment in the U.S.

Safety Planning Intervention

People at risk for suicide are likely to experience changes in their level of risk over time; acute suicide risk usually increases and then decreases over a short period of time. The goal of safety planning is for people to become more aware of their personal warning signs that a suicidal crisis is beginning or escalating so that they can take action before they are in danger of acting on their suicidal feelings.

Suicide Care Clinical Pathways​

Seattle Children’s Hospital Zero Suicide Initiative
This pathway was developed through local consensus based on published evidence and expert opinion as part of Clinical Standard Work at Seattle Children’s. Pathway teams include representatives from Medical, Subspecialty, and/or Surgical Services, Nursing, Pharmacy, Clinical Effectiveness, and other services as appropriate.

Behavioral Health Integration Program in UW Primary Care
This program is developing suicide care pathways through a Garvey small grant for the Suicide Care Research Center.

Practical Approaches to Implement EBPs and Studying Implementation

Practical Approaches to Implementing EBPs

Whether you are a clinician, or represent a clinic, suicide prevention organization, or large health care system, implementing a new evidence-based practice (EBP) can be tough.  Training is a necessary step (see our Exploring EBPs for suicide care page for training options).  But training alone is not sufficient.  There are many other strategies (more than 70, in fact) to help get an intervention in place, scaled up, and sustained over time. Here are links to four practical and accessible approaches to help you think through the implementation process – they are geared for different learning styles and settings.

Explore each site and pick the approach that is best for your setting:

Finding Implementation Training and Partnership

Experts to Implement your Interventions

In recognizing how challenging implementation can be, you may want to explore in-depth training or find an expert partner help implement suicide interventions in your setting.  These organizations offer training or contract assistance to help you lead this process.

Practical Approaches to Study Implementation

If you are a researcher or program evaluator, these practical approaches will help you think through implementation process evaluation. Some implementation science materials use a lot of unnecessary jargon, so we agree with Geoff Curran that simple non-scientific language is best when possible; his brief paper on this subject is a nice place to start.

When defining implementation science, some very non-scientific language can be helpful:

  • the intervention/practice/innovation is THE THING
  • effectiveness research looks at whether THE THING works
  • implementation research looks at how best to help people/places DO THE THING
  • main implementation outcomes are HOW MUCH and HOW WELL they DO THE THING

Curran, G. M. (2020). Implementation science made too simple: A teaching tool. Implementation Science Communications, 1(1), 27. https://doi.org/10.1186/s43058-020-00001-z

Helpful Video Explanations

These videos explain implementation science to suicide and general clinical researchers in a straightforward way:

Key Concepts

These key concepts in the field of implementation are worth understanding:

  1. Implementation Outcomes: How Much and How Well are People Doing the Thing?
  2. How do you Integrate Implementation Outcomes in Clinical Research? 
  3. What stuff can we change to help people and place do the thing?Consolidated Framework for Implementation Research
  4. How Cab We Get This Stuff To Change To Help People and Places Do The Thing?

Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L., Proctor, E. K., & Kirchner, J. E. (2015). Use of concept mapping to characterize relationships among implemen

Putting it All Together Logically



Smith, J. D., Li, D. H., & Rafferty, M. R. (2020). The Implementation Research Logic Model: A method for planning, executing, reporting, and synthesizing implementation projects. Implementation Science, 15(1), 84. https://doi.org/10.1186/s13012-020-01041-8