When I was an active duty Air Force psychologist, I learned early on in my career the importance of working closely with active duty Chaplains. In fact, Chaplains and behavioral-health providers often served on several base-level committees together focused on community initiatives. We collaborated regularly on population health-based suicide prevention efforts and crisis response following traumatic events, as well as taught relationship enhancement workshops together. I believe that caring for our Service members takes all hands on deck (to use a Navy saying). Chaplains play a very important role in military suicide prevention efforts, often being the first individuals to have contact with at-risk Service members. Serving as a gateway to care, they are extremely important in keeping our Service members connected and safe. Although there are a variety of suicide prevention training opportunities offered, a recent RAND study found variability in trainings available to Department of Defense (DoD) Chaplains (Burnette, Ramchand, & Ayer, 2015), highlighting a need for standardized, evidence-based suicide prevention strategies.
Standardized, evidence-based suicide prevention strategies are both imperative and in-line with findings from the DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, which specifically calls for training for all military healthcare providers and Chaplains. Recommendation 61 outlined in the Task Force’s final report states, “Train all military healthcare providers (including behavioral health providers) and chaplains on evidence-informed suicide risk assessment, management, and treatment planning. Create and provide continuing education tailored to their specialty and area of expertise.” (U.S. Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces, 2010, p. ES-16). Despite this policy recommendation, few DoD Chaplains have received training that focuses specifically on clinical skills to address suicidal thoughts and behaviors.
That is why I was so excited to hear about the “Chaplains-CARE Program for Military Suicide Prevention” from my colleague, Dr. Marjan G. Holloway, Ph.D. The Chaplains-CARE Program was developed by Dr. Holloway and her team to help address this gap in training for DoD Chaplains, recognizing the value of providing specialized training to the unique group of first responders (Suicide Care, Prevention, and Research Initiative, 2018). Dr. Holloway is an Associate Professor and the Director of the Suicide, Care, Prevention, & Research (CPR) Initiative at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Chaplains-CARE is a partnership between the Defense Suicide Prevention Office (DSPO), the United States Navy Chaplains Corps, and the Uniformed Services University of the Health Sciences (USUHS). This very important Suicide CPR initiative is an evidence-based suicide intervention training developed to provide United States Navy Chaplain Corps with the knowledge, skills, and strategies necessary to effectively identify and intervene with at-risk Sailors.
The Chaplains-CARE Program consists of classroom-based didactic instruction, group discussion, and reflection opportunities, complemented by simulated encounters with Service members, with the goal of enhancing suicide prevention and intervention skills, knowledge, and abilities among active duty Navy Chaplains. Last February, I had the privilege to participate in the second iteration of the program helping to train 12 Navy Chaplains on how to use specific cognitive-behavioral strategies for the prevention of suicide. Having the opportunity to participate in this week-long intensive course was one of the most rewarding experiences I have had in my professional career.
There are eight training modules covering important topics, such as hearing the suicide story, building hope, planning for safety, identifying and practicing coping strategies, and problem-solving. There is also a module on the importance of self-care and how to avoid professional burnout. One of the most important aspect of the Chaplains-CARE Program training is the opportunity for learners to engage in simulation cases to augment the didactic learning. The simulated encounters took place at the Val G. Hemming Simulation Center, where top-notch professional actors are utilized to portray a variety of different patient presentations. For the Chaplains-CARE Program, the actors portrayed Service members with suicidal thoughts and behaviors. At first, I was not sure how realistic the encounters would be, but I was thoroughly impressed with the acting that was portrayed throughout the week. At times, I almost forgot the “Service members” were acting.
Throughout the week-long training, I was able to provide both didactic instruction to the Navy Chaplains, as well as supervision of their simulated role-plays. It was amazing to watch the Chaplains’ skills improve over the week-long program. I especially appreciated the program design, which pairs behavioral health providers with Chaplains to serve as teaching and supervisory dyads, allowing Chaplain learners to receive information and feedback from both professions throughout the course. In addition to sharing my knowledge and experience regarding suicide prevention throughout the week, I learned a lot from both the Chaplain learners and the Chaplain supervisors throughout the course.
As we think about suicide prevention, we need to consider ways to expand our efforts and to ensure more people are trained to intervene and help individuals who are experiencing suicidal thoughts and behaviors. We need to think beyond Service members only seeking intervention in a behavioral health clinic setting. Although behavioral health treatment is one option, there are many Service members who may not make it into the clinic for a variety of reasons. They may fear that seeking treatment will impact their military service. For others there is stigma related to seeking behavioral health care, especially related to suicidal thoughts and behaviors. Many individuals and groups have looked at creative ways to assist at-risk Service members and to get them the services needed. Increasing skills-based training for Chaplains is one way of doing this. Military Chaplains are often sought out by Service members given their ability to offer absolute confidentiality. Although some Chaplains have clinical training experience, we need to do more to prepare Chaplains to intervene with at-risk Service members. The Chaplains-CARE program does just this!
I would love to hear your thoughts on how we can better engage and guide non-behavioral health professionals in suicide prevention efforts. Together, we can combat suicide!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Lisa French, Psy.D., is the Chief of Staff at the Center for Deployment Psychology (CDP) at the Uniformed Services University of Health Sciences (USU) in Bethesda, Maryland.
Burnette, C., Ramchand, R., & Ayer, L. (2015). Gatekeeper training for suicide prevention: A theoretical model and review of the empirical literature. Santa Monica, CA: RAND Corporation. Retrieved from https://www.rand.org/pubs/research_reports/RR1002.html
Suicide Care, Prevention, and Research Initiative. (2018). Chaplains-CARE program for military suicide prevention. Bethesda, MD: Uniformed Services University of the Health Sciences.
U.S. Department of Defense Task Force on the Prevention of Suicide by Members of the Armed Forces. (2010). The challenge and the promise: Strengthening the force, preventing suicide and saving lives. Washington, D.C.