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Article Excerpt
The Collaborative Assessment and Management of Suicidality (CAMS) was developed to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. This approach integrates a range of theoretical orientations into a structured clinical format emphasizing the importance of the counselor and client working together to elucidate and understand the "functional" role of suicidal thoughts and behaviors from the client's perspective. Based on clinical research in various outpatient settings, CAMS provides mental health counselors with a novel clinical approach that is tailored to a suicidal client's idiosyncratic needs thereby insuring the effective clinical assessment, treatment, and tracking of high risk suicidal clients.
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It has been eight years since the United States Surgeon General David Satcher, sounded the alarm about the profound impact of suicide in his Call To Action to Prevent Suicide (U.S. Public Health Service, 1999) imploring the public health, mental health, and medical communities to seriously address the issue of suicide. Since this time there have been various efforts towards developing community-based prevention strategies but remarkably few efforts have specifically focused on the development of effective clinical assessments and treatments of suicidal individuals. Despite the increased awareness of suicide as a major public health problem, gaps remain in training programs for health professionals who often come into contact with suicidal patients in need of these specialized assessment techniques and treatment approaches. Studies indicate that many health professionals are neither adequately trained to provide proper assessment, treatment, and management of suicidal patients, nor do they know how to refer clients properly for specialized assessment and treatment (U.S. Public Health Service, 2001; Bongar, 1991). For many years, suicidality has been the most commonly encountered clinical emergency for mental health professionals (Schein, 1976) and mental health counselors continue to be critically positioned on the front lines for clinically assessing, referring, and treating suicidal individuals (Barrio, 2007).
While a number of suicide risk instruments exist, survey research indicates that the majority of mental health counselors prefer to rely on a clinical interview to assess suicide risk (King, Kovan, London, & Bongar, 1999). In terms of clinical treatments for suicidal risk, there has been a remarkably limited empirical literature for treating suicidal states. Indeed, most of the extant literature over the past decades has been theory-based or anecdotal with limited empirical support (Jobes, 1995; 2000). In more recent years, however, a growing number of researchers have developed and empirically investigated more suicide-specific clinical approaches (e.g., Brown et al., 2005; Henriques, Beck, & Brown, 2003; Linehan, 1993; Rudd, Joiner, Jobes, & King, 1999; Rudd, Joiner, & Rajab, 2001). As part of this trend, the Collaborative Assessment and Management of Suicidality (CAMS) was developed to modify clinician behaviors in how they initially identify, engage, assess, conceptualize, treatment plan, and manage suicidal outpatients. In our view, this novel clinical approach can be used in a variety of mental health settings, including outpatient clinics, community mental health centers, private practice, employee assistance programs, prisons/jails, and even inpatient units (Jobes, 2006).
At the heart of the CAMS approach is an emphasis on a strong therapeutic alliance where counselor and client work closely together to develop a shared understanding of the client's suicidal phenomenology. An interactive assessment process is used to build a clinical partnership; risk assessment information gleaned from this process is then used to directly shape a suicide-specific treatment plan. Unlike traditional "Kraepelinian" approaches that emphasize treating a diagnosed psychiatric illness with the assumption that treating the illness will reduce the symptom of suicidality, CAMS is designed to specifically target suicidal ideation and behavior as the central clinical problem, independent of diagnosis. Through collaborative assessment and deconstruction of the patient's suicidality, key problems and goals naturally emerge. Collaborative treatment planning that follows thus creates a problem-focused approach that is designed to reconstruct more viable ways of coping and living. CAMS is designed to be flexible and facilitate therapeutic work, independent of theoretical orientation or clinical techniques. The approach therefore does not usurp clinical judgment or professional autonomy--it provides helpful front-end guidance on how to handle suicidality quickly and directly without getting into an adversarial power struggles (Ellis, 2004; Jobes, 2000). CAMS, therefore, fosters collaborative teamwork, launching a superior treatment trajectory and outcome (Jobes, Wong, Conrad, Drozd, & Nell-Walden, 2005).
THE CAMS APPROACH: THEORY AND PRACTIE
As noted, CAMS is designed to be a uniquely flexible and adaptive clinical framework that can be used eclectically. The approach embraces a range of theoretical approaches and employs certain practice procedures helping to create structure and guidance--a clinical roadmap--for effective care of suicidal clients.
Theoretical Aspects of CAMS
The CAMS approach to suicidality integrates a range of theoretical orientations (including psychodynamic, cognitive, behavioral, humanistic, existential, and interpersonal notions) into a structured clinical format emphasizing the importance of the counselor and client working together to elucidate and understand the "functional" role of suicidal thoughts and behaviors in the patient's phenomenological world (Jobes & Drozd, 2004). This approach embraces some overarching assumptions about suicidal states. For example, within CAMS there is a basic belief that suicidal thoughts and behaviors represent a fundamental effort to cope or problem-solve, in pursuit of meeting legitimate needs (e.g., needs for control, power, communication of pain, or an end to suffering). From this perspective, a CAMS counselor approaches suicidality in an empathic, matter-of-fact, and non-judgmental fashion. Ironically, the counselor's capacity to understand and appreciate the viability and attraction of suicide as a means of coping provides the essential ingredient for forming a strong therapeutic alliance where more adaptive methods of coping can be evaluated, explored, and tested. Philosophically speaking, CAMS emphasizes an intentional move away from the directive "counselor as expert" approach that can lead to adversarial power struggles about hospitalization and the routine and unfortunate use of coercive "safety contracts" (Jobes, 2000; 2006).
Overview of Practice Procedures
Generally speaking, the CAMS method is initiated when a client acknowledges current suicidal ideation, either through a self-report instrument or during a clinical interview. Clinical assessment pertaining to the client's suicidal phenomenology is accomplished by collaboratively completing an assessment tool called the Suicide Status Form (SSF). The SSF uses both quantitative and qualitative responses to assess key variables of suicidal risk (refer to CAMS case example that appears later). Built on the theoretical work of Shneidman (1993), Beck et al (1979), Baumeister (1990), Linehan et al (1983), and Jobes (1995), the SSF uses Likert and qualitative open-ended items related to the client's psychological pain, stress, agitation, hopelessness, self-hate, and overall suicide risk (Jobes, 2006). Use of the SSF is introduced as a collaborative endeavor, wherein the counselor asks for permission to literally take a seat next to the client to more thoroughly assess, understand, and appreciate the client's pain and suffering that leads to suicide as a means of coping. The dyad then works together to rate, describe, and rank order the client's responses to the SSF. Throughout the assessment process, the client's perspective is...
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