AMSR: Core Competencies for Behavioral Health Professionals Working in Inpatient Settings

Over 47,000 people died by suicide in the U.S. in 2017. Behavioral health professionals working in inpatient settings play a critical role in the identification, assessment, and management of suicide risk among their patients.

Assessing and Managing Suicide Risk (AMSR) teaches best practices recommended by the nation's leading experts in the research and delivery of suicide care.

"AMSR for inpatient care has allowed clinicians to become more confident and competent in providing suicide safer interventions for individuals at the peak of a crisis.”

Karen Johnson, Senior Vice President,Compliance Officer, Universal Health Services

The AMSR for Behavioral Health Staff Working in Inpatient Settings (AMSR-Inpatient) curriculum develops skills in the recognition, assessment, and management of suicide risk and the delivery of effective suicide-specific interventions.

Suicide and People Receiving Mental Health Care

Suicidal behavior is a major cause of death and disability in the United States. Each year, over 45,000 people die by suicide1 and hundreds of thousands are seen in hospital emergency departments for suicide attempts. 2 And, the risk of suicide attempt or death is highest within 30 days of discharge from an emergency department or inpatient psychiatric unit.3 Despite the acute needs of patients with elevated suicide risk and their frequency of contact with health and behavioral healthcare professionals4, many providers—psychologists, social workers, and other mental health counselors—are inadequately trained to assess, treat, and manage suicide risk in their patients.5 According to the National Action Alliance for Suicide Prevention, “Many clinical training programs do not fully prepare health care professionals to provide suicide care.”6

“[F]or those who experience suicidal crises and receive acute care interventions in hospitals and Emergency Rooms, suicide risk does not end at the moment of discharge. Rather, their elevated risk continues or is easily rekindled in the days and weeks that follow, leading to heightened rates of suicide during this post-acute care period.” 

David Knesper, Author, Continuity of Care for Suicide Prevention and Research7

Assessing and Managing Suicide Risk (AMSR) fills that training gap by teaching the core competencies that meet suicide care standards established by national organizations including The Joint Commission, the National Action Alliance for Suicide Prevention, the Substance Abuse and Mental Health Services Administration, the Veterans Administration, and others.

Behavioral health care professionals working in inpatient settings can help patients with elevated suicide risk by using the suicide risk identification, assessment, and management competencies taught in the AMSR-Inpatient training. Delivering best practices in suicide care to patients with elevated suicide risk during inpatient treatment can offset the high-risk period they may experience post-discharge.8

AMSR-Inpatient

The AMSR Inpatient curriculum follows national guidelines for caring for people with suicide risk including:

The training provides participants with the knowledge and skills they need to address suicide risk and behaviors in inpatient settings. Participants will have the opportunity to increase their knowledge and apply practical skills in the following areas:

Approaching Your Work: Learn how to manage reactions related to suicide and maintain a collaborative, non-adversarial stance. Acquire the skills to address potential conflicts between a clinician’s goal to prevent suicide and maintain a patient's safety and a patient's goal to eliminate psychological pain via suicidal behavior.

Understanding Suicide: Gain an understanding of the definitions and language used when talking about suicide, as well as the data that are relevant to addressing suicide in treatment populations including risk and protective factors, warning signs, and precipitating factors.

Gathering Information: Identify key points throughout inpatient treatment when a suicide assessment should occur, the type of information to gather to inform the assessment, and ways to build trust and thus elicit key information about the patient's risk of suicide. The training presents the main domains to assess in a comprehensive risk assessment and explores why a patient may avoid disclosing their suicidal thoughts. Participants practice using assessment questions in an interactive learning environment designed to help build confidence. The training presents case studies and other interactive exercises.

Formulating Risk: Practice synthesizing assessment information into a risk formulation that will help inform next steps in treatment. AMSR emphasizes the importance of using a risk formulation not for prediction, but as information to make a collaborative decision regarding recovery-oriented treatment planning.

Planning and Responding: Learn to use evidence-based suicide prevention interventions based on a formulation of the patient's suicide risk. Learn which evidence-based treatments and suicide prevention interventions to use with clients based on their level of acuity. Understand best practice interventions to promote continuity of care for high-risk patients post-discharge. Practice having conversations related to safety planning, contingency planning, and means counseling interventions.

This training is complemented by the 3.5-hour version of AMSR for Direct Care Staff in Inpatient Settings, which helps treatment teams of clinicians and direct care staff speak the same risk assessment and management language to provide consistent, effective care organization-wide.  

  • 1. Centers for Disease Control and Prevention (CDC). (2019). 2017, United States Suicide Injury Deaths and Rates per 100,000. WISQARS.  National Center for Injury Prevention and Control, NCHS Vital Statistics System for numbers of deaths. Bureau of Census for population estimates. https://www.cdc.gov/injury/wisqars/fatal.html
  • 2. Rui P, Kang K, Ashman JJ. (2016). National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables. Table 16. Emergency department visits related to injury, poisoning, and adverse effect, by intent: United States, 2016. https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2016_ed_web_tables.pdf https://www.cdc.gov/nchs/data/nhamcs/web_tables/2016_ed_web_tables.pdf
  • 3. Knesper, D. J., American Association of Suicidology, & Suicide Prevention Resource Center. (2010) Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc.
  • 4. Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., … Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of general internal medicine, 29(6), 870–877. doi:10.1007/s11606-014-2767-3
  • 5. Schmitz, W. M., Jr, Allen, M. H., Feldman, B. N., Gutin, N. J., Jahn, D. R., Kleespies, P. M., . . . Simpson, S. (2012). Preventing suicide through improved training in suicide risk assessment and care: An American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training. Suicide and Life Threatening Behavior, 42(3), 292–304.
  • 6. National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group. (2018). Recommended standard care for people with suicide risk: Making health care suicide safe. Washington, DC: Education Development Center, Inc.
  • 7. Knesper, D. J., American Association of Suicidology, & Suicide Prevention Resource Center. (2010) Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc.
  • 8. Knesper, D. J., American Association of Suicidology, & Suicide Prevention Resource Center. (2010) Continuity of care for suicide prevention and research: Suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit. Newton, MA: Education Development Center, Inc.

Cost

Email amsr@edc.org for additional pricing information.

Duration

6.5 hours

Audience

Behavioral health clinicians working in inpatient settings who conduct suicide risk and nursing assessments, primarily those with a master’s degree or above, including medical providers and registered nurses.

Credits

Completion of the AMSR-Inpatient training includes 6.5 CE credit hours with APA and CA BBS. AMA CME credits are available with 35 days' notice and an additional fee.

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