Using Community-Based Participatory Research to Create a Suicide Prevention Training Program with the National Domestic Violence Hotline: Development and Initial Findings

Background:  Suicide is the 10^th leading cause of death in the USA and largely preventable.  Intimate partner violence is also a public health problem affecting 44% of women and 30% of men over their lifetime.  Studies report female victims are at greater risk for suicide than nonabused women: female victims are 3.5 times more likely to report suicidal ideation than non-victims. The National Domestic Violence hotline (NDVH) responds to over 20,000 calls every month and estimates approximately one third of their callers have suicidal thoughts and behaviors. Hotline ‘advocates’ are trained to respond to callers presenting with variety of problems, risks, and need for information. However, prior to this study they did not feel they had knowledge or skills to identify and manage suicidal callers.  Aim:  Community-based participatory research principles (CBPR) informed our study with NDVH to develop and pilot test a curriculum to improve advocates’ ability to identify callers’ suicidal thoughts and behaviors, manage risk, and help callers access mental health services.  Methods:  Four site visits to the NDVH occurred over 2 years. We conducted silent monitoring of calls, environmental scans and pre and post-training focus groups to learn about callers’ suicidality, training needs, organizational climate, and preferences for delivery. A 3-hr curriculum was developed and delivered to advocates across all shifts.  Twenty-four advocates completed pre –post, and follow-up knowledge and attitude measures were. All participants completed pre-post surveys. Analyses and Results:  Focus groups discussions were transcribed and analyzed using Pope’s framework analysis.  Emerging themes include personal histories of advocates have an impact on responding to suicide, perpetrator suicidal behavior is a significant and distressing problem, and middle-aged abused women callers are at high suicide risk.  Our pilot test of training outcomes used a single group repeated measures design to examine advocates’ enhanced knowledge about suicide, improved self-efficacy to intervene with a suicidal caller, post-assessment of training transfer, and follow up use of the training.  Real time computer data that advocates enter during calls showed a significant increase in identification of suicidality after training.  The importance of using a CBPR process, the results of pilot findings, and the translation of the curriculum to three additional provider groups (domestic violence shelter workers, individuals working with abused children, and community-health workers for formerly incarcerated women) will be highlighted.