Pilot, review and final development of the Suicide Prevention

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					Pilot, review and final development of the Suicide Prevention for
          Older People: Training Manual for NSW Health.

1.     Pilot of the Suicide Prevention for Older People Training Manual.

A key resources associated with the Training Support Project was the training
package for elderly suicide prevention, based upon the 98/31 circular relating to
suicide risk assessment and management. This training manual, Suicide
Prevention for Older People: Training Manual, was initially developed by the
South Western Sydney Area Health Service (SWSAHS) in conjunction with the
ESPN and the CMH. As identified in the work plan, the Institute was required to
organise and support the pilot of this workshop.
Using the draft manual developed by SWSAHS, HIMH facilitated seven pilot
workshops across four Area Health Services in NSW in October/November 2002.
Designed to encompass metropolitan, regional, rural and ethnic communities, the
schedule for the pilots is outlined below.

     Date            Location              AHS                 Facilitators
     15 Oct 2002*    Leichart              Central Sydney      Cerdic Hall
     24 Oct 2002     Balmain Hospital      Central Sydney      Cerdic Hall & Amelia
     25 Oct 2002     Gosford               Central Coast       Raichel Green &
                                                               Peter Kerle
     6 Nov 2002      Shellharbour          Illawarra           Susan Lampe, Maree
                                                               Vukovic, Norbert
                                                               Pereira, Jenny
                                                               Kempster, Tim Kent &
                                                               Steven Maron
     7 Nov 2002      As above              Illawarra           As above
     12 Nov 2002     Corowa                Greater Murray      Margaret Dalmau &
                                                               Kerrie Ormond
     15 Nov 2002     Wagga Wagga           Greater Murray      Gail Stevens, Jan
                                                               Scott & Margaret
     *Only sessions 3 and 4.
An evaluation plan was designed by the Institute to gather structured feedback
on the ease of using the manual and it’s effectiveness in equipping participants
with skills and knowledge to identify and respond to suicide in older people. As
part of the evaluation, participant evaluation forms were developed based on the
specific learning objectives for each session of the manual.
Participant evaluation forms were used to gather feedback directly from
participants during each of the pilots. A summary of feedback from each
workshop was forwarded to facilitators for their reference. The combined data for
all of the workshops formed the basis of a participant report.
The evaluation also encompassed oral feedback from trainers gathered both
before and after each pilot, as well as notes and recommendations made by an
observer from the Institute. All of these areas of feedback were used to
recommend final changes to the manual.

2.   Revision of the Suicide Prevention for Older People: Training Manual.

Recommendations for change
Based upon the evaluation of the pilot process, the Institute coordinated a review
and further enhancement of the Suicide Prevention for Older People: Training
Manual. The Institute made a number of recommendations to further refine each
session of the training package, and these recommendations, were reviewed and
accepted by the project Working Group and the facilitators of each pilot
As part of the review process, the Institue made arrangements for all of
necessary amendments to the manual, including a reordering of the content and
altering the time allocations for various sections. Using both HIMH project staff
and external consultants, the Hunter Institute also coordinated the final formatting
and graphic design for the training package.

Development of supplementary video and CD-Rom resources
As part of the further development and enhancement the Suicide Prevention for
Older People: Training Manual, the Project Working Group decided that the training
package should also include both a video and a CD-Rom resource.
Based upon participant feedback, the video scenario Asking questions about suicide
risk, was specifically developed to accompany session 3 of the manual. This scenario
was scripted by the Institute to depict the way in which a health worker might ask an
older person about their risk of suicide. The final video featured an older person with
a high risk of suicide (depicted by a professional actor) being interviewed by a health
The Institute also produced a CD-Rom resource to accompany the manual. It
features a MS PowerPoint presentation, which includes all of the overhead
transparencies used in the training sessions and a description of activities. So that
trainers could reproduce extra copies of the resource (or change the font size or
layout), electronic files for the entire manual were also included on the MS
PowerPoint CD-Rom.

3.   Dissemination and implementation of the Suicide Prevention for Older
     People: Training Manual.

To support the dissemination of the training manual and the role out of training in
each Area Health Service, the Institute coordinated an implementation event on
behalf of the Centre for Mental Health. This event was held on the 9 and 10 of
July 2003 at Rozelle Hospital in Sydney and featured an official launch of the
manual and a train-the-trainer style two-day event.

Official Launch
The official launch of the manual was held during lunch on the first day of the
implementation event at Rozelle Hospital. As part of the lead up to the event the
Institute developed a number of supporting resources including a launch plan,
official invitation and a draft media release for NSW Health.
Chaired by Professor Trevor Waring (Director, HIMH), the speakers at the launch
•     Bernadette Dagg (Centre for Mental Health);
•     Matthew Dougherty (chairperson, ESPN);
•     Professor John Snowdon (Director of Psychogeriatric Services, CSAHS);
•     Professor Ian Webster (Chair, National Advisory Council on Suicide
The launch was attended by approximately 70 people, including those
individuals who were involved in the development and piloting of the manual,
relevant Area Health Service staff, media representatives and the individuals
who were present for the training.

Training Event
In order to facilitate the role out of training by Area Health Service staff, there
was a need to include some form of initial training as part of the implementation
of the manual. Accordingly, the major feature of the Implementation event was a
two-day train-the-trainer workshop, designed to familiarise people with the
manual and to provide training in group facilitation skills.
As part of the training, four 1.5 hour sessions were dedicated to the content of
the manual. During these sessions, specific focus was placed upon the learning
objectives of each session and an opportunity to discuss and/or practice
particular activities. The second aspect of the training involved train-the-trainer
style sessions, in which the skills and knowledge required to facilitate group
training where addressed. Aimed at addressing the needs of trainers as
identified in the consultation report in December 2001, these included:
•     Basic training skills, including planning sessions and use of equipment
      such as PowerPoint;
•     Ideas for delivering training to experienced audiences and mixed
•     Tips for dealing with difficult questions and other related training skills;

Other areas touched upon during the training included:
•     Cultural issues related to older peoples’ mental health;
•     Understanding suicide statistics; and
•     Self-care issues.

The Hunter Institute developed the training notes and resources for the two-day
event and was responsible for briefing facilitators from outside the Institute. A
number of trainers were used over the two days, including: Professor Trevor
Waring (HIMH); Jaelea Skehan (HIMH); Ettiene Kitto (CSAHS); Cerdic Hall
(ESPN); and Matt Dougherty (ESPN). A number of HIMH staff and ESPN
members provided further support over the two days.
Each Area Health Service was invited to send two staff members working in older
people’s mental health, education and training or suicide prevention to participate
in the training. In order to access the correct person from each AHS, the Area
Directors were asked to consult with the local ESPN member or 98/31 trainer to
nominate the people who should attend. This was facilitated by a letter from
Professor Beverly Raphael to each of the Area Directors and a presentation by
HIMH at the Area Director’s meeting in May 2003.
With the exception of the Far-West Area Health Service, which was unable to
send any staff, all Area Health Services were represented at the training. There
were a total of 33 people in attendance for the two days.