Feasibility and acceptability of Collaborative Assessment and Management of Suicidality (CAMS) in an Australian inpatient setting

The Collaborative Assessment and Management of Suicide (CAMS) framework is a clinical philosophy of care (https://cams-care.com). It is an evidence-based framework used to assess suicidality and inform and guide the treatment and care planning process for people who are suicidal and are at risk. It is a flexible approach that can be used across theoretical orientations and disciplines and has been used across treatment settings and treatment modalities. A collaborative and person-centered focus is fundamental to CAMS with the aim being to have the consumer be the co-author of their treatment plan. Delivery of CAMS typically involves three specific phases: an initial session of assessment and treatment planning, interim sessions that focus on monitoring and understanding current suicide risk and treatment of suicidal drivers and a final session that looks at outcomes and next steps. Completion of the Suicide Status Form is a key part of delivering CAMS that functions as a clinical roadmap for assessment, treatment planning, tracking of ongoing risk, and, ultimately, clinical outcomes. Safety planning (called a Stabilisation Plan) is part of the first CAMS session. CAMS can be delivered face to face or virtually and is usually delivered one-to-one. CAMS is delivered by a mental health clinician. Sessions are delivered over a timeframe negotiated between therapist and consumer. Weekly or fortnightly appointments are not unusual because of the presence of suicide risk. Sessions typically are delivered over 45-60 minutes and duration of treatment is determined by resolution of suicidality (three consecutive sessions where consumer rates 1 or 2 on the 'Rate Overall Risk of Suicide' question, reports 'yes' on the 'Managed Thoughts/Feelings in the past week' and reports 'no' on 'Suicidal behaviour in the past week' items within the Suicide Status Form Core Assessment). This means the minimum number of sessions to reach resolution is four, while the maximum number of sessions that may be offered is unlimited. The modal number of sessions offered in RCTs is 6-8. For this study, as informed by other inpatient CAMS studies, we propose having CAMS delivered twice weekly face to face and one-on-one during the inpatient stay (as per Ellis, 2017). The key components to deliver (as suggested by Hershey, 2016) during short term inpatient settings is development of a stabilization (safety) plan, discussions about access to lethal means of suicide and preliminary identification of issues in need of treatment (i.e. suicidal drivers) including early work on these, including planning for addressing drivers in post-hospital aftercare. Sessions will take up to an hour and may be delivered in components if required. For this study, CAMS will be delivered by clinical psychologists or clinical psychologists in training who have completed CAMS training. CAMS training comprises reading the manual (Managing Suicidal Risk by Prof David Jobes) and completing the online education modules. The 265 page manual provides an overview of the development of CAMS and an overview and guided orientation to each of the core components of CAMS, including the Suicide Status Form, coauthoring a suicide-specific treatment plan, tracking suicide risk assessments and treatment plan updates and discharge planning. The book provides a summary of the principles behind each component, the research relevant to each component, a description of how the activity should be completed and a case study description of how the activity was used in practice. The online modules take approximately 8 hours to complete and combine didactic teaching and skills demonstration through role plays. They cover the same content as the manual but are focused on the key messages and demonstrating the activities in practice. Clinicians complete a knowledge test at the end of the course. The manual and the online modules cover all components needed to deliver CAMS including engaging people with suicide prevention-focused treatment, orientation and use of the CAMS forms, treatment strategies, therapy closure and documentation. Clinicians will complete the training in a self-directed manner prior to consumer recruitment commencing and module and test completion will be reviewed to ensure all components have been completed. After the clinician participants have completed the training, the research team will meet with the clinician participants as a group to discuss and identify if there are any other specific components of the proposed intervention that need to be adapted to be able to be delivered in this study setting. Clinicians will attend monthly group supervision virtually with a CAMS-certified clinician during the period consumer recruitment is live. A weekly drop-in session with a local senior clinical psychologist experienced with CAMS will also be available to clinician participants during the period consumer recruitment is open. The purpose of these forums is to discuss practice-related issues in delivering CAMS and receive advice about how to proceed. Attendance logs will be kept for both forums. Review of completion of CAMS forms as stored within the consumer's medical record will also occur to capture fidelity to treatment. A focus group with clinicians will be conducted at the completion of consumer recruitment. The focus group will focus on clinicians' experience of the delivering CAMS, barriers and facilitators and learnings from the trial about the fit of the intervention within the inpatient setting. The focus group will be facilitated by a clinical psychologist with experience in running focus groups and a good understanding of CAMS, supported by an experienced research officer familiar with service delivery in inpatient settings and qualitative research. All clinician participants who chose to be involved will be able to be involved. Focus groups will be run with up to 8 people.