Suicide Safer Care Practices: The AIM Model

The AIM Model

The AIM model provides a clinical framework for reducing suicide risk. Developed by Dr. Barbara Stanley, Director of the Suicide Prevention, Training, Implementation and Evaluation program at Columbia University and the New York State Psychiatric Institute, the AIM model highlights three domains of clinical practice essential to reducing suicide risk:

 

  • Assess all individuals for suicide risk using evidence-based screening tools
  • Intervene with at-risk individuals, using suicide specific interventions
  • Monitor at-risk individuals with increased follow-up contact and regular screening

Assess

The assess component of the AIM model synthesizes research on best practices for suicide risk detection. Drawing on findings that individuals who do not present with traditional symptoms of suicidality remain at-risk, the AIM model prescribes universal screening for all persons seen at mental or medical health facilities.1 To detect risk in all populations, the AIM model recommends the use of validated screening tools, such as the Columbia Suicide Severity Rating Scale (C-SSRS).2 If an individual screens positive on a validated suicide risk screener, the AIM model encourages the use of a comprehensive risk assessment.

Used in conjunction with screening data, a comprehensive risk assessment should help determine the level of care most appropriate for an at-risk individual.3

Intervene

The intervene component of the AIM model offers evidence-based guidelines and tools for suicide prevention. Integral to the model is the principle that suicide risk should be targeted directly with suicide-specific interventions. Effective interventions enable at-risk individuals to call on a range of strategies to delay acting on suicidal urges. The most viable urge delay strategies are developed through collaboration between an at-risk individual and provider, and can be formulated in one sitting.4 Lethal means counseling and safety planning meet all of these criteria and are highly recommended by this model.

The Safety Planning Intervention for suicide prevention, developed by Drs. Barbara Stanley and Gregory Brown, is a collaborative process by which an at-risk individual and provider identify six strategies with which to notice and delay acting on a suicidal urge.4 As illustrated in this sample template, these steps include internal coping skills or distractions, social distractions, and the engagement of mental health professionals.

Monitor

The monitor component of the AIM model provides guidance for enhanced monitoring for individuals at-risk of suicide. The well documented peak in suicide risk immediately following a psychiatric hospital discharge and low attendance rate of aftercare appointments are two reasons why monitoring after an episode of care is so important.

Structured follow-up phone calls provide crucial linkages and clinical support. Often, they include a brief assessment of suicide risk, review of a safety plan, and problem solving around overcoming barriers to connecting to outpatient care and/or community supports. Click here for a sample structured follow-up script. Caring contacts offer a less intensive form of engagement and monitoring than follow-up calls. They are typically brief communications with patients following hospitalization or a care episode in the form of letters, e-mail messages, or text messages. Studies suggest caring contacts can be a cost-effective way to reduce suicide attempts, particularly for patients unlikely to engage in follow-up care.5,6 Finally, a host of phone or text-based crisis and support services are increasingly available as a source of support for those in distress.

References

  1. Brodsky B, Spruch-Feiner A, Stanley B. The Zero Suicide Model: Applying evidence-based suicide prevention practices to clinical care. Frontiers in Psychiatry. 2018;9:33.
  2. Chappell P, Feltner DE, Makumi C, Pharm D, Stewart M. Initial validity and reliability data on the Columbia-Suicide Severity Rating Scale. Am J Psychiatry, 2012;169:6 662–3.
  3. American Psychiatric Association. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry, 2003;160:11 Suppl 1–60.
  4. Fleischmann A, Bertolote JM, Wasserman D, De Leo D, Botega NJ, Da Silva D, et al. Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Bull World Health Organ, 2008;86:9 703–9.
  5. Motto JA, Bostrom AG. A randomized controlled trial of postcrisis suicide prevention. Psychiatric Services, 2001;52:6 828-833.
  6. Carter GL, Clover K, Whyte IM, Dawson AH, D’Este C. Postcards from the EDge project: Randomised controlled trial of an intervention using postcards to reduce repetition of hospital treated deliberate self-poisoning. BMJ, 2005;331:7520 805-807.