Elements and Performance Criteria

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.


General context of the suicide intervention work:
Telephone counselling will normally be provided in the context of a 24-hour telephone counselling service within the framework of the organisation's guidelines and competency requirements that reflect good suicide intervention practice
Telephone counsellors will have received training in generalist telephone counselling skills and in the principles and practices of crisis intervention
Supervision on 24-hour call may be accessed during a call when needed and must be consulted in certain mandated situations such as a potential suicide in progress
Other professional community resources such as Poisons Information Service, Ambulance or Police should be accessed as needed
Intervention builds on the caller's desire for help and links to living, evident in making the call, despite the ambivalence about living and dying that is often present


Identify and assess a caller's current suicide risk involves:
Vigilance about the potential for suicide risk in any caller
Recognising the wide range of warning signs that invite help and prompt enquiry about suicide
Asking directly about thoughts of suicide where there are any grounds for concern


Risk assessment involves:
Recognising that any suicide thoughts or acts of deliberate self-harm signal significant distress, pose potential risk of injury or death and should be taken seriously
Assessing factors that indicate suicide risk which include, but are not limited to, the following:
concern is aroused by the presence of suicide thoughts and things often associated with these thoughts, such as:
a desire to escape pain that feels unbearable
a sense of hopelessness
current difficulty seeing alternatives to suicide
feeling alone
immediate risk is increased when a person has begun acting on their suicide thoughts or is preparing to do so and/or has expressed suicidal intent - for example:
possible suicide in progress
presence of a suicide plan
available means
risk can be exacerbated if the caller is under the influence of excessive alcohol or other drug use
pertinent background factors, particularly prior suicidal behaviour and the presence of significant mental health problems should be carefully assessed
A wide variety of contextual or personal considerations help inform assessments and may include such things as:
significant loss
trauma
the impact of another person's suicide
a pattern of extreme agitation, anger/violent behaviour
Identifying sources of safety and support within the caller (such as coping skills and beliefs) and around them (such as friends, family and community services)
Connections to life and living are usually present alongside thoughts of suicide and can provide foundations to build upon in increasing caller safety


Safety outcomes include:
Recognising that:
vigilance about safety with all suicide related thoughts or behaviours is essential, even though the caller may have been influenced by a wide range of motives in considering or engaging in deliberate self-harm
risks to life and safety can often be greater than callers recognise or intend, so safe outcomes are a primary focus, regardless of stated caller intentions, especially given the limited contextual information available in a telephone counselling intervention
Implementing suicide safety plans that should be tailored to the caller, but typically include:
affirm and build on the desire for help and safety implicit in the call
work with the caller to identify and act on clear cooperative steps for reducing immediate risk of suicide or any self-harm during and immediately after the call
focus specifically on factors, plans and behaviours, including unsafe use of alcohol and other drugs, that endanger the caller at this particular time and seek to engage them cooperatively in steps that safely manage and reduce that risk
enable prompt, timely action that increases support, mobilises access to emergency medical help when needed and reduces the likelihood that the person will act on their suicidal thoughts
seek to create a calm environment that promotes safety for the person at risk and others involved in the situation
access support and follow up advice from the organisation's supervisor/coordinator that reflects lawful good suicide intervention practice and follows crisis management and emergency procedures


The range of available resources include:
Informal support
Professional help
Future use of telephone counselling service
A productive connection between the caller and counsellor that accompanies risk assessment and safety management can strengthen hope and motivation to commit to the safety plan and engage further with helping resources


Appropriate counselling support to people with thoughts of suicide will include:
The following general practices as a context for risk assessment and safety management:
developing an empathic, collaborative counselling relationship
recognising that the presence of any thoughts of suicide elevate risk and require plans to increase safety
understanding how these thoughts are linked to particular events or experiences - particularly involving loss, a suicide death or trauma - and the person's reaction to them
hearing feelings often found behind these thoughts such as pain, and the desire to escape it
listening for perceptions such as the caller's current difficulties in seeing alternatives to suicide
conducting careful assessment and management of suicide risk
developing and implementing a safety plan based on this assessment that includes safely reducing access to suicide methods and generally minimising the harm of any suicidal acts already in progress (e.g. mobilising an emergency medical response)
addressing problems in living and strengthening supportive life links and relationships once immediate safety has been addressed


Appropriate counselling support to people concerned about someone at risk include:
The above set of actions and deciding on:
the role the caller might have in reaching out to the person at risk and
who else may need to be involved


Appropriate counselling support to people impacted by someone's suicide includes:
Determining the nature of the caller's relationship to the person who died by suicide
Exploring and responding to the pain and impact of the loss in feelings such as sadness, anger, guilt or remorse
Asking the caller what aspects of the death or the loss they most need to focus on now and attend to these concerns
Assessing for suicide risk in the caller
Exploring internal coping strengths and external supports likely to provide support


Internal referral systems may include:
Training
The organisation's referral database and files
Supervisory and on call network
Support personnel
Protocols for supervisory consultation during a suicide call and accessing emergency services when necessary
Literature - including books and brochures


Ethical guidelines and policy requirements that affect duty of care include:
Awareness of appropriate standards of care in suicide intervention
Observance of any relevant laws
Compliance with the organisation's ethical code, policies and procedures related to delivery of the telephone counselling service
Policies about disclosure and confidentiality, including any limits that may apply in suicide intervention
Responsiveness to caller requests
Meeting the organisation's training standards
Seeking assistance and providing referrals
Participation in supervisory activities and professional development and training

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package.

Critical aspects for assessment and evidence required to demonstrate this unit of competency:
The individual being assessed must provide evidence of specified essential knowledge as well as skills
Work will be assessed in accordance with professional standards of care commensurate with the telephone counselling role
Assessment must occur in the workplace or similar environment conducive to professional work over a number of occasions


Access and equity considerations:
All workers in community services should be aware of access, equity and human rights issues in relation to their own area of work
All workers should develop their ability to work in a culturally diverse environment
In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people
Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities


Context of and specific resources for assessment:
This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged
Resources for training in and assessment of crisis intervention competencies needs to be available to:
provide initial and ongoing training
ensure baseline knowledge and skills following basic training
observe implementation of these competencies in actual counselling situations and simulated role plays
facilitate learning through reflection on practice and integration of supervisory feedback


Method of assessment:
Consistent performance and development would be expected to be demonstrated involving a combination of oral and written media while also featuring simulated and actual practice
Examples might include:
group exercises
written (e.g. journal) and verbal responses to questioning
simulated exercises
observation of practice on telephone shifts
response to and integration of supervisory feedback