Coping Long-Term with Active Suicide Program

Domain II · Behavioural & cognitive · Miller, Gaudiano, Weinstock · 2016 · Providence

What it is

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Format

• Overall shape. CLASP is a hybrid programme: it starts in person during the acute episode (inpatient stay or ED/early post-discharge) and continues by telephone for about 6 months, with call frequency decreasing over time. Miller calls it a "middle ground" between intensive psychotherapy and…
• Call schedule. For the inpatient version, the sources say only that the 11 calls get less frequent over 6 months. The week numbers were not found. A pattern of weekly calls in month 1, every 2 weeks in months 2–3, then about monthly would fit, but it is illustrative only. Table 1 lists SO phone…

Who practises it, and how they are trained or regulated

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• ED version (CLASP-ED, ED-SAFE trial). All contact is by phone after the ED visit, over 12 months. Patient calls fall in weeks 1, 2, 4, 10, 22, 34 and 48 (7 calls), and SO calls in weeks 3, 8, 20 and 32 (4 calls). The calls in weeks 1–2 cover the content of in-person sessions 1–3: history, risk, safety/crisis plan, values, Life Plan and permission to contact the SO. The week 3 call orients the SO. Later calls check…
• Other adaptations. An adolescent version adds parental involvement and extra safety planning, and the Clinician Guide has a chapter on adapting CLASP for other populations and settings. A trial combining CLASP with prolonged exposure for PTSD in military families is registered (NCT04284410). This is not drawn on.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Withdrawal, which is often an early warning sign. It is working when contact with supports increases.
• A plan written by the advisor instead of the patient. It is working when the patient refers to the plan unprompted.
• Drifting into a parallel treatment role. It is working when the provider acts on the information and care is coordinated.
• Escalating family conflict, which is a risk factor. It is working when the person reports clearer exchanges and less conflict.
• Blame, anger or burnout in the SO, and a patient who is embarrassed. It is working when the SO can name the warning signs and what to do about them.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.