Innovations in the Practice of Culturally Competent Suicide Risk Management

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Although guidelines for culturally competent suicide risk management are sparse, recent advances in theory and assessment provide direction for culturally competent practice. The Cultural Theory and Model of Suicide (Chu, Goldblum, Floyd, & Bongar, 2010) was one of the first comprehensive efforts to provide a framework that guides an understanding of how culture influences suicide risk across multiple cultural identities. The Cultural Assessment of Risk for Suicide (CARS), a 39-item self-report measure assessing culturally specific suicide risk factors, was developed based on the Cultural Theory and Model of Suicide. These theoretical and measurement works, although foundational in their importance for synthesizing a broad literature, have not been tested and translated into applied clinical practice. The current case study is a translational effort that applies these approaches to culturally competent suicide practice with “Zoe,” an Asian American veteran trans woman in her early thirties with moderate-high suicide risk. Application of the Cultural Theory and Model of Suicide and the CARS illuminated cultural risk factors that were not considered in Zoe’s original safety plan (e.g., family conflict, minority stress; hidden suicidal ideation and behaviors; and cultural expressions of suicidal distress as anger, fatigue, and shame). These results yielded differences in Zoe’s risk management plan and created a culturally informed approach that corresponded with a concomitant decrease in suicidal symptoms. This study demonstrated that the CARS may detect alternative cultural expressions of suicidal distress and behaviors and yield important implications for suicide risk assessment and management planning for culturally diverse clients.

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