QUESTIONS and candidates

March 4ward training educates a breadth of professionals and community members with the understanding and tools needed to recognize and confidently respond to the signs of people who are “Fragile,” possibly including at risk of suicide, so that they might move into healthy, quality living. Participants may include:

• schools - teachers, administrators, and other staff, as well as parent groups;

• businesses - managers and employees;

• personnel working with those in trauma - doctors, nurses, firefighters, police officers, and their administrative staffs;

• religious congregations - pastors, rabbis, and other staff and volunteers in faith communities; and

• non-profits and community organizations.

is this training only for MENTAL HEALTHCARE professionals?

No! March 4ward aims to train up as many adults as possible, since we all may find ourselves first on the scene to notice and respond to signs that the family, friends, coworkers, neighbors, students, etc. closest to us are Fragile or possibly Fragile and Suicidal. By equipping participants with knowledge and easy-to-access tools, we believe we can all become able to help each other safely through the valleys we experience.

Why does my organization need this training?

Your organization most likely has conducted fire drills, tornado drills and active shooter drills. You may have in your professional or personal capacity learned the Heimlich Maneuver and CPR. These are all plans that are established, reviewed and practiced for the purpose of saving lives in cases of emergency.

But what happens if someone in your organization is suicidal? What happens if someone in your organization suspects someone else is suicidal? What happens if a group of colleagues knows a co-worker, a student or a congregant is struggling, but takes that information only to the proverbial water cooler? March 4ward treats the prevalence and realities of suicidal tendencies with the urgency it warrants, giving organizations a response plan just as in the event of a fire, tornado, active shooter, choking or heart attack. And, just as organizations maintain fire extinguishers, security doors, and AEDs, the training equips participants with concrete tools to use when they are at the front line of the response.

WhAT makes this training different from other suicide prevention programs?

What does the MARCH 4WARD TRAINing process entail?

There are four phases of the process of coaching participants to become trained to respond to emotional pain. All phases are taught in the same day. The phases are:

1. To understand the importance of being prepared to identify when others need help to “march forward” in life, to clarify the signs for those in a “Fragile” state, and to identify a team for possible support.

2. To learn the sources of “Fragile” states and to equip each participant with steps and tools needed to help people out of “darkness.”

3. To clarify when the “Fragile” state moves to the risk of suicide, and to communicate the resources to help and action to take.

4. To equip participants with the March 4ward training tools for moving people out of a “Fragile”/suicidal state and into quality living.

Who should participate in the process?

The more individuals who are trained, the better prepared all will be to support each other. Just as all individuals in a school practice fire drills, so too is March 4ward training appropriate for everyone. Different sessions may be provided for different audiences if appropriate. For example, school personnel, parents and students may all be trained, but the sessions may be differentiated for the parents and again for the students. The training also can be refined for groups of survivors of suicide attempts, as well as groups of survivors of traumatic events such as natural disasters and mass shootings.

How can I expect individuals to respond who are not professionally trained counselors?

The prevalence and pain of suicide is real and growing. Of the 129 people a day (and rising) who die by suicide, 80% showed signs. The way this number changes is by growing the number of individuals who are trained to look, recognize and respond to their neighbors, family, friends, coworkers, students, etc. who show these signs.

We do not all have to be degree-holding mental health professionals to have the care and capacity to respond to those around us in helpful ways. There are risks with “earnest onlookers” who recognize someone in pain but respond in conversation in ways that increase the person’s darkness because they have not been trained any differently. There also are risks with those who choose not to respond at all - again, often because they have not been trained to Look, See, Ask, Tell and Do.

There are practical tools that any individual can use with someone in darkness to help them - as a colleague, a teacher, a friend. One example is “grounding” someone in panic with a 5-4-3-2-1 strategy that is explained in the training. This is so easy to use that one client has used the tool several times to help her own child, who in turn, at age 6, once used it to help an even younger sibling. In addition, trainees are advised on how to determine when not to move forward themselves.

Just as a firefighter is trained to manage a fire hose and operate a compressed air tank, and to recognize when to enter a burning structure and when to take other measures more immediately, March 4ward training participants will be trained and given tools and a workbook to call on in moments of concern or crisis.

what if i recognize myself as someone who is “fragile?” Do you offer one-on-one support?

Yes. Individual coaching is available through the Aim to Be Coaching process, separate from March 4ward. For more information about personal coaching, please visit www.aimtobecoaching.com.

Q&A for professionals in mental health care

Whose idea are these elements of your coaching?

All of the concepts as presented, including but not limited to the three energy sources (Parent, Light, Dark) and the “triangle” for managing dark voices, are Grace McLaren’s original adaptation of multiple therapies. She has designed them to give clients and laypeople and easy-to-understand framework for better managing their lives and the darkness they may face.

These concepts are based upon training, research and experience using the following:

• Transactional Analysis (adapted)

• Integrated Family Systems

• Client-Centered Therapy

• Reality Therapy

• Gestalt

More specifically, much of the design of the Parent/Light/Dark energy chips draws on adapted Transactional Analysis. The difference in Transactional Analysis and the model presented is that Transactional Analysis incorporates Parent, Adult and Child. Grace’s original model organized the energy chips as a Parent Chip with Dark Child and Light Child chips. However, cognizant of the racial sensitivities that could be received to the language of a “dark child” chip based, the “Child” framework was removed. The current adaptation provides that there is a dark chip that drains energy, a light chip that energizes, and a parent chip that self-regulates.

There also is a part that utilizes Integrated Family Systems, where Exile = Dark Chip, Manager = Parent Chip, and Firefighter = The choices made out of Dark Chip to numb the pain.

Client-Centered Therapy is drawn in heavily in the active listening coaching recommendations to listen to, write down and honor Dark Voices.

The “triangle” for managing dark voices is based in Reality Therapy. This draws a person through assessing objectively if something is truth or a lie, and on or off vision for the person’s future.

The third point of the triangle for working through Dark Chip voices is determining a Parent Chip response. This includes presented suggestions such as tearing them up, casting them in the sewer, etc. This draws on Gestalt work in asking: What do I now want to tangibly do with this thought?

What peer-reviewed concepts is this based in?

These concepts, as adapted and presented, are not tested and validated, though we welcome support in gathering and analyzing such data for measurement. Validating treatments typically takes decades of implementation, and in clinical work, we know that we do what we believe, based on grounded research and training, is most likely to help the client at any point in time in their therapy process. This is what we pursue, and what we seek to expand to equip more people with the tools needed to support themselves and those around them.

Why have you chosen the specific assessments you endorse as the ones that are best to use?

Childhood Trauma: The CDC/Kaiser ACE test is widely accepted as the leading assessment for assessing adverse childhood experiences. The presence of ACEs is a high indicator for suicide, as the original study found that a score of 4+ results in a 1200% higher likelihood of a suicide attempt, and a score of 6+ results in a 3000% higher likelihood of a suicide attempt, which is why the assessment of adverse childhood experiences is included as a critical element of the “emotional fever.”

Depression: The Pfizer Patient Health Questionnaire, or PHQ-9, has been found to be a reliable and valid measure of the presence and severity of depression. See for example: Kroenke, K et al. “The PHQ-9: validity of a brief depression severity measure” in the Journal of General Internal Medicine, vol. 16,9 (2001). It is widely used in the primary care setting.

Trauma/Stressors: The American Institute of Stress endorses the use of the Holmes-Rahe Stress Inventory, developed by psychiatrists Thomas Holmes and Richard Rahe. There have been numerous studies on its validity dating back to the late 1960s.

Suicide Risk: The Columbia-Suicide Severity Rating Scale is an evidence-supported tool developed by multiple institutions with support from the National Institute of Mental Health. It has been successfully implemented in schools, colleges, military units, emergency response departments, the justice system, and primary care settings. Other suicide prevention institutions including but not limited to the QPR Institute, Jed Foundation and Jason Foundation utilize the C-SSRS for suicide screening.