Core Competencies in Suicide Risk Assessment and Management: Implications for Supervision M. David Rudd and Kelly C. Cukrowicz Texas Tech University Craig J. Bryan Wilford Hall Medical Center The recent publication of core competencies in suicide risk assessment and management (Suicide Prevention Resource Center, 2006) and the American Psychiatric Association’s (2003) practice guide- lines have raised concerns about how best to address these issues in clinical supervision of trainees. This article reviews the identified core competencies, addresses implications for supervision of trainees, and provides a general framework for applicable strategies for the supervision process to facilitate clinical skill development and refinement. Keywords: suicide risk assessment, suicide risk, core competencies, supervision It is almost a certainty that psychologists-in-training (i.e., in- ternships and practicum placements) will at some point be required to evaluate a patient presenting with some form of suicidality (i.e., suicidal thoughts, a suicide attempt, or a history of multiple at- tempts). Suicidality is the most frequently encountered emergency situation in mental health settings (Buzan & Weissberg, 1992) and is the most anxiety-provoking clinical scenario for practitioners (Pope & Tabachnick, 1993; Rudd, 2006), with an estimated one- quarter of all psychologists experiencing a patient suicide at some point in their careers (Chemtob, Hamada, Bauer, Torigoe, & Kinney, 1988b; Pope & Tabachnick, 1993). Similarly, it has been estimated that almost 40% of psychology trainees will have a patient make a suicide attempt (29.1%) or will experience a patient’s suicide (11.3%) during training (Kleespies, Penk, & Forsyth, 1993). The challenge of responding to suicide risk in the clinical environment is not unique to psychologists, but is uniform across mental health specialties, with Chemtob, Hamada, Bauer, Torigoe, and Kenny (1988a) estimating that 50% of psychiatrists will lose a patient to suicide. McAdams and Foster (2000) reported that 23% of counselors had a client die by suicide during the course of treatment. Fawcett (1999) has estimated that up to one half of all suicides in a given year (more than 31,000 suicides per year; Hoyert, Heron, Murphy, & Kung, 2006) are by individuals cur- rently in treatment. The impact of suicidal behavior, emotionally and professionally, on those providing clinical care is profound, with clinicians reporting shock, self-blame, guilt, and shame (Kleespies et al., 1993). The impact on those in training has been found to be even more significant. Kleespies et al. (1993) found that the earlier in training a patient suicide occurred, the more severe the impact and the more enduring the emotional conse- quences and distress. What seems clear is that suicidality is a clinical scenario fre- quently, if not uniformly, encountered in clinical training environ- ments. The recent publication of core competencies in the assess- ment and management of suicide risk (Suicide Prevention Resource Center [SPRC], 2006) and the American Psychiatric Association’s (2003) practice guidelines have clear implications for the nature and process of supervision in clinical training settings. It is important for supervisors to be familiar with available standards and also consider strategies for ensuring thorough cov- erage and related skill development in the supervision process. Importance of Competency-Based Supervision Falender and Shafranske (2007) recently provided a review and discussion of competency-based supervision practice in psychol- ogy. At the heart of their review is the issue that both the American Psychological Association (APA) ethics code (APA, 2002) and licensing board rules of practice (Association of State & Provincial Psychology Boards [ASPPB], 2003) require psychologists to prac- tice within their identified and demonstrated areas of competence. Among their recommendations for best practices that have clear implications for the management of high-risk suicidal patients are the following (Falender & Shafranske, 2007, p. 238): (a) The supervisor examines his or her own clinical and supervision ex- pertise and competency; (b) the supervisor delineates supervisory expectations, including standards, rules, and general practice; (c) the supervisor identifies setting-specific competencies the trainee must attain for successful completion of the supervised experience; (d) the supervisor collaborates with the trainee in developing a M. DAVID RUDD received his doctorate from the University of Texas at Austin and completed a postdoctoral fellowship at the Beck Institute in Philadelphia. The primary focus of his research is clinical suicidology, with an emphasis on understanding acute and chronic distinctions in risk. KELLY C. CUKROWICZ completed her doctorate at Florida State Univer- sity and postdoctoral training at Duke University. Her primary research interest is depression and suicidality in the elderly. CRAIG J. BRYAN completed his doctorate at Baylor University and currently serves on active duty with the United States Air Force. The primary focus of his research is on primary care psychology, with an emphasis on suicidality in primary care settings. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Defense, the Department of the Air Force, or the U.S. government. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to M. David Rudd, Department of Psychology, Texas Tech University, MS 42051, Lubbock, TX 79409-2051. E-mail: david.rudd@ttu.edu Training and Education in Professional Psychology Copyright 2008 by the American Psychological Association 2008, Vol. 2, No. 4, 219 –228 1931-3918/08/$12.00 DOI: 10.1037/1931-3918.2.4.219 219