1. Rajeev Ramchand Joie Acosta Amariah Becker
RAND Checklist of Best Practices for Suicide Prevention Communication Campaigns
Rajeev Ramchand
Joie Acosta
Amariah Becker

2. Best Practices for Messaging?
Messaging is critical to suicide prevention (SP) efforts, but few guidelines exist for “best practices”
Proposition 63 funds in California were used, in part, to fund “Know the Signs” – a social marketing campaign aimed at preventing suicide
RAND was hired to evaluate Prop 63 PEI funding, including Know the Signs

3. We used the RAND/UCLA Appropriateness Method for our Evaluation
Our analysis of KTS focused on the mass media component of the social marketing campaign
The RAND/UCLA Appropriateness Method is a systematic method for obtaining expert judgment on topics where there is no clear cut evidence to guide practice

4. RAND/UCLA Appropriateness Method
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

5. 42 Initial Checklist Items Based on Literature Review
21 general
21 specific to SP
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

6. Initial Items Rated By Experts
Validity: Having adequate scientific evidence or professional consensus to support a link between the checklist item and the effectiveness of a SP communication campaign
Importance: Adherence to item is primary driver of campaign effectiveness or has a critical influence on the development or implementation of a SP campaign and there are serious adverse consequences to effectiveness by not adhering
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

7. Expert Panel Consisted of Leaders in Suicide Prevention and Communications
Lidia Bernik, Mt. Sinai Hospital
Annette Beautrais, Yale University
Leah Holmes Bonilla, Vanguard Communications
Janet Kemp, VA National Suicide Prevention Coordinator
David Litts, Executive Secretary for the National Action Alliance for Suicide Prevention
Ken Norton, Executive Director of NAMI
Dan Reidenberg, Executive Director of SAVE
Phil Rodgers, American Foundation of Suicide Prevention
Michael Slater, Ohio State University
Nancy Vineburgh, The Uniformed Services University
Nedra Weinreich, Weinrich Communications

8. Original Items Edited, New Items Added
2 items edited for clarity
4 new items proposed
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

9. Expert Re-Rate New Items
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

10. Checklist Is Applied to Existing Campaign
“Know the Signs” Media Campaign
RAND Developed Initial Checklist of Items
Experts Received Background Paper and Rated Checklist Items
Experts Participate in a Conference Call to Discuss Divergent Items and Propose New Items
Experts Re-Rate Items Discussed on Conference Call
Experts Apply Ratings to an Existing Campaign

11. Final Checklist Consisted of 46 Items
Theoretical basis (5 items)
Targeted, clear and simple messages (4 items)
Pilot messages before disseminating them (5 items)
Target audience input (1 item)
Continuous monitoring and evaluation (2 items)
Media presence (2 items)
Items for All Health Promotion Campaigns (N=20)
Example items for All Campaigns
1. Theoretical Basis: The Know the Signs mass media campaign has a theoretical basis.
2. Targeted, clear and simple messages: The messages that the Know the Signs mass media campaign is trying to convey are simple and clear.
3. Pilot messages: Once developed, the Know the Signs mass media campaign materials are rigorously pilot tested among different target audiences to ensure that they achieve the intended results.
4. Evaluation: The Know the Signs mass media campaign is collecting data on its impact.
5. Media presence: The Know the Signs mass media campaign is using multiple message strategies (e.g. multiple media outlets).
Examples of Items for Suicide Prevention Campaigns
Safety considerations: The Know the Signs mass media campaign minimizes potential unintended consequences on individuals considered at-risk for suicide.
Message content: The Know the Signs mass media campaign communicates about help-seeking and provides information about where to find help
Warning signs: The Know the Signs mass media campaign does not present suicide as having a single cause.
Language/visual: The Know the Signs mass media campaign does not use the phrases ‘commit suicide’ or ‘successful or failed suicide attempt.”
Dissemination: The Know the Signs mass media campaign is part of a greater strategy (e.g. a social marketing campaign built around the strategy of having more crisis lines).

12. Final Checklist Consisted of 46 Items
Items for All Health Promotion Campaigns (N=20)
Items for Suicide Prevention Campaigns
(N=26)
Special safety considerations during pilot testing (2 items)
Suggested suicide prevention message content (10 items)
Warning signs, risk factors, and protective factors (4 items)
Language and visual elements (8 items)
Moderation of public forums (2 items)
Dissemination (1 item)
Example items for All Campaigns
1. Theoretical Basis: The Know the Signs mass media campaign has a theoretical basis.
2. Targeted, clear and simple messages: The messages that the Know the Signs mass media campaign is trying to convey are simple and clear.
3. Pilot messages: Once developed, the Know the Signs mass media campaign materials are rigorously pilot tested among different target audiences to ensure that they achieve the intended results.
4. Evaluation: The Know the Signs mass media campaign is collecting data on its impact.
5. Media presence: The Know the Signs mass media campaign is using multiple message strategies (e.g. multiple media outlets).
Examples of Items for Suicide Prevention Campaigns
Safety considerations: The Know the Signs mass media campaign minimizes potential unintended consequences on individuals considered at-risk for suicide.
Message content: The Know the Signs mass media campaign communicates about help-seeking and provides information about where to find help
Warning signs: The Know the Signs mass media campaign does not present suicide as having a single cause.
Language/visual: The Know the Signs mass media campaign does not use the phrases ‘commit suicide’ or ‘successful or failed suicide attempt.”
Dissemination: The Know the Signs mass media campaign is part of a greater strategy (e.g. a social marketing campaign built around the strategy of having more crisis lines).

13. Overall Experts Rate the Campaign As Highly Aligned with Best Practices
Top Five Most Highly Rated Practices
They also indicated that this was one of the best campaigns of this type they had ever seen because it avoided many of the common pitfalls of SP campaigns.
Note: Ratings could range from 1 to 7. “Range” represents difference between the maximum and minimum rating.

14. Concerns about KTS Raised During Meeting
Information may be outdated and unsubstantiated by research
Safety planning, warning signs (giving away possessions, putting affairs in order)
“Suicide is preventable”
Insensitive to survivors
Important for a general audience
Solution: Qualifications (i.e., Most/many suicides are preventable)
Reliance on ‘stock images’ with people who appeared “too good looking”

15. RAND Checklist of Best Practices for Suicide Prevention Communication Campaigns
Consider the checklist:
When designing a messaging campaign
When developing a campaign
When disseminating a campaign
When evaluating a campaign
Further refinement may be warranted

16. Joie Acosta jacosta@rand.org
For more information:
Joie Acosta
Rajeev Ramchand
Paper and Checklist Available:
Acosta J, Ramchand R, Becker A Best Practices for Suicide Prevention Messaging and Evaluating California’s Know the Signs Social Marketing Campaign. Crisis, Feb 23: 1-13.