The steps to program installation are as follows:

• Task force or Q-I committee reviews current policies and procedures, together with agency mission statement, if indicated.
• Task group publishes and promulgates suicide-specific policies and procedures to address suicide prevention, intervention and postvention, together with documentation requirements, as approved by the Medical Director, Clinical Directors, CEO and legal counsel.
• Identification of senior staff to teach QPR Institute courses.
• Purchase of licensed training materials and program.
• QPR Institute trains and certifies trainers on site or via distance learning
• Staff notified of adoption of a suicide risk reduction program and requirement for mandatory training and credentialing
• Training timetables set
• Training initiated, with pre-post data collection (optional testing and credentialing)
• Quarterly report to governance and regular progress reports to staff

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Mandatory Staff Training
The QPR Institute recommends that, at minimum, all staff at all levels must receive basic suicide awareness and intervention training (1-hour QPR gatekeeper program).

All clinical and provider staff must have a level training that matches their level of duty to the consumer (either QPR Suicide Triage training or suicide risk management training with the QPRT). A brief description of each level of training, together with a diagram, illustrate this integrated approach (QPR Institute Training Programs and the Pyramid)

We further recommend that all new staff complete appropriate training within the first 60 days of employment and that untrained staff should not be assigned suicidal consumers.

Staff Credentialing
We strongly recommend credentialing of staff in a core competency of suicide prevention awareness and gatekeeper function and/or suicide risk assessment and risk management, depending on their level of duty to consumers of care. Credentialing is accomplished with tools provided in the suicide risk reduction program. These tools include the following measures:
a) Evidence of attendance at a course (completed evaluation and sign in sheet), and/or documentation of the completion of a CD-ROM delivered tutorial or course
b) Completion of a mock suicide intervention or risk assessment (signed by supervisor)
c) Passing a quiz at 75% or more items correct
d) For clinical staff, completion of at least three risk assessment interviews, two of which must be with persons experiencing suicidal ideation and all of which meet supervisors' review standards

Annual Program Review
We also recommend an annual Quality Improvement or other committee review of program outcomes and evaluations, together with an Annual Report to agency leadership and governance.

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