Gatekeeper Behavior Research Articles

Effectiveness of suicide prevention program (SPP) on knowledge, attitude and gatekeeper behaviour among teachers of selected Pre University colleges of Udupi district: A study protocol for randomized controlled trial

ObjectiveThe study objective is to determine the effectiveness of the suicide prevention program (SPP) on knowledge, attitude, and gatekeeper behaviour among teachers of Pre University colleges. MethodThis is a randomized controlled study, divided into two phases with assessments at baseline, one month, three months, and six months. A descriptive cross-sectional survey will be conducted in Phase-I among all teachers of first-year Pre-University courses of Udupi using the Literacy of Suicide Scale (LOSS), Attitude Towards Suicide Prevention (ATSP) scale, and Gatekeeper Behavior Scale (GBS). The participants who score below 75 % in the knowledge domain in Phase I will be recruited into Phase II. Pre-University colleges will be assigned to intervention and control groups by cluster randomization. Based on the types of colleges (Unaided, aided, and government), a proportionate sampling technique will be adopted to recruit 62 participants into each group. A ten-hour workshop on suicide prevention program (SPP) will be conducted for the intervention group. An information booklet on suicide prevention will be provided to the control group after the third follow-up (six months). The data will be analyzed statistically. Expected resultsIf the study results demonstrate statistical superiority of the intervention group over the control group in improving the knowledge, attitude, and gatekeeper behaviour on suicide prevention, it could enable the Pre-University teachers to implement the SPP. ConclusionThe present study results may support the implementation of the SPP. Trial registration numberCTRI/2022/09/045819.

Do stigma and efficacy mediate the association between training and suicide prevention behavior among Army noncommissioned officers?

Rates of suicide in the Active Component of the military have significantly increased since 2010, with particularly high rates among Army service members. One element of the Army's approach to suicide prevention relies on noncommissioned officers (NCOs) as gatekeepers who have regular contact with soldiers. NCOs receive suicide prevention training, but there is limited evidence that such training leads to behavior change. We surveyed 2468 Army NCOs participating in leadership development courses to determine (a) if training on suicide prevention and soft skills (e.g., active listening) was associated with gatekeeper behavior and use of soft skills; and (b) whether that association was explained by two potential barriers, stigma and perceptions of efficacy. Both the number of suicide prevention training topics and soft skills trained were associated with increased gatekeeper behavior; these relationships were explained in part by lower stigma and higher efficacy for use of soft skills. The use of interactive training methods and receiving coaching after training were not associated with stigma or efficacy, though both methods were associated with more frequent use of soft skills. Results suggest that the content and format of training is important to preparing NCOs to fulfill a gatekeeper role.

Brief video training for suicide prevention in veterans: A randomized controlled trial of VA S.A.V.E.

VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training developed by the Department of Veterans Affairs (VA) that teaches individuals to identify and assist veterans at risk for suicide. Although VA S.A.V.E. has been widely disseminated, rigorous evaluation is lacking. In a pilot randomized controlled trial of a brief, video-based version of VA S.A.V.E., individuals were recruited through Facebook, randomized to VA S.A.V.E. versus an attention control condition, and completed 6-month follow-up. A subgroup (n = 15) completed interviews. We used a mixed methods framework to integrate quantitative and qualitative findings. Among 214 participants, 61% were spouses/partners of veterans and 77% had prior suicide exposure. Sixty-seven percent (n = 68) of VA S.A.V.E. participants watched the entire video, and satisfaction and usability were highly rated. At 6-month follow-up, compared to the control group, the VA S.A.V.E. group had a higher proportion of participants use each gatekeeper behavior (66.7%-84.9% vs. 44.4%-77.1%), and used significantly more total gatekeeper behaviors (2.3 ± 0.9 vs. 1.8 ± 1.0; p = 0.01). Interviews supported positive reactions, learning, and behavior change from VA S.A.V.E. VA S.A.V.E. merits further investigation into its effectiveness as a brief, scalable gatekeeper training for suicide prevention in veterans.

Effectiveness of Gatekeeper Training Program (GTP) on awareness, attitude, mental help seeking intention and gatekeeper behavior among Koraga tribe: A study protocol.

Aim: This study aims to build the capacity of the people at grass root level as gatekeepers of mental health. It will assess the effectiveness of the Gatekeeper Training Program (GTP) on gatekeeper behaviour, awareness, attitude, and mental help seeking intention. Design: An evaluative research approach in two phases. Phase 1: Cross-sectional house-to-house exploratory survey. Phase 2: A quasi-experimental design with multiple follow ups at 0, 6 and 12 months. Method: Data will be collected using standardized tools like Mental Health Knowledge Questionnaire (MHKQ), Community Attitude towards Mentally Ill (CAMIS), Mental Help Seeking Intention (MHSIS) and Gatekeeper Behavior Scale (GBS). For Phase 1, a house-to-house survey will be conducted among the selected colonies of Koraga tribe to determine their awareness, attitude, and mental help seeking intention regarding common mental health problems. Phase 2 includes identification of the leaders/representatives of the selected tribal colonies, and involving them in GTP. Pre-test and multiple post-test will be conducted in Phase 2 at 0, 6, 12 months. The study is funded by Indian Council of Medical Research from 16 August 2021 for 3 years duration. Discussion: Treatment gap in psychiatric disorders remains an issue of great concern. Evidence based research promotes task shifting approaches in dealing with mental health problems in the community. Capacity building programs like GTP for the underprivileged section of the society are important especially in low and middle income group of countries. Impact: This need based GTP, will ensure mental health first aid in the society. Early identification of people with mental health problems at their doorsteps has huge impact on the prognosis of the illness, closing the treatment gap and stigma reduction.

어머니 문지기행동에 기초한 부모교육프로그램 개발 및 효과검증

Objectives The purpose of this study is to develop a parent education program based on maternal gatekeeper behavior and to investigate the effects of the program.
 Methods The researcher developed a parent education program based on maternal gatekeeper behavior according to 4 steps, and examined the effects of the program for 20 mothers(10 mothers were the exprement group, and 10 mothers were control group) with children whose first child was 3 to 5 years old living in J city. The program consisted of 5 sessions, and the program was conducted in a non-face-to-face manner through real-time video lectures. For the analysis of this program result, the researcher performed Mann-Whitney U test, Wilcoxon sign rank test for non-parametric test, and qualitative data analysis.
 Results The results of this study were as follows. First, the group that participated in the parent education program based on the maternal gatekeeping showed improvement in parental co-parenting and father-rearing participation. Second, it was found that parenting stress of mothers who participated in this program decreased and parenting efficacy improved. Third, in the qualitative data, it was possible to confirm changes in parental co-parenting and mothers' parenting efficacy in the process of participating in parent education programs.
 Conclusions Based on these results, this study is significant in that it developed a parent education program based on the concept of a mother gatekeeper and verified its effectiveness in order to enhance fathers' participation in parenting in the present age where the role of parents and co-parenting are important.

High School Educator Training by Simulation to Address Emotional and Behavioral Concerns in School Settings: A Randomized Study

The purpose of this study is to examine the impact of an online virtual human role-play simulation in teaching high school educators and staff to identify, talk to, and if necessary, refer students in psychological distress to support services. High school educators (N = 31,144) from 43 US states and 5 American territories completed a baseline survey and then randomly assigned to a wait-list control or treatment group. Participants in the treatment group completed the training simulation which included active learning strategies to teach evidenced-based communication strategies such as motivational interviewing to build skills and shift attitudes. Immediately after the training, treatment group participants completed a post-survey and then a 3-month follow-up survey. Baseline and post-surveys included the validated gatekeeper behavior scale measures which assess attitudinal constructs that predict helping behaviors. Self-reported helping behaviors were collected at baseline from both groups and at the 3-month follow-up for the treatment group. The treatment group participants’ post and follow-up data were compared to the control group’s baseline measures. The treatment group post-training scores were significantly higher (p < .001) than the control group’s baseline scores for all gatekeeper behavior scale attitudinal constructs of preparedness, likelihood, and self-efficacy to engage in helping behaviors. A teacher subsample reported significant increases (p < .001) in the number of students referred to mental health support services when compared to baseline measures of the control group. Role-play simulations hold promise in teaching educators to become the “eyes and ears” of student mental health by empowering them to identify students in psychological distress, engage them in effective conversations about their concerns, and if necessary, make a referral to behavioral health support services. Future studies need to implement measures that document students entering counseling as a result of self-reported referrals and examine the impact of the training on the overall mental health culture within schools. Such studies could lead to simulations being widely adopted to support public health initiatives that address student mental health and wellness.

Effectiveness of Gatekeeper Training Program (GTP) on awareness, attitude, mental help seeking intention and gatekeeper behavior among Koraga tribe: A study protocol.

Aim: This study aims to build the capacity of the people at grass root level as gatekeepers of mental health. It will assess the effectiveness of the Gatekeeper Training Program (GTP) on gatekeeper behaviour, awareness, attitude, and mental help seeking intention. Design: An evaluative research approach in two phases. Phase 1: Cross-sectional house-to-house exploratory survey. Phase 2: A quasi-experimental design with multiple follow ups at 0, 6 and 12 months. Method: Data will be collected using standardized tools like Mental Health Knowledge Questionnaire (MHKQ), Community Attitude towards Mentally Ill (CAMIS), Mental Help Seeking Intention (MHSIS) and Gatekeeper Behavior Scale (GBS). For Phase 1, a house-to-house survey will be conducted among the selected colonies of Koraga tribe to determine their awareness, attitude, and mental help seeking intention regarding common mental health problems. Phase 2 includes identification of the leaders/representatives of the selected tribal colonies, and involving them in GTP. Pre-test and multiple post-test will be conducted in Phase 2 at 0, 6, 12 months. The study is funded by Indian Council of Medical Research from 16 August 2021 for 3 years duration. Discussion: Treatment gap in psychiatric disorders remains an issue of great concern. Evidence based research promotes task shifting approaches in dealing with mental health problems in the community. Capacity building programs like GTP for the underprivileged section of the society are important especially in low and middle income group of countries. Impact: This need based GTP, will ensure mental health first aid in the society. Early identification of people with mental health problems at their doorsteps has huge impact on the prognosis of the illness, closing the treatment gap and stigma reduction.

The Effectiveness of Active Learning Strategies in Gatekeeper Training on Behavioral Outcomes.

Background: Studies of suicide prevention gatekeeper trainings (GKT) show temporary enhancements in short-term behavioral outcomes and limited enhancements in intermediate behavioral outcomes. Aims: We aimed to examine the impact of two training enhancements (role-play and booster) on intermediate GKT outcomes. Method: The study used a factorial randomized controlled design to assign participants to one of four groups. Three indicators of gatekeeper behavior at 6-month follow-up were the primary outcomes of interest. We used propensity score-based techniques to address observed imbalances. Results: At 6 months, among participants assigned to role-play, a significantly larger proportion of those assigned to booster performed identifications and referrals followed by a notification to the referral source, and followed by escorting the youth to the resource. Limitations: While observed imbalances were addressed, unobserved differences may persist. The validity of self-reported indicators to measure actual behavior remains unknown. Conclusion: Results suggest that active learning strategies can, in combination, enhance the effectiveness of trainings. The strategies seem to increase the comprehensiveness of gatekeeper behaviors.

Development and Evaluation of the Life Respect Enhancement Program for Nursing Officers

The present study was conducted to develop the Life Respect Enhancement Program and test its effectiveness on suicide knowledge, suicide intervention skills, self-efficacy in suicide prevention, and gatekeeper behaviors among nursing officers. The program was developed according to the ADDIE model and finalized after practical need analysis, expert verification, and a preliminary study. The present study used a concurrent embedded mixed-method research design. To compare the effects of the Program and the control group on the outcome variables, a quantitative study was conducted using a nonequivalent control group with a pretest-posttest design. Quantitative data were analyzed using χ²-tests, t-tests, and RM-ANOVA. A qualitative study was conducted using FGI with six members of the experimental group 3 months after intervention completion. In total, 56 nursing officers participated in the 3-month follow-up test. Compared to the control group, the experimental group showed significant improvements in suicide knowledge, suicide intervention skills, and self-efficacy in suicide prevention scores at post-test. The significant group differences in suicide knowledge and suicide intervention skills were maintained at 3 months. The gatekeeper behavior scores of the experimental group were also significantly higher than those of the control group at 3 months. Qualitative analysis of the participants' experiences with the Program yielded two themes and seven sub-themes. The newly developed Life Respect Enhancement Program demonstrates significant effects on suicide knowledge, suicide intervention skills, and gatekeeper behaviors. Thus, this program is recommended to promote suicide prevention competencies among nursing officers in military clinical settings.

Validation of the Korean Version of Gatekeeper Behavior Scale

Objectives The suicide rate in Korea is one of the highest among all members of the Organization for Economic Cooperation and Development. Gatekeeper...

Virtual Role-play: Middle School Educators Addressing Student Mental Health

Objectives: In this study, we examined the impact of a virtual training program, Kognito At-Risk role-play simulation, on the mental health and suicide prevention gatekeeping skills of middle school educators. Methods: The validated Gatekeeper Behavior Scale was administered to 33,703 participants at baseline, post-training and follow-up. Helping behaviors were measured at baseline and follow-up. We also assessed preparedness, likelihood, and self-efficacy concerning leading conversations with youth about bullying and suicide. Results: Participants showed positive change from pre-test to 3-month follow-up on variables of interest. Hotelling's T2 test indicated that, as a set, gatekeeper attitudes of preparedness, likelihood, and self-efficacy differed between pre-test and post-test, F (3, 33,512) = 16,283, p &lt; .001, η2 partial = .59. Number of students about whom gatekeepers were concerned (p &lt; .05), number of students approached to discuss concerns (p &lt; .001), and number of students referred to support services (p &lt;.001) increased significantly with training. Conclusions: The At-Risk simulation shows promise in detecting and referring students in psychological distress, including risk of suicide. Fidelity is maintained because the program cannot be altered. At-Risk can be an effective and affordable way to provide suicide prevention training for those working in schools.

Impact of a simulation on educator support of LGBTQ youth

LGBTQ youth frequently experience bullying and harassment in the school setting. Teachers are in an ideal position to prevent student harassment, yet most don’t have adequate training. This study evaluated the effectiveness of “Step In Speak Up,” an interactive online simulation. In a randomized controlled trial, 1390 participants received “Step In Speak Up” or no intervention. Participants were assessed pre- and post-intervention on the Gatekeeper Behavior Scale and attitudes toward the simulation. Results demonstrated significant differences (p < 0.001, multivariate η2partial = 0.17) between the training and control groups on learners preparedness, likelihood, and self-confidence in managing bullying behavior.

Evaluation of a Brief Suicide Prevention Training Program for College Campuses

Suicide is the second leading cause of death in college students. While research indicates a positive impact of gatekeeper training programs on knowledge and attitudes, few have examined change in suicide prevention behaviors. The purpose of this study was to evaluate the effects of a brief suicide prevention training for college campuses on knowledge, self-efficacy to intervene, and gatekeeper behaviors. A longitudinal design was employed to examine changes from pretest to post-test and 3-month follow-up. Participants included 517 students, staff, and faculty who attended a 90-minute training and completed self-report surveys. The training included both didactic and experiential components. Repeated measures ANOVAs indicated that knowledge, self-efficacy to discuss suicide and to refer to resources, and gatekeeper behavior increased from pretest to post-test and follow-up. Students exhibited a greater increase in gatekeeper behaviors, in comparison to non-students. Large changes were observed on publicizing suicide prevention information and having informal conversations about suicide with students, and 76% had engaged in gatekeeper behavior at follow-up. Findings offer support for the potential efficacy of a brief prevention program, with promising effects on several suicide prevention behaviors. Declines on knowledge and self-efficacy from post-test to follow-up highlight the importance of booster sessions and complementary programming.

Suicide prevention training for Christian faith-based organizations using Acceptance and Commitment Therapy: a pilot controlled trial of The HOLLY Program

This study is a pilot controlled trial of The HOLLY Program, an ACT-based suicide prevention gatekeeper training (GKT) program for Christian faith-based organizations (FBOs). Seventy-two participants took part in the study. Mixed ANOVAs with repeated measures examined changes on suicide responding outcomes and ACT processes using pre-intervention and one-month post-intervention data. Based on intention-to-treat analyses, significant increases in self-efficacy and suicide prevention behaviors were found. Increased knowledge and decreased stigma were data trends. No training effects emerged for the ACT processes; however, qualitative analyses showed that participants adaptively used ACT processes when engaging in a self-selected gatekeeper behavior. Further, correlational analyses revealed that ACT processes were associated with decreased stigma and completion of a self-selected gatekeeper behavior. Most participants (86%) awarded maximum ratings to the program's capacity to meet their expectations and needs, whilst 94% stated they would definitely recommend it to others. Although preliminary, these findings indicate the effectiveness of an ACT-based GKT program for Christian FBO members.

Enhancing Educator Engagement in School Mental Health Care Through Digital Simulation Professional Development.

Despite the critical role of educators as gatekeepers for school mental health services, they receive limited training to support student mental health. We report findings from a trial of an online mental health role-play simulation for elementary school teachers on changes in attitudes and self-reported helping behaviors for students experiencing psychological distress. We randomly assigned 18,896 elementary school teachers to wait-list control or intervention conditions in which they received the 45- to 90-minute online role-play simulation. We administered a version of the validated Gatekeeper Behavior Scale at baseline and postintervention, which measures attitudinal dimensions shown to predict teacher helping behavior change. Self-reported helping behaviors were collected at baseline and 3-month follow-up. Outcomes were compared between the intervention follow-up and control group baseline measures. The intervention group posttraining scores were significantly higher (p < .001) than the control group for all the preparedness, likelihood, and self-efficacy Gatekeeper Behavior subscales. All 5 helping behaviors were significantly higher among the intervention group at follow-up compared to the control group at baseline. We found that a brief online role-play simulation was an effective strategy for improving teacher attitudes and behaviors needed to perform a positive mental health gatekeeper role in schools.

Development and Validation of the Gatekeeper Behavior Scale.

Community-based gatekeeper trainings are effective tools in increasing gatekeeper skills but few validated measures assess impact. This study aimed at determining the validity of an 11-item Gatekeeper Behavior Scale (GBS) to assess gatekeeper skills that predict behavior. To validate the scale, 8,931 users were administered GBS surveys at pretraining, posttraining, and follow-up periods. The training was one of five from the suite of online At-Risk mental health learning simulations for university faculty/staff or students or high/middle school educators. A confirmatory factor analysis revealed the three-factor model based on the subscales of preparedness, likelihood, and self-efficacy fit the data best. Factor loadings showed all items correlated highly with theoretical constructs (r ≥ .84, p < .001). The GBS had high internal consistency (α = 0.93). Criterion-related validity for likelihood to discuss concerns at posttraining was significantly related to approaching students believed to be in psychological distress (r = .219, p < .001). Likelihood to refer significantly correlated with the number of students referred (r = .235, p < .001). Convergent validity was established via a correlation between self-efficacy in motivating someone to seek help and general self-efficacy (r = .519, p < .001). The GBS appears to be a valid tool in measuring the impact of online gatekeeper training simulations and holds promise for assessing other delivery methods.

Discrimination, Women, and Work: Processes and Variations by Race and Class

Research on gender and workplace stratification has made clear that persistent employment, wage, and mobility gaps exist, and that discrimination at organizational and interactional levels is playing a role. Few studies, however, have been able to directly capture processes involved. In this article, we draw on unique qualitative and quantitative data pertaining to verified cases of workplace sex and race discrimination (1988 to 2003), and analyze the discriminatory experiences of African-American and white women across various occupational statuses. Notable are high levels of discriminatory firing for both groups, but higher instances of race-based promotional discrimination for black women—a pattern partially linked to their disparate concentration in sex-segregated workplaces and in positions of lower occupational prestige. Our qualitative immersion into case materials reveals influential mechanisms and employer justifications, unique manifestations of differential treatment on the job, and the use of “soft skill” criteria in gatekeeper decision making. We conclude by discussing important dimensions of workplace discrimination for women, variations by social class and race status, and how complexities of status matter for what women experience and gatekeeper behavior.

Strict Liability for Gatekeepers: A Reply to Professor Coffee

This article responds to a proposal by Professor John C. Coffee, Jr. for a modified form of strict liability for gatekeepers. Professor Coffee's proposal would convert gatekeepers into insurers, but cap their insurance obligations based on a multiple of the highest annual revenues the gatekeepers recently had received from their wrongdoing clients. My proposal, advanced in 2001, would allow gatekeepers to contract for a percentage of issuer damages, after settlement or judgment, subject to a legislatively-imposed floor. This article compares the proposals and concludes that a contractual system based on a percentage of the issuer's liability would be preferable to a regulatory system with caps based on a multiple of gatekeeper revenues. Both proposals mark a shift in the scholarship addressing the problem of gatekeeper liability. Until recently, scholarship on gatekeepers had focused on reputation - not regulation or civil liability - as the key limitation on gatekeeper behavior. Indeed, many scholars have argued that liability should not be imposed on gatekeepers in various contexts, and that reputation-related incentives alone would lead gatekeepers to screen against fraudulent transactions and improper disclosure in an optimal way, even in the absence of liability. From a theoretical perspective, this article is an attempt to move the literature away from a focus on reputation to an assessment of a potential reinsurance market for securities risks, where gatekeepers would behave more like insurers than reputational intermediaries.

Barbarians at the Gatekeepers?: A Proposal for a Modified Strict Liability Regime

This article attempts to fill a few of the gaps in current scholarship about gatekeepers, and sets forth a proposal for a modified strict liability regime that would avoid many of the problems and costs associated with the current due diligence-based approaches. Under the proposed regime, gatekeepers (investment banking, accounting, and law firms) would be strictly liable for any securities fraud damages paid by the issuer pursuant to a settlement or judgment. Gatekeepers would not have any due diligence-based defenses for securities fraud. Instead, gatekeepers would be permitted to limit their liability by agreeing to and disclosing a percentage limitation on the scope of their liability for the issuer's damages. For example, a gatekeeper for an issue might agree ex ante to be strictly liable for 10 percent of the issuer's liability related to the issuance, measured by the present value of any payment by the issuer pursuant to a settlement or judgment. A particular gatekeeper's liability would be limited to the issuer's liability related to that gatekeeper's role (e.g., counsel for the issuer or the underwriters generally would not be liable for material misstatements or omissions in audited financial statements). The percentage for each gatekeeper could range based on competitive bargaining and market forces, with a minimum limit (e.g., the amount of the gatekeeper's fee, or perhaps a fixed amount of 1 to 5 percent) set by law. This modified strict liability proposal is intended to solve two important and parallel problems in securities regulation. The first problem is the rapidly increasing and substantial costs related to the role of gatekeepers in securities fraud, including both the costs of behavior designed to capture the benefit of due diligence-based defenses and - more importantly - the costs of resolving disputes about gatekeeper behavior. The second problem is that the value of gatekeeper certification is declining at the same time costs are increasing. The article gathers evidence to demonstrate these two problems, and shows how a strict liability regime might ameliorate them. Throughout this discussion, the article challenges the assumption that gatekeepers act as reputational intermediaries.