Gatekeeper Training Program Research Articles

SafeTALK suicide training: An evaluation of attitudes and actions among medical students

Background: SafeTALK is a half-day gatekeeper training program on recognizing persons at risk for suicide and intervening appropriately. Primary care clinicians have been increasingly targeted for suicide intervention training; however, evidence surrounding the effectiveness of safeTALK is lacking, particularly among medical learners. The aim of this study was to assess whether suicide literacy and intervention skills were enhanced by safeTALK training among medical learners.Methods: Undergraduate medical students from an Ontario university were invited to complete an online survey regardless if they had taken safeTALK training as part of their curriculum. Suicide literacy was measured with the Literacy of Suicide Scale (LOSS) and intervention skills were measured with the Suicide Intervention Response Inventory (SIRI).Results: The majority believed that suicide risk assessment training was very important to undergraduate medical education. Although limitations were noted, this study did not demonstrate that safeTALK training significantly improved medical students’ suicide literacy levels or suicide intervention skills.Conclusions: A more comprehensive program including the epidemiology of suicide and mental health disorders in addition to intervention skills is recommended to ensure medical learners are equipped to dispel the stigmas surrounding suicide and offer the appropriate care and follow up to their patients in future practice.

2.8 The Development, Implementation, and Evaluation of a Suicide Prevention Gatekeeper Training Curriculum for High School Students

Ample research supports the efficacy of suicide prevention gatekeeper-training programs for adults, but little research evaluates their use with adolescents. This study modified an adult gatekeeper-training program to create a suicide prevention curriculum appropriate for adolescents and evaluated its feasibility and efficacy.

A Community's Response to Gatekeeper Training

Background: Gatekeeper training remains fundamental to broad suicide prevention strategies. In this descriptive study, Question, Persuade, Refer, an evidence-based suicide prevention gatekeeper training program, was implemented community-wide in a state among the highest for suicide in the United States. Objective: To describe and compare cohort pre-post responses to suicide prevention gatekeeper training. Methods: Quantitative and qualitative data were collected from 2013 to 2016 utilizing pre-post training surveys (n=894). Results: Quantitative results were statistically significant (p<0.0001) with little between-cohort variance. Significant differences in pre-post ratings concerned ‘how to ask about suicide’, ‘how to persuade someone to receive help’ and ‘information about resources’. Post-survey qualitative results revealed a main theme of ‘appreciating learning about suicide prevention’. Conclusion: Findings from the ethnically homogenous sample are consistent with other research outcomes, adding to understandings from the few other published community-wide gatekeeper studies. Of note is that gatekeeper training is feasible, beneficial and cost-effective aligning with international and national initiatives. Future research is needed on the sustainability of gatekeeper training outcomes over time and its’ impact on suicide rates.

Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel.

Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources. We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence. School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training. Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience. Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.

Effects of a Peer Gatekeeper Training Program in Female High School Students

This study aimed to investigate the effects of a peer gatekeeper training program on existential spiritual well-being, interpersonal relationships, depression, and suicidal ideation in female high school students. Participant pool included forty-four female high school students. The study was conducted over a period of three months. To test the effects of the peer gatekeeper training program, participants were divided into two groups, an experimental group (N=22) and a control group (N=22). The program was only conducted with the experimental group, but the survey was administered to both groups. Data were analyzed on SPSS/WIN 22.0 using a chi-squared test, t-test, Fisher’s exact test, and ANCOVA. Existential spiritual well-being and interpersonal relationships were significantly higher in the experimental group (F=14.43, p<.001, F=17.60, p<.001 respectively) and depression were significantly lower (F=4.31, p=.010) as compared with the control group. Findings from this study indicate that peer gatekeeper training programs can be utilized for female high school students and effectively improve their existential spiritual well-being and interpersonal relationships while lowering depression.

A descriptive study of baccalaureate nursing students' responses to suicide prevention education

Internationally, little is known regarding the amount of educational content on suicide in undergraduate nursing curriculum. The literature conducted found few published research studies on implementation of suicide prevention instruction in baccalaureate nursing curriculum, even though various international healthcare and nursing initiatives address suicide prevention. The aim was to describe senior baccalaureate students' responses to an evidence-based suicide prevention gatekeeper training program entitled Question-Persuade-Refer implemented in a required course. This is a multi-method descriptive study. Data were collected utilizing a pre–post-survey questionnaire administered to 150 students in four classes of a psychiatric nursing course over a two-year period. The quantitative data were statistically significant (p < 0.000) indicating an overall positive rating of the training. From the qualitative data, the main theme was ‘becoming capable intervening with persons at risk for suicide’. Students responded very positively to the evidence based suicide prevention gatekeeper training program. The instruction addresses various national initiatives and strategies filling a void in nursing curriculum, as well as empowering students to engage in suicide prevention interventions.

Effectiveness of suicide prevention gatekeeper-training for university administrative staff in Japan.

Suicide is a leading cause of death among Japanese college and university students. Gatekeeper-training programs have been shown to improve detection and referral of individuals who are at risk of suicide by training non-mental-health professional persons. However, no studies have investigated the effectiveness of such programs in university settings in Japan. The aim of this study was to investigate the effectiveness of the gatekeeper-training program for administrative staff in Japanese universities. We developed a 2.5-h gatekeeper-training program based on the Mental Health First Aid program, which was originally developed for the general public. Seventy-six administrative staff at Hokkaido University participated in the program. Competence and confidence in managing suicide intervention, behavioral intention as a gatekeeper and attitude while handling suicidal students were measured by a self-reported questionnaire before, immediately after and a month after the program. We found a significant improvement in competence in the management of suicidal students. We also found improvements in confidence in management of suicidal students and behavioral intention as a gatekeeper after training, though questionnaires for those secondary outcomes were not validated. These improvements continued for a month. About 95% of the participants rated the program as useful or very useful and one-third of the participants had one or more chances to utilize their skills within a month. The current results suggest the positive effects of the training program in university settings in Japan. Future evaluation that includes comparison with standard didactic trainings and an assessment of long-term effectiveness are warranted.

Revisiting the concept of knowledge: how much is learned by students participating in suicide prevention gatekeeper training?

Although gatekeeper training is effective at increasing knowledge, some question the effectiveness of these programs due to high pretraining knowledge levels. However, knowledge scores may be artificially inflated when students guess answer options correctly but lack information needed to assist suicidal peers. To use free-recall questions to evaluate suicide prevention knowledge and compare levels of knowledge using this methodology with established assessment methods in the literature. Free-recall knowledge questions were examined before and after participation in a student gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. Unlike in studies using forced-choice assessment, students' baseline knowledge was markedly low using free-recall questions and, despite making significant improvement from pretraining levels, posttraining knowledge barely approached passable levels. Focus group findings suggest that training sessions may need to be more engaging and interactive in order to improve knowledge transfer. Free-recall questions may provide a less inflated measure of accessible knowledge learned from school-based suicide prevention curricula. Evaluators and programmatic partners should be cognizant of this methodological issue and consider using a mix of assessment methodologies to determine students' actual levels of knowledge after participation in gatekeeper training.

또래생명지킴이훈련프로그램이 중학생의 실존적 영적안녕감, 친구관계 및 자살위험성에 미치는 효과

Purpose: This study aims to investigate the effects of a peer gatekeeper training program on existential spiritual well-being, interpersonal relationship with friends, and suicide probability for middle school students. Methods: The participants were fifty students who were at a vocational middle school in D city from october 13, 2012 to november 10, 2012. To test the effects of the peer gatekeeper training program, the participants were divided into two groups in the way of matching distribution, an experimental group(24) and a control group(26). Data were analyzed by Chi-square test, t-test, and Fisher exact probability test using the SPSS/WIN 12.0 program. Results: After attending the peer gatekeeper training program, significant differences between the experimental group and the control group were found in existential spiritual well-being(t

Feasibility of a Web‐based Gatekeeper Training: Implications for Suicide Prevention

Web-based training programs have advantages such as increased scheduling flexibility and decreased training costs. Yet the feasibility of applying them to injury prevention programs such as suicide prevention gatekeeper training has not been empirically verified. Two studies were conducted to assess the feasibility and effectiveness of a web-based version of the Question, Persuade, and Refer (QPR) gatekeeper training program. Results of Study 1 revealed that participants in a web-based training demonstrated significant gains in knowledge of suicide prevention, self-efficacy for suicide prevention, and behavioral intentions to engage in suicide prevention, as compared to those in a control group. Results of Study 2 further showed that the web-based training may be as effective as the face-to-face QPR training across pre- (T1) and post training (T2); however, knowledge, self-efficacy, and behavioral intentions in both groups generally declined from T2 to 6-months after the training. Overall, these results provide initial evidence to support the feasibility of adopting web-based media to deliver gatekeeper training. Moreover, the present findings suggest the need to understand how to maintain gatekeepers' knowledge, confidence, motivation, and skills after training.

Implementing an Audience-Specific Small-Group Gatekeeper Training Program to Respond to Suicide Risk Among College Students: A Case Study

Objective: This case study evaluated the effectiveness of an audience-specific, single-session, small-group interactive gatekeeper training program conducted at a large northeastern public university. Participants: Participants were 335 faculty, staff, and students completing gatekeeper training programs tailored to their group needs. Methods: Baseline assessments of knowledge about suicide, risk factors, resources for assistance, and comfort in intervening with a student in distress were administered to participants prior to the small-group training sessions; posttest assessments of knowledge and comfort in intervening with students in distress were administered upon completion of training and at 3-month follow-up. Results: There was a statistically significant increase in knowledge and comfort upon completion of training for both faculty/staff and student groups, although degradation of training effects at 3-month follow-up was evident. Conclusions: There are benefits associated with the implementation of audience-specific gatekeeper training programs. Booster training sessions to address skill degradation over time are recommended.

Effects of a Peer Gatekeeper Training Program on Self-esteem, Interpersonal Relationships with Friends, and Suicide Probability for High School Students

Effects of a Peer Gatekeeper Training Program on Self-esteem, Interpersonal Relationships with Friends, and Suicide Probability for High School Students

The Impact of Experiential Exercises on Communication and Relational Skills in a Suicide Prevention Gatekeeper-Training Program for College Resident Advisors

Objective: In an effort to identify students at risk for suicide, many colleges are implementing suicide prevention training for campus gatekeepers. This study evaluated the efficacy of a 3-hour, experiential-based gatekeeper training that included an emphasis on enhancing communication skills and relational connection in addition to the didactic foci of standard gatekeeper training. Participants: Sixty-five college student resident advisors (RAs) were trained with Campus Connect. Methods: The training was dismantled to examine the specific contribution of experiential exercises on training outcomes. Results: Compared to didactic training alone, following participation in experiential exercises RAs’ training outcome scores exhibited additional improvement on the Suicide Intervention Response Inventory–2 and a 14-item self-report measure of self-efficacy for specific suicide- and crisis-related knowledge and skills. Conclusions: In gatekeeper training, experiential exercises emphasizing awareness and empathic responding and practice of these skills contribute to an improvement in crisis response skills above and beyond that of didactic training alone.

The Effects of Situational Obstacles and Social Support on Suicide- Prevention Gatekeeper Behaviors

Although the effectiveness of suicide-prevention gatekeeper-training programs in improving knowledge, attitudes, and referral practices has been documented, their effects do not seem to be lasting. This study investigated situational obstacles at work that prevent suicide-prevention gatekeepers from engaging in suicide-prevention behavior and the role of social support in modifying the relationship between situational obstacles and suicide-prevention behaviors. 193 gatekeepers completed an online survey to rate the obstacles they had experienced at work since completing a gatekeeper-training program and the support received from coworkers, supervisors, and the organization. Participants also reported the frequency of suicide-prevention behaviors performed. The results indicated that both situational obstacles and social support predicted the number of suicide-prevention behaviors performed, as expected. There was also a trend that support from supervisors and the organization may alleviate the adverse effect of situational obstacles on suicide-prevention behavior. The cross-sectional nature of the study does not allow for directional, causal conclusions to be drawn. By understanding the roles of situational obstacles faced by trained gatekeepers at their work and the support they receive from supervisors and organizations, appropriate strategies can be identified and applied to facilitate gatekeeper performance.

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) was evaluated among school personnel using a nonequivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.

Does a Brief Suicide Prevention Gatekeeper Training Program Enhance Observed Skills?

Suicide is a significant public health problem worldwide that requires evidence-based prevention efforts. One approach to prevention is gatekeeper training. Gatekeeper training programs for community members have demonstrated positive changes in knowledge and attitudes about suicide. Changes in gatekeeper skills have not been well established. To assess and to predict the impact of a brief, gatekeeper training on community members' observed skills. Participants in a community gatekeeper training were employees at US universities. 50 participants were randomly selected for skills assessment and videotaped interacting with a standardized actor prior to and following training. Tapes were reliably rated for general and suicide-specific skills. Gatekeeper skills increased from pre- to posttest: 10% of participants met criteria for acceptable gatekeeper skills before training, while 54% met criteria after training. Pretraining variables did not predict increased skills. Results do not provide conclusions about the relationship between observed gatekeeper skills and actual use of those skills in the future. Gatekeeper training enhances suicide-specific skills for the majority of participants. Other strategies, such as behavioral rehearsal, may be necessary to enhance skills in the remaining participants.

Does a Gatekeeper Suicide Prevention Program Work in a School Setting? Evaluating Training Outcome and Moderators of Effectiveness

The current study sought to evaluate the suicide prevention gatekeeper training program QPR (Question, Persuade, and Refer) among school personnel using a non-equivalent control group design. Substantial gains were demonstrated from pre- to post-test for attitudes, knowledge, and beliefs regarding suicide and suicide prevention. Exploratory analyses revealed the possible moderating effects of age, professional role, prior training, and recent contact with suicidal youth on QPR participants' general knowledge, questioning, attitudes toward suicide and suicide prevention, QPR quiz scores, and self-efficacy. The need for replication using a more rigorous experimental design in the context of strong community collaboration is discussed.

The Short-Term Effectiveness of a Suicide Prevention Gatekeeper Training Program in a College Setting with Residence Life Advisers

Although the college years prove to be a vulnerable time for students and a critical period for suicide prevention, few school-based prevention strategies have been empirically evaluated. The current study examined the short-term effects of Question, Persuade, and Refer (QPR), a gatekeeper training program that teaches how to recognize warning signs, question suicidal intent, listen to problems, and refer for help. One hundred twenty-two residence advisers (RAs) who were trained in QPR demonstrated significant post-training gains across a variety of domains relevant to suicide and suicide prevention, with 60 who completed the follow-up assessment showing sustained knowledge and appraisals into the following semester. Although these gains were generally more substantial for RAs trained in QPR, 86 controls who completed both baseline and follow-up assessments also demonstrated changes in appraisals relevant to suicide and suicide prevention, despite having not received QPR training. Editors' Strategic Implications this study provides some promising evidence on gatekeeper training for RAs in terms of suicide prevention knowledge and attitudes. As the authors note, replication, rigorous evaluation, and studies of systemic efforts and behavioral outcomes are needed.

Evaluation of Gatekeeper Training for Suicide Prevention in Veterans

Clinical providers and “front line” nonclinical staff who work with veterans, families, and communities are natural gatekeepers to identify and to refer veterans at risk for suicide. A national cohort (n = 602) of community based counseling center staff from the U.S. Department of Veterans Affairs (VA) participated in an evaluation of a brief standardized gatekeeper training program and a scripted behavioral rehearsal practice session. A significant difference in knowledge and self efficacy was observed from pre to post (p < .0001) with the nonclinicians showing larger effect sizes for knowledge (0.96 vs. 0.42) and self efficacy (0.89 vs. 0.41). Gatekeeper training for suicide prevention shows promise for increasing the capacity of VA staff to work with at risk veterans.