Gatekeeper Training Programs Research Articles

Audiologists’ Role in Managing Patient Suicide Risk

Audiologists’ Role in Managing Patient Suicide Risk

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.

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.

Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths.

Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse. To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously. We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011. Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.

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.

Sustaining the Effects of Gatekeeper Suicide Prevention Training.

Background: Gatekeeper training is a promising suicide prevention strategy that is growing in popularity. Although gatekeeper training programs have been found to improve trainee knowledge, self-efficacy, and perceived skills, researchers have found that the benefit of gatekeeper training may not last over time. Aims: The purpose of this study was to identify strategies for strengthening the long-term effects of suicide prevention gatekeeper training. Method: In-depth interviews and focus groups were conducted with gatekeepers (N = 44) and data were analyzed using a qualitative research approach. Results: The results of this study suggest that posttraining interventions may be more effective if they include the following seven themes: (a) social network - connecting with other gatekeepers; (b) continued learning - further education; (c) community outreach - building awareness; (d) accessibility - convenience; (e) reminders - ongoing communication; (f) program improvement -- enhancing previous training; and (g) certification - accreditation. Conclusion: Posttraining interventions that incorporate the themes from this study offer a promising direction in which to sustain the effects of gatekeeper suicide prevention 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.

An Evaluation of a Unique Gatekeeper Training for Suicide Prevention of College Students: Demonstrating Effective Partnering within Student Affairs

For college students, suicide is the second leading cause of death resulting in over 1,100 student deaths per year (Center for Disease Control, 2009). Researchers from the American College Health Association (2011), assessed over 105,000 students across the United States, and found that almost 10% of students seriously contemplated suicide and 1.5% had made a suicide attempt in the past year. In addition, Hirch and Barton (2011) surveyed 439 college students and found that 46% of students reported past suicidal ideation, 10% reported making a past suicide attempt, and 2% reported that they might attempt suicide in the future (Hirsch & Barton, 2011). Thus, the development of suicide prevention programs on college campuses is an important and urgent task. Researchers have indicated that there are numerous risk factors linked to college student suicidal behavior including previous suicide attempts, history of depression or other mental illness, alcohol or drug use, stress, low self-esteem, academic problems, relationship issues, and loneliness (Center for Disease Control, 2009). Some students enter college with pre-existing mental health conditions, while others may develop risk factors during their time in college. Garlow et al. (2008) found an association between suicidal ideation, a history of suicidal acts, and depressive symptoms in college students. Specifically, individuals with more severe symptoms of depression were more likely to experience suicidal ideation. An association was also found between suicidal ideation and other internal distress such as anxiety, irritability, and rage (Garlow et al., 2008). College is a major transitional period, which may increase the likelihood for depressive symptoms and exposure to drugs and alcohol which are two major risk factors for suicide (Westefeld et al., 2006). Gatekeeper Suicide Prevention The problem of college student suicide has drawn national attention and encourages college mental health professionals to focus on suicide prevention and intervention. One type of prevention effort for at-risk students is the gatekeeper training method. Gatekeepers have primary contact with people at risk for suicide and identify them by recognizing suicidal risk factors. In essence, gatekeepers open the gate to assistance for people at risk for suicide (Gould & Kramer, 2001). Gatekeeper training programs aim to enhance recognition and referral by training staff at colleges and universities to help identify students at risk and refer these students to appropriate supportive services or counseling. Research on gatekeeper training programs for college students is limited. Findings from a recent study on gatekeeper skills of community members after a brief suicide prevention training program, indicated that 10% of participants met criteria for acceptable gatekeeper skills prior to the training compared to 54% of participants after training (Cross, Matthieu, Lezine, & Knox, 2010). According to Aseltine and Demartino (2004), youth who are suicidal may turn to their peers first for help, therefore gatekeeper prevention programs that teach peers how to recognize warning signs of suicide, deal effectively with a student in distress, and make appropriate referrals are important. The benefit of peers helping peers has been supported by research on peer health education programs on college campuses. There is significant support in the literature for the positive effects of peer health educators on college students in regards to making healthy decisions about alcohol and drug use, sex, nutrition and exercise, and mental health issues (Sloane & Zimmer, 1993; White, Park, Israel, & Cordero, 2009). Peer health educators have credibility from students and are therefore more likely to facilitate attitude and behavior changes, as well as, be able to understand the experiences of their fellow classmates (Sloane & Zimmer, 1993). In a systematic review of gatekeeper training programs, Isaac et al. …

A Systematic Review of School-Based Interventions Aimed at Preventing, Treating, and Responding to Suicide- Related Behavior in Young People

Suicide, in particular among young people, is a major public health problem, although little is known regarding effective interventions for managing and preventing suicide-related behavior. To review the empirical literature pertaining to suicide postvention, prevention, and early intervention, specifically in school settings. MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials (CCRCT) as well as citation lists of relevant articles using terms related to suicide and schools were searched in July 2011. School-based programs targeting suicide, attempted suicide, suicidal ideation, and self-harm where intent is not specified were included. No exclusion was placed on trial design. All studies had to include a suicide-related outcome. A total of 412 potentially relevant studies were identified, 43 of which met the inclusion criteria, as well as three secondary publications: 15 universal awareness programs, 23 selective interventions, 3 targeted interventions, and 2 postvention trials. Overall, the evidence was limited and hampered by methodological concerns, particularly a lack of RCTs. The most promising interventions for schools appear to be gatekeeper training and screening programs. However, more research is needed.

News from the CDC: making evaluation findings actionable for suicide prevention practice

The economic and human cost of suicidal behavior to individuals, families, communities, and society makes suicide a serious public health concern. In the USA, it is estimated that deaths resulting from suicide create a financial burden of over 26 billion dollars a year in medical costs and work loss [1], and in 2009, nearly 14 % of high school students—or three students in a classroom of 20—reported seriously considering suicide in the past year [2, 3]. The Centers for Disease Control and Prevention's (CDC) Division of Violence Prevention (DVP) in the National Center for Injury Prevention and Control is committed to promoting a public health approach for addressing suicide proactively through suicide prevention (in particular, primary prevention, or preventing suicide before it ever occurs) and using a population approach to improve health on a large scale. These approaches augment efforts that treat suicide through clinical, individual-level, treatment-focused interventions. While research on effective suicide prevention strategies is still in development [4], a gap persists between emerging knowledge from preliminary studies and the application of these findings to improve suicide prevention practice [5]. Creation of actionable knowledge, based on knowledge exchange theory and the knowledge transfer literature [6–8], is one emerging process for translating research and evaluation findings into action to improve practice. Broadly defined, actionable knowledge is the creative intersection between what we know and putting what we know into everyday practice [9, 10]. It has roots in the business [11, 12] and knowledge transfer literatures [6–8] and provides a bridge between important research or evaluation findings and action in practice settings. This bridge has the potential to be a powerful tool for public health's work in improving suicide prevention practice, increasing program readiness for more rigorous evaluation and effectiveness research, and eventually ensuring widespread adoption of effective suicide prevention strategies to impact population health. The adapted framework DVP has begun to use for developing actionable knowledge (http://www.cdc.gov/ViolencePrevention/pdf/ASAP_Suicide_Issue1-a.pdf) comes from the knowledge transfer literature [6–8] and includes four key steps [6, 13]: (1) Determine the action (“What do we want our audience to do?”); (2) Specify your audience (“Who do we want to take action?”); (3) Determine the best method of packaging your message (“How should the message be delivered?”); and (4) Establish your desired impact and how you will measure whether your goals are achieved (“With what effect?”). From 2009 to 2011, DVP had an opportunity to use this framework through an interagency agreement with the Substance Abuse and Mental Health Services Administration. DVP provided technical assistance and support to three Garrett Lee Smith Memorial Act grantees for their youth suicide prevention efforts. In order to ensure that the findings and lessons learned from these program evaluations would be widely disseminated and integrated into suicide prevention practice, DVP used this framework and worked closely with the grantees to develop actionable knowledge products based on their findings. This had the additional benefit of helping build the capacity of suicide prevention researchers for translating their evaluation findings for suicide prevention practice. The three grantees created very different actionable knowledge products based on their unique findings and audiences. The Tennessee Lives Count initiative created the Gatekeeper Training Implementation Support System (www.gatekeeperaction.org), an online resource that provides tools to support effective implementation and evaluation of gatekeeper training programs. The Native American Rehabilitation Association's Life Is Sacred Native Youth Suicide Prevention Program developed several tools with information for service providers and families on factors that put youth at risk for and protect them from suicide (http://www.sprc.org/library_resources/items/Life-is-Sacred-Native-Youth-Suicide-Prevention-materials). The Maine Youth Suicide Prevention Program (MYSPP) developed the MYSPP Early Identification and Referral Data Toolkit (http://www.sprc.org/library_resources/items/youth-suicide-prevention-referral-and-tracking-toolkit), an online resource that provides guidance and actionable tools for collecting early identification and referral data on students at risk for suicidal behavior in schools. The knowledge–action gap is one of the most challenging barriers for public health practice, including suicide prevention [14]. The Tennessee Lives Count initiative, Life Is Sacred Native Youth Suicide Prevention Program, and Maine Youth Suicide Prevention Program used a four-step actionable knowledge framework, informed by the knowledge transfer literature, to create three very different actionable products. Each of these products is designed to make program evaluation findings accessible, useful, and relevant for application in the field. It is hoped that by facilitating a process for systematically translating research and program evaluation findings while taking into consideration the perspectives and needs of the audience, this emerging framework will provide an opportunity for narrowing the gap between knowledge and action, therefore improving public health practice. The conclusions in this report are those of the authors and do not necessarily represent the official position of CDC.

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 Practice Make Perfect? A Randomized Control Trial of Behavioral Rehearsal on Suicide Prevention Gatekeeper Skills

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are 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.

Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

Gatekeeper-training programs, designed to increase identification and referral of suicidal individuals, are widespread but largely untested. A group-based randomized trial with 32 schools examined impact of Question, Persuade, Refer (QPR) training on a stratified random sample of 249 staff with 1-year average follow-up. To test QPR impact, the authors introduced and contrasted 2 models of gatekeeper-training effects in a population: gatekeeper surveillance and gatekeeper communication. Intent-to-treat analyses showed that training increased self-reported knowledge (effect size [ES] = 0.41), appraisals of efficacy (ES = 1.22), and service access (ES = 1.07). Training effects varied dramatically. Appraisals increased most for staff with lowest baseline appraisals, and suicide identification behaviors increased most for staff already communicating with students about suicide and distress. Consistent with the communication model, increased knowledge and appraisals were not sufficient to increase suicide identification behaviors. Also consistent with the communication model were results from 2,059 8th and 10th graders surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress. Skill training for staff serving as "natural gatekeepers" plus interventions that modify students' help-seeking behaviors are recommended to supplement universal gatekeeper training.

Two-Year Follow-Up of a Community Gatekeeper Suicide Prevention Program in an Aboriginal Community

AbstractFew studies report long term follow-up of community gatekeeper training programs that aim to facilitate help-seeking for suicide and there are none in Aboriginal communities. This study aimed to determine long term effects of the Shoalhaven Aboriginal Suicide Prevention Program (SASPP), which used community gatekeeper training as its primary strategy. Following consultation with the Aboriginal community, a brief questionnaire and semi-structured interview was completed by 40 participants who attended a community gatekeeper workshop 2 years earlier. Fifteen of the 40 participants stated that they had helped someone at risk of suicide over the 2-year follow-up period. Intentions to help and confidence to identify someone at risk of suicide remained high. A significant relationship was found between intentions to help prior to the workshop and whether participants had actually helped someone at risk of suicide. Correlations suggested a link between intentions to help, and subsequent help provision. However, it is unclear whether workshop attendance contributed to this effect. Future prevention programs need to be customised to specific Aboriginal communities to reduce barriers to helpseeking behaviour.