Is Gatekeeper Training Enough for Suicide Prevention?
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Abstract
While schools have the capacity to reach youth at-risk for suicide, there remains a gap between the number of youth with mental health issues and those who receive services. Accordingly, gatekeeper training programs, which teach community members signs of psychological distress and strategies to refer youth to mental health support, are often one component of suicide prevention. Nevertheless, there is a dearth of research about the efficacy of online gatekeeper training, which may provide the flexibility and accessibility needed for overburdened schools. This study sought to investigate whether Kognito, an online and easily accessible gatekeeper training, was related to changes in teachers’ suicide prevention beliefs, behavioral intentions, and behaviors (proportion of students approached and referred over time). Teachers significantly increased their beliefs (i.e., preparedness and self-efficacy) and behavioral intention (i.e., likelihood) to intervene with at-risk students. However, teachers did not change suicide intervention behaviors. Natural gatekeeper status (i.e., teachers approaching students at baseline) impacted number of referrals over time (in the opposite direction we predicted); however, natural gatekeeper status did not have an impact on proportion of students approached. Self-efficacy change, however, preceded change in proportion of students approached, but not referred. The findings, taken as a whole, indicate gatekeeper training alone appears insufficient to change suicide prevention behaviors, and accordingly, suicide prevention needs to employ a comprehensive approach.
Keywords
Gatekeeper training Suicide prevention Teachers SchoolsNotes
Acknowledgements
This paper was developed, in part, under grant number 1U79SM061751-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Maryland Baltimore institutional committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
References
- Albright, G. (2009). Kognito: At Risk for Elementary School, Middle School, and High School Educators. Retrieved, November 2016 from: https://Kognito.com/products/?topics=Suicide%20Prevention.
- Albright, G., Adam, C., Goldman, R., & Serri, D. (2013). A game-based simulation utilizing virtual humans to train physicians to screen and manage the care of patients with mental health disorders. Games For Health, 2(5), 269–273. https://doi.org/10.1089/g4h.2013.0064.CrossRefGoogle Scholar
- Albright, G. L., Davidson, J., Goldman, R., Shockley, K. M., & Timmons-Mitchell, J. (2016). Development and validation of the gatekeeper behavior scale: A tool to assess gatekeeper training for suicide prevention. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 37(4), 271–280. https://doi.org/10.1027/0227-5910/a000382.CrossRefGoogle Scholar
- Albright, G., Goldman, R., Shockley, K. M., McDevitt, F., & Akabas, S. (2012). Using an avatar-based simulation to train families to motivate veterans with post-deployment stress to seek help at the VA. Games For Health, 1(1), 21–28. https://doi.org/10.1089/g4h.2011.0003.CrossRefGoogle Scholar
- American Foundation for Suicide Prevention. (2018). State laws: Suicide prevention in schools. Retrieved from, 10 January 2019: http://afspq.org/wp-content/uploads/sites/4/2018/09/AFSP_K-12-Schools-Issue-Brief-8-30-18.pdf.
- Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 1–191.CrossRefGoogle Scholar
- Bartgis, J., & Albright, G. (2016). Online role-play simulations with emotionally responsive avatars for the early detection of Native youth psychological distress, including depression and suicidal ideation. American Indian and Alaska Native Mental Health Research, 23(2), 1–27. https://doi.org/10.5820/aian.2302.2016.1.CrossRefPubMedGoogle Scholar
- Brent, D. A., & Brown, C. H. (2015). Effectiveness of school-based suicide prevention programmes. The Lancet, 385(9977), 1489–1491.CrossRefGoogle Scholar
- Brown, C. H., Wyman, P. A., Brinales, J. M., & Gibbons, R. D. (2007). The role of randomized trials in testing interventions for the prevention of youth suicide. International Review of Psychiatry, 19(6), 1–15.CrossRefGoogle Scholar
- Burnette, C., Ramchand, R., & Ayer, L. (2015). Gatekeeper training for suicide prevention: A theoretical model and review of the empirical literature. Rand Health Quarterly, 5(1), 1–38.Google Scholar
- Centers for Disease Control and Prevention. (2017). Disparities in select youth risk behaviors, 2017 (online). Retrieved from, 1 April 2018: https://www.cdc.gov/nchhstp/newsroom/docs/2018/Trends-Table-YRBS_508.pdf.
- Centers for Disease Control and Prevention, National Vital Statistics System. (2016). 10 Leading causes of death by age group, United States 2016 (online). Retrieved from, 15 June 2017: https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2016_1056w814h.gif.
- Condron, S., Garraza, L., Kuiper, N., Sukumar, B., Walrath, C., & McKeon, R. (2019). Comparing the effectiveness of brief versus in-depth gatekeeper training on behavioral outcomes for trainees. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 40(2), 115–124. https://doi.org/10.1027/0227-5910/a000539 CrossRefGoogle Scholar
- Cross, W., Matthieu, M. M., Lezine, D., & Knox, K. L. (2010). Does a brief suicide prevention gatekeeper training program enhance observed skills? Crisis: The Journal of Crisis Intervention and Suicide Prevention, 31(3), 149.CrossRefGoogle Scholar
- Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K., White, A. M., & Caine, E. D. (2011). Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. The Journal of Primary Prevention, 32(3–4), 195–211. https://doi.org/10.1007/s10935-011-0250-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Ewell-Foster, C. J., Burnside, A. N., Smith, P. K., Kramer, A. C., Wills, A., & King, C. (2016). Identification, response, and referral of suicidal youth following applied suicide intervention skills training. Suicide And Life-Threatening Behavior. https://doi.org/10.1111/sltb.12272.CrossRefPubMedGoogle Scholar
- Farmer, E., Burns, B., Philips, S., Angold, A., & Costello, E. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66.CrossRefGoogle Scholar
- Forman, S. G., Shapiro, E. S., Codding, R. S., Gonzales, J. E., Reddy, L. A., Rosenfield, S. A., et al. (2013). Implementation science and school psychology. School Psychology Quarterly, 28(2), 77–100. https://doi.org/10.1037/spq0000019.CrossRefPubMedGoogle Scholar
- Garraza, L. G., Kuiper, N., Goldston, D., McKeon, R., & Walrath, C. (in press). Long-term impact of the Garrett Lee Smith Youth Suicide Prevention Program on youth suicide mortality, 2006–2015. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13058.CrossRefGoogle Scholar
- Goldston, D., Walrath, C., McKeon, R., Puddy, R., Lubell, K., Potter, L., et al. (2011). The Garrett Lee Smith Memorial Suicide Prevention Program. Suicide and Life Threatening Behavior, 40(3), 245–256. https://doi.org/10.1521/suli.2010.40.3.245.CrossRefGoogle Scholar
- Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386–405. https://doi.org/10.1097/01.CHI.0000046821.95464.CF.CrossRefPubMedGoogle Scholar
- Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide Life Threatening Behavior, 31(suppl), 6–31.CrossRefGoogle Scholar
- Hatton, V., Heath, M. A., Gibb, G. S., Coyne, S., Hudnall, G., & Bledsoe, C. (2017). Secondary teachers’ perceptions of their role in suicide prevention and intervention. School mental health, 9(1), 97–116.CrossRefGoogle Scholar
- Hayden, J. (2009). Introduction to health behavior theory. Sudbury, MA: Jones and Bartlett.Google Scholar
- Hayes, A. F. (2006). A Primer on Multilevel Modeling. Human Communication Research, 32(4), 385–410. https://doi.org/10.1111/j.1468-2958.2006.00281.x.CrossRefGoogle Scholar
- Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466.CrossRefGoogle Scholar
- Isaac, M., Elias, B., Katz, L. Y., Belik, S., Deane, F. P., Enns, M. W., et al. (2009). Gatekeeper training as a preventative intervention for suicide: A systematic review. The Canadian Journal Of Psychiatry / La Revue Canadienne De Psychiatrie, 54(4), 260–268.CrossRefGoogle Scholar
- Kalafat, J. (2001). A systems approach to youth suicide prevention. Paper presented at the Institute of Medicine, The National Academies Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide Workshop on Suicide Prevention, Washington, DC.Google Scholar
- Kalafat, J. (2003). School approaches to youth suicide prevention. American Behavioral Scientist, 46(9), 1211–1223.CrossRefGoogle Scholar
- Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.CrossRefGoogle Scholar
- Katz, C., Bolton, S., Katz, L. Y., Isaak, C., Tilston, J. T., & Sareen, J. (2013). A systematic review of school-based suicide prevention programs. Depression and Anxiety, 30(10), 1030–1045.PubMedGoogle Scholar
- King, K. A. (2001). Developing a comprehensive school suicide prevention program. Journal of School Health, 71(4), 132–137.CrossRefGoogle Scholar
- Lamis, D. A., Underwood, M., & D’Amore, N. (2017). Outcomes of a suicide prevention gatekeeper training program among school personnel. The Journal Of Crisis Intervention And Suicide Prevention, 38(2), 89–99. https://doi.org/10.1027/0227-5910/a000414.CrossRefGoogle Scholar
- Madden, T. J., Ellen, P. S., & Ajzen, I. (1992). A comparison of the theory of planned behavior and the theory of reasoned action. Personality and Social Psychology Bulletin, 18(1), 3–9. https://doi.org/10.1177/0146167292181001.CrossRefGoogle Scholar
- Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., et al. (2005). Suicide prevention strategies: A systematic review. JAMA, 294(16), 2064–2074.CrossRefGoogle Scholar
- Marraccini, M. E., & Brier, Z. F. (2017). School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis. School Psychology Quarterly, 32(1), 5–21. https://doi.org/10.1037/spq0000192.CrossRefPubMedPubMedCentralGoogle Scholar
- Maryland Primary and Secondary Education – Certificated School Personnel Training Act of 2016, HB0920.Google Scholar
- Mills, C., Stephan, S. H., Moore, E., Weist, M. D., Daly, B. P., & Edwards, M. (2006). The President’s New Freedom Commission: Capitalizing on opportunities to advance school-based mental health services. Clinical Child and Family Psychology Review, 9(3–4), 149.CrossRefGoogle Scholar
- Mo, P., Ko, T., & Xin, M. (2018). School-based gatekeeper training programmes in enhancing gatekeepers’ cognitions and behaviors for adolescent suicide prevention: A systematic review. Child and Adolescent Psychiatry and Mental Health, 12(29), 1–24. https://doi.org/10.1186/s13034-018-0233-4.CrossRefGoogle Scholar
- Nadeem, E., Kataoka, S. H., Chang, V. Y., Vona, P., Wong, M., & Stein, B. D. (2011). The role of teachers in school-based suicide prevention: A qualitative study of school staff perspectives. School mental health, 3(4), 209–221.CrossRefGoogle Scholar
- Osteen, P., Frey, J. M., Woods, M. N., Ko, J., & Shipe, S. (2017). Modeling the longitudinal direct and indirect effects of attitudes, self-efficacy, and behavioral intentions on practice behavior outcomes of suicide intervention training. Suicide and Life-Threatening Behavior, 47(4), 410–420.CrossRefGoogle Scholar
- Pistone, I., Beckman, U., Eriksson, E., Lagerlof, H., Sager, M. (in press). The effects of educational interventions on suicide: A systematic review and meta-analysis. International Journal of Social Psychiatry. https://doi.org/10.1177/0020764019852655.CrossRefGoogle Scholar
- Rallis, B. A., Esposito, S. C., Disabato, D. J., Mehlenbeck, R. S., Kaplan, S., Geer, L., et al. (2018). A brief peer gatekeeper suicide prevention training: Results of an open pilot trial. Journal of Clinical Psychology, 74(7), 1106–1116. https://doi.org/10.1002/jclp.22590.CrossRefPubMedGoogle Scholar
- Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children’s mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1–13. https://doi.org/10.1037/a0022714.CrossRefGoogle Scholar
- Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., et al. (2013). A systematic review of school-based interventions aimed at preventing, treating, and responding to suicide-related behavior in young people. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 34(3), 164–182. https://doi.org/10.1027/0227-5910/a000168.CrossRefGoogle Scholar
- Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3(4), 223–241.CrossRefGoogle Scholar
- Slade, E. P. (2002). Effects of school-based mental health programs on mental health service use by adolescents at school and in the community. Mental health services research, 4(3), 151–166.CrossRefGoogle Scholar
- Smith, A. R., Silva, C., Covington, D. W., & Joiner, T. J. (2014). An assessment of suicide-related knowledge and skills among health professionals. Health Psychology, 33(2), 110–119. https://doi.org/10.1037/a0031062.CrossRefPubMedGoogle Scholar
- Stephan, S., Brandt, N., Lever, N., Acosta-Price, O., & Connors, E. (2012). Key priorities, challenges, and opportunities to advance an integrated mental health and education research agenda. Advances in School Mental Health Promotion, 5(2), 125–138.CrossRefGoogle Scholar
- Terpstra, S., Beekman, A., Abbing, J., Jaken, S., Steendam, M., & Gilissen, R. (2018). Suicide prevention gatekeeper training in the Netherlands improves gatekeepers’ knowledge of suicide prevention and their confidence to discuss suicidality, an observational study. BMC Public Health, 18(1), 637.CrossRefGoogle Scholar
- Tompkins, T. L., Witt, J., & Abraibesh, N. (2010). Does a gatekeeper suicide prevention program work in a school setting? Evaluating training outcome and moderators of effectiveness. Suicide and life-threatening behavior, 40(5), 506–515.CrossRefGoogle Scholar
- U.S. Department of Health and Human Services (HHS) Office of the Surgeon General and National Action Alliance for Suicide Prevention. (2012). 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action. HHS (pp. 1–184).Google Scholar
- Walrath, C., Garraza, L. G., Reid, H., Goldston, D. B., & McKeon, R. (2015). Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality. American Journal of Public Health, 105(5), 986–993. https://doi.org/10.2105/AJPH.2014.302496.CrossRefPubMedPubMedCentralGoogle Scholar
- Wilcox, H. C., Kellam, S. G., Brown, C. H., Poduska, J. M., Ialongo, N. S., Wang, W., et al. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug and Alcohol Dependence, 95(Suppl1), S50–S73. https://doi.org/10.1016/i.drugalcdep.2008.01.005.CrossRefGoogle Scholar
- Wilcox, H. C., & Wyman, P. A. (2016). Suicide prevention strategies for improving population health. Child And Adolescent Psychiatric Clinics Of North America, 25(2), 219–233. https://doi.org/10.1016/j.chc.2015.12.003.CrossRefPubMedGoogle Scholar
- Wyman, P. A. (2014). Developmental approach to prevent adolescent suicides: Research pathways to effective upstream preventive interventions. American Journal of Preventive Medicine, 47(3), S251–S256.CrossRefGoogle Scholar
- Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., et al. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104–115. https://doi.org/10.1037/0022-006X.76.1.104.CrossRefPubMedPubMedCentralGoogle Scholar
- Yonemoto, N., Kawashima, Y., Endo, K., Yamada, M. (in press). Gatekeeper training for suicidal behaviors: A systematic review. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2018.12.052.CrossRefGoogle Scholar