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

  • Wendi F. Cross
  • David Seaburn
  • Danette Gibbs
  • Karen Schmeelk-Cone
  • Ann Marie White
  • Eric D. Caine
Original Paper


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.


Suicide prevention School-based gatekeeper training Behavioral rehearsal Observational methods Standardized patient 



We acknowledge the generous collaboration of the Spencerport School District administration. We thank Ms. Pamela Robinson for serving as a trainer and the staff and parents who participated in the study. We gratefully acknowledge Emma Forbes-Jones, Ph.D., and Erin Hunter, Ph.D., coders on the study, and Heather McGrane-Minton, B.S., who assisted with data entry. This project was supported by an NIMH K23 grant and ARRA supplemental funding (MH073615; MH073615-03S1; PI: Cross) as well as a P20 Developing Center for Public Health and Population-Based Approaches to Suicide Prevention (MH071897; PI: Caine). Dr. Forbes-Jones’s participation was supported by an NIMH Institutional T32 grant (MH018911; PI: Caine).


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Wendi F. Cross
    • 1
    • 2
  • David Seaburn
    • 3
  • Danette Gibbs
    • 1
  • Karen Schmeelk-Cone
    • 1
  • Ann Marie White
    • 4
  • Eric D. Caine
    • 1
    • 2
  1. 1.Department of Psychiatry, Box PsychUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Center for the Study and Prevention of SuicideUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Family Support Center, Spencerport Central School DistrictSpencerportUSA
  4. 4.Office of Mental Health PromotionUniversity of Rochester Medical CenterRochesterUSA

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