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.
KeywordsSuicide 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).
- Blatt, B., Plack, M., Maring, J., Mintz, M., & Simmens, S. J. (2007). Acting on reflection: The effect of reflection on students’ clinical performance on a standardized patient examination. Journal of General Internal Medicine, 22(1), 49–54. doi: 10.1007/s11606-007-0110-y.PubMedCrossRefGoogle Scholar
- Center for Mental Health in Schools at UCLA. (2007). School interventions to prevent youth suicide (Rev. ed.). Los Angeles, CA: Author.Google Scholar
- Centers for Disease Control and Prevention. (1992). Youth suicide-prevention programs: A resource guide. Atlanta, GA: National Center for Injury Prevention and Control.Google Scholar
- Centers for Disease Control and Prevention. (1994). Programs for the prevention of suicide among adolescents and young adults. Morbidity and Mortality Weekly Report, 43(No. RR-6), 1–7.Google Scholar
- Centers for Disease Control and Prevention. (2005). Youth risk behavior surveillance system (YRBSS). Retrieved November 3, 2006, from http://www.cdc.gov/HealthyYouth/yrbs/index.htm.
- Centers for Disease Control and Prevention. (2007). WISQARS leading causes of death reports, 2007. Retrieved March 18, 2011, from http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html.
- Eggert, L. L., Randell, B. R., Thompson, E. A., & Johnson, C. L. (1997). Washington State youth suicide prevention program: Report of activities. Seattle, WA: University of Washington.Google Scholar
- Gould, M. S., & Kramer, R. A. (2001). Youth suicide prevention. Suicide and Life-Threatening Behavior, 31(Suppl.), 6–31. doi: 10.1521/suli.184.108.40.206.24219.
- Hanauer, D. A., Wentzell, K., Laffel, N., & Laffel, L. M. (2009). Computerized automated reminder diabetes system (CARDS): E-mail and SMS cell phone text messaging reminders to support diabetes management. Diabetes Technology & Therapeutics, 11(2), 99–106. doi: 10.1089/dia.2008.0022.CrossRefGoogle Scholar
- Isaac, M., Elias, B., Katz, L. Y., Belik, S., Deane, F. P., Enns, M. W., & Sareen, J. (2009). Gatekeeper training as a preventative intervention for suicide: A systematic review. The Canadian Journal of Psychiatry, 54(4), 260–268. Retrieved from http://publications.cpa-apc.org/browse/sections/0.Google Scholar
- Kataoka, S., Stein, B. D., Nadeem, E., & Wong, M. (2007). Who gets care? Mental health service use following a school-based suicide prevention program. Journal of the American Academy of Child and Adolescent Psychiatry, 46(10), 1341–1348. doi: 10.1097/chi.0b013e31813761fd.PubMedCrossRefGoogle Scholar
- Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2005). The adult learner: The definitive classic in adult education and human resource development (6th ed.). Burlington, MA: Elsevier.Google Scholar
- Koller, J., Osterlind, S., Paris, K., & Weston, K. (2004). Differences between novice and expert teachers’ undergraduate preparation and ratings of importance in the area of children’s mental health. International Journal of Mental Health Promotion, 6(2), 40–46. Retrieved from http://www.ijmhp.co.uk/.Google Scholar
- LoMurry, M. (2005). Sources of strength facilitators guide: Suicide prevention peer gatekeeper training. Bismarck, ND: The North Dakota Suicide Prevention Project.Google Scholar
- Quinnett, P. (1995). QPR: Certified QPR gatekeeper instructors training manual. Spokane, WA: The QPR Institute.Google Scholar
- SPSS. (2007). SPSS, Version 16.0 [Computer software]. Chicago, IL: SPSS Inc.Google Scholar
- Tierney, R. J. (1994). Suicide intervention training evaluation: A preliminary report. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 15(2), 69–76.Google Scholar
- Turley, B., & Tanney, B. (1998). LivingWorks Australian field trial evaluation report on Suicide Intervention Field Trial Australia (SIFTA). Melbourne, Australia: LifeLine Australia.Google Scholar
- U.S. Public Health Service. (1999). The Surgeon General’s call to action to prevent suicide. Washington, DC: Author.Google 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. doi: 10.1037/0022-006X.76.1.104.PubMedCrossRefGoogle Scholar
- Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., et al. (2010). An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100(9), 1653–1661. doi: 10.2105/AJPH.2009.190025.PubMedCrossRefGoogle Scholar