the role of minimum competencies for suicide prevention
TRANSCRIPT
The role of minimum competencies for suicide prevention gatekeeper programs: Challenges for researchers and program developers
Jacinta [email protected]
Australian Institute for Suicide Research and Prevention WHO Collaborating Centre for Research and Training in Suicide PreventionLife Promotion ClinicSchool of Applied Psychology, Griffith University
UK 2021 Suicide Summit, 12th Sept,
2021
We acknowledge the people who are the traditional custodians of the land, and pay respect to the Elders, past present and emerging, and extend that respect to all Aboriginal and
Torres Strait Islander peoples.
South Bank, Nathan and Mount Gravatt • Land of the Yugarabul, Yuggera, Jagera and
Turrbal peoples
Logan• Land of the Yuggera, Turrbal, Yugarabul, Jagera
and Yugambeh peoples.
Gold Coast • Land of the Yugambeh/Kombumerri peoples.
Source: https://www.griffith.edu.au/about-griffith/first-peoples
Acknowledgement of lived experience
We acknowledge all those with a lived experience of suicide defined as:
“…..having experienced suicidal thoughts, survived a suicide attempt, cared for someone through suicidal crisis, or been bereaved by suicide”
(Roses in the Ocean, 2018).
Overview
Suicide preventionBackground
Need for common competencies: Content, delivery, existing standards
Existing gatekeeper guidelines
Proposed minimum competencies
Summary
Questions
Aim, gatekeeper role, characteristics and
training evaluations
Gatekeeper Training
BackgroundPreventing suicide: where does GKT fit?
A key means of preventing suicide is early identification, assessment and management of suicidality to inform appropriate interventions
WHO’s LIVE LIFE approach recommends four key interventions which have proven to be effective:
1. limit access to the means of suicide2. interact with the media for responsible reporting of
suicide.3. foster socio-emotional life skills in adolescents4. early identify, assess, manage and follow up anyone who
is affected by suicidal behaviours
Health, well-being, and quality of life intervention spectrum (Adapted from Mrazek and Haggerty (1994, p. 23) to incorporate Barry's (2001, p. 32) and Rickwood's (2006, p. 7) modifications).
Frameworks for prevention
Gatekeeper training
(Adapted from Mrazek & Haggerty, 1994, p. 23)
Where does gatekeeper training sit against other initiatives?
Universal(Whole
population)
Selective(Subgroups, vulnerable)
Indicated(Those exhibiting
suicidality)
Emergency care, primary, psycho-social interventions, follow-up, safe-spaces, screening and treatment services, hospital-based etc
Mentor programs, training programs including GKT, Crisis help lines, digital help/support, peer support/safe space programs
Community and workplace based prevention, school-based wellbeing, resilience building, stigma
reduction, media guidelines, and mass media campaigns, access to means prevention
The Iceberg Phenomenon
Suicide
Deliberate self harmMedical treated/seeking help
Vaguely seen - hidden experiences of deliberate self harm and emotional/mental distress
(ideation, planning and some behaviour)
Gatekeeper training “Gatekeepers”
Identify, connect, and refer vulnerable
(selected groups)
Aim of gatekeeper training
To educate volunteers or
designated individuals in
the community to be
able to identify people
who may be at-risk of
suicide, and to refer
that person to
appropriate help.
Compassion
Skills
Attitudes
Knowledge
EnhanceCompetency
Effective
intervention
behaviour (connecting
with person
and help)
Assumptions of the effects of training on intervention behaviour
(Burnette et al., 2015; Based on Bandura’s social and cognitive learning theory)
Motivational theories – frameworks to understand goal driven behaviour; behavioural intent.
Reasoned action theory
Banduras’ Self efficacy
Pre-existing knowledgeExperience
(skills, exposure to contacts)
Theory of planned behaviour
What is a gatekeeper?
Informally designated
Family
Local petrol station
Public member
Coach
Neighbours
Friends
Formally designated
Teacher
Doctor receptionist
/admin
Office / admin
Police/
emergency officers
Clergy minister
Employer
How effective is Gatekeeper training?
Literature from 1806 to 2009
Isaac et al (2009) review of 13 papers
Literature from 2009 to 2019
Holmes et al (2010) –24 papers LT F’up;
Yonemoto et al (2019) –10RCTs + 6 Intervention
Synthesis of key results
Strongest evidence Impacts on knowledge & self
efficacy
Equivocal evidenceImpacts on attitudes, beliefs
Least evidenceImpacts on Intent,
behaviour/skills and translation
Future attention to o Behaviour/Skills measurement;o Training delivery factors; o Moderating role of individual
differenceso Competency research and
evaluation design
Gatekeeper training competencies
Heterogeneity has been identified as greatest limitation
of studies, which makes direct comparisons challenging about the effectiveness of gatekeeper
training.
Differing content and delivery mechanisms and learning outcome constructs
Learning outcomes assessed with no consistency across studies!
Huge variation in constructs of measured outcomes
Conceptual meaning – sometimes different concepts used interchangeably
Constructs are non-standardised - Knowledge, self-efficacy, attitudes and beliefs, and behavioural skills
What did we do?
1. We examined existing
training competencies –
for clinicians, vocational
education and any
existing guidelines in
training.
2. We examined measures
of outcomes
What did we propose?
We proposed a starting point
for potential competencies
that may be examined for
further research and
evaluation of programs.
What did we find?
Findings?1. Existing competencies and guidelines:
Minimum characteristics or competencies of effective gatekeepers
(Cigularov, Chen, Moore, Quinnett, Ramsay, Martinez,
Hindman & Breitzman, 2009)
Suicide Prevention and the Clinical Workforce: Guidelines for Training (structure/delivery section)
(National Action Alliance for Suicide Prevention: Clinical Workforce Preparedness Task Force, 2014).
AISRAP’s existing gatekeeper training benchmarks (formal/informal GKs)
(Hawgood, Ide, Irving & De Leo, 2006)
Essential *KSAO’s of gatekeepers Characteristics that differentiate average vs
superior level gatekeeper
a) Knowledge of warning signs/signals of
suicidal behaviour,
b) Knowledge of resources for help and
referral
Knowledge of warning signs/signals of
suicidal behaviour
Knowledge of resources for help and
referral
c) Good active listening skills,
d) Ability to keep confidentiality
Good active listening skills
Ability to remain calm under pressure
e) Showing concern about others,
f) Trustworthiness
Being genuine, sincere, and
compassionate
2. Measures in the literature: Key GKT outcomes / competencies
• Arensman et al., 2016; Aseltine & De Martino, 2004; Nasir et al., 2016; Bean & Baber, 2011; Indelicato, Mirsu- Paunand Griffin, 2011; Rallis et al., 2018
• Indelicato, Mirsu- Paun and Griffin, 2011; Rallis et al., 2018; Arensman et al., 2016; Cross et al., 2010; Chauliac et al., 2016; Clark et al., 2010
• Chagnon, et al., 2007; Mitchell et al., 2013; Coppens et al., 2014; Indelicato et al., 2011; Jacobson et al., 2012
• Bean and Baber, 2011; Tompkins and Witt, 2009; Wyman et al., 2008
✓Assesses the impact of training on both GK behavior and the person at risk.
✓Measures preparedness to act, likelihood to act, self-efficacy, and sense of control
Gatekeeper Behavior Scale (GBS)
(Albright et al., 2016)
✓Explores a different aspect of GK behavior – an individual’s willingness to intervene
✓Provides a reliable and valid measure of an important aspect of suicide prevention behavior.
Willingness to Intervene against Suicide (WIS)
questionnaire
(Aldrich et al., 2014)
Both scales contribute greatly to the ability to
measure important competency outcomes for evaluations for GKT.
Underpinned by theoretical models of:• behaviour
motivation, • social cognitive
theory, • theory of planned
behaviour.
*Knowledge
Skills and
abilities
Self-efficacy
Attitudes
Behavioural intention; willingness to intervene
Our proposed competencies!
• Knowledge of suicide facts and trends, appropriate/safe language, stigma, and diversity
• Awareness of suicide prevention approaches
• Understanding of the complexity of suicidal behaviour
• Understanding of risk and protective factors
• Knowledge of warning signs and their importance for response and intervention
• Knowledge of local referral resources
• Knowledge of the critical role of lived experience in suicide prevention
Knowledge
Knowledge
• Ability to recognize suicidality (including warning signs)
• Being able to engage and connect with the suicidal person
• Identifying appropriate response(s) to a person in crisis
• Strong interpersonal skills
• Being able to collaboratively make appropriate referrals
• Ability to identify and access resources for help and referral
• Ability to maintain confidentiality
Skills and abilities
Skills and abilities
• Positive attitudes about the efficacy of suicide (intervening will positively affect the individual) and suicide prevention
• Positive attitudes toward self-preparedness and likelihood to intervene
• Intent to collaboratively intervene
• Belief in control over intervention behavior
Attitudes
Attitudes
• Confidence in intervention behavior
• Ability to identify factors contributing to interventionist negative emotions and well-being
• Development of aptitude for personal development and insight
• Understanding of the importance of personal management and self-care when working with people with suicidal ideation
Self-efficacy
Self efficacy
Some challenges GKT program design and evaluation
Attrition and follow-up – Diverse groups vs Homogenous & Sustainability of workforce
Which GKT program to use? Learning objectives and outcomes.
Standardised measures – Which ones are best for which program? What about qualitative measures?
Funding for evaluations – Rigorous methods with long term f’up cost $$
Summary GK competency standards are important for design, delivery, and evaluation of suicide prevention training outcomes.
The extent to which training impacts can be
compared between programs is currently
limited.
Our proposed set of competencies might serve as a framework for GKT development and evaluation….a starting point for potential
competencies that may be examined for further research.
.
