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Gatekeeper Training to Prevent Suicide in the Emergency Department and in Primary Care

  • Glenn Albright
  • Jane Timmons-Mitchell
  • Jeremiah McMillan
Chapter

Abstract

Applied to suicide prevention, a gatekeeper is an individual who can recognize when a person is manifesting signs of psychological distress including depression and suicidal ideation, approach and talk with that person about concerns, and if necessary, make an effective referral to mental health support services. This chapter introduces the reader to new and innovative game-based simulation technology through which primary care professionals and emergency department personnel learn to effectively manage what can be difficult gatekeeper conversations with their patients. The simulations place users in an online environment where they practice role-plays with emotionally responsive virtual patients who have memory and personality and will react like real patients at risk for suicide. It is by practicing these role-plays, and receiving feedback from a virtual coach, that users gain the knowledge, skill, and self-efficacy to successfully apply evidence-based communication strategies such as motivational interviewing to become effective gatekeepers. The chapter overviews the advantages of utilizing virtual humans in role-plays, the learning model embedded into the Kognito conversation platform that drives the simulations, and the results of two outcome studies that examine efficacy.

Keywords

Gatekeeper training Role Play Virtual humans Simulation Technology Suicide 

References

  1. 1.
    Centers for Disease Control and Prevention. Web-based Self Injury Statistics Query and Reporting System https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_06.pdf/.
  2. 2.
    Chagnon F, Houle J, Marcoux I, Renaud J. Control-group study of an intervention training program for youth suicide prevention. Suicide Life Threat Behav. 2007;37(2):135–44.  https://doi.org/10.1521/suli.2007.37.2.135.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    US Surgeon General, National Action Alliance for Suicide Prevention. National strategy for suicide prevention: goals and objectives for action, 212. Washington, DC: HHS; 2012. http://www.surgeongeneral.gov/library/reports/national-strategy-suicide-prevention/index.html.
  4. 4.
    Wyman PA, Brown CH, Inman J, Cross W, Schmeelk-Cone K, Guo J, et al. Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff. J Consult Clin Psychol. 2008 Feb;76(1):104.  https://doi.org/10.1037/0022- 006X.76.1.104.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Suicide Prevention Resource Center. Best practices registry section III adherence to standard QPR (Question Persuade Refer). Waltham, MA: Suicide Prevention Resource Center; 2013.Google Scholar
  6. 6.
    Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA. 2005;294(16):2064–74.  https://doi.org/10.1001/jama.294.16.2064.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lewin K. Forces behind food habits and methods of change. Bull Natl Res Council. 1943;108(1043):35–65.Google Scholar
  8. 8.
    Shoemaker PJ, Riccio JR. Gatekeepeing. New York: John Wiley & Sons; 1991.  https://doi.org/10.1002/9781118541555.wbiepc202.CrossRefGoogle Scholar
  9. 9.
    United Nations Department for Policy Coordination and Sustainable Development. Prevention of suicide: guidelines for the formulation and implementation of national strategies. New York: United Nations; 1996.Google Scholar
  10. 10.
    Cross WF, Seaburn D, Gibbs D, Schmeelk-Cone K, White AM, Caine ED. Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills. J Prim Prev. 2011;32(3–4):195.  https://doi.org/10.1007/s10935011- 0250-z.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Aseltine RH Jr, DeMartino R. An outcome evaluation of the SOS suicide prevention program. Am J Public Health. 2004;94(3):446–51.  https://doi.org/10.2105/AJPH.94.3.446.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cross W, Matthieu MM, Lezine D, Knox KL. Does a brief suicide prevention gatekeeper training program enhance observed skills? Crisis. 2010;31:149–59.  https://doi.org/10.1027/0227-5910/a000014.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Isaac M, Elias B, Katz LY, Belik SL, Deane FP, Enns MW, et al. Gatekeeper training as a preventative intervention for suicide: a systematic review. Can J Psychiatr. 2009;54(4):260–8.CrossRefGoogle Scholar
  14. 14.
    Kalafat J, Gagliano C. The use of simulations to assess the impact of an adolescent suicide response curriculum. Suicide Life Threat Behav. 1996;26(4):359–64.  https://doi.org/10.1111/j.1943- 278X.CrossRefPubMedGoogle Scholar
  15. 15.
    Schurtz DR, Cerel J, Rodgers P. Myths and facts about suicide from individuals involved in suicide prevention. Suicide Life Threat Behav. 2010;40(4):346–52.  https://doi.org/10.1521/suli.2010.40.4.346.CrossRefPubMedGoogle Scholar
  16. 16.
    Nestel D, Tierney T. Role-play for medical students learning about communication: guidelines for maximising benefits. BMC Med Educ. 2007;7(1):3.  https://doi.org/10.1186/1472-6920-7-3.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Stevenson K, Sander P. Medical students are from Mars-business and psychology students are from Venus-university teachers are from Pluto? Med Teach. 2002;24(1):27–31.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Baumeister RF, Twenge JM, Nuss CK. Effects of social exclusion on cognitive processes: anticipated aloneness reduces intelligent thought. J Pers Soc Psychol. 2002;83(4):817–27.  https://doi.org/10.1037/0022-3514.83.4.817.CrossRefPubMedGoogle Scholar
  19. 19.
    Bolte A, Goschke T, Kuhl J. Emotion and intuition effects of positive and negative mood on implicit judgments of semantic coherence. Psychol Sci. 2003;14(5):416–21.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kuhlmann S, Piel M, Wolf OT. Impaired memory retrieval after psychosocial stress in healthy young men. J Neurosci. 2005;25(11):2977–82.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lupien SJ, Gaudreau S, Tchiteya BM, Maheu F, Sharma S, Nair NP, et al. Stress-induced declarative memory impairment in healthy elderly subjects: relationship to cortisol reactivity 1. J Clin Endocrinol Metab. 1997;82(7):2070–5.PubMedGoogle Scholar
  22. 22.
    Payne J, Jackson E, Ryan L, Hoscheidt S, Jacobs J, Nadel L. The impact of stress on neutral and emotional aspects of episodic memory. Memory. 2006;14(1):1–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Payne JD, Jackson ED, Hoscheidt S, Ryan L, Jacobs WJ, Nadel L. Stress administered prior to encoding impairs neutral but enhances emotional long-term episodic memories. Learn Mem. 2007;14(12):861–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Smallwood J, Fitzgerald A, Miles LK, Phillips LH. Shifting moods, wandering minds: negative moods lead the mind to wander. Emotion. 2009;9(2):271–6.  https://doi.org/10.1037/a0014855.CrossRefPubMedGoogle Scholar
  25. 25.
    McGaghie WC, Siddall VJ, Mazmanian PE, Myers J. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135(3 Suppl):62S–8S.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lucas GM, Rizzo A, Gratch J, Scherer S, Stratou G, Boberg J, Morency LP. Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers. Frontiers in Robotics and AI. 2017 Oct 12;4:51. doi.org/10.3389/frobt.2017.0005126.Google Scholar
  27. 27.
    Ericsson KA, Prietula MJ, Cokely ET. The making of an expert. Harv Bus Rev. 2007;85(7–8):114–21.Google Scholar
  28. 28.
    Van de Wiel MW, Van den Bossche P, Janssen S, Jossberger H. Exploring deliberate practice in medicine: how do physicians learn in the workplace? Adv Health Sci Educ. 2011;16(1):81–95.CrossRefGoogle Scholar
  29. 29.
    Van Merrienboer JJ, Sweller J. Cognitive load theory and complex learning: recent developments and future directions. Educ Psychol Rev. 2005;17(2):147–77.CrossRefGoogle Scholar
  30. 30.
    Miller WR. Motivational interviewing with problem drinkers. Behav Psychother. 1983;11(2):147–72.CrossRefGoogle Scholar
  31. 31.
    Miller WR, Rollnick S. Applying motivational interviewing. In: Miller WR, Rollnick S, editors. Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press; 2012. p. 335–51.Google Scholar
  32. 32.
    Frith CD, Frith U. Interacting minds—a biological basis. Science. 1999;286(5445):1692–5.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Gallagher HL, Frith CD. Functional imaging of ‘theory of mind’. Trends Cogn Sci. 2003;7(2):77–83.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bateman AW, Fonagy P. Mentalization-based treatment of BPD. J Personal Disord. 2004;18(1):36–51.CrossRefGoogle Scholar
  35. 35.
    Bateman A, Fonagy P. Mentalization based treatment for borderline personality disorder. World Psychiatry. 2010;9(1):11–5.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Allen JG, Fonagy P, editors. The handbook of mentalization-based treatment. Chichester, UK: John Wiley & Sons; 2006.Google Scholar
  37. 37.
    Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev. 2004;3(2):71–100.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Stotland E. Exploratory investigations of empathy. Adv Exp Soc Psychol. 1969;4:271–314.CrossRefGoogle Scholar
  39. 39.
    Völlm BA, Taylor AN, Richardson P, Corcoran R, Stirling J, McKie S, et al. Neuronal correlates of theory of mind and empathy: a functional magnetic resonance imaging study in a nonverbal task. NeuroImage. 2006;29(1):90–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Mercer SW, Reynolds WJ. Empathy and quality of care. Br J Gen Pract. 2002;52(Suppl):S9–12.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Neumann M, Edelhäuser F, Tauschel D, Fischer MR, Wirtz M, Woopen C, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med. 2011;86(8):996–1009.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Mehrabian A, Young AL, Sato S. Emotional empathy and associated individual differences. Curr Psychol. 1988;7(3):221–40.CrossRefGoogle Scholar
  43. 43.
    Eisenberg N, Miller PA. The relation of empathy to prosocial and related behaviors. Psychol Bull. 1987;101:91–119.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Şahin M. An investigation into the efficiency of empathy training program on preventing bullying in primary schools. Child Youth Serv Rev. 2012;34(7):1325–30.CrossRefGoogle Scholar
  45. 45.
    Pecukonis EV. A cognitive/affective empathy training program as a function of ego development in aggressive adolescent females. Adolescence. 1990;25(97):59.PubMedGoogle Scholar
  46. 46.
    Riess H, Kelley JM, Bailey R, Konowitz PM, Gray ST. Improving empathy and relational skills in otolaryngology residents: a pilot study. Otolaryngol Head Neck Surg. 2011;144(1):120–2.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Ickes W. Empathic accuracy. J Pers. 1993;61(4):587–610.  https://doi.org/10.1111/j.1467-6494.1993.tb00783.x.CrossRefGoogle Scholar
  48. 48.
    Zaki J, Bolger N, Ochsner K. It takes two: the interpersonal nature of empathic accuracy. Psychol Sci. 2008;19(4):399–404.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Noller P, Ruzzene M. Communication in marrage: the influence of affect and cognition. In: Fletcher GJO, Fincham FD, editors. Cognition in close relationshpis. Hillsdale, NJ: Erlbaum; 1991. p. 203–33.Google Scholar
  50. 50.
    Noller P, Venardos C. Communication awareness in married couples. J Soc Pers Relat. 1986;3(1):31–42.CrossRefGoogle Scholar
  51. 51.
    Zaki J, Weber J, Bolger N, Ochsner K. The neural bases of empathic accuracy. Proc Natl Acad Sci U S A. 2009;106(27):11382–7.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Gross JJ. Emotion regulation in adulthood: timing is everything. Curr Dir Psychol Sci. 2001;10(6):214–9.CrossRefGoogle Scholar
  53. 53.
    Gross JJ. The emerging field of emotion regulation: an integrative review. Rev Gen Psychol. 1998;2(3):271–99.  https://doi.org/10.1037/1089-2680.2.3.271.CrossRefGoogle Scholar
  54. 54.
    Ochsner KN, Silvers JA, Buhle JT. Functional imaging studies of emotion regulation: a synthetic review and evolving model of the cognitive control of emotion. Ann N Y Acad Sci. 2012;1251(1):E1–24.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Ehring T, Tuschen-Caffier B, Schnülle J, Fischer S, Gross JJ. Emotion regulation and vulnerability to depression: spontaneous versus instructed use of emotion suppression and reappraisal. Emotion. 2010;10(4):563–72.  https://doi.org/10.1037/a0019010.CrossRefPubMedGoogle Scholar
  56. 56.
    John OP, Gross JJ. Healthy and unhealthy emotion regulation: personality processes, individual differences, and life span development. J Pers. 2004;72(6):1301–34.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Albright G, Bryan C, Adam M, McMillan J, Shockley K. Utilizing virtual patient simulations to prepare health professionals to conduct substance use and mental health screening and brief intervention. 2016. (Accepted for Review, NREPP: SAMHSA’s national registry of evidence-based programs and practices).Google Scholar
  58. 58.
    Adams M, Albright G. Utilizing a simulation with virtual humans to prepare emergency department personnel to conduct substance use and mental health screening and brief interventions. 2015. https://resources.kognito.com//downloads/AtRisk_in_ED_Kognito_Research.pdf.
  59. 59.
    Eden D, Ganzach Y, Flumin-Granat R, Zigman T. Augmenting means efficacy to boost performance: two field experiments. J Manag. 2010;36(3):687–713.Google Scholar
  60. 60.
    Albright GL, Davidson J, Goldman R, Shockley KM, Timmons-Mitchell J. Development and validation of the Gatekeeper Behavior Scale. Crisis. 2016;37:271–80.  https://doi.org/10.1027/0227-5910/a000382.CrossRefPubMedGoogle Scholar
  61. 61.
    Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.  https://doi.org/10.1037/0033-295X.84.2.191.CrossRefPubMedGoogle Scholar
  62. 62.
    Centers for Disease Control and Prevention. Web-based Self Injury Statistics Query and Reporting System.  https://doi.org/10.1037/0033-295X.84.2.191.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Glenn Albright
    • 1
    • 2
  • Jane Timmons-Mitchell
    • 3
  • Jeremiah McMillan
    • 4
  1. 1.Department of PsychologyBaruch College, City University of New YorkNew YorkUSA
  2. 2.KognitoNew YorkUSA
  3. 3.Begun Center for Violence Prevention Research and Education, Jack, Joseph, and Morton Mandel School of Applied Sciences, School of Medicine, Case Western Reserve UniversityClevelandUSA
  4. 4.University of GeorgiaAthensUSA

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