attrition is the most serious limitation of the study; participants in the intervention group who reported a suicide attempt in the Gatekeeper training Gatekeeper training programs focus on identifying students considered natural helpers (Yonemoto, Kawashima, Endo, & Yamada, 2019). These programs teach them skills to identify and recognize the signs and symptoms of suicide. The assumption is that suicidal youth are under-identified; therefore, school staff is trained to recognize the warning signs, thereby increasing the recognition and identification of students at risk. Additionally, the programs teach adults how to respond appropriately to students identified as being at risk for suicidal ideation and suicide attempts. The program’s success depends largely on the Question, Persuade and Refer tool The Question, Persuade and Refer (QPR) Gatekeeper Program is a universal program that trains students and school staff to recognize suicide risk factors in fellow classmates or students. The program is based on four simple steps: 1. Recognize the suicide warning signs. 2. Train all school staff in QPR techniques. 3. Train school counselors to appropriately assess students identified as at-risk. 4. Organize the identified students’ access to specialists for professional assessment and treatment. (Miller Doss & Crawford, 2020) This program measures outcomes including increasing school staff awareness of suicide and their ability to intervene based on early identification. Gatekeeper training is a widespread suicide intervention tool designed to educate participants to identify when a person displays suicidal warning signs and behaviors. Case study 8: Youth suicide intervention Alex is a 16-year-old Hispanic male who is referred to his high school guidance counselor by his teacher. The teacher recognized that Alex was increasingly withdrawn in class and his grades were deteriorating. When his teacher asked Alex about these concerns, he stated that he just feels like quitting life sometimes. After a brief greeting with Alex, the school guidance counselor calls Alex’s mother and invites her in for a meeting. Alex and the guidance counselor meet, while waiting for Alex’s mother to arrive. During this time the guidance counselor determines that she will likely recommend that Alex receive therapy to address his suicidal thoughts. The guidance counselor is knowledgeable about developing effective safety plans, so they start the process of developing a safety plan, with the intent of having Alex use it while he awaits a therapy appointment. The guidance counselor first determines the absence of guns in the home and no other access to lethal means. The guidance counselor and Alex next identify triggers to Alex’s suicidal thoughts. These triggers include peer rejection, feelings of not being smart enough for college, and drinking alcohol. The counselor then moves on to identify other coping strategies that could be used during a crisis. Counselor : What can you do by yourself that might make you feel better when you are feeling down, depressed, or even suicidal? Alex : Sometimes I listen to music and that helps. Counselor : Great. What about other things that have worked for you before? Alex : Well, I suppose I could go for a walk. But I tend to feel worse at night and walking in my neighborhood after dark isn’t the best idea. Counselor : That’s probably a good idea for the day, but maybe not at night. What else could you do at night? Alex : Well, I could watch TV or a movie. Sometimes comedies make me feel better.
previous three months at baseline were more likely to be missing at post-test than their counterparts in the control group.
subsequent referral of at-risk students to specialists for further evaluation. A multicomponent preventative intervention program in the U.S. Air Force included leadership and gatekeeper training, increased access to mental health resources, coordination of care for high-risk individuals, and a higher level of confidentiality for those who disclosed suicidality. In this population, suicide rates reduced by 35%. Efforts are being made to create awareness about suicidality and its implications on university campus communities. Supporting research is tied to the U.S. Department of Health and Human Services, which has provided specified organizations, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), with training to create awareness and combat the stigma surrounding mental health (Sicairos-Sanchez, 2017). QPR Gatekeeper Training has provided suicide education to more than 2,500 entities, including middle schools, high schools, community colleges, and universities, with over 1 million participants in the United States. The Question, Persuade and Refer (QPR) tool training demonstrated positive effects on suicide knowledge, skills for identifying students at risk, and attitudes toward suicide. Overall, there was an increase in perceived preparedness, positive effects on self-assessed knowledge, and improved efficacy outcomes. Counselor : Great idea. Now, let’s pretend that you are starting to feel suicidal, but none of those other strategies seem to be working. Are there people you can hang out with or places you can go, just to help you get distracted from your thoughts and put you around others? Alex : I like to go to the YMCA to shoot hoops. Sometimes my brother and I play video games, but he’s not always home. Counselor : Those both sound like good ideas, but let’s also think of at least one other option. Alex : My cousins live a few blocks away. They’re a bit younger than me, but it’s okay hanging out with them. Counselor : Then let’s put those on our list. Now, what if distraction doesn’t seem to be making things any better? Who can you talk to if you are starting to feel down, depressed, or suicidal? Alex : Definitely NOT my mother. She doesn’t seem to understand, and she’s always telling me what to do instead of just listening to me. Counselor : That’s important to know. Maybe we can talk about that a bit when she gets here. Since she’s not a good choice now, who do you think you could talk with? Alex : Sarah is pretty cool, and she usually talks with me about junk like that. Counselor : Sarah from your class? Alex : Yes. Counselor : Okay. That’s a good idea. What’s her number? Alex : I don’t know. I’d have to look it up in my phone. Counselor : That’s okay. Take your time. I want to make sure we write it down in case you need it and you don’t have your phone with you. [Alex finds the number and writes it on the safety plan.] Great. Now let’s think about some other people. Alex : I usually can talk to my uncle about things. He’s pretty cool and knows that my mom can be a little critical at times. Counselor : Great. What’s his number?
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