Gatekeeper Trainings in American Indian Communities: Increasing Knowledge and Feelings of Preparedness to Address Youth Suicide

Background: Suicide is a significant burden on the mental health of youth and families. American Indian Health & Family Services in Detroit, MI, and the University of Michigan have worked to prevent suicide among high-risk American Indian/Alaska Native (AI/AN) youth aged 10-24 since 2011. Suicide prevention gatekeeper trainings were conducted to teach behavioral health professionals, students, and community members to identify and respond to at-risk youth. This study examined the effectiveness of gatekeeper trainings to enhance the suicide prevention knowledge, attitudes, and behaviors of participants.

Methods: We conducted 56 gatekeeper trainings in mainly AI/AN communities in MI from 2012-2019. Participants attending ASIST (N=603) and SafeTALK (N=405) were asked to complete surveys at three time points, pre-test (t1), post-test (t2), and 6-months (t3) to evaluate their suicide prevention knowledge, attitudes, and behaviors.

GLM repeated measures were used to test within-subject, and between-subject mean score changes in measures of suicide prevention-related knowledge, comfort talking about suicide, behavioral intentions, preparedness, and confidence in responding to at-risk youth. Knowledge was measured with a composite summary score of three questions on the ability to identify, discuss, and respond to at-risk youth; other measures used scores generated from single questions on a five-point scale. Mean scores were tested between two time point dyads t1-t2 and t1-t3 and across all three time points t1-t2-t3. Education level/student status served as a between-subjects factor at t1-t2-t3 (n_ASIST=233, n_SafeTALK=212) to compare longitudinal training effects for participants with differing educational backgrounds. Significance was evaluated at alpha=0.05.

Results: Results indicate that both gatekeeper trainings effectively improved each measure from t1-t2 and t1-t3. The t1-t2 mean score difference on knowledge was 1.96 for ASIST and 2.02 for SafeTALK; the t1-t3 mean score difference was 1.28 for ASIST and 1.60 for SafeTALK. For the other measures, both t1-t2 and t1-t3 mean score differences were significant. Of these, the largest mean score change was on preparedness; t1-t2 scores increased 1.01 for ASIST and 0.86 for SafeTALK, t1-t3 scores increased 0.92 for ASIST and 0.825 for SafeTALK. With education as a between-subject factor for t1-t2-t3, the main effect of time was significant on all variables, and between-subject effects were significant for all variables except ASIST scores on behavioral intention. Different trajectories characterized score changes for the two trainings; t2 scores were maintained at t3 only for SafeTALK. The education*time interaction was significant for both on knowledge and comfort.

Conclusions and Implications: Gatekeeper trainings appear to improve capacity to effectively address youth suicide, primarily through increased knowledge and perceived preparedness. Trainees with different educational backgrounds responded differently to the curriculums over time in terms of their uptake and retention of knowledge. Trainings may be more effective if tailored to specific groups who may benefit from a six-month educational booster. Behavioral health workers are uniquely positioned to attend and provide tailored gatekeeper trainings to improve the knowledge, attitudes, and behavioral capacity of communities, especially AI/AN communities, to engage in suicide prevention efforts.