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Rural veterans face 20–25% higher suicide rates than urban veterans, with ~75% of suicides involving firearms (Department of Veterans Affairs, 2024). Primary care providers, who step in where mental health specialists are scarce, often lack adequate suicide prevention training (Labouliere et al., 2021). Lethal means safety counseling (LMSC) reduces suicide risk by limiting access to firearms and medications, yet only 15% of providers are trained in it (Sale et al., 2018). Social workers, pivotal in veteran care, are uniquely positioned to develop training and promote its adoption. Virtual reality (VR) offers immersive learning, outperforming traditional methods (O’Brien et al., 2024). Our study aimed to examine LMSC practices, barriers, and VR needs. Our research questions were: 1) What are current LMSC practices? 2) What barriers limit delivery? 3) How can VR improve training? Findings will guide further design and development of the Veteran Suicide Assessment in Virtual Reality (VET-SAVR) training simulation using the ADDIE model (Analysis, Design, Development, Implementation, Evaluation; Branch, 2009).
We purposively sampled 10–15 licensed professionals (nurses, social workers) from rural veteran-serving clinics, using professional networks for diversity. Data included 60-minute video interviews and surveys on demographics and training needs, probing LMSC practices, barriers, and VR preferences. Thematic analysis used Braun and Clarke’s (2006) framework with deductive and inductive coding. Two coders analyzed data independently, resolved discrepancies via discussion, and triangulated responses with themes.
Of 11 participants (10 female, 1 male; mean age 51.55, SD=10.66, range=34–73), 10 were White, one Black; two identified as Hispanic. Most were nurses (n=7); four were social workers. Thematic analysis yielded the following themes: Training and Preparedness—82% had received some suicide prevention training; almost half had never heard of LMSC, 36% had LMSC training, and 27% had engaged in it; Intervention Processes (all screened for suicide; over half did safety planning; 55% lacked any follow-up); Resource Constraints (82% described older under-resourced clinics); Veteran-Specific Needs (45% asked about veteran status); VR Acceptance (82% endorsed VR for realism and saw it as a confidence-building tool).
There is a critical need for structured, practical training to equip rural providers with the confidence and skills to deliver effective LMSC. Training should be accessible, realistic, and aligned with the constraints of rural practice. VR offers a promising modality for simulating complex scenarios and fostering skill development in under-resourced settings. Social workers are well-positioned to lead implementation of VR-based training, ensuring it is culturally responsive, and centered on veteran care. These findings will directly shape the VET-SAVR simulation’s design, supporting scalable strategies to reduce veteran suicide risk in rural communities.