Measuring Trainer Fidelity in the Transfer of Suicide Prevention Training

Abstract

Background Finding effective and efficient models to train large numbers of suicide prevention interventionists, including ‘hotline’ crisis counselors, is a high priority. Train-the-trainer (TTT) models are widely used but understudied. Aims To assess the extent to which trainers following TTT delivered the Applied Suicide Intervention Skills Training (ASIST) program with fidelity, and to examine fidelity across two trainings and seven training segments. Methods We recorded and reliably rated trainer fidelity, defined as adherence to program content and competence of program delivery, for 34 newly trained ASIST trainers delivering the program to crisis center staff on two separate occasions. A total of 324 observations were coded. Trainer demographics were also collected. Results On average, trainers delivered two-thirds of the program. Previous training was associated with lower levels of trainer adherence to the program. 18% of trainers' observations were rated as solidly competent. Trainers did not improve fidelity from their first to second training. Significantly higher fidelity was found for lectures and lower fidelity was found for interactive training activities including asking about suicide and creating a safe plan. Conclusions We found wide variability in trainer fidelity to the ASIST program following TTT and few trainers had high levels of both adherence and competence. More research is needed to examine the cost-effectiveness of TTT models.

What Did They Learn? Effects of a Brief Cognitive Behavioral Therapy Workshop on Community Therapists’ Knowledge

“…Training quality likely varies across instructors given differences in fidelity to training strategies utilized (e.g. didactic teaching, role-plays; Cross et al, 2014). It may be the case that longer workshops including didactic and experiential exercises (Gleacher et al, 2011; Westbrook et al, 2008) are necessary to reduce the cognitive load associated with CBT training and maximize knowledge gain potential for all participating therapists.…”

Implementing Evidence-Based Suicide Prevention Training in Communities: Implications for Quality Improvement

“…We then adapted adherence items that measured trainer competencies (e.g., the style in which the content is delivered). These items were adapted from the ASIST trainer competencies in the trainer workbook and additional general trainer competencies from other research [6,8,9]. The ASIST fidelity and adherence monitoring protocol will be available for free download at http://www.rand.org/health/surveys_tools.html.…”

“…Specifically, it is important to monitor the fidelity of trainings to understand whether trainers were delivering workshops with high fidelity (i.e., covering all aspects of the manual-based training) and adherence (i.e., whether the training followed the recommended style of presenting). In addition to monitoring hotline responder behaviors and caller outcomes, the findings of [6] were complemented by a study [8] that assessed ASIST fidelity during workshops with crisis hotline responders. Video and audio segments of 66 ASIST workshops were coded.…”

“…Participants are taught how to recognize suicide risk factors, to respond in a manner that increases immediate safety, and to link suicidal persons to appropriate resources [6]. Workshops are typically led by at least two trainers who take turns presenting the ASIST curriculum.…”

RAND's Fidelity Monitoring Protocol for Suicide Prevention Workshops in California

“…We then adapted competence items (i.e., related to delivery in the recommended style of presenting) that measured trainer competencies. These items were adapted from the ASIST trainer competencies in the trainer workbook and additional general trainer competencies from other research (Cross et al, 2014;Gould et al, 2013;Howard, 1980). We then evaluated this protocol during live observation of full, two-day ASIST workshops and revised the protocol accordingly.…”