Institute of Rural Health, Idaho State University, Meridian, Idaho 2. Institute of Rural Health, Idaho State University, Pocatello, Idaho

Transcription

1 Establishing the Evidence Base for Better Todays. Better Tomorrows. For Better Mental Health. Gatekeeper Training Curriculum Using Data from 11, People over 12 Years. Final Report 213. Ann D. Kirkwood 1 and Beth Hudnall Stamm 2 1 Institute of Rural Health, Idaho State University, Meridian, Idaho 2 Institute of Rural Health, Idaho State University, Pocatello, Idaho Better Todays. Better Tomorrows is an adult gatekeeper training program that teaches the signs and symptoms of mental disorders and suicide. Between 2 and 211, 11, gatekeepers have been trained with the science based Better Todays curriculum. Better Todays includes modules for general mental disorders, traumatic stress and suicide. Resiliency modules for helpers include compassion satisfaction, compassion fatigue and vicarious traumatization. Customized trainings exist for school, primary care, emergency services, juvenile justice, coroners, LGBT, Tribal, Hispanic, and parent audiences. The data here are from courses conducted between April 21 and March 211. Five hundred and forty six (546) people registered; 264 used advance online registration and 158 registered onsite. The overall attendance rate was 78%. The most common profession was education (n=164, 3%) followed by Juvenile Justice (n=146, 25%). Post course assessment return rates exceeded 9%. The assessment includes subscales for knowledge (alpha.85) and course quality (alpha =.81). The mean agreement (1 low to 5 high) on the course quality scale is 4.28 (SD.59) and 4.5 (SD.44) on knowledge. Two questions ask participants if they know a youth (a) who needs help with a mental disorder and (b) who has attempted or died by suicide. The agreement with knowing a child with a mental disorder is 3.8 (SD.97) and on the suicide question is 4.1 (SD 1.13). Sixty three percent (n=275) of people knew a youth who needed help with a mental disorder and 77% (n=34) knew youth who attempted or completed suicide. No statistical differences were observed across the different courses. Gatekeeper training programs teach adults who interact with children the signs and symptoms of mental disorders. They are based on the research that shows early intervention can prevent mental disorders or lessen the impact they have on youth and their families. 1,2 Trained gatekeepers are more likely to identify and refer high risk youth. 3 Stigma can affect treatment seeking 4 and quality of health care received. 5,6 Youth learn from childhood through societal transmission stigma s negative attributions toward people with mental illnesses. 7 Correspondence concerning this article should be addressed to Ann D. Kirkwood, Institute of Rural Health, Idaho State University, Meridian, ID 83642, irh@isu.edu, For more information: An earlier version of this paper was presented at the International Society for Traumatic Stress Studies 211 Annual Conference. This project was funded in part by a suicide prevention grant from SAMHSA (SM & SM 5741). Additional funding came through the Idaho Department of Health and Welfare (TANF 21, Idaho First Lady Patricia Kempthorne 22; Division of Behavioral Health and Substance Abuse 22 28). In addition, the authors and others volunteered countless hours in support of the project. The contents are the sole responsibility of the authors and do not necessarily represent the official views of DHHS, the State of Idaho, or Idaho State University. The authors wish to recognize former Idaho First Lady, Patricia Kempothorne for her vision and support during the early years of Better Todays. Better Tomorrows. For Better Mental Health. If you, or someone you know, is in suicidal crisis or emotional distress help is available. Call the national Lifeline at TALK. For those with disabilities, stigma negatively affects their quality of life and self esteem. 8,9,1 Parents of children with disabilities may feel shame and experience stigma for their children, in their role as parents, and for their families. 11,12 Better Todays. Better Tomorrows. For Better Mental Health is an adult gatekeeper training program that teaches the signs and symptoms of mental disorders and suicide and stigma. Between 2 and 211, 11, gatekeepers have been trained with the science based Better Todays curriculum. Better Todays is a modularized training program composed of general mental disorders, traumatic stress and suicide. Resiliency modules for helpers include compassion satisfaction, compassion fatigue and vicarious traumatization. Customized trainings exist for military, school, primary care, emergency services, juvenile justice, coroners, LGBT, Tribal, Hispanic, and parent audiences. Methods Between 2 and 211, 8,518 adult and 2,692 youth have received training in the signs and symptoms of mental illness and suicide. Depending on the year, a combination of pre test, post test and concurrent measures has been administered (see Table 1). Data reported here are in two overlapping subsets of the postcourse evaluations. The first subset is 4,41 adult professional and community/parent gatekeepers. The second is a subset of 1,57 people who registered for courses between April 21 and May 212. Better Todays. Better Tomorrows. 1

2 Table 1: All Data Collected on Better Todays Course Evaluation trainings (23.6%, n=371) typically registered at the time of the course. An annual schedule of courses was publicized with online registration. Two thirds of registrants (66%, n=776) registered at least one to three months in advance of the course, and 32% (n=374) registered more than three months in advance. Only 9% (n=98) registered in the final two weeks before the course (see Figure 1). In many cases these were people who had been on a waitlist. Figure 1: Grouped Time Between Registration and Course. one day to two weeks 9% more than 3 months 32% two four weeks 25% 1 3 months 34% The return rate for the subset is 92% on the post course evaluation. This subsample did not receive a pretest but are in a one year follow up utilization study. All participants are told that if the content of the course is causing them distress they are free to leave and, if needed, someone from the teaching staff will be available to speak with them. Most participants choose to receive certificates of attendance for continuing education. The evaluations are anonymous and kept separate from the certificates of attendance. Evaluations are provided to participants in packets. Instructors explain how to complete the forms, including providing verbal informed consent to reinforce the written informed consent. Evaluation data analysis is conducted by staff who are not involved with training. The study is conducted under the approval of the ISU Human Subjects Committee. Results Registration There were 1,57 participants included on the course roles either as registrants or as participants in customized courses created for a specific group of people. Only 1.5% (n=25) did not register prior to or at the time of the course. Participants in customized When viewed by number of days, not groups of days, the most common number of days (mode) was 34 days. The median number of days was 47 and the average 66 days with a SD of 58 days. Figure 2: Percent of People Registering by Day Percent Registering Number of Days Before Course Attendance Of the 1,57 people registered, 46% (n=722) preregistered and attended the course. There were 327 (2.8%) walk ins who registered on site. Many walk ins had contacted staff just days in advance of the course and were advised to try to attend as walk ins. Among those who pre registered, 22.6% (n=355) were no shows and 9.4% cancelled their registration (n=148). Only 1% (n=18) people were waitlisted and not able to attend a course. Most people who were waitlisted were able to attend their chosen course date or another date. Due to waitlisting, at times additional courses were offered when there were financial and personnel resources to add courses. 2 Better Todays. Better Tomorrows.

3 How Participants Heard About the Course Ninety one percent (9.7%, n=1,428) reported at least one way they heard of the course, reporting a total of 2,293 points of contact about the course. Fifty five percent (55%, n=865) reported hearing by or from a colleague or both. The most common method for people to hear about the course was via (3%, n=464). Being advised of the course by a friend or colleague was nearly as common (24%, n=379). A small proportion of participants (<1%) were required to attend for their work. Participants also reported learning about the course by print and broadcast media, by Facebook, and over the internet including internet searches. Affiliations Eight hundred seventy four (55.6%, n=874) reported an affiliation. The most common affiliations were juvenile justice (11%, n=171), mental health (9.3%, n=146), and education (45%, n=263) together accounting for 66% (n=58) of participants who reported affiliations. (See Figure 3.) Nine hundred and seventy (61.7%, n=97) people reported on whether they provided direct social services to youth or were community members. The majority of respondents (41%, n=643) provided some sort of direct services to youth. The remaining were community members (7.8%, n=123) or people who worked with youth but did not provide direct social services (12.9%, n=24). Post Course Evaluations Scale statistics were calculated on both the 4,41 and 1,57 participants collected between 21 and 212. Some item wording and formats were refined over the years. In these cases data are reported collapsed into a common variable and individually with the years during which the format was collected. The question regarding knowing a youth who had attempted or died by suicide was added in 27 as a yes/no question and then changed to a Likert scale in 21. Both are reported here (see Table 2). The assessment includes subscales for post course knowledge (alpha.83) and course quality (alpha.72). The mean agreement (1 low to 5 high) on the course quality scale is 4.34 (SD.6) and 4.19 (SD.6) on the knowledge scale that contains both suicide and mental health knowledge. Figure 3: Affiliations of 874 Registrants Type of Affiliation Better Todays. Better Tomorrows. 3

4 Table 2: Key Scale and Item Statistics from Post Course Evaluation Table 2: Key Scale and Item Statistics from Post Course Evaluation Quality of Training Scale Quality of Training Category Knowledge Reported Post-training Scale Category of Knowledge Reported Post-Training Know Youth With Mental Disorder Aware Of Youth Who Attempted Or Died From Suicide Mean Median Mode 5 High 4 High 4 5 Std. Deviation # Items on Scale Not a scale Not a scale Not a scale Alpha Reliability Standard Error Mean.72 n= n= Dichotomous High=3716, 78.8% Medium=968, 2.5% Low=31,.7% High=383, 8.7% Medium=868, 18.4% Low=44,.9% Y=958, 76.38% N=289, 23.2% Number of People n=4644 n=4715 n=4589 n=4715 n=4463 n=1199 N=1275 Estimate of Seriousness of Mental Disorders and Suicide in Participant s Community There is little knowledge available regarding the prevalence and impact of mental disorders and suicide in course participant s communities. In order to estimate the level of seriousness in participant s communities they were asked two questions: Do you know a youth who needs help with a mental disorder and Do you know or are aware of a child in my community who has attempted or died as a result of suicide. These questions are not intended to provide information about prevalence but about the participant s awareness of mental disorders and suicide and to learn about how many people have direct experience with mental disorders and suicide. Figure 4: Know Youth with a Mental Disorder Number of People Reporting Two thirds (62%, n = 254) knew a youth who needed help with a mental disorder (see Figure 4). The agreement with knowing a child with a mental disorder is 3.8 (SD.95) and on the suicide question is 4.1 (SD 1.2). Seventy six percent (76.8%, n = 958 of 1,247) people knew of a youth who had attempted or died by suicide (see Figure 5). No differences were observed between community members and professionals on the knowledge scales or on the knowledge of a youth with a mental disorder, but there was a difference on the Quality of Training scale with community members scoring higher than professionals (F 1,441 =116; p <.1; power 1.; community mean 4.5, SD.64; professional mean 4.27, SD.56). Figure 5: Know of Youth Who Attempted or Died by Suicide 4 Better Todays. Better Tomorrows.

5 Discussion Better Todays has been a successful program in reaching both professionals and community members with training in mental health and suicide prevention. The course has run continuously for 12 years. The results are consistent from year to year. A unique aspect of Better Todays is its inclusion of consumers, parents, and advocates like the Suicide Prevention Network, SPAN Idaho. These speakers are able to share their personal experiences to convey the human toll of stigma and give voice to people s concerns. The results pertaining to how many people know someone who needs help with a mental illness or suicide issues are impressive. Regardless of the method used to measure it, consistently 75% of people reported that they know of a youth who attempted or died by suicide. This result has held steady since 27. There are minor differences in the perceptions of course quality between community members and professionals. This may be course related or perhaps due to outside factors. References 1. National Research Council and Institute of Medicine. (29). Preventing Mental, Emotional, and Behavioral Disorders Among Young People. National Academies Press. 2. Beardslee et al. (211). Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective. Psychiatr Serv 62, Wyman, et al. (28). Randomized clinical trial of a gatekeeper program for suicide prevention. J Consult Clin Psychol, 76, Teachmanet, et al. (26). Implicit and explicit stigma of mental illness in diagnosed and healthy samples. J Soc Clin Psychol, 25, Strauser, Ciftci & O'Sullivan. (29). Using attribution theory to examine community rehabilitation provider stigma. Int J Rehab Res, 32, White & Clark (21). Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution. J Nur Mgmt 18, Wahl. (1995). Media madness: Public images of mental illness. Rutgers Univ Press. 8. Yanos, Rosenfeld & Horowitz. (21). Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness. Com Mental Health J, 37, Corrigan & Watson. (22). The paradox of self stigma and mental illness. Cl Psych: Res & Pract, Link, et al. (21). Stigma as a barrier to recovery. Psychiatric Servi, 52, Gray. (22). Felt and enacted stigma among parents of children with high functioning autism. Soc Health & Illness, 24, Green. (23). Stigma and the lives of families of children with disabilities. Social Science & Medicine, 7, To Cite This Paper Kirkwood, A.D. & Stamm, B.H. (213). Establishing the Evidence Basis for Better Todays. Better Tomorrows. For Better Mental Health. Gatekeeper Training Curriculum Using Data from 11, People over 12 Years. Final Report 213. In A.D. Kirkwood and B.H. Stamm (Eds). Resources for Community Suicide Prevention. Meridian, ID and Pocatello, ID: Idaho State University. Better Todays. Better Tomorrows. 5