Applied Suicide Intervention Skills Training Clinical Trial
Gatekeeper training is where people in the community are trained to recognize and identify
those who are at risk for suicide and assist them in getting care. Gatekeeper training has
been widely implemented around the world. There are two types of gatekeepers: 1) Designated
gatekeepers - individuals who have been trained in helping professions (medicine,
psychology, social work, nursing), and 2) Emergent gatekeepers - individuals who are not in
caregiving roles (family members, police, teachers, clergy). Applied Suicide Intervention
Skills Training (ASIST) has been implemented in Manitoba. However, a recent randomized
controlled trial in First Nations community members (emergent gatekeepers) from the Swampy
Cree Tribal Council (Northwestern Manitoba) demonstrated that the training had no positive
impact on self-reported gatekeeper skills or behavior. Also, compared to a resilience
retreat, the ASIST training was associated with a slightly higher likelihood of reporting
suicidal ideation. The demonstrated lack of efficacy and the possibility of adverse effects
associated with this training program in this vulnerable group have raised concerns about
the safety and efficacy of ASIST. There were several key limitations of the previous study.
First, the study only recruited community members (emergent gatekeepers), therefore findings
may not be generalizable to designated gatekeepers (clinicians, nurses, counselors). Second,
the study had a small sample size (n=55) and may have not been large enough to detect small
effects that are often associated with educational interventions. Finally, the increase in
distress in the ASIST trained group may not have been directly related to the training. To
overcome the above limitations, we aim to conduct a larger evaluation of the safety and
effectiveness of gatekeeper training that is occurring in Manitoba First Nations, Inuit and
Metis communities. Based on previous work that suggests designated gatekeepers are more
likely to benefit from gatekeeper training than emergent gatekeepers, we will examine these
groups separately.
Hypotheses: 1) ASIST will be associated with an increase in gatekeeper skills and behaviors;
2) ASIST will have a stronger impact on designated gatekeepers than emergent gatekeepers; 3)
ASIST will not be associated with an increase in suicidal ideation or distress.
n/a
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label