Suicide Intervention Training for Counselors: A Quasi-Experimental Study on Self-Efficacy

ABSTRACT

This study explored the influence of the Applied Suicide Intervention Skills Training (ASIST), a 14-hour gatekeeper training, on emerging counselors’ self-efficacy in working with individuals experiencing suicidal thoughts. Through a pre-post design, counselor participants from five ASIST trainings were assessed. The results demonstrated a significant increase in self-efficacy among counselors after completing ASIST, underscoring its potential as an effective method for bolstering self-efficacy within counselor training. The implications for counselor preparation are discussed, highlighting the value of integrating ASIST to augment clinicians’ preparedness in addressing suicidal ideation.

KEYWORDS:

• Suicide prevention
• self-efficacy
• counselor preparation
• Applied Suicide Intervention Skills Training (ASIST)
• gatekeeper training

Introduction

Suicide persists as a critical public health issue, ranking as the 10th leading cause of death in the United States (Hedegaard et al., 2020). In 2019, the United States witnessed one suicide every 11.1 minutes and a suicide attempt every 26.6 seconds, emphasizing the immediate need for comprehensive suicide prevention strategies and the cultivation of robust skills among mental health practitioners (American Association of Suicidology [AAS], 2022). Further, the urgency to address suicide prevention, especially clinically, has intensified in response to prevailing social and economic stressors (Ahmad Mir & Saini, 2023). Despite counseling accreditation standards emphasizing suicide intervention, counselors and trainees often report feeling inadequately prepared to address such matters with clients (Elston et al., 2020).

Research consistently underscores the heightened stress and anxiety experienced by therapists when addressing suicidal clients (Feldman & Freedenthal, 2006; Scupham & Goss, 2020). Additionally, studies reveal that many mental health professionals possess only moderate levels of self-efficacy in suicide prevention practices (Labouliere et al., 2018; Osteen, 2018). The impact of suicide-related cases can further have both professional and personal effects on clinicians (McAdams & Foster, 2000; Schmitz et al., 2012). Thus, it is important to investigate ways to increase counselors’ self-efficacy in addressing matters of suicide. This article investigates the effectiveness of the Applied Suicide Intervention Skills Training (ASIST), a distinctive approach aimed at enhancing counselors’ self-efficacy and proficiency in working with individuals contemplating suicide. The goal of ASIST is to empower anyone with a desire to aid in suicide prevention with the requisite knowledge, skills, and self-efficacy, fostering a collaborative and coordinated approach to suicide prevention and ultimately contributing to saving lives.

Literature review

Therapist preparation in suicide assessment and intervention is a significant topic within the mental health field, as working with suicidal clients can be a stressful and anxiety-inducing situation for therapists (Feldman & Freedenthal, 2006; Scupham & Goss, 2020). Due to the prevalence of suicide within the United States (AAS, 2022) and the serious potential outcomes for such ideations and plans, it becomes critical that therapists be prepared and adequately trained in effective suicide prevention methods. Additionally, counselors and trainees must feel confident in their ability to implement such interventions appropriately and to work generally with suicidal clients. However, counselors have expressed feeling unprepared (Elston et al., 2020). Further, the limited suicide prevention and intervention education provided in graduate programs and the lack of mandatory continuing education may contribute to these gaps in preparedness (Feldman & Freedenthal, 2006; Love et al., 2020; Scupham & Goss, 2020).

Recognizing the need for change, the AAS has called for significant revisions in suicide prevention training within counselor education programs (Schmitz et al., 2012). To address the gaps in education and enhance preparedness among emerging clinicians, it is crucial to integrate more comprehensive suicide intervention and prevention training during or shortly after training programs (Feldman & Freedenthal, 2006). This includes both fostering self-efficacy and equipping counselors with the necessary skills and knowledge to work with suicidal individuals effectively. By doing so, institutions can alleviate the concerns associated with inexperienced clinicians working with high-risk clients while also promoting improved outcomes in suicide prevention and intervention.

Self-efficacy in working with suicidal individuals

Self-efficacy plays a critical role in counselors’ confidence and perceived competence when working with clients with suicidal ideation (Elston et al., 2020; Schmidt, 2016). It encompasses their belief in effectively addressing risk factors, implementing evidence-based strategies, and engaging in successful therapeutic interactions. The lack of confidence in suicide assessment or intervention may lead counselors to avoid these behaviors altogether, potentially harming clients’ well-being (Douglas & Morris, 2015; Elston et al., 2020). However, research has demonstrated mental health professionals have only moderate levels of self-efficacy regarding suicide prevention preparedness (Labouliere et al., 2018; Osteen, 2018). This is critical as low self-efficacy in suicide assessment and intervention skills can hinder a counselor’s performance, leading them to overlook important clinical information (Elston et al., 2020; Schmidt, 2016).

Further, improving one’s confidence in their training can decrease feelings of anxiety and discomfort when working with suicidal clients (Osteen, 2018). While mental health professionals receive some training in suicide assessment, additional experiential and practice-focused training may enhance their self-efficacy and contribute to effective intervention and prevention efforts (Labouliere et al., 2018). The implementation of gatekeeper training programs, for instance, may serve to increase self-efficacy in suicide prevention preparedness within counselor education programs (Labouliere et al., 2018). Thus, improving self-efficacy equips counselors to provide support and help preserve lives in situations involving suicidal ideation.

Gatekeeper training

Gatekeeper training constitutes a pivotal element in suicide prevention, aiming to empower individuals (including non-clinicians), with the capacity to recognize signs of suicidal ideation or risk, and facilitate timely referrals for effective crisis management or therapeutic intervention (Cimini et al., 2014; Indelicato et al., 2011). Notable examples include the Question, Persuade, Refer (QPR) training, which emphasizes identifying warning signs, direct questioning to assess risk, and guiding individuals at risk toward appropriate help and resources (QPR Institute, 2023), and the Response program, which provides a comprehensive high school-based framework for recognizing warning signs, engaging with empathy, sharing concerns, providing support, seeking consultation, and encouraging professional help (Hawgood et al., 2022). Gatekeeper trainings address diverse aspects of suicide prevention, encompassing awareness, crisis communication, resource referral, and stigma reduction, thereby contributing to community-based suicide prevention efforts. They have also demonstrated significant improvements in competency and knowledge related to suicide among participants (Cramer et al., 2013).

Tailorable to different populations and settings, gatekeeper trainings benefit professional clinicians by fostering collaboration, promoting early intervention, addressing stigma, and providing essential tools for effective suicide intervention and prevention (Cimini et al., 2014; Hawgood et al., 2022; Indelicato et al., 2011). One specific program, ASIST, provides in-depth training with experiential learning and face-to-face interaction, allowing participants to refine their skills through feedback from trained instructors (Lang et al., 2013). ASIST is a well-established and empirically supported suicide intervention program that has gained global recognition and adoption since its development in 1983 (Mellanby et al., 2010; L. Shannonhouse et al., 2017). It is widely embraced within mental health disciplines as a valuable resource for professionals, as well as general members of the community, seeking to enhance their competencies in suicide prevention and intervention (LivingWorks Education, 2020).

This two-day experiential workshop equips participants with the skills to identify suicide risk and intervene effectively (Mellanby et al., 2010), and follows the Pathway for Assisting Life (PAL) model, which emphasizes building a connection, engaging in crisis resolution, and implementing a follow-up plan (Jobes, 2006, 2016). Evaluation studies have consistently shown significant improvements in trainees’ readiness to intervene with suicidal individuals after ASIST training (Elston et al., 2020; Griesbach et al., 2008; Rodgers, 2010; L. Shannonhouse et al., 2017; Turley et al., 2000). ASIST has been found to enhance skills, attitude, comfort, competence, and confidence related to suicide intervention among various populations, including counselor trainees, college personnel, military members, and health professionals (Cimini et al., 2014; L. Shannonhouse et al., 2015, 2017; L. R. Shannonhouse et al., 2018; Smith et al., 2014; Smith-Osborne et al., 2017). The training’s positive effects have been observed in settings such as Army Reserve Units and crisis call centers, leading to reductions in hopelessness, suicidality, and increased feelings of hope and well-being among individuals receiving support from ASIST-trained counselors (Gould et al., 2013; Smith-Osborne et al., 2017).

Therefore, ASIST and similar gatekeeper training programs may enhance counselor self-efficacy in working with suicidal individuals, increasing access to crisis support for individuals with thoughts of suicide. The present study aimed to explore counseling participants’ self-efficacy in working with suicidal individuals before and after their ASIST training. Specifically, our research questions were: 1) Is there a significant difference in counselor self-efficacy before and after the ASIST training? and 2) Does the ASIST training improve counselors’ self-efficacy in general suicide assessment, assessment of personal characteristics, assessment of suicide history, and suicide intervention?

Method

This quasi-experimental investigation utilized a pre-posttest design to evaluate the impact of ASIST on participants’ self-efficacy in addressing suicidal thoughts. The study aimed to discern changes in participants’ outcomes after ASIST training, employing a paired t-test analysis to gauge alterations in suicide assessment efficacy before and after the intervention. Emerging clinicians were chosen as participants for this study due to their specific stage in professional development, wherein the targeted application of gatekeeper training could potentially shape foundational skills and enhance self-efficacy in suicide prevention, contributing valuable insights for future interventions within the mental health profession. Furthermore, this design aligned with Feldman and Freedenthal’s (2006) recommendation to incorporate more comprehensive suicide intervention and prevention training, either during or immediately after a training program, to address historical gaps in suicide prevention preparedness in counselor education. Hypotheses were formulated, positing that participants’ self-efficacy in suicide intervention and perceived effectiveness in working with individuals with suicidal thoughts would significantly improve after ASIST training.

After Institutional Review Board approval, participants were criterion-sampled from emerging counselors attending one of five ASIST workshops conducted by the first and second authors over four semesters. Four workshops were offered free of charge as part of a research grant, while the final workshop required payment for the manual and shipping expenses. Research procedures included participants completing a demographic form, pre- and post-surveys assessing self-efficacy in working with individuals experiencing suicidal thoughts and engaging in simulations and role-plays to master the training content. Participants were randomly assigned to groups during role plays and paired with another individual for practice. The workshops introduced participants to the PAL model, guiding suicide first aid provision. In addition, trainers observed participants’ skills during practice and provided feedback.

Participants

The study included 87 participants comprising emerging counselors who completed the 14-hour ASIST training. Demographic information was not reported by a small proportion of participants (n = 2, 2.3%). Participants’ ages ranged from 22 to 58 years (M = 27.42, SD = 9.45). The sample exhibited diversity in racial and ethnic backgrounds: Asian/Asian American/Pacific Islander (n = 1, 1.1%), Asian/Asian American/Pacific Islander and White/Caucasian (n = 1, 1.1%), Black/African American (n = 11, 12.7%), Black/African American and Hispanic/Latino(a) (n = 2, 2.3%), Hispanic/Latino(a) (n = 3, 3.5%), Middle Eastern/Arab (n = 1, 1.1%), White/Caucasian (n = 65, 74.8%), Multiracial/Biracial (n = 1, 1.1%), and two participants who elected not to answer (n= 2, 2.3%). Most participants identified as female (n = 79, 90.8%), and a smaller percentage as male (n = 6, 6.9%), with two participants who elect not to answer (n = 2, 2.3%). The sample included graduate students (n = 71, 81.6%), professional counselors (n = 6, 6.9%), faculty (n = 2, 2.2%), staff/administrators (n = 1, 1.1%), and individuals identifying in a combination of roles including graduate student and professional counseling (n = 3, 3.5%) and graduate student and staff/administrators (n = 2, 2.3%). The primary counseling specialty reported was Clinical Mental Health Counseling (n = 63, 72.4%), followed by School Counseling (n = 12, 13.8%), Clinical Rehabilitation Counseling (n = 4, 4.6%), Counselor Education (n = 3, 3.5%), Counseling Psychology (n = 2, 2.3%), one participant (1.1%) indicated not applicable, and two participants did not to answer (n = 2, 2.3%).

Treatment fidelity

The ASIST sessions in this study were conducted by two doctoral-level counselor educators who underwent a 5-day ASIST trainer training, ensuring adherence to the standardized ASIST manual (11th ed.; Lang et al., 2013). The workshops followed the manual’s structure and provided comprehensive information on suicide, suicide risk, and suicide first-aid, incorporating experiential learning through simulations and role plays facilitated by the trainers. Consistency in content, experiential simulations, and role plays was maintained across all ASIST workshops according to the ASIST manual (11th ed.; Lang et al., 2013). Training adherence was documented, and participant feedback was collected through ASIST participant feedback forms. Certification and inclusion in the study required participants to complete the full 2-day training, with data from incomplete participants excluded and measures with unmatched codes securely discarded.

Instrument

The Counselor Suicide Assessment Efficacy Survey (CSAES; Douglas & Morris, 2015) evaluates efficacy in four domains or subscales: general suicide assessment, personal characteristics, suicide history, and suicide intervention. This measure was appropriate for this study since it was developed from and tested on both master’s level counseling students and counseling faculty. Utilizing a 5-point Likert scale (1=not confident, 5=highly confident), the scale provides scores ranging from 25 to 125; higher scores indicate more self-efficacy in the four domains. Sample items include assessing risk level (“I can effectively assess a person’s level of risk for a suicide attempt”) and inquiring about family history of suicide (“I can effectively ask a person about his or her family history of suicide”). The internal reliability of the scale during development demonstrated strong values, with Cronbach’s alpha coefficients of .88, .88, .81, and .83 for the respective subscales. In the current study, the scale exhibited robust reliability with a calculated Cronbach’s alpha of .93.

Participants were given the CSAES before and after completing the training to assess their self-efficacy in working with individuals experiencing suicidal thoughts. To ensure confidentiality, each participant received a unique 3-digit identifying number they used on the pretest and posttest, allowing for anonymous tracking of scores. Data collection occurred through paper-and-pen assessment instruments administered before the start of Day 1 and at the end of Day 2 of each training. Participants also completed a demographic form capturing relevant information. Data entry was conducted electronically and securely stored in a password-protected file. The analysis of the data involved using the Statistical Package for Social Sciences (SPSS) and performing a paired samples t-test to examine significant differences between pre and posttest scores. Statistical significance was determined at p < .05. Eighty-seven participants from five trainings were included in the survey for self-efficacy measurement. To assess whether there had been changes in self-efficacy before and after completing the ASIST program, a paired samples t-test was conducted. Additionally, effect sizes are reported at the overall and item level.

Results

Assumptions were met with participants being randomly sampled and data paired by numerical identifier. A Kolmogorov-Smirnov test indicated the differences were normally distributed (82) = .072, p = .200. No outliers were identified for the overall difference. The findings revealed a significant increase in overall self-efficacy among participants after completing the ASIST program (M = 4.52, SD = 0.50), compared to before the training (M = 2.95, SD = 0.86), as evidenced by a paired samples t-test, t(82) = −18.38, p < .001. Furthermore, overall self-efficacy met Cohen’s (1988) convention for a large effect size (d = .78), emphasizing the meaningful difference between pre- and post-test means. A Gpower analysis with an effect size of .78 and a sample size of 82, indicated a power value of 0.99.

While the needed assumptions regarding data sampling and pairing were met for all subscales, a Kolmogorov-Smirnov test and Q-Q plot showed that normality assumptions were not met for the subscales. The null hypothesis for the general suicide assessment subscale was not rejected using the Kolmogorov-Smirnov test (D[82] = .101, p = .038), and one outlier was identified. The null hypothesis for the assessment of personality characteristics subscale was not rejected using the Kolmogorov-Smirnov test (D[82] = .136, p = < .001). The null hypothesis for the assessment of suicide history subscale was not rejected using the Kolmogorov-Smirnov test (D[75] = .132, p = .003). Finally, while the null hypothesis was rejected for the suicide intervention subscale using the Kolmogorov-Smirnov test (D[75] = .096, p = .083), two outliers were identified. Given this weakness revealed in the assumptions violated, additional nonparametric tests were completed for each subscale with the null hypothesis rejected for each.

A paired-sample t-test was conducted on each assessment subscale to explore the impact of ASIST on counselors’ self-efficacy in specific areas. Results demonstrated significantly higher self-efficacy scores across all subscales (see Table 1). For example, the general suicide assessment subscale showed a marked increase in self-efficacy after the training (M = 4.59, SD = 0.93), compared to before (M = 2.66, SD = 0.97), t(82) = −15.60, p < .001. Similarly, the assessment of personal characteristics (M = 4.43, SD = 0.51), assessment of suicide history (M = 4.64, SD = 0.47), and suicide intervention (M = 4.54, SD = 0.48) subscales displayed significant improvements in self-efficacy (p < .001). The effect sizes ranged from .82 to 1.12, all indicating large effects and highlighting the substantial impact of ASIST training on self-efficacy within each subscale. The effect sizes ranged from .802 to 1.12, all indicating large effects and highlighting the substantial impact of ASIST training on self-efficacy within each subscale (Cohen, 1988).

Table 1. Means, standard deviations, and pretest-posttest results of the Counselor Suicide Assessment Efficacy Survey (CSAES).

	Pretest		Posttest
Item	M	SD	M	SD	t	p	Cohen’s D
General Suicide Assessment Subscale	2.664	0.970	4.588	0.934	−15.598	<.001	1.117
Assessment of Personal Characteristics Subscale	3.152	0.912	4.429	0.507	−14.422	<.001	0.802
Assessment of Suicide History Subscale	3.089	1.047	4.644	0.469	−14.023	<.001	0.961
Suicide Intervention Subscale	2.813	0.959	4.536	0.476	−16.395	<.001	0.910
Overall Mean	2.947	0.860	4.521	0.502	−18.382	<.001	0.775

For the general suicide assessment subscale, a Wilcoxon Signed Ranks test showed that there was a significant difference (Z = −7.869, p = <.001) with higher efficacy scores after the intervention (Md = 4.143, n = 82), compared to before (Md = 1.857, n = 87) and a large effective size, r = −0. 605. For the assessment of personality characteristics subscale, a Wilcoxon Signed Ranks test showed that there was a significant difference (Z = −7.822, p = <.001) with higher efficacy scores after the intervention (Md = 4.600, n = 82), compared to before (Md = 3.300, n = 87) and a large effective size, r = −0.602. For the assessment of suicide history subscale, a Wilcoxon Signed Ranks test showed that there was a significant difference (Z = −7.169, p = <.001) with higher efficacy scores after the intervention (Md = 5.000, n = 79), compared to before (Md = 3.000, n = 83) and a large effective size, r = −0.563. For the suicide intervention subscale, a Wilcoxon Signed Ranks test showed that there was a significant difference (Z = −7.360, p = <.001) with higher efficacy scores after the intervention (Md = 4.600, n = 79), compared to before (Md = 2.800, n = 83) and a large effective size, r = −0.578.

Discussion

This study evaluated the impact of ASIST on counselors’ self-efficacy in addressing suicidal ideation. The pre-posttest results indicated a significant increase in participants’ overall self-efficacy after completing ASIST, highlighting the program’s potential as a valuable supplement to counselor training. These findings align with and build upon previous research that has demonstrated the positive effects of ASIST on counselors’ attitudes and confidence in working with individuals at risk of suicide (Elston et al., 2020; Griesbach et al., 2008; Rodgers, 2010; L. Shannonhouse et al., 2017). Regarding attitude and confidence, Elston et al. (2020) found that counselors who completed the ASIST program reported more positive attitudes toward working with suicidal clients and greater confidence in their ability to intervene effectively. Similarly, Griesbach et al. (2008) observed that ASIST participants showed improved confidence and knowledge about suicide prevention. These studies collectively support the notion that the ASIST program can positively influence counselors’ attitudes, knowledge, and now, self-efficacy in working with clinical matters regarding suicide.

While existing literature has emphasized the effectiveness of ASIST, the current study uniquely focused on counselors’ self-efficacy. This study’s results are promising, as counselors with self-efficacy in working with suicidal individuals will exhibit greater engagement in asking and attending behaviors of at-risk individuals. By specifically evaluating self-efficacy, this study contributes to the growing body of literature on strategies for enhancing counselor self-efficacy in the context of suicide assessment and intervention. The increased likelihood of lifesaving intervention is supported by previous studies that demonstrated participants who completed ASIST engaged in helping twice as many suicidal clients as those who did not complete ASIST, suggesting a potential influence of increased self-efficacy on counselors’ willingness to engage with suicidal clients (Coleman & Del Quest, 2015; Elston et al., 2020). In addition, the observed increase in counselors’ overall self-efficacy following the ASIST program provides further evidence of its effectiveness in improving counselors’ beliefs in their ability to address suicidal ideation. An optimistic consideration is that retaining competence from ASIST training has been found to be significant at follow-up periods of 3 to 6 months (Foster et al., 2017; L. R. Shannonhouse et al., 2018). Therefore, integrating evidence-based gatekeeper training workshops like ASIST into counselor training programs can be a valuable approach to addressing the existing suicide prevention training gaps while also empowering counselors to intervene effectively in suicide risk situations long-term.

Implications for counselor education

Recognizing the escalating significance of suicide intervention and professional growth in counseling training programs, clinical supervision, and mental health facilities, gatekeeper training programs like ASIST emerge as invaluable supplements capable of significantly augmenting clinician competence and self-efficacy. Furthermore, ASIST is highly relevant for professionals like school counselors and clinical rehabilitation counselors who may not usually undergo extensive suicide training nor have ongoing responsibilities and skill building for the care of suicidal individuals. However, these professionals often find themselves in situations where they interact with individuals experiencing thoughts of suicide. The structured and comprehensive nature of ASIST provides them with essential suicide first-aid and response skills, bolstering their ability to navigate and intervene effectively in such situations within the scope of their respective practice domains.

To harness the full potential of ASIST, collaborative efforts among counselor educators, administrators, supervisors, and clinicians are pivotal. By engaging with local ASIST trainers, available through the LivingWorks platform (https://legacy.livingworks.net/training-and-trainers/find-a-training-workshop/), stakeholders can establish recurring or on-demand training sessions for students, providers, and staff. As well, integration of ASIST into counseling education proves transformative, offering students a comprehensive understanding of suicide that complements coursework on crisis, trauma, and suicide intervention. This incorporation positively influences their attitudes, beliefs, comfort, and confidence in effectively intervening with suicidal individuals, delivered in a structured format by experts in the ASIST model, yielding proven beneficial effects (Lang et al., 2013).

This level of preparedness also equips future counselors with adaptive coping skills, mitigating the likelihood of severe emotional responses arising from interactions with suicidal individuals (McAdams & Foster, 2000). Supervisors, in turn, can enhance their support for supervisees by familiarizing themselves with gatekeeper trainings, enriching their expertise and knowledge in guiding professionals through challenging situations. Aligning with Knox et al. (2006) recommendations, training programs, and supervisors should focus on preparing trainees for the emotional impact of working with suicidal individuals, as well as the aftermath of a client’s suicide. This comprehensive approach ensures counselors are well-prepared to address the multifaceted aspects of suicide intervention, fostering overall effectiveness and comfort in helping individuals in crisis.

The advantages of ASIST extend across the spectrum of counseling practitioners. For novices, ASIST imparts essential skills and knowledge, providing foundational training and tools to navigate the complexities of suicide intervention. Experienced counselors, on the other hand, can leverage ASIST to refresh and reinforce their crisis counseling abilities, applying the PAL model embedded within ASIST. This model guides the provision of suicide first aid, emphasizing the importance of building a connection, engaging in crisis resolution, and implementing a follow-up plan for ongoing support and safety (Jobes, 2016). Thus, seasoned counselors, counselor educators, and clinical supervisors can enhance their effectiveness in working with individuals experiencing suicidal thoughts and improve outcomes for their clients.

The applicability of ASIST extends even into the non-clinical positions within mental health facilities. Incorporating ASIST training into professional development programs equips administrative staff and other non-clinical personnel with essential suicide first-aid skills. Moreover, ASIST is particularly valuable for other professions with elevated suicide rates, including the military, non-psychiatric medicine, veterinary science, dentistry, and first responders. Tailoring ASIST to these professions not only enhances mental health awareness but also bolsters prevention efforts and intervention strategies within their respective domains, contributing to a comprehensive approach to suicide prevention.

Limitations and recommendations for future research

These findings highlight the importance of continuous improvement and exploration of suicide intervention training to empower counselors and enhance their readiness to support individuals at risk of suicide. However, it is crucial to consider the limitations that may impact the generalizability of the findings. These include using self-reported data, which may introduce biases, and the quasi-experimental design without randomization and control groups, making it challenging to establish causal relationships. Another important consideration is the potential influence of facilitator effects during ASIST, as trainers’ prior interactions with participants may impact their engagement and comfort with the material. Furthermore, participants’ clinical experience and the frequency of crisis management in their work settings may affect their self-efficacy.

Outcomes may vary among participants with licensure as professional counselors or those with greater clinical experience compared to the sample involved in this study. Financial considerations related to the varying costs of ASIST and the scheduling challenges posed by the two-day duration of the training should also be considered. Readers should exercise caution in interpreting the results, considering the potential influence of various extraneous variables on the outcomes of this study. Future studies should address these limitations by employing more rigorous study designs and exploring alternative data collection methods. Future research should also replicate these findings with larger and more diverse samples, conduct longitudinal studies to assess the long-term effects of ASIST and explore the experiences of utilizing ASIST through qualitative studies. By addressing these limitations, we can further advance suicide intervention practices and improve the quality of counselor training programs.

Conclusion

This study examined the impact of ASIST, a gatekeeper training program, on the self-efficacy of emerging counselors in addressing suicidal ideation. Through a pre-and posttest design, participants demonstrated a significant increase in self-efficacy related to employing suicide intervention skills. These findings support the effectiveness of ASIST and the potential of utilizing gatekeeper training to enhance counselors’ abilities and confidence in suicide prevention. Incorporating gatekeeper training programs like ASIST into counselor education and mental health facilities can improve suicide intervention efforts and contribute to a suicide-safer community.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by an Auburn University departmental faculty research grant.

Notes on contributors

Jessica Meléndez Tyler

Jessica Melendez Tyler, PhD, LPC-S, NCC, is an Associate Professor of the Practice in the Department of Human and Organizational Development at Vanderbilt University.

Heather Delgado

Heather Delgado, PhD, LCMHCA, NCC, is an Assistant Professor in the Department of Counselor Education at Buena Vista University.

Elizabeth Brittany Dennis

Elizabeth Brittany Dennis, PhD, LPC, NCC, is an Assistant Professor in the Department of Counseling, Rehabilitation, and Interpreter Training at Troy University.

Madeline LaPolla

Madeline LaPolla, PhD, LPC, NCC, is a recently graduated doctoral student in the Special Education, Rehabilitation, and Counseling Department at Auburn University.

John W. Elmer

John W. Elmer, M.Ed., is a doctoral student in the Department of Educational, School & Counseling Psychology at the University of Missouri.