Case Study: Designing Professional Training for Suicide Prevention

Audience

I completed ethnographic interviews with several educators from our target population and consulted with my team (members of which had worked extensively in the school system as educators and/or school counselors).

Key insights:

• Educators are often the first point of contact for youth receiving mental health services. However, their primary training didn’t prepare them for the mental health work they are expected to do.

Impact: This insight led me to frame the training as necessary to fill in gaps in training through mental health literacy.

• Educators are incredibly busy and are constantly being asked to go above and beyond. They also complete several professional trainings each semester.

Impact: This insight led me to prioritize delivering the material quickly and memorably to increase buy in and convince educators that this information should be considered a priority.

• “If teachers don’t see kids that are close in age to their students, they won’t relate to the training module.”

Impact: This insight led me to prioritize finding video content closely matching classroom settings.

Secondary Research

Research goals included finding information to increase educators’ buy in and suggest actionable steps. I looked for quantifiable information and specific warning signs that could be presented to educators, keeping in mind that we would have limited time with them.

Key insights

• Suicide in the third leading cause of death among teenagers. Each year in the United States, approximately 2 million children and adolescents attempt suicide. 

• Considering the prevalence of youth suicide attempts in the United States, it is likely that in a class of 24 students, 4 students consider suicide, 3 make a plan, and 2 make a suicide attempt each year.

• Warning signs include: talking about death or wanting to die, talking about feeling hopeless or empty, planning or researching ways to die, feeling intense physical or emotional pain, giving away possessions, saying goodbye to others, demonstrating risky behavior, change in eating or sleeping, and withdrawing from others.

Impact

This information provided a framework with which we would be able to both convince educators that youth suicidality is a real danger to their students, as well as give them an understanding of behavioral indicators to watch out for.

I presented the research to my team in a way that I felt would best facilitate collaboration: in 1-2 page executive summaries of each topic with an easily scanned visual hierarchy.

Learning Objectives

With oversight from the directors and collaboration with the senior instructional designer, I pulled information from the research to create objectives in line with learning goals: teaching educators to be better able to identify behavioral signs of distress with greater self-efficacy (confidence in their abilities). Keeping in mind that educators are constantly completing professional trainings, I sought to make this material more memorable by focusing on teaching key points from the research with specific, actionable takeaways, as well as keeping the overall list relatively short.

Script Writing

Drawing information from research and with learning objectives in mind, I wrote a script for 6-8 minutes of content (out of a total of 10 minutes for the module). Based on Mayer’s Personalization Principle, as well as feedback from the directors and school professionals who were consulted, I wrote the script with a conversational tone that centered the experiences of the educator. By using specific examples, I aimed to increase educators’ understanding of and ability to recognize behavioral indicators.

View Script

Assessment Development

We used performance based metrics to measure whether educators had successfully retained the information. Ultimately, we wanted educators to be able to identify behavioral signs of distress and exhibit greater self-efficacy.

With oversight from the directors and collaboration with the senior instructional designer, I created assessments (both pre- and post-) with 70% minimums to test educators’ recall of specific information and behavioral indicators from the modules. Due to the time constraints of the module, questions were designed to take 1-2 minutes to answer in total. I then input these questions, along with feedback for incorrect answers, into the Canvas test bank.

I also adapted a self-efficacy Likert Scale assessment for our use, based on a research specialty of one of the directors. This would allow us to measure educators’ feelings of mastery over the material.

Data from these measures would later be used to fuel continued research and innovation.

View Assessments

Video Content

Due to insights about educators not relating to images of classrooms that don’t look like their own, I prioritized finding video content matching their classroom environment. This meant finding a wide range of age groups to represent, as well as finding multicultural images as much as possible.

Parameters

• Creative Commons and educational material as much as possible; ensure fair use

• High resolution videos and photos (1080p and at least 300 dpi with at least 1000 x 1000 pixels)

• Show specific, observable behavioral indicators as much as possible, thinking practically about what would be useful to an educator with no prior mental health training

I sourced content from multiple sharing sites using search terms such as “depression, anxiety, school children, classroom, suicidal thoughts, disruptive behavior, playground,” etc.

Screenshots of some of the videos that were used:

Storyboarding

With the script and video content ready, I created a storyboard to organize content and ensure information would be communicated in the best way possible. This included queuing up specific video clips to go with the script while the senior instructional designer practiced voicing it and provided feedback on pacing. I also gathered extra video clips to use as backup.

I separated the information into 3 columns: script, video source, and selected clip with description, with each part of the script visually corresponding to a segment of video clips.

Impact

The senior instructional designer used the storyboard as a reference for her work with the video editor and for designing the course in Captivate. Using a storyboard also allowed us to better see where there may be gaps in our imagery.

Iteration

All content went through multiple rounds of feedback and iteration based on the reactions of the directors, the senior instructional designer, and stakeholders such as the superintendent of schools.

Script

The script went through at least 3 rounds of edits with feedback given by both directors and senior instructional designer and ultimate approval given by the directors.

We used color coding to better visualize the structure of the script and ensure it met learning objectives:

Edits

• With more information added in each round, I became stricter with cutting length and being concise. This included consolidating behavioral signs instead of dividing them into multiple sections of content.

• Instead of using clinical terms like internalizing and externalizing, I increasingly relied on conversational (and therefore more relatable) descriptions of behaviors as either “internal or external signs.”

• I also increased emphasis on Adverse Childhood Experiences (ACEs) and their negative impact on children’s health and behavior, an area of study that would be especially relevant for Title I schools.

Video Content

Video content went through at least 4 rounds of edits with feedback and ultimate approval given by the senior instructional designer.

Edits

• We received feedback that some of the images of self-injurious behavior were too graphic. Also, some behaviors were not being represented at all.

Solutions: I sought out more general footage to accompany the voice over and focused more on 2 or 3 main behavioral indicators instead of all of them. The senior instructional designer then designed graphic overlays to replace some of the visual representations of behaviors.

• Footage of school children was not culturally diverse enough and did not present enough variability in ages to be relatable for educators. This was due in part to difficulty in finding high quality content and having somewhat limited choices as a result.

Solutions: I expanded the number of sources I used for finding materials and reused some footage between modules. I also added still shots to accompany video clips. Adding more generic footage and relying more heavily on the script and graphic overlays helped with this as well.

Impact & Improvements

My work on this project as part of my graduate research experience in counselor education helped the BIT program complete 3 training modules. The program would later increase to 7 modules and implement pilot testing before rolling out to the entire state of Florida.

Research by Co-Director of the BIT program, Dr. Laurie Campbell (Campbell et. al., 2019) found that, in a field test of the first two modules,

“Results indicate an improvement in knowledge of behavioral indicators and improved self-efficacy for recognizing suicide ideation, suicidality, and self-injurious behavioral indicators.”

The training proved effective as a teaching tool and as a tool to increase educators’ confidence in their abilities to handle mental health concerns in the classroom.

In the future, this work could be built upon by

• Completing continued testing with target users/learners and continuing direct collaboration with stakeholders such as superintendents, teachers, school counselors, and other educational professionals

• Continuing to built short, interactive content intended to increase educator self-efficacy

• Building extended educational content to supplement existing modules, as well as interactive guides and other resources for further education (for example, articles depicting who to contact in the case of mental health concerns)

• Expanding and adapting this training for educators in other states.

Citation

Campbell, L.O., Haugen, J.S., Sutter, C.C., Lambie, G.W. Building Capacity for Mental Health Literacy of Suicidality and Self-Injurious Behaviors: a Formative Design Investigation. J Form Des Learn 3, 53–61 (2019). https://doi.org/10.1007/s41686-019-00029-y.