title: 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.
  
  
  OBJECTIVE
  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. In all, 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.
authors.affiliation: <location>Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, NY, USA</location> <location>Department of Pediatrics, University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Wendi F
authors.initials: WF
authors.lastname: Cross
authors.affiliation: <location>Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, NY, USA</location> <location>Department of Pediatrics, University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Pisani
authors.affiliation: <location>Department of Psychiatry, University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Karen
authors.initials: K
authors.lastname: Schmeelk-Cone
authors.affiliation: <location>Department of Biostatstics and Computation Biology, University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Yinglin
authors.initials: Y
authors.lastname: Xia
authors.affiliation: <location>Department of Biostatstics and Computation Biology, University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Xin
authors.initials: X
authors.lastname: Tu
authors.affiliation: <location>Center for Employee Wellness at the School of Nursing at the University of Rochester Medical Center (URMC), Rochester, NY, USA</location>
authors.forename: Marcie
authors.initials: M
authors.lastname: McMahon
authors.affiliation: <location>Division of Child and Adolescent Psychiatry at the New York State Psychiatric Institute, New York, NY, USA</location>
authors.forename: Jimmie Lou
authors.initials: JL
authors.lastname: Munfakh
authors.affiliation: <location>Division of Child and Adolescent Psychiatry at the New York State Psychiatric Institute, New York, NY, USA</location> <location>Departments of Psychiatry and Epidemiology (School of Public Health), Columbia University Medical Center, New York, NY, USA</location>
authors.forename: Madelyn S
authors.initials: MS
authors.lastname: Gould
mesh_terms: D003419:Crisis Intervention / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D013663:Teaching / Q000379:methods / Q000592:standards; D000092864:Suicide Prevention
keywords: Suicide prevention; fidelity; observations; telephone crisis service; train-the-trainer