stigma and barriers to care - Uniformed Services University of the ...

Optimizing Access to Care 83
with its learning outcomes, the transfer of that training — meaning, to the setting it
is supposed to be implemented, and then finally the clinical outcomes.
Variables at the pre-training level phase include things like the program components,
the curriculum, and manuals. What about the training modality That is
a pre-training variable. Is it conducted face to face What about the move toward
online training Wouldn’t it be interesting to put these modalities head to head in
studies of training Other pre-training variables are the trainer and trainee characteristics.
Hendricks Brown mentioned something about this. There are studies that
have looked at individual training char acteristics, and we have examined some of
these characteristics in our studies as well. It turns out that if somebody already had
similar training, they show better learning outcomes than those who are new to the
training. The question of trainee selection challenges our typical “one-size-fits-all”
approach to many of our training programs.
We have conducted studies that have examined training modalities. One study
examined a program that Hendricks discussed, the QPR program, which is primarily
a “passive learning” approach in the form of lecture. We wanted to do a training
study and thought that if we are looking for behavior change as a learning outcome,
why do we not put behavior into the training We randomly assigned people to two
conditions, either training as usual — which is a knowledge transfer type of training
using a lecture like I am doing right now — or training with a low-tech, behavioral
rehearsal condition within small groups. We used standardized patients, actors actually,
to test trainee gatekeeper skills. I will present our findings in just a minute. The
other training modality that we have examined in two studies is the train-the-trainer
model. It is very popular and considered to be very efficient. Here is an example of
how a train-the-trainer program can be efficient. First, you have master trainers who
deliver the training to people who come to be trained, and here are all those new
instructors delivering the training to many other people, who then go on to deliver
the intervention in practice to many, many target individuals. Exponential growth!
I said that I would mention two train-the-trainer studies. One was a naturalistic
study of a disaster mental health training program. We followed the dissemination
process for a year to assess “spread”: Does the train-the-trainer model actually
spread the way it is intended That is, do new instructors go on to train others as
intended The other study is a suicide hotline prevention study. In this case, we are
conducting observational coding of the newly trained trainers to look at “quality”
to answer the question: If you could get 100% of the people to conduct the training
with the next generation in the train-the-trainer model, how well do they deliver it
These are the types of questions you might pose about pre-training characteristics
and variables.
Moving on in the model to the training event, we can measure learning outcomes
such as knowledge, attitude, and skills. Often, people assess confidence or
self-efficacy as a measure of attitudes. In terms of popularity, after satisfaction, the
most frequently measured learning outcome is pre-post knowledge change. Change
in knowledge is considered to be necessary for change in behav ior, but the literature
shows that improved knowledge is not sufficient for changes in most behaviors.
There is a relationship between enhanced attitudes and skill development, therefore
it would be good to measure attitude change — it might predict behavior change.
We demonstrated the same learning outcomes with the QPR program as Hendricks
Brown did in a different school setting. We found that both parents and teachers had
the same change in knowledge about suicide and suicide prevention and the change