Delivering Professional Development in Suicide Prevention

Abstract

Online learning has emerged as a new technology for professional development for secondary school teachers and staff, including administration and nonclinical counselors. It is unknown if suicide prevention can be taught and learned effectively in an online learning modality. A quasi-experimental pre–post design study compared suicide prevention knowledge of 197 secondary public school teachers, administrators, guidance counselors, and staff in a traditional 2-hour in-person training versus a self-paced Web-based online training. Both training modalities led to a statistically significant increase in knowledge; however, knowledge acquisition was significantly greater among individuals in the online training. Age of the participants moderated the relationship across the two training modalities. The majority of participants reported the online training as useful and relevant, and 100% would recommend the online suicide prevention training to others. Online trainings are just as effective in teaching emotionally sensitive content such as suicide prevention as traditional in-person trainings.

Keywords

online learning professional development suicide prevention

Online learning or distance learning has emerged as a new approach to learning beyond the classroom. A variety of academic disciplines in higher education (e.g., social work—Vernon, Pittman-Munke, Vakalahi, Adkins, & Pierce, 2009; Education—Topper, 2007; general education—Burkhardt, Kinnie, & Coumoyer, 2008) as well as postgraduate professional development and continuing education for secondary education (Trindade, Carmo, & Bidarra, 2000) have adopted online learning to reach their populations. Professional development of educators is required to maintain knowledge of the expanding field of issues that are confronted after formal education has been completed. While no official statistics regarding the utilization of online professional development among educators could be found, there are a variety of websites offering access to online professional development opportunities.

Online professional development has grown in its popularity, as traditional in-person professional development is more rigid in scheduling and limited in offerings (Kleiman, 2004; Russell, Carey, Kleiman, & Venable, 2009; Vrasidas & Zembylas, 2004). Given the demands on time and the need to balance professional, educational, work, and family/personal responsibilities, online professional development is a logical mode of education (Dash, de Kramer, O’Dwyer, Masters, & Russell, 2012). A survey of 510 school psychologists demonstrates a situation similar to that of educators (Armistead, Castillo, Curtis, Chappel, & Cunningham, 2013). While approximately 50% of school psychologists report having taken an online professional education webinar/course, almost half of all participants indicated they would like more online professional development opportunities because they reported that excessive cost, heavy workload, and family obligations make traditional education difficult (Armistead et al., 2013).

Some of the many benefits of online or distance learning include its efficiency, inexpensiveness, and flexibility (James, 2002). Online learning is efficient as it has the opportunity to reach a vast audience of learners; it is inexpensive since once the training is developed the costs to maintain and update the training are minimal; and, finally, online learning without face-to-face contact is flexible, allowing learners to proceed through the content at their own pace (Russell et al., 2009). The Web-based Education Commission (2000, as cited in A. Brown & Green, 2003) reports that Web-based professional development for secondary education (i.e., middle and high school) teachers is not only convenient, it also allows teachers to have access to high-quality education and experts that local schools and districts may not be able to afford. While there have been several evaluations of online versus traditional face-to-face learning, the majority of the studies have not been conducted regarding the professional development of secondary teachers. Similar to studies of high school students (Angiello, 2010) and college students (Rabe-Hemp, Wollen, & Humiston, 2009), secondary school teachers who received professional development via an online program learn just as much if not more than those in traditional face-to-face learning (Dash et al., 2012).

It has been suggested that students need student–teacher interaction or reduced transactional distance when learning complex material (Brown & Liedholm, 2002; Hauser, Paul, & Bradley, 2012). However, pure online learning, de facto, reduces human contact or, at least, increases the distance between teacher and learner, which may be necessary for discussion and education of more complex and sensitive or emotional topics, such as suicide, which may evoke a more personal emotional response (Hauser et al., 2012; Vernon et al., 2009). While learning online may be better for a variety of reasons, there may be emotionally sensitive content (trauma, depression, abuse, and suicide) that are understandably more difficult to learn via an online environment.

Students in an online learning environment may learn more because they take ownership of the material rather than being passive receptacles of a teacher in a commonly used face-to-face didactic teaching environment (Rabe-Hemp et al., 2009). Nevertheless, it has been suggested that these differences are based on self-selection of method of learning, meaning that those who select online learning do so because they are more confident and comfortable with the technology (Burkhardt et al., 2008). Confidence with technology and perceived ease of use of technology may be directly related to success in online classes compared to those who lack confidence with technology (Miller, Rainer, & Corley, 2003). Online learning requires knowledge of, and access to, computers, which may impede the learning experience of students who have been out of school for an extensive period of time and not as accustomed to using computers. Kao, Tsai, and Shih (2014) surveyed 214 elementary school teachers in Taiwan finding that teachers with greater Internet competence and comfort level are more accepting and willing to participate in Web-based professional development; however, Kao et al. did not adjust for age of the teacher.

The self-pacing option for online Web-based training may be particularly beneficial for learners when addressing stressful and emotional material. By moving through the content at an individually tailored pace, the learner can repeat material that is confusing or stop and restart, if breaks are needed due to fatigue, emotional concerns, or distractions. If the material being presented is stressful or evokes emotion, the individual could be distracted from the psychoeducational material and fail to capture details and thus fail to learn during the face-to-face presentation (Andersson et al., 2013). Hence, having the ability to repeat the material or take breaks during the online training may increase knowledge acquisition of sensitive and emotional material, such as suicide prevention.

In a randomized trial of online versus face-to-face cognitive-behavioral therapy for the treatment of depression, Andersson et al. (2013) found the online/Internet cognitive-behavioral therapy to be just as effective in treating depression among adults as the face-to-face therapy. The online Internet cognitive-behavioral therapy is a guided self-help group that requires participants to do work on their own via reading, submitting weekly homework, and receiving feedback from a therapist within 24 hours of submitting the homework. A randomized comparative study of online versus face-to-face cognitive-behavioral therapy demonstrated no difference in improvement, with both approaches being effective in reducing depressive symptoms (Andersson et al., 2013). This suggests that addressing emotional content during depression treatment via an online format may not interfere with treatment impact. However, individuals seeking help for depression may be motivated to improve and, therefore, overlook the emotional distress for the greater good. Contradictory evidence is suggested by Karam, Clymer, Elias, and Calahan (2014), who compared traditional learning with blended learning (part online part in-person) for students learning about couple and family relationships. Their study also found that despite knowledge being the same at baseline, students in traditional in-person classrooms learned more than those students in the blended learning environment. They suggest that for students to learn more personal and social science type of content there needs to be more social interaction and exchange with other students and the teacher, which is not as available in the blended learning situation (Karam et al., 2014).

Professional Development in Suicide Prevention

The No Child Left Behind Act (Klein, 2015), passed by President of the United States George W. Bush in 2002, sought to update the Elementary and Secondary Education Act of 1965 (a law that demonstrates the commitment to equal opportunity for all students), by requiring schools to be accountable to student outcomes. Under the No Child Left Behind Law, if states receive funding for programs and services for struggling learners, they are required to provide educators with professional development. However, the amount and content of the professional development vary by state and even local district (U.S. Department of Education, & Office of Elementary and Secondary Education, 2002). As of Fall 2015, 27 states in the United States had legislative mandates for educators to obtain professional development in suicide prevention. Educators see students every day and are well situated to be able to recognize changes in a youth’s behavior. Educators often identify students in their classrooms who, for one reason or another, seem vulnerable or at risk for problematic behavior. Therefore, educators are in an ideal position to identify and refer youth at risk for suicide to the appropriate school resources. However, these educators may be unsure as to whether what is being observed is part of the normal ups and downs and challenges of adolescence or is indicative of something more severe. The goal of professional development in suicide prevention is to improve educators’ awareness of suicide risk and their ability to identify and refer youth to the appropriate school professionals. Given that in 2014 in the United States, over 42,000 individuals died by suicide with approximately 1,800 of those individuals being between 10 and 18 years (Centers for Disease Control and Prevention & National Center for Injury Prevention and Control, 2014), educators in secondary schools are not the only individuals in schools who may be in a position to identify a student who may be at risk for suicide. In fact, administrators, school staff, and academic counselors may also benefit from training in suicide awareness, identification, and referral processes. Therefore, while the legislation requires teachers to receive professional development in suicide prevention, other school staff, counselors, and administrators often participate in the trainings.

State mandates for suicide prevention training/education vary in length (1-8 hours, with the mode being 2 hours) and the frequency with which they should occur (every year to every 5 years). However, given the demands for professional development and limits in professional days and time, there is growth in the need for online professional development inclusive of sensitive topics such as suicide prevention.

Content of Professional Education in Suicide Prevention

School suicide prevention programs are not intended to serve as outpatient counseling programs, nor should schools be expected to be mental health counseling centers (Underwood, Kalafat, & the Maine Youth Suicide Prevention Program, 2009). Instead, school suicide prevention programs should enjoin all members of the school community to work together to identify youth who are at risk for suicide and refer them to appropriate resources. Under this philosophy, the school is viewed in the context of a “competent community,” where all members care about each other’s welfare and know how to get help for those students in need (Kalafat & Underwood, 2008; Underwood et al., 2009).

The typical suicide prevention training for school educators and staff is intended to facilitate an understanding of the nature of suicide and identification of suicide warning signs, risk factors, and protective factors among adolescents. Providing practical examples during the training can help learners improve their ability to recognize the signs of suicidal behavior and risk in adolescents, know the appropriate resources for referral, and know how to refer identified students to these services/resources. This material is not meant to stimulate an emotional response; however, some individuals who have had exposure to deaths by suicide or suicidal attempts or have had suicidal thoughts themselves may get upset by the content as they apply the information to their own lives.

The studies reviewed above document the benefits of online professional development compared to traditional in-person methods. However, it is unclear if online professional development through a self-paced, Web-based course would be as effective as traditional in-person teaching modality for potentially emotionally charged content such as suicide prevention. In the United States, many states require school personnel to be educated in suicide prevention in order to help identify students who may be at risk for suicide. Therefore, this study seeks to determine the following questions: Would teachers and staff (defined as nonteachers including academic counselors and administration) from public secondary schools in the United States learn as much about suicide prevention in an online modality as teachers and staff in traditional in-person learning? Would their learning be moderated by their age and comfort with technology? Would their learning be affected by their previous experiences/exposure to suicide? This article compares the knowledge acquisition of teachers and staff who received a 2-hour suicide prevention training for school personnel during a traditional in-person school in service compared to the identical suicide prevention curriculum delivered via a Web-based, online training.

Method

Design

A quasi-experimental pretest–posttest design was used to assess the change in knowledge about suicide prevention among teachers and staff (including administration and academic counselors) from public secondary schools by comparing two methods of teaching. The two teaching modalities included (1) a 2-hour traditional in-person suicide prevention education and (2) the identical suicide prevention training as the in-person modality but delivered via a self-paced, Web-based online course.

Program Description

The suicide prevention curriculum, “Making Education Partners in Suicide Prevention” (MEPSP; Kalafat & Underwood, 2008), is a training program designed specifically for middle and high school teachers; however, it is often completed by nonteaching staff including administration and nonclinical, academic counselors. MEPSP was developed for The Society for the Prevention of Teen Suicide (www.sptsusa.org), a foundation based in the United States and designed by two nationally recognized mental health practitioners from the United States, John Kalafat, PhD, and Maureen Underwood, LCSW, with over 60 years of collective experience in school-based youth suicide prevention. The 2-hour training (both the in-person and online versions) provides practical and realistic suggestions, for secondary school educators and other nonclinical school personnel (e.g., administration, academic counselors, coaches, facilities management, etc.), for the identification of risk factors and warning signs for suicide risk, referral of those students who might be at risk for suicide, and strategies for youth suicide prevention in schools. The MEPSP training is based on a competent community model, which stresses that while everyone has a role to play in suicide prevention; educators have a critical but limited role in suicide prevention in a school setting. The role of an educator or nonclinical school staff in suicide prevention is not to assume the role of a mental health professional or to make a diagnosis but rather to identify and refer youth to the appropriate school professional who is, ultimately, responsible for determining if a student needs a referral to a community mental health resource (Kalafat & Underwood, 2008; Underwood et al., 2009). The main objectives of the MEPSP training include the following: (1) to review benefits of the training, (2) to correct myths about suicide and individuals at risk for suicide, (3) to present accurate data about suicide, (4) to outline the roles of educators and staff; (5) to discuss how to interact with a student who may be at risk for suicide, and (6) to provide additional resources about referral within the school community.

The MEPSP program is listed on the “Best Practices Registry” of the National Suicide Prevention Resource Center (www.sprc.org) and has received an award for its quality and effectiveness. The training includes the use of PowerPoints and video clips. The videos include clips of two families’ talking about the suicide deaths of their children as well as situations that model how an educator or staff would talk to a student they are concerned about. The training is currently offered at no cost online (www.sptsusa.org) or through a traditional in-person professional development training session. Working with a digital media company, a Massachusetts-specific version of the MEPSP online training was created incorporating Massachusetts-specific suicidal behavior (i.e., ideation, attempts, and deaths by suicide) statistics and local resources. The trainings (both online and in-person) were considered “professional development” time, for which teachers received professional development credits commensurate with the 2 hours of in-person training time required to present the MEPSP material.

Participants

Study participants from three public schools in suburban and rural school districts in Massachusetts received the traditional in-person suicide prevention education, reaching 141 educators and staff (which included academic counselors and administrators). The participating schools included two regional public high schools with enrollment from several neighboring school districts, and one public high school with students from its own local community/district.

One rural, public high school volunteered to participate in the online version of the MEPSP training. Additionally, to enhance participation of secondary school teachers and staff in the online training, volunteers were recruited to participate through a Department of Education (state level) contact who forwarded the MEPSP training link to several colleagues (administrators, faculty, etc.). A recruitment letter detailing the nature of the research (along with Informed Consent information) was distributed through e-mail to all potential subjects. Schools provided multiple computer terminals for teachers and staff to complete the consent process and, if needed, to complete the training; otherwise the training was completed on the teachers’ own computers. The online sample included 56 secondary school educators and staff (including academic counselors and administrators); 49 of the participants came from the rural school and 7 additional participants were obtained via the Department of Education.

Measures

Participants were asked to complete several questions including demographic questions, knowledge questions, as well as satisfaction questions.

The demographic questions included questions about gender, age, role in the school, years of experience, exposure to suicide (professionally and personally), suicide-related experience (prior training, interaction with students, referrals of students), and suicide prevention policies in their school. Participants were not asked about their ethnicity.

The knowledge questions included 25 true/false questions about concepts that are reviewed in the training. The pre–post knowledge test was developed for the purposes of this specific program and content; therefore, there are no reliability or validity measures of the knowledge questions. Concepts covered in the knowledge questions include (1) myths about suicide, (2) epidemiology of youth suicide, (3) risk factors/warning signs/protective factors, (4) impact of suicide risk on ability to function, (5) role of educators in suicide prevention, (6) components of a competent community, (7) what students need to take care of themselves, and (8) help-seeking resources. Correct responses received 4 points and incorrect responses received zero points, for a total possible score of 100.

The satisfaction questions were asked at the conclusion of the training. Questions were asked using a 5-point Likert-type scale and queried the training’s overall usefulness, relevance, likelihood they would suggest the training to others, preferences about the modality of the training, overall satisfaction, as well as satisfaction with specific content questions such as the emotional content of the survivor stories/video clips.

Procedure

Teachers and staff (including administrators and academic counselors) participating in the in-person training were provided a letter explaining the nature of the research and the importance of the role of educators and staff in youth suicide prevention. Prior to each in-person training, the principal of each school provided a very brief introduction of the trainer and thanked the teachers and staff for participating. In addition, the trainer provided a brief PowerPoint presentation (nine slides) that explained the research design component of the study and detailed the informed consent process (e.g., voluntary participation in the study measures, etc.). Participants were also informed they would be receiving the same training content as contained in the online version, for purposes of consistency and maintaining fidelity to the research. The online training began with a written description of the research project and provided an online consent form. All consents were obtained prior to the completion of any measures. Participants in both training modalities completed the identical demographic items, pre and post knowledge questions, and the satisfaction questions. The in-person trainer used the same PowerPoint slides to disseminate the MEPSP content. Additionally, there were several short video clips embedded in the presentation, again mirroring the same material and content contained in the online version. Before the trainings began, all participants completed the demographic and pre knowledge questions. Participants completed the post knowledge test and satisfaction questions immediately after the training (both online and in-person).

Data Analysis

Binary demographic characteristics are described using frequencies and percentages. Continuous characteristics are described using measures of central tendency and dispersion (i.e., standard deviation and range). Demographics were compared across training condition using chi-square and dependent variable t tests. Both independent and dependent t tests were used to assess for change in knowledge over time as well as a change in knowledge across training conditions. Multiple comparisons were adjusted using Bonferroni correction setting the level of significance to p ≤ .00.

Results

Characteristics of Study Participants

Overall demographics of study participants and a comparison of demographics of the study participants across training modality are found in Table 1. The majority of the participants was male (63.5%, n = 125) and comprised of teachers (82.3%, n = 167). Despite approximately 50% of the participants having interacted with suicidal students and more than two fifths (44%) of the participants having referred a suicidal student to mental health services, the participants reported limited training in suicide prevention. Only one third (32%) of the participants had prior suicide prevention training. Approximately 10% of participants reported not having a school suicide prevention policy/protocol, while almost three quarters (71.5%, n = 151) of the participants reported not knowing if the school had a suicide prevention policy/protocol.

Table 1.

Demographics of Participants by Training Modality.

Demographics	Total (N =197), % (n)	In-person training (n = 141), % (n)	Online training (n = 56), % (n)
Gender
Male	63.5 (125)	58.9 (83)	75 (42)
Female	36.5 (72)	41.1 (58)	25 (14)
School role
Teacher	82.3 (167)	85.7 (126)	73.2 (41)
Administrator	3.9 (8)	4.1 (6)	3.6 (2)
Counselor	7.4 (15)	4.7 (7)	14.3 (8)
Other	6.4 (13)	5.5 (8)	8.9 (5)
Experience
Prior suicide training	32.0 (62)	33.3 (47)	28.6 (16)
Interacted with suicidal student	48.0 (94)	47.1 (66)	50.0 (28)
Referred a student concerned about suicidal risk	44.7 (88)	44.7 (63)	44.6 (25)
School suicide policy
Yes	22.3 (44)	22.7 (32)	21.4 (12)
Don’t know	71.5 (151)	69.5 (98)	76.8 (43)
Exposure
Personal loss	22.3 (44)	27.7 (39)	8.9 (5)*
Professional loss	27.9 (55)	25.5 (36)	33.9 (19)
Age, M (SD), years	40.9 (12.2)	42.5 (12.4)	37.9 (11.1)*
Age 40 years or older	45.8 (81)	48.5 (63)	38.3 (18)
Years of experience	11.0 (8.4)	11.1 (.73)	10.9 (1.1)

Note. Bonferroni corrected adjusting for multiple comparisons.

Difference between groups statistically significant at p = .00 or less.

A t test was conducted on each of the background variables across training modality to examine whether the training modalities differed with respect to their demographics, prior training in suicide prevention, suicide experience, and exposure. The individuals in the online training modality were younger than the individuals in the in-person training modality (online: M = 37.9, SD =11.1, vs. in-person: M = 42.5, SD = 12.4), t(178) = 2.647, p = .009. While there was limited suicide experience and exposure in the two groups, the individuals in the in-person training condition had experienced more personal loss due to suicide (online = 8.9% vs. in-person = 27.7%), χ²(1) = 8.107, p = .004, than individuals in the online group.

Is Learning Affected by Training Modality?

Table 2 provides the results of the t tests comparing the change in knowledge for each of the training conditions as well as subgroup comparisons. There is a significant increase in knowledge under both training conditions. Individuals who completed the training via the in-person format improved knowledge from a mean score of 86.5 (SD = 6.8) at pretest to 88.5 (SD = 7.6) at posttest, t(129) = −2.718, p = .007. Individuals who completed the training online increased knowledge with a mean of 85.8 (SD = 7.2) at pretest to 91.8 (SD = 5.7) at posttest, t(46) = −5.9, p = .000. When comparing the two training modalities, there was no statistically significant difference between the baseline knowledge across the two groups. However, at posttest, the online group had a significantly greater knowledge score than the in-person training modality, t(175) = −3.7, p = .006.

Table 2.

Pre- and Posttest Assessment of Knowledge by Teaching Modality.

	In-person training		Online trainings
Moderators	Pre	Post	Pre	Post
Overall	86.5 (6.8)	88.5* (7.6)	85.8 (7.2)	91.8*^ (5.7)
Training experience
Prior training	87.7 (7.4)	89.8 (6.6), NS	88.5 (6.7)	93.3* (5.6)
No prior training	85.9 (6.3)	87.8 (8.1), NS	84.5 (7.1)	91.3* (5.7)
Age of participant, years
<40	86.2 (6.9)	88.5* (6.3)	84.8 (8.3)	90.6* (5.9)
≥40	86.9 (6.6)	88.5 (8.9), NS	87.3 (4.6)	93.8*^ (4.8)
Personal exposure
Yes	87.1 (6.8)	89.8 (5.4), NS	74.7 (8.3)	90.7^a (8.3)
No	86.3 (6.8)	88.0 (8.3), NS	86.6 (6.5)	91.9*^ (5.6)
Professional exposure
Yes	87.6 (7.0)	89.5 (4.9), NS	85.6 (8.4)	92.5* (6.7)
No	86.1 (6.7)	88.12 (8.4), NS	85.9 (6.7)	91.5* (5.2)

Note. NS = not significant. Bonferroni corrected adjusting for multiple comparisons.

n = 3.

Change within group statistically significant at p = .01 or less. ^Statistically significant difference across training condition at p = .01 or less.

Moderating Effects of Prior Suicide Prevention Training on Knowledge

Knowledge scores were compared within training modality among individuals who had prior suicide prevention training on suicide prevention and among individuals who did not have prior suicide prevention training (see Table 2). Whether or not the individual had prior training experience, there was no statistically significant change in knowledge score from pre- to posttest in the in-person training modality; however, knowledge significantly increased for both groups in the online training modality—prior training: pre: M = 88.5, SD = 6.8; post: M = 93.3, SD = 5.6), t(14) = −3.055, p = 009; no prior training: pre: M = 84.5, SD = 7.1; post: M = 91.3, SD = 5.7, t(31) = −5.086, p = .000. Therefore, prior training in suicide prevention did not moderate the knowledge scores.

Moderating Effects of Age of Student on Knowledge

Knowledge scores were compared within training modality by age of individual (under and over 40 years old; see Table 2). The knowledge change within training modality is moderated by the age of the participant. In the in-person training modality, there was a significant increase in knowledge for individuals under the age of 40 years (under age 40: pre: M = 86.2, SD = 6.9; post: M = 88.5, SD = 6.3), t(66) = −2.76, p = .007; however, there is no difference in knowledge pre- and posttest for individuals aged 40 years or older (pre: M = 86.9, SD = 6.6; post: M = 88.5, SD = 8.9), t(62) = −1.31, NS. In the online training modality, knowledge significantly increased for individuals regardless of age—under age 40: pre: M = 87.3, SD = 4.6; post: M = 93.8, SD = 4.8; t(28) = −6.26, p = .000; 40 or older: pre: M = 87.3, SD =4.6; post: M = 93.8, SD = 4.8; t(17) = −1.31, p = .000. Across training modalities, there is no significant difference in posttest knowledge for the individuals under age 40 years; however, individuals 40 and older in the online training modality had a significantly higher posttest knowledge score than older individuals in the in-person training modality (in-person: post score: M = 88.5, SD = 8.9; online: post score: M = 93.8, SD = 4.8), t(79) = −2.41, p = .01.

Moderating Effects of Exposure to Suicide on Knowledge

Knowledge scores were compared across and between training modalities for individuals with and without exposure to loss by suicide. Exposure to suicide can be personal or professional. No significant difference in knowledge scores were found in the in-person training condition by either type of exposure to suicide (Table 2). On the contrary, knowledge scores significantly increased in the online training modality regardless of professional exposure—professional exposure: pre: M = 85.6, SD = 8.4; post: M = 92.5, SD = 6.7; t(14) = −4.8, p = .000; no professional exposure: pre: M = 85.9, SD = 6.7; post: M = 91.5, SD = 5.3; t(31) = −4.2, p = .000; therefore, professional exposure did not moderate change in knowledge in either training modality. Knowledge scores for individuals in the online modality increased whether or not the individual had exposure to a personal loss of suicide—no personal exposure: pre: M = 86.6, SD = 6.5; post: M = 91.9, SD = 5.6; t(43) = −6.1, p = .000; personal exposure: pre: M = 74.7, SD = 8.3; post: M = 90.7, SD = 8.3; t(2) = −1.9, p = .195. However, given that there were only three individuals in the online training modality with personal exposure, the change in knowledge scores was not statistically significant.

Online Experience and Preference in Learning Method

Individuals in the online training modality (n = 42) completed questions regarding their satisfaction and online training experience (see Table 3). The majority of participants reported that the content of the online training modality was useful (90.5%, n = 38) and relevant for their jobs (97.6%, n = 41), with 100% of the participants reporting they would suggest the training to others. The majority of participants were satisfied with watching the survivor stories online (95.2%, n = 40); while 19.1% of the participants found the emotional content upsetting, 83.3% of participants felt it must be included. This number increases to 97.6% if individuals who were neutral on the topic are included. Questions were asked about limitations of online experience including 23.8% (n = 10) of participants preferring to ask questions and to make comments (21.4%, n = 9) during the presentation. Despite these limitations of static online training, 85.7% (n = 36) reported finding satisfaction with the total online experience and 23.8% (n = 10) of participants preferring to have taken this training in person rather than online; 38.6% (n = 16) participants equally reported either not having a preference in training condition or preferring the online training modality. The change in knowledge was compared across individuals who preferred the online training and those who reported rather having had the training in-person format. There was no significant change in knowledge scores for individuals who completed the online training modality, but respondents reported that they would have rather had the training in person (pre: M = 82.8, SD = 8.9; post: M = 89.2, SD = 5.7), t(9) = −2.7, p = .03: not significant given Bonferroni correction). However, there was a statistically significant change in mean knowledge score for individuals in the online training modality who reported preferring the online training modality (pre: M = 84.8, SD = 6.6; post: M = 92.8, SD = 6.1), t(15) = −4.9, p = .000.

Table 3.

Satisfaction With Online Training Experience.

Satisfaction	Strongly agree	Agree	Neutral	Disagree	Strongly disagree
Useful	54.8 (23)	35.7 (15)	9.5 (4)	0	0
Relevant	69.0 (29)	28.6 (12)	2.4 (1)	0	0
Satisfaction with
Survivor stories	71.4 (30)	23.8 (10)	4.8 (2)	0	0
Total experience	35.7 (25)	50.0 (21)	11.9 (5)	2.4 (1)	0
Suggest to others	83.3 (35)	16.7 (7)	0	0	0
Prefer to
Ask questions	2.4 (1)	21.4 (9)	52.4 (22)	19.0 (8)	4.8 (2)
Make comments	0 (0)	21.4 (9)	52.4 (22)	21.4 (9)	4.8 (2)
Content
I didn’t understand	2.4 (1)	0	11.9 (5)	46.7 (20)	38.1 (16)
Emotional content was upsetting	2.4 (1)	16.7 (7)	21.4 (9)	23.8 (10)	35.7 (15)
Must include emotional content	59.5 (25)	23.8 (10)	14.3 (6)	2.4 (1)	0

Discussion

There is a significant level of teacher professional education required ranging from academic subject matter development to awareness of social problems (i.e., drugs, alcohol, mental health problems, and suicide). However, teachers face difficulties accomplishing all of the professional development hours given the competing demands of professional, educational, work, and family/personal responsibilities. Online learning is growing in popularity as an alternative to the more restrictive traditional face-to-face/in-person learning methods for professional development for educators. Evidence suggests that there is no difference in knowledge acquisition between the two methods of learning when the material is academic in nature (Angiello, 2010; Dash et al., 2012; Rabe-Hemp et al., 2009). Few studies have looked at the differences between in-person and online learning of emotional or sensitive material, such as suicide prevention. This study used a quasi-experimental pretest–posttest design to compare traditional in-person learning versus self-paced online learning when acquiring knowledge about suicide prevention, an area that would qualify as having highly emotional or sensitive material.

Results suggest that secondary school teachers and staff (including administrators and nonclinical counselors) gain more suicide prevention knowledge after completing either a 2-hour online or in-person professional development training. However, knowledge of teachers and staff who participated in the online training increased more than knowledge gained via traditional in-person learning. This finding is counter to Karam et al.’s (2014) study, which suggested that social science and personal content was not learned as effectively via blended or online education.

The results ran counter to our hypothesis regarding the age of the learner and its effect on knowledge across learning methods. While individuals of all ages acquired knowledge in the online training modality, the older individuals scored higher on the online posttest than the younger individuals. This supports Tallent-Runnels et al.’s (2006) review of the literature that found that students who chose the online method of education were consistently older, highly motivated, and more focused on achieving specific learning goals that would improve their knowledge gain. In fact, individuals of all ages were satisfied with the online training experience, and while some educators found the online material upsetting, the majority did not, and additionally, they felt it was necessary to present sensitive material of this nature. Given that the younger participants learned under both training modalities, our evidence runs counter to Karam et al. (2014), who suggested that millennial learners need face-to-face interaction in order to process “personally, psychologically and sociologically challenging material” (p. 92).

The participants reported their willingness to do another online training on this topic. These findings are similar to Smith and Sivo’s (2012) study. Smith and Sivo studied 517 educators to determine the predictors of participating in an online professional education program. The teachers reported that the perceived ease of use, perceived usefulness of material, and social presence (i.e., the extent to which the student perceives that the person online is physically present or real) would increase their likelihood of completing future online professional education programs.

Limitations

This study is not without several limitations. There were limitations in obtaining participants, which affected the matched comparison of schools for the two teaching modalities and reduced the number of participants in the online teaching modality. The in-person trainings were presented to three schools as originally planned. However, our ability to acquire a group of schools to participate in the online training modality and that matched the in-person training schools on demographic characteristics was problematic due to multiple unforeseen and unanticipated issues. For example, because of Teachers’ Union contract stipulations, many school districts required multiple levels of approval, which delayed and ultimately prevented delivery of the training. Individual principals were often hesitant to approve participation of their staffs without first gaining administrative-level approval, contributing to prohibitive delays. Paid professional development time directed to teachers and staff is precious and, thus, well protected. Many school administrators, sought to be recruited, felt they had “other issues to which professional development hours should be devoted.” Also, the inability to “squeeze in” additional professional development training time into already crowded professional development calendars prevented schools from participating. Many schools when approached about the online training reported they had already filled up such times to be devoted to professional development of their teachers and staff. Significant advance time (at least 1 year) is apparently often required for secondary schools to make decisions about the inclusion of nonmandatory trainings in professional development–related training calendars. In general, the aforementioned issues are related to teacher contract issues, which include rigid professional development guidelines and commensurate compensation requirements. Furthermore, some school administrators were reportedly “uncomfortable” with the focus of the training (i.e., suicide), which inhibited their participation.

Difficulties and obstacles encountered in identifying and recruiting schools to complete the online training limited the sample of teachers and staff in the online condition. Despite these difficulties, one school agreed to participate in offering the online training to their teachers and staff. Furthermore, after a Department of Education administration endorsed the online suicide prevention training, seven additional teachers participated in the online training on a voluntary basis.

While some demographic information was collected, ethnicity of the participants was not collected. The lack of knowledge regarding the ethnicity of the sample precludes the analysis of effectiveness of training condition by ethnicity. While there is no prior literature to suggest a difference would exist, there may be differences by ethnic group that were not identified. It is recommended that more detailed demographic information be collected in future studies.

Another limitation was that the baseline knowledge of suicide prevention was already very high even for people without experience with suicide prevention. This is a positive limitation as it suggests that many school professionals are beginning to learn more about suicide prevention and would be ready for more advanced identification and referral techniques. Nevertheless, the educators in this study improved their learning of suicide awareness, identification, and referral in a school setting.

Given the limitations and restrictions in school staff’s ability to access professional development hours, there has been increased attention to obtaining professional development online via the Internet. However, it is unknown whether material with sensitive or emotional content, such as suicide prevention, could be as effective online as through traditional in-person training. This study suggests that a self-paced online training may be a welcome alternative to traditional in-person training even with sensitive and emotional material.

Footnotes

Acknowledgements

The authors thank Jonathan Clayfield, Scott Fritz, Don Quigley, Carmine DeFalco, Pixel Light Inc., and Judith Springer.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

References

Andersson

Hesser

Veilord

Svedling

Andersson

Sleman

. . . Carlbring

(2013). Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. Journal of Affective Disorders, 151, 986-994.

Angiello

(2010). Study looks at online learning versus traditional instruction. Hispanic Outlook in Higher Education, 20, 18-20.

Armistead

L. D.

Castillo

J. M.

Curtis

M. J.

Chappel

Cunningham

(2013). School psychologists’ continuing professional development preferences and practices. Psychology in the Schools, 50, 415-432. doi:10.1002/pits.21684

Brown

Green

(2003). Showing up to class in pajamas (or less)! The fantasies and realities of on-line professional development courses for teachers. The Clearing House, 76, 148-151.

Brown

B. W.

Liedholm

C. E.

(2002). Can web courses replace the classroom in principles of economics? American Economic Review, 92, 444-448.

Burkhardt

J. M.

Kinnie

Coumoyer

C. M.

(2008). Information literacy successes compared: Online vs. face to face. Journal of Library Administration, 48, 379-389.

Centers for Disease Control and Prevention, & National Center for Injury Prevention and Control. (2014). Web-based injury statistics query and reporting system (WISQARS) [online]. Retrieved from www.cdc.gov/injury/wisqars

Dash

de Kramer

R. M.

O’Dwyer

L. M.

Masters

Russell

(2012). Impact of online professional development on teacher quality and student achievement in fifth grade mathematics. Journal of Research on Technology in Education, 45, 1-26.

Hauser

Paul

Bradley

(2012). Computer self-efficacy, anxiety, and learning in online versus face to face medium. Journal of Information Technology Education, 11, 141-155.

10.

James

(2002). Advantages and disadvantages of online learning. Retrieved from http://www.comminit.com/?q=ict-4-development/node/210058

11.

Kalafat

Underwood

(2008). Making educators partners in suicide prevention (MEPSP). Freehold, NJ: Society for the Prevention of Teen Suicide.

12.

Kao

C. P.

Tsai

C. C.

Shih

(2014). Development of a survey to measure self-efficacy and attitudes toward web-based professional development among elementary school teachers. Educational Technology & Society, 17, 302-315.

13.

Karam

E. A.

Clymer

S. R.

Elias

Calahan

(2014). Together face-to-face or alone at your own pace: Comparing traditional vs. blended learning formats in couple & family relationship coursework. Journal of Instructional Psychology, 41, 85-96.

14.

Kleiman

G. M.

(2004, July). Meeting the need for high quality teachers: E-learning solutions. Paper presented at the U.S. Department of Education Secretary’s No Child Left Behind Leadership Summit. Retrieved from http://toddhitchcock.com/resources/NeedforHighQualityTeachers.pdf

15.

Klein

(2015, April 10). No child left behind: An overview. Education Week, 34(27). Retrieved from http://www.edweek.org/ew/section/multimedia/no-child-left-behind-overview-definition-summary.html

16.

Miller

Rainer

R. K.

Corley

J. K.

(2003). Predictors of engagement and participation in an on-line course. Online Journal of Distance Learning Administration, 6(1). Retrieved from http://www.westga.edu/~distance/ojdla/spring61/miller61.htm

17.

Rabe-Hemp

Wollen

Humiston

(2009). A comparative analysis of student engagement, learning, and satisfaction in lecture hall and online learning settings. Quarterly Review of Distance Education, 10, 207-218.

18.

Russell

Carey

Kleiman

Venable

J. D.

(2009). Face-to-face and online professional development for mathematics teachers: A comparative study. Journal of Asynchronous Learning Networks, 13(2), 71-87.

19.

Smith

J. A.

Sivo

S. A.

(2012). Predicting continued use of online teacher professional development and the influence of social presence and sociability. British Journal of Educational Technology, 43, 871-882. doi:10.1111/j.1467-8535.2011.01223.x

20.

Tallent-Runnels

M. K.

Thomas

J. A.

Lan

W. Y.

Cooper

Ahern

T. C.

Shaw

S. M.

Liu

(2006). Teaching courses online: A review of the research. Review of Educational Research, 76, 93-135. Retrieved from https://www-jstor-org.web.bisu.edu.cn/stable/3700584

21.

Topper

(2007). Are they the same? Comparing the instructional quality of online and face-to-face graduate education courses. Assessment & Evaluation in Higher Education, 32(6), 681-691. doi:10.1080/02602930601117233

22.

Trindade

A. R.

Carmo

Bidarra

(2000). Current developments and best practice in open and distance learning. The International Review of Research in Open and Distance Learning, 1(1). Retrieved from http://www.icaap.org/iuicode?149.1.1.5

23.

Underwood

Kalafat

., & the Maine Youth Suicide Prevention Program. (2009). Lifelines: A suicide prevention program. Center City, MN: Hazelden Foundation.

24.

U.S. Department of Education & Office of Elementary and Secondary Education. (2002). No Child Left Behind: A desktop reference. Washington, DC: Author. Retrieved from https://www2.ed.gov/admins/lead/account/nclbreference/reference.pdf

25.

Vernon

Pittman-Munke

Vakalahi

Adkins

Pierce

(2009). Distance education programs in social work: Current and emerging trends. Journal of Social Work Education, 45, 263-276.

26.

Vrasidas

Zembylas

(2004). Online professional development: Lessons from the field. Education + Training, 46, 326-334.