Question Persuade Refer (QPR): Basic Gatekeeper Training

How to access the program?

Visit https://qprinstitute.com/professional-training to review training options.

What is the program? 

QPR is an emergency mental health intervention for suicidal persons created in 1995 by Paul Quinnett. An abbreviation for Question, Persuade and Refer, the intent is also to identify and interrupt the crisis and direct that person to the proper care. In QPR trainees are educated about the known warning signs of a suicide crisis: expressions of hopelessness, depression, giving away prized possessions, talking of suicide, securing lethal means, and then taught how to respond. 

Who is the program for? 

This training is designed for all adults including but not limited to teachers, school counselors, administrators, other educators, and school staff.  

How is this program implemented? 

Any school personnel trained in QPR gatekeeper training can use the knowledge and skills gained in the training throughout their daily activities.  

What is the practice that is supported? 

A gatekeeper is someone who can recognize a crisis and the warning signs that someone may be contemplating suicide. Gatekeeper training teaches people to identify individuals who are showing warning signs of suicide risks and help these individuals get the mental health services they need. Gatekeeper training improves the skills, confidence, and willingness to help those in distress. Gatekeeper trainings are for public health information purposes and are not intended to take the place of assessments, screening, diagnoses, or treatment of any mental health issues.  

What outcomes does the program produce? 

• Increase in awareness of suicide warning signs 
• Increase in awareness of resources for help related to suicide risk 
• Increase in student referrals for suicide concern 
• Improve skills, knowledge, and attitudes for suicide prevention 

What is the evidence? 

Condron, Susan. (2015) Identifying and Referring Youths at Risk for Suicide Following Participation in School‐Based Gatekeeper Training—Suicide and Life-Threatening Behavior—Wiley Online Library. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/sltb.12142 

Using survey data of over 136,000 individuals (teachers, service providers, parents/caregivers) collected from school-based gatekeeper trainings, this study examined the effectiveness of the trainings to increase knowledge and skills to identify youths at risk of suicide. The results showed that while the knowledge of those in gatekeeper trainings increased, the number of referrals of at-risks youth depended on length of training and time spent with the youth. Additionally, between half and two-thirds of youth identified by trainees were receiving services at the 3 month follow up of training.  

Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J., & Pena, J. B. (2008). Randomized Trial of a Gatekeeper Program for Suicide Prevention: 1-year Impact on Secondary School Staff. Journal of Consulting and Clinical Psychology, 76(1), 104. https://doi.org/10.1037/0022-006X.76.1.104 

This randomized control trial assesses the impact of QPR on the school staff’s knowledge, willingness to assume gatekeeper role, and self-reported suicide identification behaviors with students.  Two groups were created at the campus level, the treatment group received QPR training while the control group did not receive training. The effectiveness of QPR was analyzed after a series of pre and posttest along with observations, and other evaluations. The results did show that those trained in QPR saw an increase in knowledge and commitment to intervene. QPR training also had a positive effect on the ability of trained staff to accurately identify warning signs and risks factors for youth suicide and recommend interventions.  

Reis, C., & Cornell, D. (2008). An Evaluation of Suicide Gatekeeper Training for School Counselors and Teachers. Professional School Counseling, 11(6), 2156759X0801100605. https://doi.org/10.1177/2156759X0801100605 

In this study, researchers evaluated the impact of gatekeeper trainings on suicide knowledge and prevention practices among teachers and counselors. Survey results were compared between a group that received gatekeeper training and a control group not receiving training. Results showed that difference in the number of student referrals made between teachers and counselors was smaller in the trainee group than the control group. This study also showed that school staff attending gatekeeper training reported more knowledge of suicide risks factors.  

What are the costs associated with implementing this program? 

Please contact the program for the most recent costs and commitments, as these may change. 

There are costs associated with becoming trained in QPR. The costs of training depend largely on the role of the individual trainee and the organization funding the training. There are options for both online and in-person trainings at various prices.  

What resources are helpful for understanding this program? 

• Information on cost of training: https://qprinstitute.com/professional-training 
• QPR Institute site: https://qprinstitute.com/ 
• Suicide Prevention Resource Center description: https://bpr.sprc.org/program/qpr-gatekeeper-training-for-suicide-prevention/

Any training or interventions from this repository should be used in accordance with established staff development standards and adopted professional development policies of the Local Education Agency (LEA) per §21.451 and §21.4515 of the Texas Education Code (TEC) and the LEA’s suicide prevention policies and procedures pursuant to §38.351. While this training satisfies the statutory training requirements of §21.451(d)(3)(A), §21.451 (d-1)(1), §21.451 (d-2) and §38.351, it is best practice for staff to receive ongoing training which may include job embedded professional development, coaching opportunities and annual training. 

Rating: Research-Informed 

Secondary components: Grief and Trauma- Informed practices; Early Mental Health Prevention and Intervention; Positive, Safe, and Supportive School Climates