Expanding Provider Capacity to Prevent Rural Veteran Suicide: Virtual Reality Lethal Means Safety Training

Rural Veterans experience a suicide rate more than three times the national average, a crisis exacerbated by the lack of healthcare providers trained in Veteran-specific suicide risk factors and lethal means safety planning. Virtual Reality Lethal Means Safety Training (VR-LMST) is an innovative approach to enhance suicide prevention training among allied healthcare providers who treat rural Veterans. VR-LMST aims to address critical skills gaps through an immersive virtual reality training simulation that provides a realistic and engaging learning experience.

Research Aims and Hypotheses:

The project includes three primary aims. The first aim is to develop a comprehensive VR training program for lethal means safety counseling tailored to rural Veterans. The first hypothesis is that allied healthcare providers who complete the VR-LMST training will report high levels of spatial presence, engagement, and ecological validity, and low levels of negative effects within the VR environment. The second aim is to evaluate the effectiveness of VR-LMST in enhancing provider competencies in suicide prevention. Our second hypothesis is that providers who complete VR-LMST training will demonstrate a significant increase in self-efficacy (confidence and comfortability) in conducting lethal means safety counseling compared to those who do not receive this training. The third aim is to understand the impact of VR-LMST on suicide prevention practices. The third hypothesis is that providers trained with VR-LMST will show a greater intention to engage in lethal means safety counseling in their practice.

Sample and Procedures:

The study will employ a randomized controlled trial design, recruiting allied healthcare providers who serve rural Veterans. Thirty-six participants will be randomly assigned to either the intervention (VR-LMST) group or an active control group. The VR-LMST will simulate a rural health clinic visit, enabling participants to engage in an interactive scenario and practice lethal means safety counseling with a Veteran avatar. Control group participants will view a brief video in VR depicting a lethal means safety counseling session. Data will be collected at pre-test, post-test, and 3-month follow-up.

Measures:

Primary study measures include the Counseling on Access to Lethal Means (CALM) Survey and the ITC-Sense of Presence Inventory (ITC-SOPI). These tools will evaluate self-efficacy and counseling intentions around suicide prevention and lethal means safety, and VR elements of spatial presence, engagement, ecological validity, and tolerability.

Potential Impact:

By improving providers' abilities to engage in effective lethal means safety counseling, the project aims to reduce the incidence of Veteran suicides in rural areas, a critical concern given the high rates of firearm ownership among Veterans and the established link between firearm access and suicide risk.

Next Steps:

Following the evaluation, the next steps will include refining the training based on participant feedback and expanding its accessibility to a broader range of healthcare providers. Our goal is to establish VR-LMST as a scalable, evidence-based tool for suicide prevention training across various healthcare settings, making a substantial contribution to public health and the well-being of rural Veterans.