With suicide rates rising among young Minnesotans, the Minnesota Department of Health (MDH) and the Minnesota Department of Education (MDE) have teamed with New York-based education software company Kognito to offer an interactive suicide-prevention training program for education professionals statewide. Thanks to funding provided by the Minnesota Legislature, the program is available free of charge to all schools in the state.
Using an avatar to simulate real-life conversations at different age levels, the program, known as Kognito’s “At-Risk Series,” offers an alternative to the traditional role-play simulations often used at staff training workshops. In the program, participants play the role of an educator in conversation with a young person in a mental health crisis. With the help of an avatar “guide,” the educator works through different possible reactions and conversations that could take place between adult and student.
Because the program takes away the social pressure of in-person role-play activities and gives participants an opportunity to go back, change their answers and compare the results, organizers believe that it will be a better way to help educators learn how to respond when a student exhibits signs of depression or suicidal ideation.
Stephanie Downey, MDH suicide prevention coordinator, worked closely with the program’s development in Minnesota. She said participants in early testing reported that the online simulations felt engaging and impactful and allowed for more comfortable interactions and learning.
“This kind of approach is less intimidating for somebody who might not have a lot of experience with in-person training,” Downey said. “You don’t need to feel as self-conscious about the questions you ask or about engaging in an in-person role play in front of a group.”
If a person usually feels shy or uncomfortable engaging in large-group activities, the At-Risk program provides a safe place for a participant to try out different approaches without fear of making a mistake, Downey added: “They don’t have to worry as much about what they are saying. It builds confidence in a setting that is not in front of a large group.” And in this age of social distancing, the activities are contact free, designed to be done alone, in an office or at home.
Building confidence around talking with young people about suicide is seriously important, Downey said: “If we look at Centers for Disease Control data about Minnesota, suicide is the leading cause of death for 10- to 17-year-olds and suicide is the second-leading cause of death for 15- to 35-year-olds.”
Downey, who’s been working in suicide prevention for more than a decade, said that it is a public health issue that deserves close attention. “We know from Minnesota Student Survey data that there has been an increase in the last year of students reporting long-term emotional-behavioral mental health issues. We also know that students who reported having one caring adult in their life were five times less likely to report suicide attempts and three times less likely to report suicidal ideation. So connectedness is a preventative factor.”
Learning the tools needed to help build connectedness between educator and student is an important takeaway from the “At-Risk” series, Downey said. The simulated conversations between teachers or other education professionals and their avatar “student” demonstrate potential communication tactics that show a young person that they have an adult in their life who cares.
“Having this At-Risk simulation is an opportunity to build onto what schools are already doing around comprehensive mental health and suicide prevention,” Downey said. “It is an opportunity to increase the school’s ability to have multiple staff be aware of what is going on with students, to build relationships with students — and maybe even save a life.”
Jennifer Spiegler, Kognito senior vice president for strategic partnerships, said that one of the goals of the At-Risk program is to expand the number of available adults who can reach out to students in crisis.
“Your goal is to be the eyes and ears of mental health in your school,” Spiegler said. “We’re not talking just about teachers. We’re talking about all school staff. It could be the cafeteria worker. It could be the bus driver, the custodian. You don’t know what adult in the building will have the right conversation or encounter with the student at the right moment. This program can work for all staff.”
Avoiding awkward interactions
Anyone who’s ever attended a staff workshop or group-training event has likely suffered through a well-intentioned but awkward role-play exercise, where volunteers are selected to play roles that illustrate a specific scenario. The more extroverted among us thrive in these situations, but the shy — or cynical — crowd tend to freeze up or roll their eyes, in the process negating the point of the exercise.
“In face-to-face trainings, because we are so focused on this practice conversation, you might be working with an adult who is trying to pretend they are 9 years old,” Spiegler said. “They’re not an expert in that, and they shouldn’t be, but it can make for some awkward situations.”
When the same exercise is done through an animated computer program, Spiegler said, “As a learner you are going to feel that this is a less risky, more comfortable experience. You can make mistakes. You can take your time deciding which answer or prompt is the best one. The best thing is if you make a mistake you can undo your choices and learn from that.”
Avatar-based trainings remove the awkward edge from the learning experience, Downey said, and because the programs are by nature interactive, participants are engaged in a way that they wouldn’t be in a traditional online learning platform.
“Some online learning is not even engaging. But this is. You are actively participating with the avatar and it keeps you engaged.”
Kognito has used the At-Risk program with school districts nationwide. The animated characters, which are voiced by professional actors, use a neutral accent that can’t be associated with a specific region of the country. This minimizes distractions and helps participants focus on the central message of the program.
“We’ve used these programs with half a million educators,” Spiegler said. “Our data has told us that they generalize very well.”
The program also provides lists of resources that participants can access to further help at-risk students and their families, Downey explained. Those resources are localized to the state so that participants can reach out to organizations in their area.
Life in the age of COVID means that many people are tired of attending endless Zoom meetings, but Spiegler said that because it is interactive in real time, the At-Risk program feels more like real life and nothing like Zoom.
“Educators are very picky consumers of technology,” she said. “You could do a lot of your in-person training on Zoom, but this is different. It’s really engaging. It’s story-based. It’s scenario-based. You get emotionally involved with the characters.”
How the program works
The At-Risk program works a bit like a video game, where participants assume the role of a teacher, Siegler said. “You have students that you’re concerned about and you need to find a way to broach the topic of your concern, find out what’s happening and make a determination about the level of urgency so you can take the right next step, which would be creating the conditions for a handoff to a mental health support — whether that’s a counselor or a crisis intervention team.”
Because children at different ages express depression or suicidality in different ways, the program offers three age-specific options. “We have an elementary version, a middle-school version and a high-school version,” Downey explained. “They are focused developmentally at those age groups.”
In each scenario, participants are engaged in a virtual role play with an avatar student. Each scenario is based on real-life situations that are causing the student psychological distress or mental health struggles.
“They are situations that are realistic, that would happen in a school setting,” Downey said. “It could be a bullying scenario. It could be a student who is having struggles at home with relationships, with parents or peers at school.”
The program gives participants the option to choose their response to a student, and then back up to see how the student might have reacted to a different response.
“When the participant engages virtually with that avatar student in that situation they have a choice of how they want to converse with them,” Downey said. “They can pick the question or comment they want to say to that student.”
The virtual “coach” helps participants understand why one response garners a different reaction, and helps guide them through different ways of communicating, Downey explained.
“If the participant chooses something that might not have gotten the most effective response or might have been seen as judgmental or uncaring, the coach will pop up with a suggestion about how they could improve their response with that student.”
Through the interaction with the virtual coach, Downey said, participants learn about motivational interviewing techniques, like asking open-ended questions, using affirmations, circling back to the student and summarizing what they’ve heard them say.
While the program could have been created using live actors playing the different characters, Spiegler said that the choice of avatar-based animation was intentional. Minnesota schools serve a wide range of ethnic groups and backgrounds: Developers wanted to program to cut across demographics, to appeal to people from all walks of life. One way to do this is through animation, which somehow feels more neutral.
Spiegler explained that, “Animation resists what psychologists would call ‘transference reactions,’ the idea that when you are looking at a person on video they might look like your aunt or uncle or the least-favorite teacher you had. We’re trying to really focus you on the skills we want you to build, rather than having you be distracted by fact the teacher looks like somebody you don’t like. Everything in the simulation is designed to be effective which is why this can be a very short program. We teach something in an hour that other programs might teach in an eight-hour face-to-face setting.”
Part of a larger initiative
The At-Risk program’s introduction to Minnesota schools is one result of the efforts of mental health advocates to secure legislative funding to support programs designed to address rising rates of teen suicide.
“There were legislative dollars appropriated for online suicide-prevention training,” Downey explained. “Kognito was one of the online training programs that was explored. It was part of an overall plan to provide comprehensive suicide-prevention training across schools in Minnesota.”
The At-Risk program was piloted in a number of Minnesota schools in the 2017-2018 school year, and educators and administrators were asked to give their opinion about its effectiveness. Sue Abderholden, executive director of NAMI Minnesota, testified in support of the At-Risk program, which was funded by HF813, legislation introduced by Rep. Ruth Richardson, DFL-Mendota Heights, and Sen. Carla Nelson, R-Rochester, that provided funding for suicide and mental health awareness training for the state’s teachers.
“In 2016 the Minnesota Department of Health put some funding towards trying out an online suicide prevention training,” Abderholden said in her testimony. “The funding was funneled through NAMI so that we could track the schools and outcomes. There were 30 schools and 1,064 staff that completed the training. Ninety-five to 97 percent said they would recommend the training to a colleague and 79 percent said they were more prepared to discuss a sign of distress with a student after the training.”
Legislative funding for the At-Risk program made it free to schools statewide. Participation in the program isn’t mandated by DHS or MDE, Downey explained. “Schools do it as a choice, but in Minnesota there is a statue that does require one hour of suicide-prevention best practice for re-licensure of licensed teachers.”
Many schools find the At-Risk program to be a good option for educators, Spiegler said, and because of legislative support, giving it a try comes at no risk to the participants: “This is a way for schools to deliver that information at no cost in a way that is meaningful and engaging.”
And now that odds are high that at least some of the next school year will be conducted virtually, this new approach to training couldn’t come at a better time, Downey added.
“Given our distance learning situation and the uncertainty about what that will look like this fall, this could be an attractive tool for leaders to use and build upon for their professional development. We were planning this before the pandemic. We believed it would be a good addition overall to what schools are doing, and it is.”