Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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NOT_YET_RECRUITING
NA
36 participants
INTERVENTIONAL
2025-11-15
2026-09-30
Brief Summary
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Detailed Description
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This project builds on our prior Veteran Suicide Assessment in Virtual Reality (VET-SAVR) study, which showed that VR can be a feasible and acceptable way to deliver suicide prevention training. In the current study, called the Virtual Reality Lethal Means Safety Training (VR-LMST) project, we will compare an immersive VR training simulation to a 2D video training.
Study Aims
Aim 1: Develop a VR training simulation focused on suicide prevention counseling with rural Veterans.
Aim 2: Test whether VR-LMST improves provider confidence (primary), and comfortability and intention (secondary) to engage in lethal means safety counseling.
Aim 3: Assess user experience of the VR simulation, including presence, realism, acceptability, feasibility, and tolerability.
Study Design
This is a randomized controlled trial. Participants will be assigned to one of two groups:
VR-LMST group: Participants will use a VR headset (Meta Quest 3) to enter a simulated rural clinic visit with a Veteran avatar who presents with thoughts of suicide. They will practice counseling skills related to safe firearm and medication storage.
2D Video group: Participants will use a VR headset to view a 10-minute video showing a provider having a lethal means safety conversation with a Veteran.
Assessments
Pre-test, post-test, and 3-month follow-up surveys will be completed online.
The Counseling on Access to Lethal Means (CALM) Core Scale (13 items) will measure provider confidence (1-5), comfortability (6-8), and intentions (9-13). An additional two items measure counseling behavior at 3 months (14-15).
The ITC-Sense of Presence Inventory (ITC-SOPI) will measure presence, naturalness, engagement, and negative effects.
Open-ended questions will gather feedback about realism, acceptability, and feasibility.
Demographic and professional background information will also be collected.
Sample Size and Timeline We will recruit 36 participants (18 per group). Power analysis indicates this sample size is sufficient to detect moderate effects with 80% power for the primary outcome.
Phase 1 (completed): Recruited 11 healthcare providers for qualitative interviews; conducted coding and analysis; developed and refined VR and 2D scripts.
Phase 2 (completed): Prototype VR clinic environment developed through iterative meetings with VR developers.
Phase 3 (completed): Pilot playtesting in October 2025 with 5 participants.
Phase 4 (planned): Randomized trial enrollment to begin mid-November 2025.
Phase 5 (planned): 3-month follow-ups to begin January 2026.
Oversight IRB approval was received September 27, 2024, from the University of Texas at Arlington. This study is funded by the American Foundation for Suicide Prevention (AFSP).
Significance This project will test a novel, scalable training method to give allied healthcare providers repeated opportunities to practice suicide prevention counseling in a safe environment. By equipping rural providers with the skills and confidence to have culturally sensitive, Veteran-centered conversations about firearm and medication safety, VR-LMST has the potential to improve clinical practice and reduce suicide risk among rural Veterans.
Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
Intervention (VR-LMST): Participants use a Meta Quest 3 headset to complete an interactive virtual reality simulation of a rural clinic visit with a Veteran avatar at risk for suicide, practicing lethal means safety counseling (firearm and medication storage).
Control (2D Video): Participants use the headset to view a 2D, \~10-minute video of the lethal means safety counseling training.
Randomization is computer-generated (Excel) with no crossover. Masking is None (Open Label); outcome assessment uses standardized self-report instruments. Surveys are administered pre-intervention, post-intervention, and at 3-month follow-up (e.g., CALM Scale for confidence/comfortability/intentions; ITC-SOPI for presence/engagement/ecological validity/negative effects.
OTHER
NONE
Study Groups
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VR-LMST Intervention
Participants use a Meta Quest 3 headset to complete an interactive virtual reality simulation of a rural clinic visit with a Veteran avatar at risk for suicide. The simulation incorporates skills in suicide risk identification, firearm and medication safety counseling, and collaborative safety planning.
Virtual Reality Lethal Means Safety Training
An immersive behavioral training program delivered through a Meta Quest 3 virtual reality headset. Participants enter a simulated rural health clinic and interact with a Veteran avatar at risk for suicide. The simulation incorporates realistic dialogue and decision points where providers practice skills in suicide risk identification, lethal means safety counseling (firearm and medication storage), and collaborative safety planning. The VR format allows repeated practice in a safe environment and provides a more engaging and realistic training experience than traditional methods.
2D Video Training
Participants use a VR headset to view a 10-minute 2D video depicting a lethal means safety counseling session with a veteran.
2D Video Training
A 10-minute video delivered through a VR headset that depicts a healthcare provider conducting lethal means safety counseling with a Veteran. This is a non-interactive training used as an active comparator.
Interventions
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Virtual Reality Lethal Means Safety Training
An immersive behavioral training program delivered through a Meta Quest 3 virtual reality headset. Participants enter a simulated rural health clinic and interact with a Veteran avatar at risk for suicide. The simulation incorporates realistic dialogue and decision points where providers practice skills in suicide risk identification, lethal means safety counseling (firearm and medication storage), and collaborative safety planning. The VR format allows repeated practice in a safe environment and provides a more engaging and realistic training experience than traditional methods.
2D Video Training
A 10-minute video delivered through a VR headset that depicts a healthcare provider conducting lethal means safety counseling with a Veteran. This is a non-interactive training used as an active comparator.
Eligibility Criteria
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Inclusion Criteria
* healthcare providers serving rural Veterans in Texas (e.g., physicians, physician assistants, nurse practitioners, nurses, pharmacists, social workers, healthcare case managers)
* English-speaking
* Able to provide informed consent
Exclusion Criteria
* History of motor or balance disorders
* Color blindness
* Neurological or cognitive disorders
* Cardiovascular issues that may be worsened by VR use
* Use of cardiac pacemakers, defibrillators, or hearing aids incompatible with VR equipment
* Significant discomfort in virtual reality environments (e.g., severe motion sickness, vertigo)
18 Years
ALL
Yes
Sponsors
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American Foundation for Suicide Prevention
OTHER
The University of Texas at Arlington
OTHER
Responsible Party
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Principal Investigators
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Donna L. Schuman, PhD, LCSW
Role: PRINCIPAL_INVESTIGATOR
University of Texas at Arlington, School of Social Work
Locations
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University of Texas at Arlington
Arlington, Texas, United States
Countries
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Central Contacts
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Facility Contacts
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Donna L. Schuman, PhD, LCSW
Role: primary
J. SuLynn Mester, DNP, RN
Role: backup
References
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Sale E, Hendricks M, Weil V, Miller C, Perkins S, McCudden S. Counseling on Access to Lethal Means (CALM): An Evaluation of a Suicide Prevention Means Restriction Training Program for Mental Health Providers. Community Ment Health J. 2018 Apr;54(3):293-301. doi: 10.1007/s10597-017-0190-z. Epub 2017 Nov 28.
Hunter AA, DiVietro S, Boyer M, Burnham K, Chenard D, Rogers SC. The practice of lethal means restriction counseling in US emergency departments to reduce suicide risk: a systematic review of the literature. Inj Epidemiol. 2021 Sep 13;8(Suppl 1):54. doi: 10.1186/s40621-021-00347-5.
Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. Prof Psychol Res Pr. 2021 Aug;52(4):387-395. doi: 10.1037/pro0000372. Epub 2021 May 20.
Diurba S, Johnson RL, Siry BJ, Knoepke CE, Suresh K, Simpson SA, Azrael D, Ranney ML, Wintemute GJ, Betz ME. Lethal Means Assessment and Counseling in the Emergency Department: Differences by Provider Type and Personal Home Firearms. Suicide Life Threat Behav. 2020 Oct;50(5):1054-1064. doi: 10.1111/sltb.12649. Epub 2020 Jun 29.
Boggs JM, Quintana LM, Powers JD, Hochberg S, Beck A. Frequency of Clinicians' Assessments for Access to Lethal Means in Persons at Risk for Suicide. Arch Suicide Res. 2022 Jan-Mar;26(1):127-136. doi: 10.1080/13811118.2020.1761917. Epub 2020 May 7.
Other Identifiers
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ECR-0-140-23
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
2024-0085
Identifier Type: -
Identifier Source: org_study_id