Trainer Fidelity as a Predictor of Crisis Counselors' Behaviors With Callers Who Express Suicidal Thoughts.

OBJECTIVE The relationship between trainer fidelity during a two-day suicide prevention program for counselors at crisis centers and counselors' behaviors during calls from individuals with suicidal thoughts was examined. METHODS The study used two data sets from a randomized control trial of a suicide prevention program delivered by counselors at 17 crisis centers who had previously received training (train-the-trainer [TTT] approach). One data set examined counselors' behaviors by silently monitoring calls (N=764) to the crisis lines, and one assessed adherence to manual content and competence in delivery among trainers (N=34) by coding training videotapes. Multilevel modeling was used to account for nested data. RESULTS Use of recommended behaviors by counselors was primarily related to trainers' competence in delivery of the program rather than adherence to the program content. CONCLUSIONS Trainer selection for competence may be particularly critical for group-based TTT programs involving experienced counselors and the use of experiential activities.