Virtual Reality Lethal Means Safety Training

NCT07219355 | Recruiting

• 2 other identifiers: 2024-0085ECR-0-140-23
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this randomized clinical trial is to determine whether a virtual reality (VR) training program can help healthcare providers improve their skills in discussing suicide prevention and safe storage of firearms and medications with Veterans. The study will test whether VR training increases providers' self-efficacy, confidence, and comfort in conducting lethal means safety counseling, and whether it improves their intention to use these counseling practices in their clinical work. Researchers will compare healthcare providers who complete the VR training to those who complete a 2D video training to determine whether the VR approach is more effective. Participants will complete online surveys before and after the training and again three months later. They will be randomly assigned to one of two groups: VR training group: Participants use a VR headset to interact with a virtual Veteran patient in a simulated rural clinic and practice suicide prevention counseling skills; Video training group: Participants use the same headset to watch a \~10-minute 2D video depicting the lethal means safety counseling session. After the training, participants will also provide feedback about their experience, including how realistic and useful they found the training.

Conditions

Mental Health Training; Suicide, Attempted; Rural Health; Veterans; Suicide, Completed; Suicide Prevention

Keywords

Veterans; Rural Veterans; Suicide Prevention; Suicide Risk; Firearm Safety; Medication Safety; Lethal Means Safety Counseling; Virtual Reality (VR); VR Training Simulation; Rural Health

Outcome Measures

Primary Outcomes (1)

• Confidence in Lethal Means Safety Counseling

  Measured by the Counseling on Access to Lethal Means (CALM) Core Scale (Sale et al., 2018) Confidence subscale ("How confident are you that …"). Items are rated on a 4-point scale and summed; higher scores indicate greater confidence (range = 5 - 20).

  Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up

Secondary Outcomes (6)

• Comfortability in Lethal Means Safety Counseling

  Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up

• Counseling Intentions

  Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up

• Spatial Presence

  Immediately after intervention (post-test only)

• Engagement

  Immediately after intervention (post-test only)

• Ecological Validity / Naturalness

  Immediately after intervention (post-test only)

Other Outcomes (2)

• Feasibility of VR Training (Qualitative)

  Immediately after intervention (post-test only)

• Acceptability (Qualitative)

  Immediately after intervention (post-test only)

Study Arms (2)

VR-LMST Intervention

EXPERIMENTAL

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.

Behavioral: Virtual Reality Lethal Means Safety Training

2D Video Training

ACTIVE COMPARATOR

Participants use a VR headset to view a 10-minute 2D video depicting a lethal means safety counseling session with a veteran.

Behavioral: 2D Video Training

Interventions

2D Video Training BEHAVIORAL

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.

2D Video Training

Virtual Reality Lethal Means Safety Training BEHAVIORAL

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.

VR-LMST Intervention

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 or older
• 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

You may not qualify if:

• Self-reported pregnancy
• 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)

Sponsors & Collaborators

• The University of Texas at Arlington: lead
• American Foundation for Suicide Prevention: collaborator

Study Sites (1)

University of Texas at Arlington

Arlington, Texas, 76019, United States

RECRUITING

Related Publications (5)

• 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.

  PMID: 29185154 BACKGROUND

• 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.

  PMID: 34517912 BACKGROUND

• 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.

  PMID: 34421193 BACKGROUND

• 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.

  PMID: 32598076 BACKGROUND

• 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.

  PMID: 32379012 BACKGROUND

MeSH Terms

Conditions

Suicide, Attempted; Suicide, Completed; Suicide Prevention

Condition Hierarchy (Ancestors)

Suicide; Self-Injurious Behavior; Behavioral Symptoms; Behavior

Study Officials

• Donna L. Schuman, PhD, LCSW

  University of Texas at Arlington, School of Social Work

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Donna L. Schuman, PhD, LCSW

CONTACT

817-272-3181; donna.schuman@uta.edu

J. SuLynn Mester, DNP, RN

CONTACT

sulynn.mester@uta.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Participants and study personnel are aware of assignment because the intervention content differs (interactive VR simulation vs. 2D video). Both groups use headsets to reduce expectancy differences, but this does not blind allocation. To mitigate bias, we use centralized randomization, standardized instructions, and prespecified analyses; where feasible, data analysts will be masked to group labels.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This is a randomized, parallel-group behavioral clinical trial with two arms. Healthcare providers (≥18, serving Veterans in Texas) are prospectively assigned in a 1:1 ratio to: 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.

Study Record Dates

• First Submitted: September 23, 2025
• First Posted: October 21, 2025
• Study Start: February 23, 2026
• Primary Completion: May 1, 2026
• Study Completion (Estimated): September 30, 2026
• Last Updated: March 4, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)