ABSTRACT
Background
Community Helper Training (CHT) equips people to identify and support individuals thinking about suicide. Most CHT occurs in person, but interest in online delivery is growing. Living Works Start is a 90 min online CHT designed to improve recognition of warning signs, confidence, and willingness to help.
Aims
Evaluate learning outcomes from Start using quality assurance (QA) data, examine the efficacy of online CHT, and determine if prior suicide prevention training influences gains.
Methods
Pre- and post-training surveys from 44,003 learners assessed willingness to talk, ability to recognize signs, confidence to help, and knowledge of how to get help. Paired t-tests and effect sizes examined changes. Subgroup analyses explored differences by quantity and recency of prior training.
Results
Significant improvements were observed across all outcomes (p < 0.001). Learners with no prior training showed the greatest gains, though all improved.
Limitations
QA data lacked randomization, comprehensive demographics, and follow-up, limiting generalizability, understanding of skill use, or long-term retention.
Conclusions
Start was associated with self-reported learning gains. Benefits were observed across learners and were strongest among those with no or more distant prior training. Future research should test efficacy under controlled conditions and examine long-term outcomes and real-world use of skills.