988 Suicide and Crisis Lifeline Centers' Workforce Challenges and Barriers: Analysis and Recommendations

988 SUICIDE AND CRISIS

LIFELINE CENTERS’

WORKFORCE

CHALLENGES

AND BARRIERS

ANALYSIS AND

RECOMMENDATIONS

APRIL 2023

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DISCLA IMER

The views, opinions, content, and positions expressed in this paper are those of the authors and do not

necessarily represent or reflect the official views, opinions, or policies of any governmental, academic, or other

institution with whom the authors are affiliated; nor does mention of trade names, commercial practices, or

organizations imply endorsement by the U.S. government, any state government, academic or other institution.

ACKNOW LED G EM ENTS

Participants

Amy Gestoso

Family Service Association of Bucks County, PA

Bill Zimmermann

Rutgers University Behavioral Health Care, NJ

Chris Sandwell

BHR Worldwide, MO

Debbie Fitzgerald

Ozark Center, MO

Eric Schmidt

Idaho Crisis & Suicide Hotline, ID

Janice Cote

The Harris Center, TX

Jared Auten

Kansas Suicide Prevention HQ, KS

Jennifer Piver

Mental Health America of Greenville, SC

Josh Burke

Northeast Kingdom Human Services, VT

Kathy Eckart

Mental Health America of Greenville County, SC

Kelly Goshen

Keystone Health, PA

Kyle Kinney,

Boystown, NE

Laura Clark

PRS Inc., VA

Lee Flinn

Idaho Crisis & Suicide Hotline, ID

Marcus Brown

Family Services Assoc. of Bucks County, PA

Michelle Watson

CommCare, MO

Rachelle Pellissier

Crisis Support Services of Nevada, NV

Richard Shutes

Jewish Community Service of South Florida, FL

Rozanna Bracken

First Choice Services, WV

Ryan Dickson

CommUnity, IA

Tanisha Brown

Contact Lifeline, DE

Terrance Hamm

First Choice Services, WV

Wendy Caruso

211 Contact Center Operations, United Way, CT

NASMH P D Staff

Christy Malik, Project Director, Contributing Writer

Arlene Stephenson, Senior Advisor, Lead Writer

Nili Ezekiel, TA & Research Associate,

Contributing Writer

Paige Thomas, Sr. Coalition Program Specialist

Vibrant Emotional Health Staff

Public Policy Department Staff

Standards, Training, and Practices Staff

Equity and Belonging Staff

Workforce Staff

Crisis Continuum Staff

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TABLE OF CONTENTS

INTRODUCTION AND PURPOSE ............................................................................................. 4

ADMINISTRATIVE ROLES AND TECHNOLOGY ..........................................................................5

CONTACT CENTER ADMINISTRATION ................................................................................................................ 5

HIRING ADMINISTRATIVE STAFF .......................................................................................................................... 5

SUPERVISION ......................................................................................................................................................... 6

STAFFING SHORTAGES ........................................................................................................................................ 6

GRANT WRITING ................................................................................................................................................... 7

OPERATING POLICIES ........................................................................................................................................... 7

TECHNOLOGICAL SUPPORT ................................................................................................................................ 7

TECHNOLOGY TRAINING ..................................................................................................................................... 8

CHAT/TEXT TECHNOLOGY .................................................................................................................................. 8

COMPLEX DATA COLLECTION PLATFORMS ...................................................................................................... 9

FUNDING FOR SUPPORT ROLES .......................................................................................................................... 9

SCOPE AND PRACTICE ......................................................................................................... 11

IMPACT OF LICENSING ON HIRING AND RETENTION..................................................................................... 11

TRAINING ............................................................................................................................ 13

SERVICE QUALITY AND BURNOUT .................................................................................................................... 13

COMPLEX TRAINING ........................................................................................................................................... 14

ONBOARDING ..................................................................................................................................................... 14

REMOTE WORKER ACCOMMODATIONS ......................................................................................................... 14

SALARIES ............................................................................................................................ 15

HIRING AND RETENTION .................................................................................................................................... 15

WORK ENVIRONMENT ......................................................................................................... 16

SHIFT WORK ........................................................................................................................................................ 16

REMOTE WORK ................................................................................................................................................... 16

TEXT AND CHAT VOLUME .................................................................................................................................. 17

EVOLVING NEEDS OF CONTACTS .................................................................................................................... 17

MANAGING CULTURE CHANGE ......................................................................................................................... 17

OPERATING MODEL ........................................................................................................................................... 18

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INTRODUCTION AND PURPOSE

On July 16, 2022, the new 988 Suicide & Crisis Lifeline (988 Lifeline) became available across all

access points across the United States. 988 Lifeline provides direct connection via call, chat, or

text to compassionate, accessible care and support for anyone, anytime and anywhere who is

experiencing behavioral health-related distress or experiencing a suicidal crisis. The 988 Lifeline is

a national network of over 200 local, independent crisis centers providing free and confidential

support 24 hours a day, 7 days a week, across the U.S. and territories. Crisis contact centers in the

988 Lifeline network are an entry point to the continuum of crisis care services. Crisis counselors at

the crisis contact centers will talk, text or chat with an individual about their concerns, and provide

emotional support and crisis interventions in order to help keep the individual alive and safe. As

needed, the crisis counselor may make a referral to mental health resources or a local mental health

professional for ongoing care. In cases where speaking, chatting or texting with a crisis counselor

is not sufficient to ensure a person’s safety, crisis counselors may make a referral to a mobile crisis

team to the location, or in cases where mobile crisis teams are not available contact 911 to send an

emergency response team. Numerous studies have shown that most callers are significantly more

likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful after speaking to a

988 Lifeline crisis counselor. The crisis counselors are the superheroes who save lives. They are part

of a larger team of heroes who ensure the operation of the crisis contact centers 24/7/365. They

oversee the expansion of the call centers, hire staff, conduct staff training, ensure the operation of

the equipment, analyze and report data, and so much more. They are part of a transformation of the

crisis care system which is taking place now and for the foreseeable future. However, changes and

growth do not come without challenges.

During December 2022 and January 2023, NASMHPD conducted a workforce analysis of 988

Suicide & Crisis Lifeline crisis contact centers in seventeen states through a series of focus group

meetings and interviews. The Directors within the crisis contact centers shared their perspectives

to assist us in identifying main themes as well as to provide insight into the difficulties they face. The

purpose of this report was to identify challenges and barriers and to make short– and long-term

recommendations that would benefit the crisis contact centers directly and in turn benefit the crisis

system. It is also intended to provide information for federal partners, 988 Lifeline admin-istrator,

Vibrant Emotional Health (VEH), state behavioral health agencies (SBHAs), state licensing boards,

and all crisis contact centers in the 988 Lifeline network to assist with their future planning and

efforts to help resolve the workforce challenges and barriers. All key recommendations aim

to expand the workforce pipeline as well as focus on retaining staff. It was an honor to have the

opportunity to meet and discuss the issues with these extremely talented and dedicated individuals.

It is our hope that these recommendations will make a positive difference for them and in the

transformation of the 988 Suicide and Crisis Lifeline and help save lives.

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ADMINISTRATIVE ROLES

AND TECHNOLOGY

CONTACT CENTER ADMINISTRATION

CHALLENGE: New and different administrative responsibilities (i.e., for staff in non-counselor

positions), the increase in the volume of contacts, and hiring and onboarding new employees

created a major challenge in the area of administration.

SHORT-TERM RECOMMENDATION: A playbook on how to create a new contact

center or assume new responsibilities as an existing center would be very helpful as the number

of crisis contact centers continues to grow, e.g., staff ratio information, what factors are dictated

by contact volume, etc.

HIRING ADMINISTRATIVE STAFF

CHALLENGE: Lack of adequate funding and capacity to hire administrative staff (e.g., HR

directors, supervisors, trainers, public relations, IT/telecom staff, data analysts) as quickly as needed,

or at all.

SHORT-TERM RECOMMENDATION: Standard templates for job descriptions and

advertisements could be developed to assist centers. Job descriptions could be collected from all

centers, reviewed, and common items identified and created into job description templates. The

template could easily be customized by a Center to accommodate their needs.

LONG-TERM RECOMMENDATION: Flexibility within new federal and private grants to

fund administrative positions needed to support the operations of the center such as supervisors,

follow-up coordinators, data analysts, and quality assurance staff.

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SUPERVISION

CHALLENGE: Access to supervision is critical and important for follow-up and quality

assurance on all shifts, but organizing supervision for remote workers is difficult. Supervision

is critical for reducing burnout rates as crisis counselors may feel more confident if they know

someone is available 24/7 who can answer questions and provide support. This can help crisis

counselors adhere to best practices and improve self-care due to the availability of debriefing.

SHO R T-T ER M RECOMM ENDATI ONS:

1. The ability to listen in real-time to calls and review chats and texts for remote staff is important.

Also, the ability to provide prompts, debriefs, and other support between crisis conversations

will help new employees.

▪ Understand common work from home challenges and make clear what is not acceptable

▪ Set clear remote work productivity standards

▪ Identify and provide the right tools, including a real time communication platform and easy

access to all needed resources

▪ Set aside specific days, times, and methods for supervision, mentoring, and team interaction

▪ Follow up with remote employees regularly

▪ Create a video or tip sheet with suggestions for remote employees

▪ Remember to actively listen to staff

▪ Continuously communicate with your team

▪ Celebrate successes

▪ Find ways to keep remote staff involved with the agency, their coworkers, and the work

▪ Promote healthy boundaries between work and personal life

More detail is available for 988 Lifeline crisis contact centers regarding guidance for remote

work.

2. The Society for Human Resources Management offers tips. Purdue University developed an

extremely comprehensive Guide to Managing Remote Teams.

STAFFING SHORTAGES

CHALLENGE: Supervision hours often become a tradeoff when there are staffing shortages.

SHO R T-T ER M RECOMM ENDATI ON: Staffing must accommodate various types of

leave as well as adequate supervision. As important as it is at this time, it will be difficult until a full

workforce is realized. Consider using experienced workers to mentor new staff providing at least

some support/communication when supervision is not possible.

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GRANT WRITING

CHALLENGE: Grant writing is a special skill that needs to be developed by administrative staff

as grant funding is critical for some centers whose funding is insufficient or unstable.

LON G-TERM R EC OMM EN DA TI O N S:

1. Grant writing workshops and other grant technical assistance should be provided within the

988 Lifeline network.

2. It is advisable to have two or more staff trained such that overlapping grant timeframes or staff

loss would not become a crisis.

3. SAMHSA has resources on grant writing and should expand on future resources (e.g., webinars).

OPERATING POLICIES

CHALLENGE: The crisis contact centers have multiple sets of operating policies for a variety

of support lines overseen by a variety of funders (states, Vibrant, private foundations, etc.).

LON G-TERM R EC OMM EN DA TI O N : A single procedure manual could be developed

for all lines managed by a crisis contact center by reviewing the requirements of each type of

support line and identifying the commonalities. Items that fall outside of standard procedures could

be identified by a note indicating a difference.

TECHNOLOGICAL SUPPORT

CHALLENGE: The crisis contact centers’ workforces cannot perform their jobs without

technological support or acquiring the technological skills themselves.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Explain why technology is needed and keep employees in the loop as decisions are made

regarding new technology.

2. Include the users (staff) in selecting new technology.

LON G-TERM R EC OMM EN DA TI O N : Use technology to improve work environments

for employees.

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PROMISING

PRACTICE

Boys Town National

Hotline, Nebraska

Knowledge of telecommunica-

tions systems and information

technology (IT) is an important

element of 988 contact center

operations and having leadership

and/or staff with this expertise

can be a huge benefit to the

workforce. The director of

Boys Town National Hotline,

Mike Klemme, has a background

in contact center management,

product management, and tele-

com IT. His background supports

Boys Town in identifying oppor-

tunities to address operational

gaps through people, processes,

and/or technology solutions,

as well as leveraging workforce

management best practices to

use historical data and current

trends to forecast future needs.

Klemme’s understanding of the

journey that a call, text, or chat

takes as it routes between carriers,

vendors, platforms, and ultimately

to the Boys Town Crisis Coun-

selors, helps the center to place

measurement in the areas of the

call-flow to identify what is needed

for the team to better answer as

many calls as possible and help

external partners by creating

awareness of opportunities for

improvement in the call flow.

TECHNOLOGY TRAINING

CHALLENGE: Technology has become increasingly complex

thus requiring more training and specialized staff and/or skills

(e.g., information technology and telecom). Centers have lost staff

due to anxiety and frustration related to the technology.

SHO R T-T ER M RECOMM ENDATI ON: Sometimes staff

learn better from other staff who are familiar with it than from the

IT technology staff. On a regular schedule ask staff to identify aspects

of the technology that present the greatest problems for them and

consider refresher training or perhaps even revamping the

technology.

LON G-TERM R EC OMM EN DA TI O N S:

1. Adoption of technology will be more agreeable to staff, and

more manageable for the trainers, by breaking the workforce

into groups and the material into shorter training courses.

2. Make technology training interesting/fun and stressless,

demonstrate how it is practical, and allow adequate time to

learn it.

CHAT/TEXT TECHNOLOGY

CHALLENGE: Chat and text are new technologies that require

training for staff. Also, the volumes of text and chat contacts are

overwhelming the centers’ current technology.

SHO R T-T ER M RECOMM ENDATI ON: Data on text and

chat growth demonstrates that text and chat are modalities of strong

growth for contacting the 988 Lifeline and are therefore a priority for

training crisis counselors on the new technology. When onboarding

a new employee, the crisis contact centers may want to train on chat

and text first. Chat/text clinical training was added to Vibrant’s

learning portal during February 2023. This training, along with all the

clinical trainings, is provided at no cost to crisis contact centers in the

988 Lifeline network.

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LON G-TERM R EC OMM EN DA TI O N : Chat/text equipment will move to the Unified

Platform. All applications used to access the platform are web-based so there is nothing to

download onto center computers. For chat/text centers and for any phone centers moving to the

Unified Platform, the items that will need support include: a solid internet connection; security

software (to protect against malware, etc.); and center-owned devices (rather than crisis counselors

using personal devices).

COMPLEX DATA COLLECTION PLATFORMS

CHALLENGE: Centers have lost staff due to the use of new complex data collection platforms.

LON G-TERM R EC OMM EN DA TI O N : Training is part of the solution. Data collection

does not need to be complex. Develop simple user-friendly systems or reprogram existing ones to

be more user-friendly.

FUNDING FOR SUPPORT ROLES

CHALLENGES:

▪ Funding for support roles (admin, HR, IT, etc.) is increasingly difficult to obtain and typically not

covered by federal, state, or other grants.

▪ Grants are welcome, but come with considerable inflexibility, e.g., differences in pay for identical

positions.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Grants available from public and private funders are useful for startup/one-time costs. Com-

petitive grants are the highest risk for a return in that a considerable amount of time can be used

writing a grant for which thousands of organizations have submitted proposals, making the

chances of receiving an award small. Developing templates or other stock language that can be

used multiple times across grants may help crisis contact centers save time.

2. Deliver the message regarding the narrow/inflexible nature of grants by asking associations to

communicate the importance of funding that adjusts for volume and flexibility to their state

members, state and federal agencies, and large private funders.

3. Hosting open houses for groups such as the police department, EMS, 911, legislators,

businesses, philanthropies, etc. may alert them to your needs (financial, space, etc.) and open

some avenues for funding or other types of assistance.

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POLICY

SPOTLIGHT

Fair Chance Licensing Act

As mental health conditions have been

criminalized, excluding candidates who are

otherwise qualified and well suited for the

role may increase and exacerbate the

workforce shortage. According to the

National Employment Law Project (2016),

approximately 70 million Americans with

a criminal background face hiring barriers

for licensing and occupational certification

positions, which are required for one in

four jobs. The primary barriers are the

criminalization of mental illness and the fact that background checks are required for occupational

certifications and licenses for many behavioral health professions such as licensed professional

counselors, nurses, social workers, and certified peer specialists.

Since occupational licensing standards are set at the state level, many states have enacted

“Fair Chance” licensing laws to address this hiring barrier as a strategy to expand their workforce.

The Council of State Governments reports that several states have adopted laws focused on best

practices to expand licensing opportunities for individuals with a criminal background. For exam-

ple, Rhode Island passed the Fair Chance Licensing Act which prohibits state licensing boards from

denying applicants an occupational license if the crime or conviction is not substantially related

to the license being sought. The Restoration of Rights Project includes a state-by-state analysis of

employment and licensing laws and codes for each state’s occupational regulations.

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SCOPE AND PRACTICE

IMPACT OF LICENSING ON HIRING AND RETENTION

CHALLENGE: Licensing requirements are different across the states and are changing

regularly. Some SBHAs and/or licensing boards have imposed a requirement that centers hire only

those with a master’s degree in a related field, and in some cases only licensed clinicians. This

increases recruitment challenges and is not always critical for job performance. For example, some

state boards do not recognize 988 call, chat, and text contact response as applicable for licensing

hours. Some of the difficult rules that are being imposed by various states include:

▪ a requirement for a license clinician to activate a Mobile Crisis Team;

▪ 24/7 clinical supervision requirements (either onsite or by phone). This applies to individuals

in graduate school or with a master’s degree, so they leave. It seems strict because previously

a trained crisis counselor without hours or degrees had been acceptable;

▪ a Community Mental Health Center (CMHC) is only permitted to hire call counselors that have

a master’s degree or higher-level education in a related field;

▪ the need for clinical hours for graduate school students; and

▪ interns are permitted to only work in the office rather than remotely.

Some state policies are also tightening rules by requiring that all employees with a bachelor’s

degree be replaced by employees with a master’s degree.

LON G-TERM R EC OMM EN DA TI O N S: Addressing these issues on a state-by-state and

board-by-board basis should be considered a long-term solution. Recommendations are:

1. Education regarding the role of crisis counselors and their role in providing emotional support to

individuals experiencing a mental health or suicidal emergency is needed across all stake-

holders, including licensing boards and other state policymakers within the SBHA and the state

legislature. This clarity regarding roles, combined with many areas of the country facing mental

health provider shortages, would reduce the chances of provider “territorial” issues with scope

of practice issues.

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2. The crisis contact centers should inform state policymakers of the difficulties that these rules

create for them. The SBHA should simultaneously inform the coordinator who oversees the

boards (social work, psychology, etc.) of the issues and the health officer (to whom the

coordinator usually reports). In addition, the SBHA may need to brief the coordinator and the

health officer about the new 988 number and the important role the centers play as an entry

door to the crisis service continuum. The centers should request an audience with the

coordinator and the relevant board staff of the various boards to request that the board staff take

the issue to the boards at their monthly meeting or that the center and/or SBHA be able to do

so. It would be advantageous to also provide the problem in writing such that no relevant points

are lost in communication. If the coordinator or the board staff do not take the issue to the

boards, the centers can write directly to the board chairperson. Note: This would not be

considered a good first step because it would catch staff off guard and potentially delay any

discussion.

3. Request that the state health department or a legislator submit a bill requiring the board to take

action. Grandfathering should be considered as an option.

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TRAINING

SERVICE QUALITY AND BURNOUT

CHALLENGE: Training is key to service quality for the crisis contact centers and is also key

to averting staff burnout and attrition.

LON G-TERM R EC OMM EN DA TI O N S:

1. Incorporate components of training that are complex or challenging, such as:

▪ Add refresher trainings, which are shorter versions of the initial training

▪ Embed interactions and accessible content via a micro-learning burst (a 1- to 5-minute pop-

up) for review when logging in/out of the system

▪ Use built-in compliance via an easy access system for staff to review and sign off on required

training material on completion

▪ Add Level 2 trainings, which are refresher courses that go more in depth for crisis counselors

taking calls, texts, and/or chats

▪ Add trainings with short practice scenarios

2. Use the following resource: SAMHSA’s Evidenced-Based Resource Guide, Addressing Burnout

in the Behavioral Health Workforce Through Organizational Strategies which addresses the six

drivers of burnout: workload, control, reward, community, fairness, and values.

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COMPLEX TRAINING

CHALLENGE: Counselors are trained with the 988 Lifeline curriculum in addition to any

training the center provides, including for different support lines or positions.

SHO R T-T ER M RECOMM ENDATI ON: Utilize Vibrant’s 988 Lifeline modular training,

which can be easily incorporated into contact centers’ existing training curriculums. This has

the benefit of allowing for easy comparisons of differences between or among various types of

support lines.

ONBOARDING

CHALLENGE: Despite the benefits of a thorough onboarding process, training the workforce

is intensive. The average onboarding time for centers interviewed was 5–7 weeks.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Implement a multi-phased, multi-component training approach so that crisis counselors can

better retain what is in the training, and feel supported as they begin answering calls, texts,

and/or chats. This also enables faster onboarding.

2. The Vibrant Standards, Training, and Practices Committee (STP) is focused on creating online

trainings to address the need to train counselors quickly.

REMOTE WORKER ACCOMMODATIONS

CHALLENGE: Requirements to be in-house hampers new hires who are only interested in

remote work. Also, unfortunately, it does not guarantee that the new employee will continue to

work beyond the training period.

SHO R T-T ER M RECOMM ENDATI ON: In-person training can be adapted as a Zoom

meeting thus enabling remote individuals to participate in real-time.

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SALARIES

HIRING AND RETENTION

CHALLENGE: Salaries are both a hiring and retention issues. As with most salaries in public

health, salaries at a majority of (but not all) crisis contact centers are not competitive with the market.

Some centers lose staff due to higher salaries offered by other organizations. Centers also report

the challenge of hiring experienced professional staff at entry level wages.

LON G-TERM R EC OMM EN DA TI O N S:

1. Low salaries as well as the inability for staff to obtain licensing hours places crisis contact centers

in the position of being the “great exporter” of talent. Adequate sustainable funding is needed

to allow crisis contact centers to be competitive in the job marketplace.

2. Higher reimbursement levels for services that are payable by public and private insurers would

also allow crisis contact centers to allocate more of their funds to salaries.

3. Incentives such as overnight and weekend shift bonuses, scholarship programs, sign-on

bonuses, paid leave, and improved health insurance benefits should be considered by all

contact centers as a cost-effective recruiting tool.

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WORK ENVIRONMENT

SHIFT WORK

CHALLENGE: Night shifts and weekends create the greatest hiring challenges. During these

shifts transportation may be more difficult, and safety a concern, but the conflict with family life is

the major impediment.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Allowing for flexibility in schedules and length of shifts has been an effective strategy for some

crisis contact centers. For example, one center has staff that work three 12-hour shifts and a

Sunday 8-hour shift, which allows for personal time.

2. Centers may consider stipends to assist with the extra cost of transportation for night and

weekend shifts. A cab or transportation service such as Uber would address safety and

geographic accessibility but is more costly than public transit.

LON G-TERM R EC OMM EN DA TI O N : It may be possible to offer a higher shift

differential or a greater number of vacation days.

REMOTE WORK

CHALLENGE: Remote work is a preference for a large percentage of the workforce, but some

crisis contact centers are not permitted by the state to offer remote opportunities and for others

remote options are limited.

SHO R T-T ER M RECOMM ENDATI ON: The inability to offer remote work should be

negotiated. It is widely used in all industries. Assuring the supervisors’ abilities to monitor remote

work should help alleviate concerns. Noting that remote work creates a wider hiring pool (e.g.,

employees with medical conditions and those living in high traffic areas) could also be useful.

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PROMISING

PRACTICE

First Choice Services

West Virginia’s

Second Chance

Hiring Program

“Our organization knows that

people who are struggling can

recover.” Lata Menon, MSW, CEO

of First Choice Services, shared

that hiring people with lived

experience of the criminal justice

system, substance use, and/or

mental health challenges is an

integral part of their workforce.

To effectively be a second

chance employer, it is essential

to understand, destigmatize,

and create solid supports for all

employees, including having

policies and procedures in place

to address any relapse or other

challenges that any employee

might experience. People with

the right orientation to the work

and a commitment to openness

in their approach can be trained

to be excellent counselors,

regardless of education level.

TEXT AND CHAT VOLUME

CHALLENGE: The volume of text and chat has become

overwhelming for some Centers.

LON G-TERM R EC OMM EN DA TI O N : As previously

mentioned, text and chat are a growing communication preference

for individuals in crisis and must be addressed urgently. The increase

in the texts/chats should drive the increase (using ratios) in the

number of staff needed to respond and should be addressed in

funding/budgets.

EVOLVING NEEDS OF CONTACTS

CHALLENGE: A new challenge for contact centers is the

increase in the variety of needs of 988 contacts, e.g., co-occurring

mental health and substance use, gender identity, etc.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Update staff training and skills to increase competence in all

types of behavioral health issues including substance use, gender

identity, suicidal ideation, anxiety, and emotional distress.

2. Since the crisis contact centers’ past focus has been primarily

mental health, staff may have inaccurate or outdated information

regarding individuals with substance use disorders (SUD).

Additional training on SUD may be helpful for staff.

MANAGING CULTURE CHANGE

CHALLENGE: Unhappy staff are pushing back or resigning.

SHO R T-T ER M RECOMM ENDATI ONS:

1. Remember that change is difficult and more so for some people

than others. Be sure staff know that leadership understands the

change may be difficult, but everyone will adjust together.

2. Keeping staff in the loop regarding new plans and rationale for

changes helps them feel more comfortable and feel a part of the

improvement to the system. Including them will help the transition.

3. Provide staff with satisfying tasks, even if they are small, that staff

can be proud of to feel that they are more a part of the change.

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P A G E 18 O F 19

4. With 988 implementation, include staff in decision-making by providing opportunities for input

from staff about the organizational change, such as working on special projects. Supervisors and

leaders should provide regular check-in points to ensure bidirectional feedback. Leadership

needs to drive the change and convey their support.

OPERATING MODEL

CHALLENGE: Staff are uncomfortable with the move from being small, often primarily

volunteer organizations, to adopting a more corporate-like model, including adapting to managed

care policies.

SHO R T-T ER M RECOMM ENDATI ONS:

1. There are more lives to be saved and improved and no one has those skills nor understands the

urgency better than the crisis counselors answering 988 contacts. They are dedicated and will

adapt for the cause. Help staff understand that the challenges they face every day in helping

others are far more complex than changing to corporate-like models.

2. Help staff understand the big picture and how even “going corporate” can still be staff oriented.

Encourage the sharing of ideas and implement the ideas if possible and logical. Use group

discussions and/or a suggestion box.

3. Provide staff with the information and opportunity to join learning communities, such as the

988 Crisis Jam Learning Community. By participating in learning and other professional

development opportunities, staff may obtain a better understanding and connectivity to their

work.

4. Hold an onboarding meeting with members of 988 leadership to encourage the new center.

This could help ease the transition.

LON G-TERM R EC OMM EN DA TI O N : Find creative ways to educate and amplify the

work of crisis contact centers as many stakeholders and the general public may be unaware of the

great work crisis centers provide to their communities and beyond.

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PROMISING

PRACTICE

Lines for Life YouthLine

Long-Term Workforce

Pipeline

Lines for Life launched a youth-serving crisis

support line, YouthLine, in 2000 because

they believed that the voices of peer-to-peer

connection are more powerful to youth

in crisis. Located in Portland, Oregon, the

program started with 9 youth volunteers

and has since grown to over 130 volunteers

ranging in age between 15 to 24 years old.

Recruitment occurs organically through word-of-mouth referrals, social media, and presentations

at high schools. After completing 70 hours of training, the youth counselors respond to calls, chats,

emails, and texts 7 days a week from 4 pm to 10 pm PT. They are continuously supervised and

supported by at least two Lines for Life clinical staff.

YouthLine offers stipends to eligible youth counselors to diversify the volunteer pool to be more

reflective of the greater Portland youth demographics. Through a generous private donation, the

stipends eliminate potential barriers for some youth volunteers such as transportation and reduced

wages from missing work.

“This direct volunteer experience is nothing like teens would get anywhere else in the field, without

a master’s degree," said Morgan Lee, YouthLine Assistant Director of Youth Development, Training,

and Quality Assurance. The skills they learn volunteering can be applied to their day-to-day living

and future positions in the mental health and crisis services field. Lee shared that many former

youth counselors return to Lines for Life through college internships and post-graduation stepping

into roles for the adult crisis line, administrative support positions (e.g., finance, quality assurance),

volunteer coordinators, and YouthLine supervisors.