Enhancing Crisis Response: Evaluating the Impact of 988 Suicide & Crisis Lifeline Training on Crisis Counselors

Body of Abstract: Research Aims

The 988 Suicide & Crisis Lifeline is the entry point to getting individuals in suicidal, behavioral health, or emotional crisis the help that they need quickly. Prior research has found that use of crisis lifelines is associated with decreased distress, suicidality, hopelessness, and psychological pain (Gould et al., 2021; Ramchand et al., 2017). Crisis counselors typically resolve over 80% of issues on the call and successfully collaborate with over 75% of callers to help them stay safe (Balfour et al., 2022; Gould et al., 2016). Thus, crisis counselors play an integral role in alleviating help-seekers’ emotional distress and saving lives.

All 988 Suicide & Crisis Lifeline counselors are required to complete four self-paced online training courses provided by Vibrant Emotional Health (Vibrant) and meet local contact center requirements before they respond to crisis contacts. Systematic, comprehensive training improves counselor skills in responding to those experiencing suicidal, behavioral health, or emotional crises. This study is being conducted as part of a program evaluation to evaluate the effectiveness of Vibrant’s training courses and Lifeline Safety Assessment Model in improving crisis counselors’ self-efficacy, knowledge, and skills. Specifically, this study provides insight into (1) crisis counselors’ self-efficacy, knowledge, and skills in conducting safety assessment practices and interventions; (2) conditions under which crisis counselors’ skills vary based on comfort working with different groups; and (3) individual, organizational, and role-related characteristics that may explain variations in self-efficacy, knowledge, skills, and behavior.

Methods

Crisis counselors who have completed the four core self-paced online training courses (i.e., Fundamentals of Crisis Counseling, Essential Skills for Crisis Counseling, Assessing Safety and Suicide Risk, and Imminent Risk of Suicide) are invited to complete a Workforce Follow-Up Survey (WFS) 6 months after completing their training. The WFS, which launched in October 2024, assesses self-efficacy (measured through the Risk Assessment and Management Self-Efficacy Scale; Delgadillo et al., 2014), knowledge of safety assessment and engagement principles (measured via training assessment items developed by Vibrant), and skill in risk assessment (measured via the Suicide Counseling Skills Inventory; Coohey et al., 2022). WFS data is matched with existing pre-/post-test knowledge scores to highlight changes in learning in the time since training. Reaction is gauged through participant feedback gathered on post-training survey and the WFS. The WFS also asks crisis counselors to share examples of new practices they have implemented since training, as well as the results of those changes.

Organizational data will also be obtained from each center through the Organizational Catalyst and Capacity Inventory (OCCI), which was launched in July 2024 and is completed by one director/administrator per crisis contact center. Through an inventory of center practices, the OCCI serves as a tool to better understand the extent to which additional training supports and other organizational drivers (e.g., supplementary training, supervisory support; Hughes et al., 2018) are associated with any identified changes in outcomes.

Results/

Conclusions:

This study uses a rolling approach to data collection from centers (via the OCCI) and crisis counselors (via the WFS) in order to ensure that feedback is representative of the full 988 Suicide & Crisis Lifeline Network, including both incumbent and newly-hired crisis counselors. As such, the study team is still in the process of collecting WFS data. To date, we have received complete responses from approximately half of all 988 Suicide & Crisis Lifeline contact centers (85 of 203, 42%) and 769 crisis counselors and anticipate being able to share full study results during AAS 2025. Potential results and conclusions that may be highlighted include:

-Description of common trends across locally-administered training programs used by centers to supplement the training provided by Vibrant. For example, preliminary descriptive analysis of OCCI data submitted through the end of October 2024 (n=85 centers) indicates that nearly all centers incorporate practice activities into their initial onboarding plans. Shadowing is the common type of practice activity (94%). Training plans for new crisis counselors, including both didactic and experiential learning components, typically last for 4 or more weeks (72% of centers). Most centers continue providing formal training opportunities after onboarding is complete on a monthly (40%) or yearly (32%) basis, while informal, peer, or supervisor-based training occurs most commonly on a weekly basis (48% of responding centers).

-Retention of training knowledge between initial training and 6-month follow-up, based on the results of a linear mixed model (as appropriate based on data structure and final sample size).

-Relationships between self-efficacy/confidence, knowledge, and skills measures, based on the results of a linear mixed model (as appropriate based on data structure and final sample size) and bivariate correlations.

-Training outcomes and any identified barriers to applying training concepts associated with the 4 core training courses, based on descriptive analysis of counselor-reported data.

-Center- and counselor-suggested future training topics. For example, OCCI data submitted through the end of October 2024 (n=85 centers) described a need for resources that addressed specific population groups, like inappropriate or abusive contacts (n=15 references). As new centers open and grow, some centers (n=10 references) shared a desire for training content that is focused on things like providing effective feedback, managing crisis counselors who work remotely, and supporting crisis counselors in managing burnout.

In line with the “in the works” submission category, we will invite audience reactions to our findings, solicit suggestions for future training topics, and gather any additional feedback regarding trainings. This study is IRB approved.

Learning Objectives:

• At the conclusion of this presentation, the participant should be able to discuss the benefits of cross-center training courses.
• At the conclusion of this presentation, the participant should be able to assess whether additional or ongoing training is needed to support knowledge retention after training.
• At the conclusion of this presentation, participants should be able to compare different approaches for local- or center-administered training programs.
• At the conclusion of this presentation, participants should be able to apply findings to their own organizational contexts and identify potential improvements to their local- or center-administered training programs.