Perceived Satisfaction and Effectiveness of Crisis Lines Based on Number and Type of Crisis Intervention Strategies Used (Board#21)

Abstract : Introduction. Suicide is a public health crisis, with more than 720,000 people dying each year due to suicide (World Health Organization, 2024). With this number continuing to rise in recent years, prevention efforts have become a priority for many organizations (Hedegaard et al., 2018; U.S. Department of Health and Human Services, 2024). One such type of prevention effort is crisis lines. Crisis lines were created so individuals facing emotional crises or suicidal thoughts can connect with a trained crisis line counselor (Joiner et al., 2007). This trained counselor can then utilize a variety of tools related to crisis intervention and support, such as risk assessment and referring individuals to additional resources. Some studies have shown overall satisfaction and perceived effectiveness for these crisis lines through both calling and texting modalities (Gould et al., 2021; Gould et al., 2022). Additional research has also found evidence that crisis line counselor characteristics (e.g., empathy and respect) impact the satisfaction of callers (Mishara et al., 2007). Practices such as collaborative problem-solving (e.g., asking about resources, discussing a plan of action) may also positively impact satisfaction. Despite the growing evidence of satisfaction with crisis lines, there is limited research on how a comprehensive list of crisis intervention strategies impact caller/texter satisfaction and if the number of intervention strategies utilized in an interaction between the person in crisis and the crisis counselor relates to caller/texter satisfaction.

Research Aims. The present study aims to investigate whether the number of intervention strategies used during a call/text to a crisis line is related to the perceived effectiveness and satisfaction of individuals who called or texted the crisis line and how specific intervention strategies are related to satisfaction. We hypothesized that as the number of intervention strategies increases, perceived effectiveness and satisfaction with the crisis line would increase. Though we did not hypothesize specifically which strategies would be more associated with perceived effectiveness and satisfaction, we examined which strategies had larger effects on perceived effectiveness and satisfaction.

Methods. Data collected for this poster were part of a larger, self-report online survey completed by undergraduate students at a large university in the southern United States. IRB approval was obtained from this university. The number of intervention elements that occurred during crisis line calls were evaluated by 16 questions about different strategies crisis line counselors may use, which were selected based on discussions with former crisis counselors. Questions included “Did your counselor introduce you to a safety plan”, “Did you discuss coping strategies”, and “Did you discuss triggers for suicidality”. These questions were asked for specific modalities of communication (call and/or text) depending on which modality the participant endorsed using. Response options for these questions were “Yes”, “No”, and “I don’t know/I’m not sure”. All "yes" responses were summed for each participant to create a score representing the total number of elements present in participants’ calls/texts with the crisis line. If someone responded for the number of elements they experience for both call and text, data from only the call was included to avoid using data from the same participants twice. Outcomes were measured with three questions. Participants answered how they felt after the call ended on a 5-point Likert scale from “much worse” to “much better”. The extent to which the call kept them safe in that moment was measured on a 5-point Likert scale from “a lot” to “it made things worse”. Finally, participants rated their overall experience calling/texting the crisis line using a 0 to 100 slider scale from “very bad” to “very good”.

Results. Among the sample that endorsed calling and/or texting a suicide crisis line (n = 107, 65.4% White, 74.8% Female), the number of elements present during a call/text to the crisis line (M = 5.08, SD = 4.69) was positively correlated with how participants felt after the call ended, r(78) = .573, p < .001, the extent to which the call kept the participant safe, r(74) = .498, p < .001, and how participants rated their overall experience with the crisis line, r(76) = .601, p < .001.

Further, independent samples t-tests were conducted to determine which elements had the largest effect on participants' overall experience with the crisis line. Receiving social support from the crisis counselor (d = 2.013), discussing social contacts to call for help (d = 1.394), and exploring reasons for living (d = 1.389) had the largest effect sizes for overall experience while receiving referrals for financial, food, or healthcare assistance (d = .459), discussing triggers for suicidality (d = .436), and exploring reasons for dying (d = .201) had the smallest effect sizes. These findings indicate that receiving social support, discussing social contacts to call for help, and exploring reasons for living have more of an effect on how participants rate their experience with the crisis line after they have called or texted with a counselor.

Conclusions. As the number of intervention elements utilized in crisis line calls/texts increased, perceived effectiveness and satisfaction by callers/texters increased. Additionally, ratings of participants’ overall experience with the crisis line were most impacted by receiving social support from the crisis line counselor, discussing social contacts to call for help, and exploring reasons for living. These findings indicate that crisis lines may be most effective when utilizing more intervention techniques. However, if there is limited time, crisis lines may be more effective when counselors give social support to callers or texters, discuss social contacts they can contact for help, and discuss reasons for the caller or texter to keep living.