SAMHSA Austin Closing

- Disseminate and embed best practices across a nationwide system

- Impossible to maintain training in F:F environment over so many crisis centers

- Allows practicing of risk assessment and imminent risk guidelines

- No limit to how many trainings can be taken and allows supervisor control over completion

Why Chat/Text for Crisis Intervention and Suicide Prevention?

Increase in requests for online based crisis intervention services

Need to access populations that are typically hard to engage over the phone – including the hearing impaired, youth, people with social anxieties and phobias, gender questioning

Create a safe space, online, where people can access help

Provide people with ways to access services that decreases the stigma associated with accessing mental health support services

Online dis-inhibition effect – same for text and chat

- Text originally piloted with SAMHSA supplemental funds through Lifeline

- Several states, in partnership with local centers, creating regionalized responses

- Public and Private organizations answering demand.

Ex:

YouthLine in Oregon, TeenLine in LA, Crisis Text Line and Text4Life in Minnesota

- Originally piloted, along with text, by 18 crisis centers

- Lifeline, in partnership with Contact USA, created nationwide response

- In Feb 2014 went 24/7

- Using chat for follow-up

- Reaching new people- Through the chat program we have significantly increased our reach to young people. Recent statistics indicate that 44% of those that reach out via chat are under the age of 20 (75% are under 29). They are also a high risk group with 53% entering the chat reporting current suicidal thoughts (and an additional 27% with suicidal thoughts in the "recent past")

Phase 3 (2014/2015)- phased in U.S. regionally throughout 2015…then internationally adapted after…

- When to remove content (suicide/self-harm instructional messages, displays of method, etc.)

- Improve “reporting” process to Facebook: more intuitive, immediate and direct

- Choices offered to person in crisis (resources, “self-care” tips—”help yourself”)

- Less “reporting” and more “supporting” of friends in crisis—activating and educating friends wishing to help (choices for friends, too)

- Send suggested messages/actions to friends

- Resources

- Follow-up suggested/offered

Where we are going:

Social Media: How will you use it? Do you even know?

• Can be a powerful tool in engaging individuals
• Will efforts be used to disseminate information or generate content?
• Must have ability to respond to individuals in crisis if user generated content is created
• What is your plan to evaluate your efforts??

What about mHealth/Apps?

Facebook-Lifeline Partnership

• 2008: Lifeline Facebook Service Profile page
• PHASE 1 (2011): First “report suicide” protocol in social network; replicated internationally
• PHASE 2 (2012): “Facebook Chat” service (2 dedicated centers responding)—link offered to “reported suicidal person”

With So Many Choices

Must ensure that you thoroughly evaluate implementation and outcomes of all technology choices

- How will you know if you are having a positive impact?

- Are you evaluating increase in utilization? (system)

- you able to follow those to ensure services are utilized? (individual)

- Are you evaluating reduction in BH symptoms and improvement of quality of life from end user of services? (individual)

Next Steps For

you:

• Identify what components of BH response and services you currently have available
• Identify what gaps you have and how emerging technology can help bridge/enhance traditional services
• The time has never been better- many low cost or no cost
• Plan to show impact, short term and long term, through evaluation

THANK YOU!

James Wright, LCPC

Public Health Advisor

SAMHSA

240-276-1854

james.wright@samhsa.hhs.gov

Using Chat and Text

CHAT

TEXT

New Ways to Communicate:

• Email was the start
• Chat
• Text
• Social media including Facebook

A Way To...

• 165 local crisis centers
• Answered 1.3 million calls 2014, on pace for 1.7 million 2015
• Answered more than 6 million calls to date
• In response to Lifeline evaluation findings, created the Crisis Center Follow-up Grants (30 crisis center grantees to-date funded)
• Alternative contact started at local level through email
• Chat services added 24/7 Feb 2014- more later
• Follow-up grants, risk assessment standards, and imminent risk guidelines were all a result of the Lifeline evaluation findings. (research-to-practice in action)
• … enter Simmersion

Where we are now- A Review of SAMHSA Initiatives:

National Suicide Prevention Lifeline

– Training, Chat, Text

Recap of App Development

Facebook Partnership

Movement on focus of Impact

“If you've seen a state system then…”

You've seen a state system...

Immediate Problems Identified

National Council for Behavioral Health’s Crisis Services Track 2014 (out of demand from list serve questionnaire)

- Lack of best practices

- Lack of information dissemination process

- Lack of unified training

Difficult to accomplish all of these with national focus of independent agencies

- Crisis Residential Services

- Cost savings due to Crisis Stabilization/hospital diversion

- Outreach and follow-up after crisis

- Partnering (or not) with Law Enforcement with Mobile Outreach

- Trauma Training for Law Enforcement

- Peer Support Services

- Use of Electronic Bed Boards

- Handling High Frequency Callers

- CIT Training

- Tele-crisis Services

- Improved Health Outcomes due to Crisis Services

- Funding for Services

- Accreditation

- Standardization of Crisis Terms and types of Crisis Services

Options Limited

Point of Focus- Crisis Centers

• Call in or walk in
• Emergency Departments (ED)
• Police
• Crisis Hotlines
• Crisis Centers
• vast difference between services offered, personnel, and funding requirements

- Many different types; priority around instilling hope

- Over 1,200 crisis centers in 61 countries; approx. 600 in USA

- Size, funding, staffing, and operations vary

- All: Confidential; nonjudgmental listening; assessment; referral

- Many venturing into chat/texting/e-mail services

Community Hub for Crisis Intervention

- Community Involvement: Use of volunteers

- Community-wide Access: Free access, expanding ways through online services

Current system is:

- Fragmented

- Deficit-based

- Crisis-driven

- Ineffective

- Costly

- Harmful

Up until 2011, use of traditional-based technologies

Where We Have Been:

• Traditional based treatments utilized due to lack of evidence based/best practices and comfort of emerging technology
• Ex: Telephonic services through National Suicide Prevention Lifeline
• Majority of grant programs focused on F:F trainings
• Social Media mostly used as information dissemination, not focused on assessing increase in help seeking behavior or safety of user generated content

In the Next Few Minutes:

James Wright LCPC

Public Health Advisor

Suicide Prevention Branch

Where have we Been?

Where are we Now?

Where are we Going?

Using Technology for Permanent Change...