The impact of their role on telephone crisis support workers' psychological wellbeing and functioning: Quantitative findings from a mixed methods investigation

Holding the Line - Mental Well-Being, Stressors, and Coping in Crisis Supporters

Background: Crisis supporters can experience numerous stressors in their role that can impact their own mental well-being. The area remains underexplored in research, particularly relating to substance use, and new trends in the role such as working remotely or the impact of providing chat-based support. Aims: This study identifies crisis support-related stressors, as well as levels of mental well-being and substance use, and factors associated with mental well-being. Method: Participants (n = 422) were recruited from four leading crisis support services and via social media advertising. They responded to an online survey, assessing demographics, stressors, mental well-being (compassion fatigue, compassion satisfaction, and psychological distress), substance use, and coping styles. Results: Findings identified several important stressors (e.g., argumentative callers) and moderate to high rates of compassion fatigue and psychological distress. High levels of compassion satisfaction were reported, and levels of risky substance use were low. Problem-focused coping emerged as a key factor related to positive mental well-being, while emotion-focused, avoidant coping, remote work, and providing chat-based support were linked to negative well-being. Limitations: The study's cross-sectional design and convenience sample limit causal inferences and generalizability. Conclusion: The findings reveal significant stressors and challenges in crisis supporters that require consideration and intervention.

Evaluating the Experience of Teen-to-Teen Crisis Line Volunteers: A Pilot Study

Teen-to-teen (t2t) crisis lines are a special type of crisis service where youth volunteers help their peers. Although prior research has examined the experience of adult crisis line responders, no research has examined the experience of adolescents who do this work. In collaboration with two of the largest t2t lines in the U.S., this pilot study is the first examination of t2t crisis line work. Volunteers (ages 14-20) reported: their primary motivation for joining the crisis lines was to help others and give back to the community; responding to a range of peers' problems on the t2t crisis line, including high-risk suicide contacts; and a range of ways the crisis line work impacted their lives. Findings provide preliminary information about the experience of adolescents engaging in t2t crisis line work. Additional research is needed in larger and more diverse samples to understand the impact of crisis line work for youth.

The impact of their role on telephone crisis support workers' psychological wellbeing and functioning: Qualitative findings from a mixed methods investigation

Little is known about how telephone crisis support workers are impacted by frequent empathic engagement with callers in crisis, including those who are suicidal. This is the only known qualitative study to specifically examine the impact of their role on telephone crisis support workers' psychological wellbeing and functioning. Eighteen telephone crisis support workers participated in semi-structured interviews, providing detailed accounts of the impact of the role on their wellbeing and functioning. Interpretive Phenomenological Analysis of interview data resulted in four key themes. Results suggest that telephone crisis support workers' motivations, background, personal help-seeking and coping practices are likely to impact their experiences of psychological wellbeing and functioning in relation to empathic engagement with callers in crisis. Telephone crisis services should seek to integrate an understanding of workers' experiences into the provision of training, supervision and support strategies to optimize workers' wellbeing and functioning.

Missed Opportunities: Substance Use Hotline Operator Uncertainty of State Buprenorphine Prescribing via Telemedicine

OBJECTIVES

We examined substance use hotline operator certainty of each US state and Washington, DC's endorsement of buprenorphine (initiation and continuation) prescribing via telemedicine.

METHODS

Between March and May 2021, we called hotlines in 50 US states and Washington, DC, requesting information on whether practitioners in that state could initiate or continue buprenorphine treatment for opioid use disorder (OUD) via telephone or video conference. We compared operator responses to state implementation of buprenorphine telemedicine initiation. This study was designated as not human subjects research by the Boston University Institutional Review Board.

RESULTS

We spoke with operators in 47 states and Washington, DC. Operators could not be reached in Alaska, California, and Montana. Most operators were uncertain (don't know, probably yes, probably no) whether the state permitted buprenorphine initiation (81%, n = 39) or continuation (83%, n = 40) via telemedicine. Practitioners could initiate buprenorphine prescribing via telemedicine in 7 states (100%) where operators were certain practitioners could initiate buprenorphine, 1 state (100%) where the operator was certain practitioners could not, and 6 states (86%) where operators indicated practitioners probably could not.

CONCLUSIONS

Most US states and Washington, DC, expanded the role of telemedicine in OUD treatment. However, most operators expressed uncertainty and sometimes communicated inaccurate information regarding whether practitioners could initiate buprenorphine treatment via telemedicine. There is an urgent need for policy mandates institutionalizing the role of telemedicine, and of buprenorphine specifically, in OUD treatment and for resources to train and support substance use hotline operators in this evolving policy environment.

A machine learning approach to identifying suicide risk among text-based crisis counseling encounters

Introduction

With the increasing utilization of text-based suicide crisis counseling, new means of identifying at risk clients must be explored. Natural language processing (NLP) holds promise for evaluating the content of crisis counseling; here we use a data-driven approach to evaluate NLP methods in identifying client suicide risk.

Methods

De-identified crisis counseling data from a regional text-based crisis encounter and mobile tipline application were used to evaluate two modeling approaches in classifying client suicide risk levels. A manual evaluation of model errors and system behavior was conducted.

Results

The neural model outperformed a term frequency-inverse document frequency (tf-idf) model in the false-negative rate. While 75% of the neural model's false negative encounters had some discussion of suicidality, 62.5% saw a resolution of the client's initial concerns. Similarly, the neural model detected signals of suicidality in 60.6% of false-positive encounters.

Discussion

The neural model demonstrated greater sensitivity in the detection of client suicide risk. A manual assessment of errors and model performance reflected these same findings, detecting higher levels of risk in many of the false-positive encounters and lower levels of risk in many of the false negatives. NLP-based models can detect the suicide risk of text-based crisis encounters from the encounter's content.

Exploring experiences of a telephone crisis support workplace training program in Australia

Telephone crisis support (TCS) is considered by the World Health Organization to be an integral part of an effective suicide prevention framework. However, as TCS lines worldwide are primarily staffed by volunteers, they frequently experience high staff turnover impacting on their ability to provide crucial crisis counselling to the population. One group that has been identified as potentially lessening staff shortages is university students, who may be attracted to TCS as a way to gain professional experience and qualifications. However, challenges are associated with the recruitment of this cohort, due to the potential impacts working in crisis support may have on the well-being of a group that is identified as being at higher risk of poor mental health. This study used semi-structured interviews, conducted between March and May 2020, to explore university students' experiences of a Crisis Support Workplace Training Program. It included 16 university students who completed (fully or partially) the training programme. Thematic analysis was used to identify patterns across the dataset. NVivo 12© was used throughout the analysis to assist with organisation and coding of data. Two overarching themes were identified: 1) Becoming and being the role, and 2) Experiencing and managing barriers to helping. Results illustrate how students experienced varying levels of distress due to empathetic engagement with callers, while also highlight the impact of students' experiences on the development of their professional identities. This study is amongst the first to examine the perceptions and experiences of training for and delivering TCS, and the first to focus specifically on university students as volunteer workers. The study's findings highlight the challenges participants face in undertaking crisis support training and our discussions provide a range of recommendations for future practice and research.

Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study

BACKGROUND

Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area.

OBJECTIVE

This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline's crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline's crisis support services if technology and automation were implemented in the future.

METHODS

A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline's crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives.

RESULTS

One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline's crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services.

CONCLUSIONS

Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue.

The Development of an Online Training Tool for Crisis Supporters on Late Life Suicide: Improving Knowledge While Promoting Empowerment

Telephone crisis services have an increasing role in suicide prevention yet existing interventions have not empowered crisis supporters with adequate education targeting the needs of older people in crisis. An existing educational intervention was adapted for crisis supporters through collaboration between a crisis support service, clinician researchers, and an eLearning technology company. Empowering crisis supporters, through improving knowledge and highlighting their strengths and expertise, was emphasized. The adaptive learning technology featured a pretest, middle learning module (educational content), and post-test individualized to the participant's incorrect pretest answers. The online training tool on suicidal behaviors in late-life combined clinician researcher expertise and evidence, insights from crisis supporters, and adaptive learning technology to create a purpose-built educational tool addressing an unmet need.

Advancing Public Mental Health in Canada through a National Suicide Prevention Service: Setting an Agenda for Canadian Standards of Excellence

The Public Health Agency of Canada is funding a new Canada Suicide Prevention Service (CSPS), timely both in recognition of the need for a public health approach to suicide prevention, and also in the context of the COVID-19 pandemic, which is causing concern about the potential for increases in suicide. This editorial reviews priorities for suicide prevention in Canada, in relation to the evidence for crisis line services, and current international best practices in the implementation of crisis lines; in particular, the CSPS recognizes the importance of being guided by existing evidence as well as the opportunity to contribute to evidence, to lead innovation in suicide prevention, and to involve communities and people with lived experience in suicide prevention efforts.

Secondary trauma and impairment in clinical social workers

BACKGROUND

Secondary traumatic stress (STS), symptomatology resulting from indirect exposure to trauma, is one potential negative effect from engaging in clinical social work. Yet, little is known about the relationship between STS and workers' distress and impairment due to their work.

OBJECTIVE

The purpose of this paper was to explore STS in a national sample of clinical social workers (N = 539).

METHOD AND RESULTS

A structural equation model demonstrating good model fit indicated that STS mediated the association between trauma exposure at work and reports of significant distress and impairment (β = .08, p < .01; 95 % CI = .03, .12). Likewise, STS mediated the association between working with children aged 13 and under and reports of significant distress and impairment (β = .05, p < .05; 95 % CI = .02, .09). Results indicated that the model accounted for 25 % of the variance in significant distress and impairment (R² = .25, p < .001) and 5% of the variance in STS (R² = .05, p < .05).

CONCLUSIONS

Implications for agencies working with child welfare are provided, including a discussion of addressing STS and significant distress and impairment at the individual and larger agency levels.