On Wednesday, October 4th at 1pm EST, iCarol will host a webinar on the topic of Crisis Center/Emergency Department (ED) partnerships, specifically those where crisis centers make follow-up calls to discharged patients who came to the ED presenting with suicidal thoughts or behaviors.
Research shows that for about 1 in 5 deaths by suicide, the person had actually visited their local emergency department in the weeks before their death. While hospital EDs can keep a person safe in the short-term and provide referrals to long-term care, they aren’t often the best resource to handle the complex and ongoing mental health and emotional needs of someone who is struggling with thoughts of suicide. Most people who visit an ED for concerns related to suicide are discharged after a very short period of time, and the discharge plan often doesn’t involve ongoing direct contact to check and see how the person is doing following their visit, potentially leaving the patient feeling lost and unsupported.
This is where more and more helplines are stepping in. Crisis Centers across North America have engaged in partnerships with their local emergency department to help provide care for ED visitors or discharged patients in the form of follow-up calls. Because crisis center professionals have the best knowledge, training, and resources to provide ongoing care such as this, EDs will make connections between the ED visitor to the crisis center. From there, crisis centers talk to the patient and make a series of follow-up calls or texts to the visitor to keep them feeling supported and engaged with a safety plan. Crisis centers are also best-equipped to see that a person receives referrals to more long-term mental health care or other needed referrals that can help resolve issues compounding a person’s distress and desire to end their life.
During this hour-long webinar, we’ll invite presenters to discuss first-hand experience of these partnerships:
Charissa Tvrdy is a Lead Crisis Clinician and Hospital Follow-Up Coordinator at Rocky Mountain Crisis Partners. Ms. Tvrdy is responsible for oversight and project management of RMCP’s Hospital Follow-Up program. She works as a liaison between RMCP and participating Colorado emergency departments. Ms. Tvrdy assists call center staff in the training, implementation, quality assurance and daily operations of the program. Ms. Tvrdy received her Master of Science in Counseling Psychology from The University of Kansas. She has experience working in a call center serving people experiencing behavioral health crisis. Ms. Tvrdy also has clinical experience within a Community Mental Health Center.
Dr. Michael Allen built the model Comprehensive Psychiatric Emergency Program at Bellevue Hospital. He was chair of the APA’s Task Force on Psych Emergency Services, president of the Am Assoc for Emerg Psychiatry, member the NIH Emergency Medicine Roundtable, a National Suicide Prevention Lifeline steering committee member, a STEP-BD, ED SAFE and PRISM investigator and an author of the Suicide Prevention Resource Center’s ED Decision Support Guide. He has served as a subject matter expert for the US DOJ Civil Rights Div, CMS, NIMH, the Joint Commission and SAMHSA. He was instrumental in forming the Colorado Suicide Prevention Commission and the Colorado National Collaborative. He is currently Professor of Psychiatry and Emergency Medicine at the Johnson Depression Center, University of Colorado Anschutz Campus and Medical Director of Rocky Mountain Crisis Partners.
Caitlin Peterson is the Coordinator of Best Practices in Care Transitions for the National Suicide Prevention Lifeline, working closely with crisis centers, professional organizations, community partners, and mental health providers to support and advocate for follow-up and partnership with crisis centers. Caitlin has worked in the mental health, crisis intervention, and suicide prevention field for over 10 years, 7 of those in various positions, and later manager, of a blended suicide prevention and information and referral hotline. She has a Master of Science degree in Marriage & Family Therapy from the University of Rochester School of Medicine and Dentistry.
We hope you can attend — space is limited so please register ASAP if you’re interested in joining the live presentation. For those who can’t join us, we’ll have the recording available on our website at a later date. To learn more about this webinar and to register, click the button below.
The success of your follow-up program hinges in part on how many contacts you can make and how much outcome data you can collect. And that is very dependent upon how many help-seekers will agree to take part in your program.
Asking a client to agree to a follow-up can be intimidating, and it takes skill and experience to ensure their participation. Here are some tips guaranteed to turn more of your inbound contacts into follow-up opportunities.
Build rapport – The success or failure of getting a caller to agree to a follow-up contact actually begins from the first moments of the call. Building rapport and trust between the specialist and help-seeker is a key component to the success of the call itself, but also impacts the chances of future contacts. If your specialist struggles to make a connection, or the client doesn’t feel heard or helped, they’re unlikely to welcome a call back. But, if your help-seeker feels connected to the call specialist and feels a sense of trust, they’re much more likely to agree to hear from your service again.
Don’t ask – One strategy that will help you get a “Yes” is to not ask them the question at all. Asking someone, “Can I call you back tomorrow?” gives them a choice of saying “Yes” or “No.” What if you make the assumption that they want to hear back from you? Instead of asking permission, try telling them you’re going to reach out to them again, and put them in position of having to refuse. Sound uncomfortable? It’s all about the delivery and can take some skill to pull off. Some example phrasing:
If done correctly, your client won’t feel pushed or pressured, they’ll feel cared for.
- “I’m so glad you reached out to us today. Hey, I’m going to call you back tomorrow just to see how things are going, what time is good for you?”
- “I want to check in and see how you’re feeling tomorrow, what’s the best number to reach you at?”
- “Just to be sure you got everything you needed, I’m going to call you back to make sure those referrals could help you. How’s Thursday afternoon?”
- “When we get back in touch to check in, what works better for you, should I text you or call you?”
- “We want to help you through this, I’ll check in again tomorrow to see how you’re feeling.”
Pick your moment – There’s no rule saying that you have to schedule the follow-up contact at the end of the interaction. If there’s a moment earlier in the call that feels right, take the opportunity then. Maybe it’s when you’re giving referral information, or at a moment when the person needs to be reassured that you truly care. If you find that moment at some point earlier in the conversation, schedule the follow-up then, or at a minimum, plant the seed, and continue your conversation. Then come back to the topic at the end of the call to remind them you’ll be following up and firm up the details.
Avoid the “S” Word – Surveys and feedback are important, no doubt, and there’s a great likelihood you’ll need to collect data from the client when you follow-up. But, there’s usually no reason the help-seeker needs to know this when scheduling the follow-up. The word “survey” can be a turn off to many people, so knowing this is expected of them may discourage the very thought of being called back. If you must give them notice of this, then the word “feedback” may be safer (e.g. We’d like to call you back and get your feedback”). If possible, don’t mention either when you’re scheduling the follow-up contact. Instead…
Make it about them – The client should feel like you’re following up because you care, because you want to know they’re okay, because you want to continue helping. This shouldn’t be hard, because of course you DO care and you DO want to keep helping! The more you make them feel like there’s nothing in it for you, and that it’s all about being there for them, the better your chances that they’ll want to hear from you again. And the more successfully you do this, the more eager they’ll be to give back to you by answering your survey questions when the time comes.
Continue helping – Speaking of what’s in it for them, don’t forget to let your callers know that they have something to gain from hearing from you again. Having the chance to talk about their situation again may be an attractive prospect. Maybe you can offer them additional referrals, or brainstorm more options with them dependent upon what’s transpired since you last spoke. If they feel like you’re an ally on this journey with them, they’ll welcome continued contact.
Give them options – Give your help-seekers options for how they can hear back from you, and consider how they reached you as a guide for how they may wish to be contacted again. Phone callers may wish to be called back, but make sure they know you can text them or email them, too, if those provisions are in place. Research conducted by Varolii Corporation in 2013 found that text messaging was quickly becoming the preferred channel of communication for most American consumers, and one in five consumers were equally likely to prefer a text message as they are receiving a voice call. Consider your client’s age as well – 36% of 18 to 24 year olds said a text message was their preferred form of communication with businesses. For help-seekers whose initial interaction happened via live chat or text, there’s a good chance they’ll reject a follow-up by phone. Convenience may be key for some clients; your ability to reach back out by alternative channels could improve the chances they’ll agree to future contacts from your service.
We recently enhanced the “Follow-up Activity” section of call report forms to allow for scheduling several follow-ups at the time that the original form is being filled out. Previously you could add just one initial follow-up activity when first filling out a new call form. Scheduling additional follow-ups was possible, but it required that you first submit and then view or edit the report form before adding additional activities. These additional steps are now unnecessary.
Here’s how this capability works:
1. If you’re only scheduling one follow-up for the client, do what you have always done, which is to fill out your reporting form, fill out the Follow-up Activity information on the ‘Finish’ tab of the form, and then Submit the form.
Important Note: If you only want to add one follow-up activity, follow the steps above as written. You DO NOT need to click the “Add New Follow Up” button. If you do, then enter the follow-up details again, two follow-up activities will be created. The Add New Follow Up button is only to be used if you want to add more than one follow-up activity at a time.
2. If you know at the time the initial report form is being created that this client should receive not one, but several follow-ups, you can schedule several follow-ups at this time, before submitting the form. After scheduling the first follow-up, click the Add New Follow Up button to save this follow-up and create an additional follow-up.
3. Once the first follow-up has been scheduled, you’ll see it listed under the Scheduled Follow-ups area. Then, your follow-up activity will be clear once again and you can now schedule an additional follow-up. Once the information is complete, click the Add New Follow Up button as you did before to add this second follow up.
4. You can follow steps 2 and 3 as many times as needed to scheduled a series of follow-ups for this client, before clicking the Submit button once finished. If at any point you make a mistake when filling out follow-up details, the Clear Follow Up button can be used to clear all details entered.
You’ll still be able to add additional follow-up activities in both View or Edit mode of report forms just as you always could, but these new capabilities allow for a more efficient process if you’d like to schedule several follow-ups right from that first, newly created form.
There are many scenarios in which you may know during the first interaction that a help-seeker will want or need several follow-ups. One example is shown in our screenshots above, where a caller presenting with thoughts of suicide may need several follow-ups to stay in touch and help them maintain a safety plan. In fact, many authorities on suicide prevention best practices suggest that ongoing follow-ups from crisis contact centers are an important part of successfully seeing someone safely through a period of intense suicide ideation.
Other examples of multiple follow-up planning during the initial interaction could be planning out a series of surveys with a caller, or a series of follow-ups to follow their progression through an application process or other ongoing activity.
By being able to set out and schedule these follow-ups all at once when completing the initial form documentation, your staff and volunteers will save some additional steps and clicks, which saves time and more quickly gets them back and available for the next call, chat, or text.
Recently we announced the availability of several exciting new capabilities related to Texting/SMS in your iCarol system:
- Send a text message (SMS) to your callers from a follow-up task attached to a call report. Best practices from suicide prevention professionals show that proactive follow-ups can reduce risks to suicidal callers.
- Send ad hoc text messages to your staff and volunteers, and allow them to receive automated iCarol notifications like shift reminders by text message. As many people now check email less frequently, this is an important new channel for them to use.
- See the total text message usage for your iCarol system. If you have any feature enabled that can generate Text/ SMS messages, you can now go to the Statistics -> Messaging page to see how many are being sent and received.
- If you also have iCarol Messaging (SMS), then when people respond to these outbound text messages, their responses will come into your Messaging queue. If not, they will receive an auto-responder indicating responses are not monitored.
To turn on these features and learn more about using Text Messaging/SMS at your helpline, go to the Admin Tools page and click on the new Messaging tab. Please note that Text Messaging / SMS traffic can result in additional charges from iCarol as well as for the recipient from their mobile phone service provider. If you have any questions, feel free to contact the iCarol Support Team by logging a case.