Partnerships Save Lives: Funding Crisis Chat Services

By Rena Fitzgerald, MIT

Our crisis center programs are primarily funded through the North Sound Behavioral Health Organization, which oversees how the public mental health dollars are spent in our 5 county region of Washington State.

When our crisis center participated in the original chat pilot through Lifeline, chat was not incorporated into our existing crisis line program because of the need to keep the funding streams separate. We had no data to back up an “ask” for funding from North Sound BHO.

The people who visit chat are young, many of them teens struggling with very serious thoughts of suicide and this population was largely underrepresented in our system of crisis services. The importance of chat as a valid crisis option for youth, especially youth who would not or could not make a phone call was obvious and the need for more paid staff dedicated to answering chats was recognized as we struggled to maintain a viable volunteer base. Getting Chat funded by North Sound BHO, so that we were not dependent on grants, became our mission.

Be involved

We involved ourselves in every committee and board opportunity presented by North Sound BHO. At least one manager is or has been on training and policy committees, RFP evaluation groups, and/or regional boards to oversee how services are delivered. We say yes to everything offered or asked. 
We took every opportunity and created opportunities to talk about chat, always framing it as a crisis line opportunity for underserved populations. We shared stories of suicidal youth being rescued from abusive homes who would have been left to continue suffering if they had not had a way to ask for help that their abusers could not hear. We stressed making phone calls can be dangerous in many situations where abuse is involved. When a suicide cluster began in our largest county and we had our first high school shooting in the same county, we made sure to stress that, teens do not call the crisis line, that teens don’t make phone calls in today’s world — they instant message and text.* The funders were very interested in learning more about chat and how it could meet the needs of youth — especially in the midst of an ongoing suicide cluster.

Figure out what they want

They wanted a technology-based service to act as the crisis line for teens that could be operational on a limited start-up budget and available 24/7 as quickly as possible. They wanted assurance that our chat service was delivered professionally and consistently within the framework of the existing crisis line and compliant with laws and policies. They wanted a modern website that would work with mobile devices of various types. They wanted evidence that the “cases” we have in chat are the same as the crisis line.

Prove that you’ve got it

We already had an operational system to deliver chat services. We already had 24/7 policies, HIPAA and confidentiality policies, and imminent risk policies in place. We adopted the crisis line policies and made adjustments as needed to reflect anything specific to chat as the program evolved. We already had a relationship with a web developer. To prove that chat and the crisis line deal with the same types of cases I evaluated 100 randomly selected chat transcripts, by hand, to shape the presentation or “pitch” to offer proof that our chat program was the service they wanted. I gathered data on age, gender, suicidality and imminence, issues presented during each conversation, the presence and type of trauma, and whether or not a report was made. I also created case studies by taking five chats and removing everything the staff said; what was left was just the voice of that particular visitor telling their story. The case studies were not randomly selected. I chose specific chats to represent one person from a targeted population: teens, LGBTQIA+, adult females, and adult males, and one of our child abuse cases where I actually knew the outcome because the detective involved kept me informed.

“We say yes to everything offered or asked.”

Involve the funder

Once the funding was approved, I involved the North Sound BHO representative assigned to my program and his boss in as many development pieces as possible. I want them as much invested in the program as am I. To date, this has primarily involved the website, www.imhurting.org. I wrote all of the content myself and made the basic layout and style design myself to make sure it reflected what I want and what the funders want and to ensure it would appeal to youth. I sent copies of the text and examples of styles to the funder for feedback regularly. They love the new website as much as I do and the more they are personally involved, the harder they will fight to keep the program funded and make it grow in the future. We are currently working together on a marketing campaign and will be adding texting in the not too distant future.

*Editor’s Note: Research has shown varying degrees of results regarding chat vs. phone use with different demographics, but especially in relation to use by teens. The Lifeline encourages its centers to research what services are best for local consumers and to use data to best steer programming in your communities. Having more services is more valuable than fewer and can comprehensively accommodate different users in the community.

Rena Fitzgerald, MIT (rfitzgerald@voaww.org)

Rena Fitzgerald is the Sr. Program Manager for Care Crisis Chat and the Learning and Development Consultant for the Behavioral Health Programs at Volunteers of America Western Washington. She has over 15 years experience in crisis intervention and suicide prevention and is identified by Washington State as a Mental Health Professional. She is active in community education regarding mental health issues and works closely with public schools to reduce youth suicide by providing suicide awareness instruction to students, staff, and parents. She has been an active participant in the Community Health Improvement Plan group for the Snohomish Health District and is a current member of the subcommittee tasked with increasing routine depression screenings for all primary care visits within Snohomish County. She has worked closely with the National Suicide Prevention Lifeline over the past 2 years to establish Best Practices for online suicide prevention and improve methods for Quality Improvement and Quality Assurance for hotline work, including presentations at the American Association of Suicidology Conferences the past 2 years. She is chairing the first AFSP Out of the Darkness Community Walk in Snohomish County and also serves on the Advisory Board for Human Services at Edmonds Community College.