Building and preparing the crisis services workforce

An insightful discussion with Erik Jacobsen, crisis specialist at Rocky Mountain Crisis Partners, on transforming the crisis care workforce through diversity and flexibility

In 2022, the U.S. transitioned the 10-digit National Suicide Prevention Lifeline to 988 as part of the bipartisan National Suicide Hotline Designation Act. To address the nation’s mental health crisis and increase access to crisis care, the transition to 988 scales call center capacity to support the influx in reach.

In this podcast, hosted by Taylor Moore, director of research science at ICF, discusses the need for a prepared and diverse workforce in crisis call centers with colleague Kary James, vice president of equity and inclusion for the public sector at ICF. They are joined by Erik Jacobsen from Rocky Mountain Crisis Partners to discuss the shifting landscape of crisis workforce development. Together, they cover topics including:

• The transition to 988 in Colorado and beyond
• The impact of remote work on the crisis care workforce industry
• Supporting the mental health needs of crisis care staff
• The importance of adequate staffing for crisis call centers
• Expanding the cultural responsiveness of the industry’s workforce
• The need for a diverse and prepared workforce

Full transcript below:

Taylor: Delivering on the promise of a transformed crisis care continuum begins with a prepared workforce. The crisis call centers answering the calls to 988 stand at the ready as the initial point of contact for individuals who are experiencing a mental health or substance use crisis. With the anticipated call volume expected to double by the end of the first year of implementation, there is a critical need for adequate staffing in call centers.

Welcome to our podcast on building the crisis services workforce. My name is Taylor Moore and I will be the host for this podcast today. I'm a behavioral health researcher at ICF. Today we are joined by Erik Jacobsen from Rocky Mountain Crisis Partners, who will share about the work they've done to develop a prepared and diverse workforce that answers crisis calls in Colorado. I'm also joined by one of our ICF experts on diversity and inclusion, Kary James, who will discuss ideas for further expanding the cultural responsiveness of the crisis call center workforce. Now, I will turn over to each of my guests so they can introduce themselves. Erik, can you tell us a little more about who you are and your role at Rocky Mountain Crisis Partners?

Erik: Thank you, Taylor. Thanks for having me on the podcast today. My name's Erik Jacobsen and I work for an organization called Rocky Mountain Crisis Partners in the state of Colorado. We answer the Colorado Crisis Line as well as Lifeline, which has now become 988, as you mentioned. I've been with this organization for about three years now in varying capacities. I started out as a crisis specialist, and so that's the person that's answering the crisis line. I did that exclusively for about a year and a half whereupon I've moved into some other areas of our organization. Honestly, I'm not even sure what my title is these days, but I find myself involved in quite a few different projects, including 988 and the preparation and launch for that, so I'm excited to have a conversation today.

Taylor: Thank you, Erik. Kary, would you like to introduce yourself, your background, and your role at ICF?

Kary: Sure. Thank you, Taylor. My name is Kary James. I am the vice president for equity and inclusion for ICF for our public sector group. I am a career clinical social worker. I have spent the last 25 years of my professional career working in public child welfare and doing that specifically in looking at our service provisions and the way that we are meeting the needs of our most vulnerable populations, how we're looking at equitable service delivery. In my current role now with ICF, I am taking really all of that work that we've done, looking at systems level, and helping us as we think about the ways in which we're meeting the needs of our clients across the federal structure. As we all know, there has been a lot of momentum in the past couple of years around advancing our executive order, focused on specifically looking at equity in the federal government and we are looking at wanting to make sure our practices at ICF, the solutions, the way in which we are partnering with our federal clients, the way that we are designing solutions are being done so with equity in mind, with inclusive practices, and with diverse representation and perspectives.

Understanding Colorado’s crisis center landscape and its post-pandemic transition

Taylor: Thank you, Kary. Thank you both for joining us today. To begin, I'd like to hear more from you, Erik, about Rocky Mountain Crisis Partners. Can you briefly describe how your call centers work in the state of Colorado?

Erik: Sure. I have been with Rocky Mountain Crisis Partners for about three years, but our organization has been around for more than 10 years answering the Colorado Crisis Line, and we've started answering Lifeline in 2014, so we've been doing this work for a while. To help paint the picture, when I started in 2019, we had one call center located in the greater Denver area, and I signed up to be a frontline call-taker. I got hired on and everything we did was in the call center and we had our team there supporting the needs of Coloradans.

Then something called COVID happened and that really threw a wrench in our operation, as it did for many other people. I was the first employee that was sent home to test the remote capacity of being a call-taker. So they piled a bunch of laptops and wires and headsets into a backpack and sent me home on a Friday in March of 2020. I spent a couple of hours sorting out things with the Wi-Fi and the VPN and eventually I was able to take a call. That really revolutionized the work and how we're able to function as call-takers.

I don't want to go too far into this. But fast forward to now—we have a very robust remote workforce that are answering 988 throughout the state of Colorado. We also have our call center where that's available for folks that would prefer to be in person alongside team members doing this very challenging and potentially exhausting work.

Taylor: Great. I want to get back to that piece you mentioned about the remote workforce, but first I want to hear more about the success that you all are having in Colorado. We know we look at the national numbers and we see that since the first few months that 988 has been live that there's been great success in the number of calls answered and the answer rate. According to SAMHSA [Substance Abuse and Mental Health Services Administration], the national answer rate back in September was at 84% still, with an average speed of answer of about 36 seconds. Tell me, how is Colorado doing on these metrics? How are you tracking the success and being able to answer the calls that you're receiving?

Erik: I think it's important to note that we've actually been doing this work for years. The transition to 988 wasn't as if we had to completely create something new from scratch. What we had to do was take our existing infrastructure and scale it up based on anticipated call volume and the growth that we expect. This is work that we've been actually preparing for years. I can remember when I was a frontline call-taker and there was an announcement about this 988 legislation—and this was years ago, so we had been aware of this.

I will say that in the year leading up to July of this past summer, we had a very intense, robust ramp-up in preparation. A lot of that was related to hiring. We had job fairs, we had all administrative staff participating in interviews with the goal of really scaling up our staff. That was all work that was put in prior to the launch. And so, of course, we didn't know what was going to happen. There was an element of anxiety about, "Is the call volume going to spike and things going to ring off the hook?"

I will say that the actual launch was underwhelming in terms of volumes. But as you've noted, call volume is steadily increasing, and so we started out doing really well in terms of our answering metrics. Now, we're facing some challenges currently, and that's related to our maintaining staff, which I'll certainly get into later on. But overall, things have been going well. I think we were well-prepared, and that's a testament to our leadership and the preparation. But now, the ongoing challenge is maintaining performance, maintaining consistency.

Scaling services for diversity and inclusion

Kary: Erik, this is a piece that I'm just really fascinated by. Having a little bit of detail of what it takes to staff a call center of this magnitude, I'm wondering, as you all were thinking about that staffing up, what considerations you maybe put in place to think about the diverse representation—how you potentially recruited for that? Or did you even have questions about that, or concerns, or thoughts as you were looking to fill seats with qualified employees that would be able to do this really challenging work in a virtual infrastructure?

Erik: It's a great question. I think that one thing I've learned—Colorado is a diverse state in a lot of ways. If you look at its geography, there is just quite a bit of difference in terms of what life is like on the eastern part of the state and what we call the Eastern Plains, which is mostly small, rural, farming, agricultural communities. You then have what we call the Front Range, which is our population centers—the urban corridor, Denver, Boulder, Colorado Springs. Then you have these mountain towns that are spread throughout the Rockies. What I learned as a call-taker is that if you're taking a call from somebody in the Eastern Plains, in downtown Denver, or in a ski town like Telluride, life is different. And how you connect and relate to that person is integral to providing them adequate emotional support, or a resource connection.

What we're trying to do and what we've been trying to do is create a workforce that is representative of the population that we serve. Initially, that was challenging. When we were a singular call center, that required people to come into the office to answer the phone. If you think about that, our catchment area for potential employees was people within driving distance of Denver, and so that employee is just different than somebody that perhaps is living in the Eastern Plains or in a more rural section of our state. With the transition to offering a remote workforce, we are now able to hire and support individuals that live in all corners of our state, and that has helped us in one front in terms of just increasing the number of call-takers we have, but it also increases our quality in terms of we have a representative workforce of the population that we are serving.

Kary: I love that you mentioned that. I think we oftentimes, over the past three years now, we are constantly focusing on the challenges that COVID brought to our collective workforce challenges. I don't mean to suggest that there aren't many, but I agree with you.ne of the things that we—I think similarly—I found in our child welfare workforce was leveraging the equity challenge, right? There was a way to ensure that we could reach more diverse people to enter the workforce. I had folks on my team who have, for example, perhaps been remote for over a decade and said, "Due to COVID, the fact that we're all at home, I finally feel like I'm on the same team. I don't feel like the outsider." So it's fascinating that with the challenge really came a great opportunity to better meet the service delivery needs of people in Colorado.

The challenges and successes of a remote crisis workforce

Taylor: I'm curious, Erik. I think there's that positive aspect of having this remote workforce now, but I think some of the people that may be listening may see that there's a challenge there, too—right?—that having this call center workforce of all remote workforce is not something that is traditional in terms of a call center, right? What are the challenges and successes you've had really being able to train people remotely to do this work?

Erik: You're right in that there are certainly benefits to having a remote workforce, but there's also real challenges—and I think that is related to the work that we are doing. We are answering a suicide prevention hotline and that is hard work. It's emotionally exhausting, emotionally draining. The benefit of being able to be alongside your coworkers in the same physical location in solidarity, working as a team to support the needs of the callers I think is really energizing and can make the job more sustainable.

I'll just illustrate my personal experience. Having transitioned from being someone that worked in the call center to then going home and taking hotline calls from my couch. Going into the office, it was enjoyable. I'd come in and I'd make jokes with my friends and then we'd get our serious face on and we'd log in and we'd take calls. If you had a particularly challenging call, you could take a moment, go to the break room, and debrief with a coworker that is so skilled and active listening and thoughtfully responding to you. That whole process was very energizing. Then you left work and you were able to physically leave work and go home and do whatever it is you need to do. That was life as a call-taker going into the call center.

Now, when I came home, I was fortunate in that I had been involved in this work for a while. I had taken quite a few calls and so I was aware of the challenges and the difficulty of certain calls and so I was able to navigate the challenge of being completely alone in a HIPAA-compliant workspace, doing this really challenging work where you are having conversations with people that are just really, really intense, and then having to turn off my laptop and put it away and put it out of sight, out of mind, and flip on the TV—and I'm still on my couch and I'm trying to relax and enjoy myself.

I know from feedback we got from colleagues that transition to working alone in this work can be very isolating and challenging, and so it's a cost benefit. The benefit is that we're able to welcome more potential employees by making that remote option. But the drawback is supporting someone in this really challenging work when they are remote is unique. It's a unique challenge and it's something that we as employers have to be really aware of because the average length of employment in this space, generally speaking, is not long. That's a testament just to the challenge and the difficulty and the intensity of the work.

Supporting the mental health needs of crisis care staff

Kary: Erik, I'm curious from your perspective with maybe some of those cost-saving measures of going to a remote workforce, have you all been able to reinvest resources to support the mental health needs of your workforce during the work? Maybe a second piece to that is from a culturally responsive lens, not just the lens in terms of the way in which you are responding to the callers, Have you all thought about how you're also meeting the needs of your workforce with a culturally responsive lens?

Erik: I think this is an ongoing challenge and I think that part of it is because it's the need of the moment. Let me explain that a little bit further. Ever since I've been involved in answering a crisis line, and prior to working at Rocky Mountain Crisis Partners, I did it as a volunteer in Massachusetts for two years. And in those five years, the pace and the demand of calls has been steadily growing. The phone is almost always ringing and the people involved in this work are well-meaning and want to contribute and support others. And so these are individuals that will at times go above and beyond to grab that phone and make sure that that call is answered. What does that do to the call-taker over time? Well, you can feel trapped. You can feel as though this phone is never going to stop ringing and I am the only person answering it. Now, in reality, that's not true. There's many other people answering it, but at times it can feel like that, and so you feel stuck, you feel trapped.

With 988 being launched, it's as though I don't know when our workforce is going to get a break. I don't know when the work is going to get easier. I don't know when the volume is going to start plateauing, or even decline, and so we're kind of in the thick of it right now. The challenge is when we think about supporting that call-taker, it's how to make their job easier—but how do we make their job easier while still answering the phone and still meeting the need of the community?

I believe that we need to make this job easier by bringing more people into this work because if we bring more people into this work, the workload gets distributed over more individuals and the burden on that individual call-taker inevitably will lessen and they will become a little bit more energized and a little bit more able to go grab that phone when it does ring. This is a really complex problem right now because we have stakeholders and we have contracts and we have to meet certain metrics in terms of picking up the phone. But in the medium- to long-term, if we're not supporting our workforce and empowering them, this thing is going to struggle because nobody's going to want to work in this space.

Current barriers to expanding the workforce

Taylor: I think that's a great perspective to have. Yes, I think, right, we need to—we have to—support our workforce and make sure that they're feeling support in the work that they do. I want to hear more about what you're describing as expanding the workforce, broadening those who see themselves as people who could be answering the call. How are you doing that? What have you found to work in terms of expanding that workforce, reaching out to places to get people excited about joining the workforce here and being a part of 988, and what maybe are still the barriers or challenges that are preventing you from even further expanding that workforce?

Erik: When I was hired in 2019, the job was a full-time, 40-hour position and that was my only option. Now, that was what I wanted, so that was perfect. So I signed on, and I answered the crisis line for 40 hours a week. Now, the person that wants to answer the crisis line for 40 hours a week making not a whole lot of money is somewhat rare. You have to really want to be there. We did okay because people wanted to be there. But if you think in terms of scaling up this entire operation at the state level nationally, we need to widen our catchment area of potential employees and it needs to go beyond this 40-hour-a-week people that want to be there because there are people that want to be there for perhaps 20 hours a week, or four hours a week, or eight hours a week.

To give an example of how this model potentially works, when I was in Massachusetts at an organization called Samaritans, we were completely staffed by volunteers. My volunteer shift was once a week on Thursdays from 7 a.m. to 11 a.m. and I was alongside three or four other fellow volunteers. We had a pool of volunteers that was in the hundreds and we were staffing these four-hour blocks seven days a week, 365 days a year. And so we were able to do it because you had a large number of individuals that were willing to contribute four hours a week.

If you try to extend that thinking to Colorado, there are many people that want to contribute to this work—that want to contribute to this space—but they just don't necessarily want to make it their job and contribute 40 hours a week. So what we need to do—and I think what others in other states should consider doing—is we need to make it easier to contribute to this work. How do you do that? You offer different positions: 40 hours, 20 hours, 10 hours a week, you have interns. We've started growing an internship program which I'm thrilled about because these are people that really want to be involved in this work. They want to get experience and they can contribute eight hours a week, 10 hours a week.

I also think in the medium- to long-term, we need to accept volunteers because there are many people, and I've encountered them at our job fairs, that will come in and say—and this is a true story—"I'm a retired ER psychiatrist. I would love to contribute to this work." Now, at the time, unfortunately, we were limiting ourselves because we only had these full-time positions. He was retired and he didn't want to work 40 hours a week and I totally understand that. He wanted to work eight hours, and we weren't able to accommodate him or his expertise because we hadn't set up the infrastructure to welcome in a person like that. I think what we need to do is really emphasize building the infrastructure to welcome in anybody who would like to contribute to this space and then train and support them in this work, which will take even more infrastructure, but this is an upfront cost to ensure that in the medium- to long-term, you support a diverse, representative workforce that can meet the volume, that can meet the demand that is in our community right now.

Kary: Erik, what do you see as the greatest barrier to realizing that?

Erik: I see multiple sides to it. Our organization right now is—we're really extended. We are trying to answer the phone according to these metrics because this is in our contract and we have been empowered to answer 988 in the state of Colorado, so we take that really seriously. And so we are in an all-hands-on-deck mentality of making sure this phone is answered. While that is wonderful in a sense that we are rising to the occasion to meet the need of this particular moment, the vision of 988 and the vision of making mental health services more widely available and accessible in our country is that this is going to be a long-term thing.

It's almost as if we need to pause the moment right now to think about how is this going to succeed next year, the year after, and 10 years into the future. It's hard to stop specifically people working in this space because they want to grab that phone, they want to keep grabbing it. But what if we needed to pause for a moment so that we could thoughtfully put together a plan to create this infrastructure so that this job becomes easier over time? We're able to leverage this well-meaning, diverse population we have in Colorado that want to contribute, that want to answer this phone, but perhaps in a capacity that fits their life and their demands. How do we do that? When it's almost as if there's a fire over here, but you need to build some—how do you manage that kind of concurrent responsibilities?

Kary: I get it. I mean, I guess that's always the constant balance and struggle when you think about systems improvement work, particularly when we're talking about life or death, right? It's how do I go from being reactive to being proactive? That definitely is the challenge.

Erik: I love that language, Kary. You just eloquently described what I was going for, which is that we're in a very reactive phase right now. We are reacting to the needs of the moment, but I think at some point, there's going to be an inflection point where we need to transition to being proactive because that is how you sustain long-term success.

Kary: Sure. Well, and it's also something that fundamentally I don't know that we have figured out how to do well, right? When you think about any of our systems that I would consider this to be no different in terms of those that are on the front line of meeting the needs of our vulnerable populations day in and day out, we have not as a nation and as multiple human service systems figured out how to get out of being reactive to being proactive well. There are outliers, and there are places where we do it better than others, but this is really a challenge that is maybe not just inherent to the workforce that is supporting 988, right? This is really about the human service systems. How do we build infrastructures that allow us to be proactive? How do we tie together prevention? Inevitably, if we were really able to effectively leverage support from multiple systems from partners, that call number would drop because people were getting their needs met before that urgent moment of needing to make that call. That's where you start getting to the proactive and going further upstream. But I guess we're all trying to figure out what that looks like in an experience where it's constantly changing.

Exploring opportunities to leverage across expertise, ability, and systems

Taylor: Kary, something you mentioned—leveraging across discipline, across just all the different systems, working across different areas, and how leveraging that different expertise with different abilities and different experiences—especially across the many different social service programs and areas—do you see intersections or opportunities to leverage, especially different lived experience in terms of, like Erik's talking about, expand that workforce and that pool of potential helpers people to answer the call?

Kary: I mean, absolutely. Just threading the needle of the alignment—I think that this is a similar conversation that we're having in multiple systems, from child welfare to public health to mental health. It's the same discussion. Particularly for this work, early in my career I worked— I'm a clinical social worker by trade—I think I mentioned that. And one of the populations that I worked with were women recovering from substance abuse, right? Specifically women with Axis I, Axis II disorders, also substance abuse—so dual diagnosed.

Truthfully, I hadn't worked in the substance abuse workforce. Until this time, I'd been in clinical children and adolescents for much of that time, so you could almost in this sense see an experience where you're able to engage maybe folks who once needed the service that are further along in their journey, or family members who have been impacted by their own family members who were needing to reach support through 988 or call centers like it. So I think it's incumbent on us not to continue to think about the traditional roles as they've been, but to think about how we really elevate those who have used services, and maybe are in different place, and how we create space.

Erik: Kary, I completely agree with you. I think one frustration that our organization has had is that we have a peer line. We have a quite large peer program that is completely staffed by individuals with lived experience with either mental illness or substance use. That program has been thriving over the last couple of years. If you call the Colorado Crisis Line, which is answered by us, you have the option to select a prompt to opt-in to speak with a peer if you'd prefer. You can also speak with a crisis specialist, so you have that option, and you can receive different levels of support based on the line you select. That's wonderful because I totally agree that what somebody can provide having lived it themselves is just so invaluable and we should be leveraging that as a means to support the needs of our community.

Kary: Yeah. One, that is just amazing and fascinating. I mean, Colorado never ceases to amaze me in terms of innovation that I have seen come out of Colorado over the past 20 years, so kudos to you all for that. But I love the fact that you do have data and when we think about the opportunities to being more proactive, data is just a fantastic tool that can be used—particularly when you're able to say, "Look at how many people are personally opting out? We could increase or we could improve by offering this option or even pilot it, right? Maybe we only pilot it on a day and let's just see where that takes us.” Could be pretty cool. But I love that that just even exists as an option. You all don't have to build that. It's there to test how you can bring it to greater access through 988.

Erik: Honestly, I appreciate the kind words about Colorado, and I completely agree. I'm not from Colorado. I've only been here three years, but I am very impressed with just the buy-in at all levels of government and the funding and the support and the engagement with this incredibly important work that we're doing. I almost feel at times as though the national 988 launch, Colorado was positioned to run faster than everyone else. But we're having to slow our pace a little bit because things are written into contracts, they're written into legislation, and you almost have to adhere to that, even though it might not be the best thing for the callers that are outreaching us from Colorado.

This is where a podcast like this is a tremendous opportunity to talk about the work that we are doing in Colorado and the capacity we have and the ability to think creatively and meet the need of the moment and then share that with others and ring the alarm bell in a sense in trying to get the attention of some key decision-makers, legislators, et cetera, so that we can make this system better. Because, ultimately, I think that's what we're trying to do is take an existing service that's available, and thank goodness it's available—but let's make it better. Let's scale it up. Let's make it more accessible, and make it just appreciated and well-understood amongst our community so in that moment of crisis, you can just grab the phone and dial 988 and you don't have to remember the 10-digit Lifeline number.

Taylor: Erik, I couldn't agree more. I think it's just great to hear all of this coming out of Colorado and your perspective on this. I am hopeful that our podcast is able to reach those audiences that you said. I want to wrap us up here. I feel like we've really covered a lot of ground today and there's probably more—there's more to talk about, there's more to dig into, and so hopefully we'll get a future opportunity to come back to you and hear more about how things are going and more successes that you've had in Colorado in the coming months and years. We'll keep this conversation going. Thank you, Erik. Thank you, Kary, for joining me on today's podcast. It's been just an outstanding conversation. Thank you again and we will hopefully keep this conversation going.

Kary: Absolutely. Thank you, Taylor, and thank you, Erik. This has been great.

Erik: Yes, thank you all. Thanks for having me and I look forward to keeping the conversation going because, as you said, I think that that's a critical element.