Creating a Suicide Prevention Hotline 1

Creating a Suicide Prevention Hotline in Your State or Community: An Idaho Case Study

Ann D. Kirkwood1 and Beth Hudnall Stamm2 1Institute of Rural Health, Idaho State University, Meridian, Idaho 2Institute of Rural Health, Idaho State University, Pocatello, Idaho

Suicide hotlines have been shown to be effective in preventing suicide and providing meaningful referrals to needed services and

supports. This paper reports on the development of an Idaho suicide prevention hotline. There are many aspects to launching a hotline.

Prior to going live with a hotline, the purpose of the proposed hotline should be determined and a case for the need for a hotline must be

established. These will be needed to explain and obtain buy-in from various people who will be important to the establishment and

maintenance of a hotline. Prior to launch of a hotline, the structure of the hotline must be established. These include finding a home

for the hotline. A working group can guide the direction of the hotline including location, administration and fund raising. Hotlines do

need legal advice. Other important decisions include operating hours, developing a mission statement, plans for long-term strategic and

sustainability plans. This sets the stage to identify the specific aspects of the operation of the hotline including program evaluation,

administrative structure, accreditation, recruitment and training of volunteers and staff. Finally, the operating of a strong hotline will

depend on the quality and accuracy of a resource and referral data base.

Idahos suicide rate is the 4th in the nation. Before that

statistic was released, Idaho State Universitys Institute of

Rural Health (ISU-IRH) had been working to build

infrastructure for suicide prevention in Idaho. Over the

years, and incrementally, infrastructure has been

developed to lay a foundation for strategic, focused

suicide prevention, intervention, and postvention. ISU-IRH

has been working to build infrastructure for suicide

prevention in Idaho since 1998, first with a fledgling group

and later with those preparing a first-ever state plan.

Beginning in 2000, ISU-IRH worked with then-Idaho First

Lady Patricia Kempthorne to begin forming a cadre of now

11,000 trained childrens mental health and suicide

prevention participants who could address the high

suicide rate in their everyday work.

Correspondence concerning this article should be addressed to Ann D.

Kirkwood, Institute of Rural Health, Idaho State University, Meridian, ID

83642, irh@isu.edu, www.isu.edu/irh.

An earlier version of this paper was presented at the International

Society for Traumatic Stress Studies 2011 Annual Conference.

This project was funded through multiple grants and volunteer efforts.

Partial funding for this project came from the Garrett Lee Smith State

and Tribal Suicide Prevention Grants at SAMHSA (SM 059188 & SM

057401) and a Community Collaboration Grant appropriated by the

Idaho Legislature under Contract No. 4C082000 administered by the

Idaho Department of Health and Welfare, State of Idaho. In addition, the

authors and others volunteered countless hours in support of the

project. The contents are the sole responsibility of the authors and do

not necessarily represent the official views of DHHS, the State of Idaho,

or Idaho State University.

If you, or someone you know, is in suicidal crisis or emotional distress,

help is available. Call the national Lifeline at 1-800-273-TALK.

Since that time, ISU-IRH has undertaken the Idaho

Awareness to Action Youth Suicide Prevention Project

with Garrett Lee Smith (GLS) Memorial Act funding to

redouble efforts to increase infrastructure to sustain

suicide prevention into the future. ISU-IRH received its

first GLS grant in 2006, and in 2009 joined Cohort 5 for our

second grant. Throughout the past 5-1/2 years, ISU-IRH

has supported suicide prevention advocacy groups to

build their infrastructure and has supported community

groups to organize and implement awareness and

advocacy activities. At the start, in 1998 Idaho had little

infrastructure to support suicide prevention. Today, there

has been a sea change and a strong, sustainable

foundation has been laid upon which Idaho can move

forward in a focused and strategic way.

Various ISU-IRH activities have addressed development of

awareness-building materials; training advocates and

professionals in risk assessment, intervention, and

referral; facilitating development of a new 2011 Idaho

Suicide Prevention Plan to guide state and local

prevention efforts; teaching juvenile justice professionals

to reduce suicides in their facilities; and creating teams for

postvention response in schools and among first

responders. Most notably, a Suicide Prevention Hotline for

Idaho will become a reality in 2012.

Purpose This handout focuses on one of the most significant

accomplishments of ISU-IRHs infrastructure development

activities: an Idaho Suicide Prevention Hotline. To date,

Idaho is the only state in the nation without a hotline in

the Lifeline Network. But that is changing. ISU-IRH, the

Idaho Council on Suicide Prevention, the Idaho National

Guard, the U.S. Veterans Administration, SPAN Idaho, and

the nonprofit Mountain States Group have joined forces

to raise funds and an Idaho Suicide Prevention Hotline

should begin taking calls by the end of 2012. None of this

2 Creating a Suicide Prevention Hotline

could have been done without the evolution of

infrastructure in Idaho to support suicide prevention

efforts and raise public awareness of the need for an

Idaho Hotline.

Developing a Case for an Idaho Hotline In 2009, mental health advocates were successful in

obtaining legislative funding for a study outlining how a

Hotline could be established for Idaho. The Mental Health

Advisory Board for the Boise area and 30 advocacy

organizations statewide endorsed ISU-IRHs application for

this state-funded grant and the result was Idahos Hotline

Options Report.1 This Idaho Suicide Prevention Hotline:

Options for Decision Makers report reviewed 13 separate

national and Idaho studies to identify issues relating to

accreditation, marketing, sustainability, policy

development, and training. A major economic analysis of

the financial and community development benefits of a

Hotline was conducted. Copies were distributed to

advocates, educators, and every member of the Idaho

Legislature. The document made a case that Idaho had an

opportunity to reduce suicides and reduce both human

suffering and the financial costs of suicides in the state.

This report has guided all activities and provided the

infrastructure for hotline development to proceed.

On Selecting a Home for the Hotline Idahos previous Hotline closed in late 2006 in part due to

funding difficulties. Since that time, advocates endeavored

to re-open the Hotline. In 2009, ISU-IRH joined forces with

the Idaho Council on Suicide Preventions Chair Kathie

Garrett to redouble efforts to build the administrative

infrastructure and raise funds to open a sustainable,

accredited Idaho Hotline that could be welcomed into the

Lifeline Network. Various configurations for a Hotline

were pursued. The state-operated resource and referral

2-1-1 CareLine declined to house the Hotline. Due to

economic conditions, multiple nonprofit organizations

also declined. Finally, in 2011, as a result of rigorous

efforts by Ms. Garrett and ISU-IRH, an established

nonprofit organization with 30 years of experience in

managing projects and grantsMountain States Group

agreed to host the Hotline, provided that funding for two

years of operations could be secured.

Hotline Administrative Structure Technical Work Group While Ms. Garrett actively pursued funding options, ISU-

IRH consulted with its SAMHSA project officer to identify

GLS funds that could be used to develop the

administrative infrastructure for the Idaho Hotline. To

ensure policies, procedures, and training plans were

developed prior to start-up, and to speed up the process,

Idaho entered into an agreement with Mountain States

Group to convene a small Technical Working Group (TWG)

to prepare policies, procedures, volunteer requirements,

job descriptions, a training plan, and a code of ethics for

the Hotline. The ISU-IRH Hotline Options Report was

used to guide the efforts. The TWG involved SPAN Idaho,

ISU, legal advisors, mental health providers, military

suicide prevention personnel, public health, and

individuals familiar in policy development in a nonprofit

context.

Role of TWG The TWG is responsible for making recommendations

concerning policies, procedures, and training plans for

submission to a Hotline Advisory Council once it is created

at start-up. The Advisory Council will be the permanent

leadership body for the Hotline. Under its agreement with

ISU-IRH, Mountain States Group led the TWG and ensured

that the requirements of the host organization regarding

personnel and liability issues were addressed. As of April

2012, the TWG has met seven times and is expected to

complete its work prior to the anticipated July 1, 2012

hiring of an Executive Director for the new Hotline.

Fundraising Ms. Garrett led fundraising efforts during the same time

as the TWG was meeting. She shepherded an

appropriations bill through the Legislature and the

Governor signed it on April 4, 2012, providing $110,000

for Hotline start-up. Combined with private donations

from Wells Fargo and the Jaret Speedy Peterson

Foundation as well as those garnered through a

fundraising effort of the United Way of the Treasure

Valley and an anticipated contract with the states mental

health authority, the two years operating expenses were

achieved to allow hiring of an Executive Director on July 1,

2012. The Hotline is expected to begin taking calls by the

close of 2012.

Legal Advice The TWG identified two legal issues which it felt needed

to be addressed. First was an analysis of the duty to

report laws for the state. Second was the need to enter

into MOUs with multiple 911 systems across Idaho.

Established attorneys in a continuing education program

volunteered to provide this service for free.

Operating Hours The TWG chose to operate on a business-hours format for

the first year of operation and move to 24-hour

operations in Year 2. This will give the host agency time to

set up management structures and ramp up to a full

volunteer roster of 90 people estimated to staff a hotline

around the clock, 365 days per year.

Creating a Suicide Prevention Hotline 3

Mission Statement The TWG created the following mission statement to

provide to the Hotline Advisory Council:

The Idaho Suicide Prevention Hotline is committed

to the prevention of suicide in Idaho. The Hotline

provides emotional support, risk assessment, crisis

intervention, linkages to local services, and follow-

up for persons with potential suicide risk factors.

Recommendations for Long-Term Strategic and Sustainability Plans The TWG decided that the new Hotline Advisory Council

should be charged with creating and maintaining long-

term strategic and sustainability plans for the Hotline.

Initial fundraising in 2012 identified donations and

government funding for two years. The TWG said that

fundraising for Year 3 and beyond should begin

immediately.

Program Evaluation The TWG recognized the need to report regularly to its

funders, its accrediting agency, and Lifeline on the status

of operations. Hotline services and functioning will be

evaluated at regular intervals (monthly, quarterly, and

annually) using evaluation criteria defined in the TWGs

Hotline Evaluation Plan.

Data Collection A uniform call log will include demographics of callers,

presenting problems, level of risk, safety planning, a

record of rescue calls, and referrals. The call log in Idaho

will be based on call logs at other crisis centers

nationwide. The accrediting agency and Lifeline must

approve the log format before admission to the Lifeline

Network. TWG recommended and wrote its budget to

utilize the nationally available software iCarol for

managing data and recording calls as it is employed widely

by other crisis centers in the U.S.

Administrative Structure Upon completion of the TWGs work by July 1, 2012,

Mountain States Group will assume authority over the

Hotline. An Advisory Council will be named to guide staff

and volunteers, develop strategic and fundraising plans,

and frame policy development and personnel matters.

The TWG prepared a job description for the Executive

Director, a volunteer coordinator, and a volunteer/staff

supervisor responsible for shift management. The Director

job description requires mental health certification so the

person can provide clinical supervision to potential mental

health professionals volunteering

at the center, at least at start-up. This may change over

time as certified staff are hired to support the Director.

Accreditation Accreditation is necessary to meet best practices, increase

safety, maintain volunteer and staff skills, promote

sustainability, and for formal admission to the Lifeline

Network. The TWG selected CUSA (Contact USA) as the

body from which accreditation will be sought initially, with

the ultimate goal of also receiving AAS (American

Association of Suicidology) accreditation. Requirements of

CUSA accreditation include the following:

Adherence to basic organizational structure for a

nonprofit entity

Adopted policies and procedures for personnel,

travel, fiscal management, and liability

Established staff training and performance review

policies

Adherence to publicized operating hours

Timeline for moving to 24-hour, 365-day-per-year

operating hours

Hotline Volunteers The Hotline will have an active volunteer recruitment

program to ensure there are a sufficient number of

volunteers for all hours of Hotline operations.

CUSA requires at least 90 active volunteers to

operate a 24-hour hotline.

Volunteers must successfully complete Hotline

training of at least 24 hours and pass an initial

competency evaluation before responding to Hotline

calls.

Volunteers will be encouraged to commit to shifts of

at least 6 hours in length, and a range of 8-16 hours

per month.

Volunteers will be reimbursed monthly for their

mileage to and from the Hotline offices, based on

federal mileage rates.

Hotline Volunteer Training CUSA requirements for training were accepted.

As done at crisis centers nationwide, ASIST training

will be required.

Additional training will be required on policies,

procedures, risk assessment, rescue calls, special

populations, cultural competency, loss survivors and

attempt survivors, self-care, mental health and

substance use, domestic violence and abuse,

accessing resources for referrals, setting limits during

calls, repeat or abusive callers, procedures for

follow-up calls, and a volunteer code of ethics.

Before taking calls, volunteers will demonstrate core

competencies and receive an apprenticeship at the

call center.

Quarterly continuing education will be required.

Instructors will be drawn from expert volunteers

from the community.

4 Creating a Suicide Prevention Hotline

Hotline Volunteer Supervision and Evaluation

Volunteer job applications were prepared by the

TWG.

Volunteers will receive quarterly performance

evaluations and will participate in at least monthly

review and discussion of Hotline call experiences and

self-care strategies.

The Hotline will have at least one qualified, paid or

volunteer supervisor on-site (office or telephone

room) during all hours of operation. A job

description for the supervisor was written by the

TWG.

Hotline Resource and Referral Data Base The Hotline will maintain an accurate, current statewide

listing of referral resources to provide to its callers. ISU

contracted with SPAN Idaho to expand its referral toolkit

for initial use as the Hotline referral database. Hotline

volunteers will update the database at least every six

months.

Reference 1Kirkwood, A. D., Stamm, B. H., Hudnall, A. C., & Blampied, S. L. (2010). Idaho Suicide Prevention Hotline: Analysis of Options

for Decision Making. Meridian, ID & Pocatello, ID: Idaho State University. Available from www.isu.edu/irh/publications.

To Cite this Paper Kirkwood, A.D. & Stamm, B.H. (2012). Creating a Suicide Prevention Hotline in Your State or Community: An Idaho Case

Study. In A.D. Kirkwood & B.H. Stamm (Eds). Resources for Community Suicide Prevention. [CD]. Meridian, ID & Pocatello, ID:

Idaho State University.