A Survey of Telephone Answering Services in Suicide Prevention and Crisis Intervention Agencies*

ABSTRACT: The telephone service established by directors of suicide prevention and crisis intervention services is generally given little careful consideration. Many agencies take their telephone systems for granted, assuming that almost any system will function adequately if an operator is available and a crisis worker is on call. There are a number of important issues at stake that should be carefully considered before a program is established that uses any system other than full-time coverage by the trained crisis worker at a permanent location. In order to investigate just what really happens under the various systems in use, a series of 76 calls was placed to 19 different emergency crisis services in the southeastern United States. Times were recorded to show how much time elapsed, through what various systems, to get an actual crisis worker on the line. There were marked differences across the eight different systems identified. The results clearly indicate that crisis services are in danger of unknowingly providing inferior and dangerously low quality service unless they maintain maximum control over their own telephone answering system 24 hours a day.     

Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan

Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high‐risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high‐risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.     

Coping with Crisis Across the Lifespan: The Role of a Telephone Hotline

We describe over 300,000 crisis calls made to a large national hotline over a 5-year period. Callers consisted of males and females between the ages of 10 and 89. Overall, a slight majority of callers were first time callers (52%) and most (73%) sought assistance with issues related to parenting, youth concerns, and mental health. Across the lifespan, issues dealing with loneliness increased with age whereas depression-related calls decreased. Additionally, females were more likely than their male counterparts to call the hotline by over a 2- to 1-margin. Findings lend preliminary support to the efficacy of crisis call centers to utilize a flexible, yet well-defined problem-solving approach to assist those of all ages calling with the wide range of problems.     

A Comparison of the Effects of Prejob Training and Job Experience on Nonprofessional Telephone Crisis Counselors

ABSTRACT: This study, carried out in a telephone crisis intervention program in which nonprofessional volunteer counselors received 55 hours of prejob training, isolates the effects of prejob training and on-the-job experience. Participants in the study were evaluated on several parameters including knowledge, counseling skills, acceptance of others, and dogmatism. Three groups of volunteers were measured: group 1—measured immediately before and after prejob training, group 2—measured just after prejob training, and group 3—measured after five months of telephone counseling experience. Results indicate that counselor skills and knowledge significantly increased with prejob training, but did not show further improvement as a result of five months of experience. Attitudes such as acceptance of others and dogmatism did not change either as a result of training or experience. Dogmatism was found to be inversely related to both counselor skill and knowledge.     

Validity of the Suicide Assessment Checklist in an Emergency Crisis Center

Validity of the Suicide Assessment Checklist (SAC; J. R. Rogers, 1990) was investigated in a sample of 1,969 admissions to a psychiatric emergency crisis center. Internal consistency reliability for rated items of the SAC was .87. Supporting construct‐related validity, total score differences were found in the expected directions as a function of referral reason. Convergent validity was based on observed correlations between selected SAC items and conceptually similar items on the Beck Depression Inventory (A. T. Beck, 1970). Supporting criterion‐related validity, total score differences in the expected directions were found as a function of disposition setting. Recommendations are made for the use of the SAC in the practice of counseling.     

A Two-Year Follow-up of Suicide Prevention Center Patients*

ABSTRACT: A random sample of Los Angeles Suicide Prevention Center patients was selected for follow-up about two years after their prior contact with the Center. Of 417 patients sought, 184 were located and interviewed at follow-up. Sixteen had died and nine had committed suicide. The deaths were studied in depth by interviewing survivors (by means of a psychological autopsy). Results of the psychological autopsies uncovered two apparent suicides who had been certified as natural deaths (included in the total of nine). Interviews with the 184 follow-ups yielded longitudinal information about the onset, duration, and recurrence of suicidal states.     

Recognizing Anxiety Disorders in the Aftermath of the World Trade Center Crisis

This article seeks to educate the reader on how to recognize the presence of anxiety disorders as they occur in the church community. The author uses medical information, Scriptural wisdom and a case illustration to help concerned Christians to assist sufferers in getting appropriate care. Anxiety disorders in the aftermath of the World Trade Center trajedy will be on the rise and the paper addresses this matter particularly for clergy, caregivers and professional counselors.     

Exchange,Balance, and Formal Organization in Psychotherapeutic Interactions*

ABSTRACT: Psychotherapeutic interactions in crisis situations are analyzed in terms of the “sociodynamic” concepts of exchange, balance, and formal organization. It is argued that psychodynamic interpretations of crisis intervention therapy tend to be incomplete and nonsystematic and, thus, fail to produce adequate predictions, explanations, and control of psychotherapeutic outcomes. Small-group principles and methods are applied to selected crisis cases to illustrate gains in prediction and control over psychiatric approaches.     

Survey of the Use of Crisis Intervention Centers by the Black Population*

ABSTRACT: In an attempt to determine the extent to which crisis centers meet the needs of black communities, questionnaires were sent to 12 centers. Responses were received from six. Only two centers, in Nashville and Washington, D.C., had statistics of callers identified by race. The findings from these two centers indicate that there are differences between the white and black callers with regard to age, marital status, and type of problem. As an example, the typical black male caller was older and more concerned about his job and financial problems than were white males. This kind of information suggests a need for expanded services within the crisis center framework, possibly for a more preventive approach. More data gathering concerning the black community using crisis centers is urged in order better to identify the needs of this population and the methods to be used for meeting those needs.     

Evaluation of Crisis Intervention Programs and Personnel: A Summary and Critique*

ABSTRACT: Many of the suicide prevention centers that developed throughout the country during the last decade have evolved into general crisis intervention services. At the same time, they have stimulated the development of a wide variety of agencies that utilize nonprofessional volunteers who, primarily through telephone contact, provide helping services to people in crisis. This paper presents a critique of three particular problem areas relating to the use of volunteer personnel, along with a summary of research aimed at providing new technologies for their solution. Methods have been developed for rating on-the-job performance of crisis intervention workers, based upon criteria that are thought to have general application to crisis intervention centers. Efforts to describe personality characteristics of volunteers are reported, along with suggestions for the direction of additional investigations. Finally, the issue of assessing the outcome of crisis intervention cases is summarized. A four-phase conceptualization of the crisis intervention process is proposed, and appropriate measures of outcome at each point in the process are suggested. The overall significance of this type of research is discussed in terms of the need for standards by which to evaluate crisis intervention services.     

The Relationship between Coping Strategies and Perceived Stress in Telephone Intervention Volunteers at a Suicide Prevention Center

This study examines stress perceived by telephone intervention volunteers at a suicide prevention center before their shift, during the most high-urgency call, and after the shift. Eighty of the 82 active volunteers completed questionnaires concerning stress, coping strategies, motivations for volunteer work, and experiences with suicide. Stepwise multiple regression analysis indicated that only one variable, the amount of experience in telephone intervention with suicidal persons, predicted stress level before the shift; volunteers with more experience tended to be less stressed. Stress during the most urgent call was related first to the level of urgency of the call, then to the total length of all calls received, followed by the coping mechanisms of magical thinking, detachment, and feeling personally responsible. Stress after the shift was related first to the total amount of time spent on calls, then to the number of other persons present during the shift. Stress after the shift was also negatively related to amount of education and having realistic expectations about interventions. Magical thinking was positively related to stress, and the mechanism of positive thinking was negatively related. A high proportion of volunteers had attempted suicide, had previous thoughts about suicide, and had known persons who attempted or died by suicide. These findings are discussed as to their implications for the selection and training of volunteers in suicide prevention.     

Bound by Infinities: Technology,Immediacy and Our Environmental Crisis*

The American Journal of Psychoanalysis - This paper explores the relationship between human desire, technology, and imagination, emphasizing (1) the phenomenology of this relationship, and (2) its...     

Friendship Interactions in Children with and without Depressive Symptoms: Observation of Emotion during Game-Playing Interactions and Post-Game Evaluations

This observational study supplements the strong and consistent link found between childhood depression and deficits in interpersonal functioning by examining the relationship between a high versus low score on the Children’s Depression Inventory (CDI) and children’s emotions when interacting with their best friends. High-CDI and low-CDI target children (n=86) were paired for videotaped game-playing with self-reported best friends. Researchers found that although high-CDI target children were not distinguishable from low-CDI peers in their displays of positive and negative emotion. However, the partners of high-CDI target children displayed significantly more negative emotion during the competitive task and significantly less positive emotion during the cooperative task than did partners of low-CDI target children. In addition, high-CDI target children and their partners reported less enjoyment of their interactions than low-CDI target children and their partners. This combination of findings suggests that depressive symptoms were associated with a relative lack of success achieving an optimal friendship interaction even under highly favorable conditions.     

Assessment Center Procedures: Cognitive Load During the Observation Phase

This study explores the traditional procedure of observing assessment center exercises while taking notes vs. an alternative procedure where assessors merely observe and postpone note‐taking until immediately after the exercise. The first procedure is considered to be cognitively demanding due to the requirement of simultaneous note‐taking and observing. Also, dual task processing (concurrent observing and note‐taking) is considered to be especially demanding for assessors without rating experience. The procedures are evaluated using a 2 × 2 design (with note‐taking/without note‐taking × experienced/inexperienced). Some 121 experienced and inexperienced assessors rated videotaped candidates, observing either with or without taking notes. Results showed that experienced assessors yield significantly higher differential accuracy than inexperienced assessors. We did not find an effect of observation procedure on accuracy, interrater reliability or halo. Implications for future research are described.     

Evaluation of the 113Online Suicide Prevention Crisis Chat Service: Outcomes,Helper Behaviors and Comparison to Telephone Hotlines

Recognizing the importance of digital communication, major suicide prevention helplines have started offering crisis intervention by chat. To date there is little evidence supporting the effectiveness of crisis chat services. To evaluate the reach and outcomes of the 113Online volunteer‐operated crisis chat service, 526 crisis chat logs were studied, replicating the use of measures that were developed to study telephone crisis calls. Reaching a relatively young population of predominantly females with severe suicidality and (mental) health problems, chat outcomes for this group were found to be comparable to those found for crisis calls to U.S. Lifeline Centers in 2003–2004, with similar but not identical associations with specific helpers' styles and attitudes. Our findings support a positive effect of the 113Online chat service, to be enhanced by practice standards addressing an apparent lack of focus on the central issue of suicidality during chats, as well as by the development of best practices specific for online crisis intervention.     

Evaluation of a Suicide Prevention Center by Sampling the Population at Risk*

ABSTRACT: At present there are no clear guidelines for assessing the effectiveness of suicide prevention and crisis centers. This report focuses on one readily available source of data, specifically that segment of the population at risk made up of persons admitted to the inpatient service of a mental health center due to depressive and/or suicidal states, including suicide attempts. To determine the role of the suicide prevention center in providing services to this group, 575 persons meeting these criteria were interviewed. The findings included the following: (a) 11 percent had utilized suicide prevention center services, with 59 percent of these experiencing substantial benefit; (b) 20 percent stated they were unaware of the center; (c) 8 percent expressed the view that calling the center would be inappropriate because a suicide attempt was not imminent; and (d) 26 percent indicated an inclination to call the center in the event of subsequent difficulties. Experience suggests that response to a crisis (intervention) as well as response to low lethality callers with “everyday problems” (prevention) constitute valid functions of a suicide prevention and crisis center. Preoccupation with short-term goals, such as reducing the apparent suicide rate, should not dominate the conceptualizing of program evaluation methods.     

Comparing Live and Video Observation to Assess Early Parent-child Interactions in the Home

Observation is the ‘gold standard’ for assessing parent-child behavior, however few studies have compared coding live, in real time, versus coding from videotapes in terms of their achievable levels of coder reliability within the field of parent programme research. This is important for practitioners and researchers for whom decisions might be influenced by time and financial constraints, but where outcomes may have real practical and clinical implications. Trained coders in the Dyadic Parent-Child Interaction Coding System Revised, coded 40 half-hour videotapes of 33 parent-toddler dyads interacting in the home on 29 items of dyadic behaviour. Four theorised composite variables were constructed. Videotaped data were compared to data drawn from the same interactions previously coded ‘live’ in the home. Correlations indicated significant agreement between the two modes at the item by item level (p?<?.001). Wilcoxon Rank tests revealed significant differences (p?<?.001) between the two modes. Eight items exceeded a ±30% change in median score suggesting clinically relevant differences. Although both methods achieved acceptable levels of inter-rater reliability, video coding achieved higher levels of agreement. Subtle differences exist between the two modes. Whilst neither mode proved superior it is suggested that they should not be used interchangeably.