How do we measure infrastructure support? An example from the 988 Suicide and Crisis Lifeline by Kristen Quinlan

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Hi there! My name is Kristen Quinlan. I’m a Senior Research Scientist at the Education Development Center (EDC). As part of this role, I support the National Action Alliance for Suicide Prevention (Action Alliance), which is a public-private partnership charged with supporting the National Strategy for Suicide Prevention and the Surgeon General’s Call to Action on Suicide Prevention.

The Action Alliance was instrumental in creating the “Crisis Now” framework, which served as the foundational model for the 988 Suicide and Crisis Lifeline. 988 is the nation’s three-digit telephone, chat, and text service. It provides stabilization services for individuals facing a mental health or substance misuse crisis and facilitates connection to care. As 988 and its related services (e.g., mobile crisis) were being revitalized and rolled out, the Action Alliance wondered, “How will we know that 988 has the supportive infrastructure it needs for roll out to be successful?”.

Our Work

To answer this question, we created a logic model to reflect some necessary infrastructure supports. For example, 988 needs:

• Capacity. Activities to increase the capacity of the crisis system and create an integrated approach to crisis care.
• Awareness. Activities to build awareness of 988, with trusted messengers for effective communication across populations.
• Diversion. Activities to increase the capacity of diversion services (e.g., training for first responders, policy development)
• Other Supports. Activities to build policy, funding, and leadership commitment.

The Action Alliance assembled an expert panel with representatives from across the crisis system to help create short-term, intermediate, and long-term outcomes for our logic model. Equipped with outcomes, we turned our focus to a brainstorm of possible indicators. We cast a wide net, asking our experts to generate metrics that were currently available, as well as those that would need to be built. We conducted a prioritization process to assemble a list of indicators that would provide a comprehensive view of the “pulse” of the infrastructure supporting 988. Our prioritization process included an initial rating of brainstormed metrics according to their importance, quality, and feasibility, followed by a consensus-building discussion on essential metrics to be included in the final report. Our goal is to begin to assemble these indicators in a single space, to allow for a snapshot of 988’s supportive infrastructure.

Lessons Learned

• Be aware of size and scope. Because the Action Alliance is a public-private partnership with national influence, we realized our biggest impact would be in building supportive infrastructure related to 988. We drew boundaries around the outcomes and indicators that would be within our scope of influence to change. For example, while we cannot impact answer rates, we can support coordinated diversion services by working with our federal, state, and local partners and our first responder connections.
• Think outside of what currently exists. Our final report includes “wish list” indicators. These indicators are not currently collected, but because our expert panel deemed them to be essential to our understanding of 988 infrastructure, we focused a section of our report on how we can build capacity to collect them.
• Seek expert support. Our expert panel helped us understand which perspectives were missing from our panel and could articulate how data flows through the crisis system. For example, in our final report, we call for increased connections to public safety answering points (e.g., 911) to increase opportunity to collect metrics of interest.

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