Client Key Informa Client Key Informant Interview Direct Contact

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988 Suicide & Crisis Lifeline and Crisis Services Program Evaluation

Client Key Informant Interview Protocol – Direct Contact (C-KII-DC)

     

Introduction

Today, I want to hear your story of your experiences accessing help for an emotional or behavioral crisis. We appreciate your willingness to share your story. It’s important to us to understand what helped you – or didn’t help you – so that we can keep improving crisis services and make sure everyone has access to the kind of help they need. We understand that remembering and sharing difficult moments in our lives can be hard. If at any point you would like to pause or stop the interview, just let me know. I want to create a safe space in this interview so that you can be comfortable sharing what you think and feel.

To get us started, please tell me your first name and where you’re joining us from today. 

Crisis Experience and Services Used

1. We understand that you were connected to a crisis service on [date of referral]. Crisis services can include talking to someone through a crisis hotline like 988, having someone come out to support you in person through mobile crisis, or going to a safe place for help like a crisis stabilization unit or walk-in center. This may have been a time when you needed help with thoughts of suicide or violence, or with substance use issues. Would you be willing to share a bit about your story and what was happening at that time in your life that made you feel that you needed help? Please share all that you would like to share, in your own words, and in your own way.   

   1. During that time, were you having any thoughts about harming or killing yourself or someone else? Were you worried you might be at risk of accidental overdose?

   2. How likely do you think you were to act on the thoughts you were having? Do you think your life was in danger at that time?

2. Thank you for sharing that with me. I know this can be hard to talk about and I appreciate your willingness to share your experiences with me. Now I’d like to ask some questions about the process of getting connected to help. We understand that you were connected to [988 Lifeline/Mobile Crisis/a Crisis Stabilization facility]. How did you get connected to that service?

   1. Did someone help you get connected to that service, or did you reach out to get help for yourself?

   2. In addition to [988 Lifeline/Mobile Crisis/Crisis Stabilization Facility], did you connect with any other crisis services at that time? Walk me through how you got connected to those.

   3. Did you get connected with any emergency services at that time, like 911, EMS, or an emergency department? Can you tell me about that experience?

      1. Was this connection voluntary or involuntary on your part?

   4. Did you need or receive medical help at that time, like from a doctor or medical facility?

   5. Were you able to connect with any other supports or services at that time, like family or friends, a therapist or counselor, or any types of social services? Please share how those supports got involved.

3. Was [date of referral] your first experience of engaging with crisis services like 988, mobile crisis, or crisis stabilization, or have you used these types of services before?

   1. [If participant has used crisis services before:] How many times would you say you have connected with crisis services before the situation you described earlier? Which types of services did you use?

   2. [If participant has used crisis services before:] For those earlier times using crisis services, were the problems you were having the same as what you needed help with this time, or were they different?

4. I’d like to hear about the days, weeks, and/or months following when you were connected to help. Walk me through what has happened since [date of referral].

   1. What other services or programs, if any, have you connected with since that time? Have you been able to make any new connections with friends or family, therapy or counseling, or any types of social services? How did you get connected with these?  

   2. How often, if at all, have you connected with crisis services like 988, mobile crisis, or crisis stabilization since the situation you described earlier? Can you tell me a little bit about those times?

   3. Have you connected with emergency services like 911 or EMS, or visited a hospital emergency room for a mental health or substance use crisis since that time?

5. What else can you tell me about your experience(s) on [date of referral]?

• If a participant’s referral was from 988, or if they described using 988 in response to questions 2-4, include the 988 Lifeline section.

• If a participant’s referral was from Mobile Crisis, or if they described using Mobile Crisis in response to questions 2-4, include the Mobile Crisis section.

• If a participant’s referral was from Crisis Stabilization Facility, or if they described using a Crisis Stabilization Facility in response to questions 2-4, include the Crisis Stabilization Facility section.

• For all participants: include the Crisis Services Satisfaction and Outcomes section.

988 Lifeline (use this section only if participant describes contact with 988)

6. We understand that you contacted the 988 Lifeline (or someone in your life contacted the 988 Lifeline on your behalf). [Interviewer note: If participant has used 988 more than once, focus this section on the use of 988 during the index crisis.] What was the process of contacting the 988 Lifeline like for you?

   1. How did you choose 988 as a source of help?

   2. Did you reach out to 988 by phone, or by chat or text? What made that mode of connecting feel most helpful for you?

7. What barriers, if any, did you experience in connecting to the 988 Lifeline?

   1. Did you experience any hesitation in connecting to the 988 Lifeline? If so, why?

8. Tell me about your experience after you connected with the 988 Lifeline counselor.

   1. What, if anything, did you like or find helpful about your experience?    

      1. Would you say that connecting to 988 Lifeline helped to save your life?

   2. What, if anything, did you NOT like or find helpful about your experience?

      1. What, if anything, got in the way of the 988 Lifeline counselor’s ability to help you and/or connect you to further resources?

9. Would you say there was any part of your identity or background that was relevant to the kind of crisis you were having, or to the kind of help you needed from 988 Lifeline? Can you tell me what that was for you?

   1. How sensitive, if at all, do you think the 988 Lifeline counselor was to aspects of your identity?

      1. Can you share examples of their sensitivity (or lack thereof)?

10. What, if anything, changed for you from the beginning to the end of the conversation with the 988 Lifeline counselor? 

    1. How did you feel at the end of the conversation?   

11. What plans, if any, did you and the 988 Lifeline counselor make for what you could do to keep yourself safe after the conversation ended? 

    1. What hesitations or concerns, if any, did you have about these plans?

    2. Have you been able to put these plans into practice? How helpful have they been?

12. What else can you recall about your conversation with the 988 Lifeline counselor?

13. What, if anything, would have made the experience better for you?

    1. What recommendations, if any, would you have for someone else who is contacting the 988 Lifeline?

Mobile Crisis (use this section only if participant describes receiving mobile crisis services)

14. We understand that you have experience engaging with a Mobile Crisis Service. [Interviewer note: If participant has used Mobile Crisis more than once, focus this section on the use of Mobile Crisis during the index crisis.] What was the process of connecting with the Mobile Crisis Service like for you?

15. What barriers, if any, did you experience in connecting to the Mobile Crisis Service?

16. Tell me about your experience after you connected with the Mobile Crisis Service.

    1. What, if anything, did you like or find helpful about your experience?    

       1. Would you say that connecting to Mobile Crisis helped to save your life?

    2. What, if anything, did you NOT like or find helpful about your experience?

       1. What, if anything, got in the way of the Mobile Crisis team’s ability to help you and/or connect you to further resources?

17. Would you say there was any part of your identity or background that was relevant to the kind of crisis you were having, or to the kind of help you needed from 988 Lifeline? Can you tell me what that was for you?

    1. How sensitive, if at all, do you think the Mobile Crisis team was to aspects of your identity?

       1. Can you share examples of their sensitivity (or lack thereof)?

18. What, if anything, changed for you from the beginning to the end of your experience with the Mobile Crisis Service? 

    1. How did you feel at the end of the interaction?   

19. What plans, if any, did you and the Mobile Crisis team make for what you could do to keep yourself safe after your interaction with them? 

    1. What hesitations or concerns, if any, did you have about these plans?

    2. Have you been able to put these plans into practice? How helpful have they been?

20. What else can you recall about your experience with the Mobile Crisis Service?

21. What, if anything, would have made the experience better for you?

    1. What recommendations, if any, would you have for someone else who is connecting to the Mobile Crisis Service?

Crisis Stabilization (use this section only if participant describes receiving crisis stabilization services)

22. We understand that you have experience visiting a Crisis Stabilization Facility. [Interviewer note: If participant has used Crisis Stabilization more than once, focus this section on the use of Crisis Stabilization during the index crisis.] What was the process of visiting the Crisis Stabilization Facility like for you?

23. What barriers, if any, did you experience in visiting the Crisis Stabilization Facility?

24. Tell me about your experience after you connected with the Crisis Stabilization Facility.

1. What sorts of resources or supports were available to you there?

2. What, if anything, did you like or find helpful about your experience?    

   1. Would you say that connecting to Crisis Stabilization helped to save your life?

3. What, if anything, did you NOT like or find helpful about your experience?

   1. What, if anything, got in the way of the Crisis Stabilization Facility’s ability to help you and/or connect you to further resources?

25. Would you say there was any part of your identity or background that was relevant to the kind of crisis you were having, or to the kind of help you needed from the Crisis Stabilization Facility? Can you tell me what that was for you?

    1. How sensitive, if at all, do you think the Crisis Stabilization Facility was to aspects of your identity?

       1. Can you share examples of their sensitivity (or lack thereof)?

26. What, if anything, changed for you from the beginning to the end of your experience with the Crisis Stabilization Facility? 

    1. How did you feel at the end of the interaction?   

27. What plans, if any, did you and the Crisis Stabilization Facility make for what you could do to keep yourself safe after your visit ended? 

    1. What hesitations or concerns, if any, did you have about these plans?

    2. Have you been able to put these plans into practice? How helpful have they been?

28. What else can you recall about your experience with the Crisis Stabilization Facility?

29. What, if anything, would have made the experience better for you?

    1. What recommendations, if any, would you have for someone else who is connecting to a Crisis Stabilization Facility?

Crisis Services Satisfaction and Outcomes

30. Overall, how well did the help you received from crisis services on [date of referral] meet your needs?   

31. I’d like to hear more about what you feel happened because you connected to [988 Lifeline/Mobile Crisis/a Crisis Stabilization facility] on [date of referral]. What positive things, if any, happened because of your involvement with crisis services on that day? You can take some time to think about your response.  

    1. What negative things, if any, happened because of your involvement with crisis services on that day?

32. How would you describe your mental health and/or substance use now?

    1. What programs and services, if any, are you currently engaged in related to your mental health and/or substance use?

    2. What, if anything, are you doing differently in your day-to-day life to help manage your mental health and/or substance use?

    3. If there are changes in your mental health and/or substance use since [date of referral], what do you think has made a difference?

33. What inspires or motivates you to manage your mental health and/or substance use since your involvement with [988 Lifeline/Mobile Crisis/a Crisis Stabilization facility]?

    1. What hopes do you have for the future related to your mental health and/or substance use?

34. What suggestions or recommendations do you have for improving the crisis services system – including [988 Lifeline/Mobile Crisis/a Crisis Stabilization facility] – to better support people like yourself?

Demographics

35. Would you mind telling me how old you are?

36. What is your sex?

37. How would you describe your race and/or ethnicity?

Closing

Thank you for sharing your feedback with us. Before we wrap up, is there anything else you’d like to share today about your experiences with crisis services?

I also want to check in to see how you’re feeling after talking through that together and remind you that if answering any of these questions has made you want to talk to someone about your feelings and experiences, there are resources available to you. This could be a trusted friend, family member, therapist or counselor, or 988. Can I help connect you with someone to support you right now?    

   

[Interviewer: if requested, support the participant in connecting directly with a trusted support person or 988. Stay on the call until they have connected with this person or 988. If participant declines, continue:]

Okay. Please remember you can reach out to a crisis counselor at any time by calling or texting 988 or visiting https://988lifeline.org/chat/ to chat with someone who can help. Thank you again for spending time with me today.