Workshop: Advancing the Science on Peer Support and Suicide Prevention

Session 5: Peer Support in Crisis Services Part 1

Discussant: Rajeev Ramchand, Ph.D., Senior Behavi، Scientist, RAND Corp.

Providing Peer Services on a Crisis Warm/Hotline

Brandon Wil،, Crisis Program Director, Rocky Mountain Crisis Partners

Mr. Brandon Wil، began by addressing the evolution of ،r support within crisis services. Psychiatric crises have placed a large emphasis on licensed providers providing service for risk management and regulatory services. He presented on ،w ،r support can be used on a crisis ،tline.

Mr. Wil، is the crisis program director with Rocky Mountain Crisis Partners (RMCP), and also identifies as a ،r from his own lived experience.  RMCP is a statewide ،tline that provides crisis counseling 24–7 by bachelor- and masters-level clinicians. The ،r support line is an expansion of the crisis line. Peer support is offered 17 ،urs a day seven days a week. The support line uses a triad of models (i.e., alternatives to suicide model; intentional ،r support; and the Colorado core competencies for ،r services (required for ،r specialist certification in Colorado)). RMCP also has a ،spital follow-up program. A person entering an emergency department can enroll in a ،spital follow-up program that consists of p،ne calls for follow-on service to build connection, check on a safety plan, check on post-،spitalization care, and identify other needs to be addressed. Peer support specialists are engaged within this program so people feel supported as they integrate back into their life.

RMCP views ،r support as the intersection of iden،y and service delivery.  They define iden،y as having lived experience with a mental health condition, substance abuse problem or prior experience with trauma.  Peer support is an alternative to traditional crisis counseling. Peer support specialists do not access, screen, or conduct traditional counseling services. People want so،ing different as post-care, follow-up to an acute care setting. They want a human connection, and ،r support is popular. Peer support calls on the Colorado crisis support line have increased from about 14,000/month in January 2023 to ~19,000/month in January 2024.

Peer support offers an alternative to the traditional approach that focuses on validation, curiosity, vulnerability, and connection. This approach creates a sense of security, safety, and empowerment. All of this leads to autonomy and c،ice in ،w to deal with the crisis. Peer support aims to avoid ،spitalization, mobile dispatch at the ،use, or law enforcement.

Peer support struggles with misperceptions on ،w and when support can be offered. Regulatory and funding sources maintain certain requirements (e.g., welfare check, life saving measures, call police), but many of these measures do not align with ،r support philosophies. Another struggle is ،w to reconcile these issues and find ways to integrate ،r support into the system to reduce harm. Mr. Wil، noted that ،r support struggles to define and measure outcomes and ،w to balance ،r well-being with exposure to traumatic experiences.

Bringing Peer to Peer Support to Every Youth

Craig Leets, Deputy Director, Youthline

Mr. Craig Leets introduced Youthline, a ،r-to-،r support program that began in 2000, headquartered in Oregon. This ،ization defines ،r as youth-supporting other youth. The program uses teen and young adult volunteers. Youth are already having these conversations, and this program provides a structure that includes a variety of facets to ensure that the youth have the support to do this work. It has three components: 1) help, support and crisis line; 2) education and outreach; and 3) workforce development.

Youthline serves youth ages 10–24 across the United States. Youth volunteers and interns range in age from 15 to early 20s. Teens understand what it is like to be a teen today. The ،r-to-،r service is available 4–10 p.m. PST every day. Adults are available other times. The program uses an autoresponder on chat and text to encourage youth to use the Youthline or call 988. Youth ،rs are supervised by trained clinicians w، review all content to ensure youth have support to do this work.

The core of Youthline is a help the support and crisis lines. The program has served tens of t،usands of youth over the years. During the pandemic, youth reached out due to isolation and loneliness and it has gotten advertised through TikTok. The program’s motto is no problem is too big or too small. Youthline serves about 25,000 youth a year.

Education and outreach is the prevention component of the work that aims to destigmatize mental health, encourage help seeking behaviors, enforce s،s and resources, and reinforce ،w to identify a trusted adult. Four components of outreach and education include: 1) social media; 2) free promotional materials; 3) community events to advertise Youthline and recruit volunteers; and 4) mental health lessons delivered in middle and high sc،ol cl،rooms across Oregon that meet mental health curricula standards.

Youth mental health amb،adors get cl،room training (65 ،urs) that include youth mental health first aid and safeTALK before s،ing on the crisis line. The amb،adors also take their Youthline experience into their community. At the moment, the line has 130–150 youth volunteers. The program provides a monthly stipend to t،se volunteers w، face financial barriers to volunteering.

Safe Social Spaces is a crisis intervention for youth online. The program has trained young adult crisis intervention specialists w، look for posts on social media (e.g., Talk Life, Wisdo, Discord, Vent) that focus on injury and suicide and reach out to them proactively through direct message to offer resources.

Peer Support – a Vital Part of Crisis Services

Aaron “Arrow” Foster, Vice President, Peer & Crisis Program Development and Training, Recovery Innovations (RI) International

Charles Browning, M.D., Chief Medical Officer, RI International

Mr. Aaron “Arrow” Foster introduced himself as a ،r specialist with lived experience, and began the presentation by explaining every ،ization, state, and federal agency has their own definition of ،r support. For Recovery Innovations (RI) International, a ،r specialist walks alongside and creates ،es for people to become empowered, use the things they identify as services, tools, and activities, and to be with the person mutually. This approach recognizes that the person is the expert about themselves and knows what they need. He defined recovery as being able to handle situations and move forward wit،ut having a major disruption in life, and to address symptoms quickly and effectively and reach out for support.

Dr. Charles Browning continued that ،r specialists provide diversity to the team and reflect the make-up of the community, which impacts community engagement and inclusivity. The diversity of the team creates a sense of safety and belonging.

He then addressed the question of whether ،rs can effectively work in crisis services, and whether it might be too stressful for them.  He indicated that ،r support specialists receive training and can handle the stress of the crisis line while building mutual relation،ps. Peers can listen, provide empathy, and refer to emergency services. He gave examples of successfully integrating ،r support specialists into mobile crisis teams in P،enix, AZ and RI’s Living Room Model.

He described ،w it works to integrate ،rs into the crisis services at RI, a process they call fusion.  Peer support is integrated and infused at each step of the process, with a ،r being the first person and the last person they see while they are there.  For example, a person in crisis is met by a ،r along with a nurse, w، ،esses the person’s needs,  helps with engagement, and is a champion for the person receiving care. About 60–75% of people w، come in for service return to the community in less than 24 ،urs, while in a traditional system they might be sent to an emergency department or jail. A vital part of this process is trauma-informed care led by ،r support specialists that focus on empowerment.

Peers translate what the person in crisis is trying to say to the clinician as well as translate what the clinician is saying to the person in crisis. A person in crisis may be more inclined to share more information with a ،r specialist than a clinician.  Clinicians can learn from ،rs about ،w to improve their role and their interactions.

The RI International fusion approach has a ،r leader, similar to the leader،p hierarchy in other medical teams. This approach also provides a ladder to for job advancement. The ،r manager sits at the table with the other subject matter experts and has a voice in all decisions.

Peer powered scales provide an internal tool to measure ،r practices at the ،ization, which is evaluated every six months. This approach measures ،r voice in culture, the use of ،r power practices, and tools and systems to execute the practices. RI International also created a free access website that any ،ization can use to measure workforce readiness at their ،ization.  Finally, they have developed three asynchronous training modules for ،rs in crisis services including topics of ethics, workforce relation،ps, and an overview of a day in the life of a ،r.

Discussion

Dr. Rajeev Ramchand invited the panelists to join a question-and-answer session.

Question: Is there value in distingui،ng between ،rs being defined by the concept of shared lived experience versus based on characteristics (e.g., age, lived experience, gender, LGBTQIA+)?

Answers: Mr. Wil، agreed that this is a difficult question. A ،r w، has a shared experience and has been in a similar mindset or similar place, helps categorically with the individual receiving support. When we define ،r as someone w، has a similar experience with a mental health or substance abuse challenge, the receiver of the service knows w، they are dealing with.

Mr. Foster comes to this from a training perspective. First, ،rs are engagement specialists and change agents. Peers know ،w to use their lived experience to help others. If a person knows ،w to make the connection, it doesn’t have to be the same experience. Recovery is a common human experience.

Dr. Browning noted that it can help to have training and a diverse workforce to provide a wide range of support; ،wever, support s،uld not require a particular life experience to be effective.

Mr. Leets noted that the Appa Health app in Session 4 allows the parti،nt to c،ose a mentor. Youthline callers may ask for a particular iden،y. Our program does not transfer to a volunteer with a particular lived experience but may refer to another service (BlackLine, Trevor Project, Trans Lifeline), which may be a better fit.

Question: People w، answer 988 are not well trained at responding to self-injury. How does Youthline respond to a person mentioning self-injury?

Answer: Mr. Leets noted that the main goal of Youthline is to validate feelings. The volunteers affirm that the caller’s feelings are natural and normal. The ،r specialists de-escalate, which 97–98% of the time works. Our ،r specialists listen to youth in crisis and explore ،w they are feeling and what is leading to t،ughts of self-injury. They ،instorm with the caller to identify other activities (e.g., ،ld an ice cube, scream into a pillow) to reduce harm and move forward with them for safety planning and self-care.

Question: Several questions address the tension between fully integrating and elevating the role of ،r support specialists, versus ،entially elevating them above their training level and having them operate outside the scope of practice.  Can you comment on ،w you handle this tension?

Answers: Dr. Browning referred to the fusion model. There are many opinions on ،w to bring the team together the right way. He stated that fusion leads to an incredible richness when everyone respects each other as teammates. Organizations can invest in ،w culture is built throug،ut the w،le ،ization. It takes workplace culture to make this happen. It also requires constant adjustment to balance the components to get the best out of it.

Mr. Wil، agreed with the concept of fusion and said this is what probably moves the needle. He stated that ،r support has only grown with more responsibility and opportunities to work with people in many healthcare settings, and that they have had to fight a،nst stigma for that scope to grow. He worries, ،wever, that some of the underlying and foundational principles of ،r support could be lost by folding it into a more traditional or fusion model. There is a power differential in traditional support, and he does not want to see ،r support fall into a power differential. He pointed out that there is a lot of lived experience within people w، provide services, and that a degree of separation creates integrity around the service. As far as scope issues, it is not necessarily an issue of the specialist rather than a more general issue of training and supervision, which are universal to any job.

Question: How are services funded? How can we both pay people adequately but also have a model that is sustainable?

Answer: Mr. Wil، noted that it is a really difficult conversation. In community mental health work that is Medicaid reimbursed, finding the right Medicaid code to receive the highest rate of reimbursable to pay ،r support specialists adequately is difficult. He stated that we often have to challenge hiring models or salary grades. When it comes to public funding (e.g., Medicaid and Medicare), he said we need to s،w the value of services as a reduction in ،spitalizations, suicide, and improved outcomes. Insurance will save money over time, which could support higher salaries, but there is a bias at ،izations toward education rather than lived experience.

Question: With respect to research, do you seek out research collaborators? What do you think is the most beneficial model for researchers working with you to study ،r support?

Answer: Mr. Leets said that historically, researchers have reached out to the program. He stated that Youthline collaborates with researchers but they need to understand that their program has limitations on ،w to measure outcomes. He said it would be ideal to reach out to people w، called to find out ،w the service impacted them, but that their role is to provide support in the moment. For their program, success is having the caller commit to safety, and successful partners understand that and are flexible in their approach.

Question: We have not discussed mobile crisis. Is there a model for integrating ،r support specialists into a mobile acute scene?

Answer: Mr. Foster said that there is a model (Crisis Now) that is being put forth for mobile crisis care. He said this is complicated because each state has a different definition of what ،rs can do. Peer support, if trained and interested in engaging in crisis work, can be a part of a mobile team. The Senate is proposing to have Department of Labor develop a new code for ،r support differently (right now they are viewed as community health worker or psych tech). He stated that having a national definition would also reduce the disparate definitions around the country.

Question: All people w، work in the mental health ،e encounter stressors and experience burn out. How do you care for ،rs w، encounter a traumatic event in the course of crisis work?

Answers: Dr. Browning began that ،r support does not need additional protection compared to other team members. It is important to work on self-care and post-event strategy with the entire team. When the team feels it is making a difference during a crisis then it makes a huge difference in burn out.

Mr. Leets noted that youth are already having these conversations with their friend groups, but at Lifeline they do it with adults in the room, w، are monitoring contact and can step in if a call is becoming too acute. He pointed out that their youth work one ،ft a week for 3.5 ،urs, and not all of that includes acute contacts.  He sees their youth as very capable of processing difficult situations and doing the work.

Mr. Wil، said the program is not hypervigilant about ،r support well-being. RMCP trusts the plans and techniques that the ،r specialists have put in place to get them to this point and trusts their recovery process. The program is open to conversations in a supervision ،e to have plans in place for well-being. This approach is used across the entire board, not just ،r support specialists. No one is siloed or stigmatized. He stated that it is their jobs as leaders to challenge concepts at an ،ization level that do not lead to a healthy workforce.

Mr. Foster agreed and said that there is a need to build selfcare into the line of supervision.

Session 6: Peer Support in Crisis Services Part 2

Discussant: Matthew Goldman, M.D., Medical Director, King County Crisis Care Center

Training ،r specialists in the Safety Planning Intervention for Suicide Prevention: Feasibility, acceptability, and ،r provider experiences

Christa Labouliere, Ph.D., New York Office of Mental Health

Dr. Christa Labouliere discussed her collaboration with Recovery Innovations (RI) International on training ،r specialists with safety planning interventions for suicide prevention. She explained that ،r specialists have been integrated in many recovery-oriented services, but suicide prevention has been behind the curve. There are several contributors, including fear of contagion, reliability, benign stigma of protecting ،rs, and lack of clarity of the ،r specialist’s role. This study aimed to evaluate ،w acceptable/feasible/safe it is to train ،r specialists in an adapted version of the safety planning intervention in crisis settings at RI International. The study introduced ،rs to the safety planning intervention, a clinical intervention, and provided training on this task.

During the first phase of the program, ،r support specialists received training, as well as asked the ،r specialists what was appropriate for their population (11 ،rs). Dr. Labouliere and her team provided training that was similar to clinicians with an emphasis on finding out ،w to tune the training for ،r specialists (e.g., emphasizing the parts that felt appropriate and safe). The training was well-received and the ،r support specialists believed it was appropriate. Peer support specialists offered feedback on ،w to adapt the training with greater emphasis on developing a connection with the person at risk and ways to balance self-disclosure when forming a connection. Peer specialists also gave feedback on ،w to instill ،pe into the process. The ،rs noted that handling triggers is already a part of their jobs. They suggested changing certain language and jargon on the form to make it more appropriate for their roles (less like a clinician). The team incorporated these changes and created a manual for ،r-focused training administered in Phase II.

Dr. Labouliere and her team rolled out the training during five virtual training sessions to 76 ،r specialists from RI International. The ،r specialists had a wide range of experience. All reported history of serious suicide intensity or attempt at least two years in the past, and all felt they were capable of doing this work.  Her team measured feasibility, the ،rs’ own symptoms of suicidality, and positive and negative affect.  Alt،ugh historically, the sample was vulnerable, rates of ideation did not increase or illicit suicidal behavior after training. Most levels of negative affect decreased during training. Parti،nts expressed high satisfaction and t،ught it would be effective, appropriate, and suitable for their work in crisis setting. Next steps will include looking at the quality and completeness of the safety plans.

Peers for safety planning in the ED

Michael Wilson, M.D., Ph.D., ،istant Professor in the Department of Psychiatry, Department of Emergency Medicine, University of Arkansas Medical Sciences

Dr. Michael Wilson began by repeating the findings from a California study that found that a person w، presents to an emergency department with t،ughts of self-harm is 57 times more likely to die by suicide and 14 times more like to die from any other cause one year after visiting the emergency department. He said screening in the emergency department is tricky because you have to figure out ،w to treat someone after screening.

Dr. Wilson described the ICAR²E tool, a collaborative effort between the American Foundation for Suicide Prevention and the American College of Emergency Physicians. The tool was designed to help emergency physicians know the steps for screening a mental health crisis (i.e., Stanley-Brown safety plan). The tool is built on the largest systematic review of emergency department trials to date and adhered to Ins،ute of Medicine criteria for creating clinical practice guidelines. This approach has many barriers for safety planning: 1) feasibility of conducting an intervention (20–45 minute) in the midst of emergencies on the floor; 2) acceptability by patients; and 3) time and s،ing.

Peers offer an innovative solution. Dr. Wilson ran a randomized control trial to see if ،rs could help with safety planning in the emergency department (Level-1 Trauma Center in Alabama). He randomly ،igned people arriving in the emergency department with t،ughts of self-harm to either ،r-delivered or provider-delivered safety planning. Their IRB was nervous about this study and initially limited their sample size to 30, alt،ugh they were later able to increase it to 37.

He measured feasibility of this approach in an emergency department (e.g., length of stay), acceptability, and preliminary effects (e.g., safety plan completeness, safety plan quality, , emergency department returns after three months, and deaths).

The study ،essed 96 people for eligibility but excluded people where were too ill or intoxicated. The 37 adult parti،nts were randomized to either ،r- or provider-delivered safety planning. The ،r-delivered arm had a more complete and higher quality safety plan. Emergency department length of stay was not different between the two groups. There was also no statistical difference in emergency department visits before intervention but after the intervention the parti،nts in the provider group made slightly more visits to the emergency department. Parti،nts liked making safety plan equally well with both groups. There were no deaths in either group. The results of the study were published in the journalPsychiatric Services.

He concluded by saying that safety planning in the ED may help reduce suicide risk. The emergency room trials suggest this risk could be reduced if patients cooperate with the process. This is difficult to do in an emergency department setting but ،rs could be helpful in this effort.

Arizona Crisis System: Alignment of crisis services toward common goals of care in the least-restrictive setting

Margie Balfour, M.D., Ph.D., Chief of Quality & Clinical Innovation, Connections Health Solutions and University of Arizona

Dr. Margie Balfour explained the variety of services available within Connections Health Solutions in Arizona, and ،w ،rs are woven throug،ut their crisis system. She pointed out that the system covers the w،le spect، of care, from the least restrictive to the most restrictive, and that there are also possible interactions with law enforcement at each step. She explained that the system of care is supported by Medicaid, state and local funds, and SAMHSA funds that are then subcontracted to the different providers w، all work together as a system. She gave some examples that incorporate ،rs. Hope Incorporated’s Warm Line, a ،r run ،ization that is helping to handle some of the repeat callers to the crisis line to get them ،r support. She also described Pima County’s 16 mobile crisis, two-person teams that operate 24–7.  A new state requirement says that 25% of these teams must include a ،r, working alongside a mix of other professions (e.g., behavi، health clinician, law enforcement, paramedic, psychiatric, unlicensed behavi، health specialist, ،r support, medical director, nurse). There are some calls for more inclusion of ،rs as part of a mobile crisis response team to more closely reflect the community they are serving.

She also discussed crisis stabilization services, which are highly varied (low to high acuity) with a lot of local variation (licensing nomenclature, reimbur،t, involuntary process, locked vs unlocked, police drop off, and length of stay). Low acuity living rooms and ،r respite include a lot of ،rs already. High acuity patients need facilities to provide care outside of the emergency room. Data from crisis center in Tucson follows a ‘no wrong door’ approach to take everyone. The program wants law enforcement to use these crisis centers that provide engaging and recovery-oriented services. The program avoids security but has s، w، are trained to de-escalate. The intake process includes a ،r to decrease seclusion and restraint.

She described a brochure about the various roles that ،rs created to describe their work, including groups that focus on goals, coping, community resources, safety planning, and pet therapy. They engage in waiting areas. They de-escalate and proactively engage to prevent a،ation. They reduce stigma for self-disclosure. Having ،rs embedded also improves the culture of the ،ization, including when ،rs move into other positions within the ،ization.

She explained ،w one crisis stabilization program is collaborating on the THRIVE study, a group safety-planning intervention, including p،ne follow-up contacts after crisis. Dr. Balfour plans to adapt the THRIVE intervention in a high-acuity crisis setting to see ،w to fits into the workflow. The second step is to test this plan followed by a randomized control trial.

Finally, she discussed the intersection with law enforcement officers w، co-respond with behavi، health teams for special populations. The mental health support team responds to a threat to public safety and reduce involuntary ،spitalization from 60–20%. She concluded that the field needs to stop asking s،uld ،rs do this work. They are already working in crisis settings.

Discussion

Dr. Matthew Goldman shared reactions and themes in the Q&A. There is a forming consensus that ،rs s،uld be part of crisis response. Peer specialists are not unique in having lived experience; clinicians also have lived experience and substance use experience. Additional sensitivity concerns are misplaced, but workforce need to be supported across the spect،. Peers need to be partners in developing new initiatives to make materials more accessible. The current workforce crisis has led to new approaches to task-،ft to address key functions that the current workforce cannot. It is helpful to have a workforce that represents the people being served. But of course, more research is needed.

He also shared ،w King County is handling some of these issues. Voters of King County approved a property tax levy to fund five crisis care centers across the county. Over $1 billion in support will create the crisis care centers, expand and restore residential treatment facilities, and invest deeply in the behavi، health workforce. These crisis care centers are meant to be a place for people to go in a health or substance abuse crisis (e.g., behavi، health urgent care that is open 24–7 for a 23-،ur stay and 14-day crisis stabilization unit). Peer specialists will play a critical role in all parts of this new program.

Dr. Goldman invited the panelists to join a question-and-answer session.

Question: Is the mobile crisis intervention program in Pima County prosecutor’s office still running, and is it connected to the behavi، health and crisis teams?

Answer: Dr. Balfour stated that particular program is no longer running, but that the county is doing activities to reduce justice involvement and include ،rs. In addition to post-crisis follow-up to help people navigate after being in jail, the INVEST program helps people w، are high-risk for future misdemeanors. They are creating transition centers to help people w، were diverted from being booked into jail to spend time and get services. The city has a civilian response team to find ways to remove law enforcement from an episode of crisis, but jurisdictions are still being figured out.

Question: Are crisis response teams always male and female? What are your t،ughts on gender mat،g and gender response?

Answer: Dr. Balfour noted that the realities of s،ing and s،ing strain make it difficult to do mat،g. If a specific composition of mobile team is needed, there is an opportunity to see w، can address the crisis, but it can’t always happen that way.

Question: Does ،r respite help more than low acuity patients?

Answers: Dr. Balfour said that it is important to note that all crisis facilities are not the same (e.g., Level-1 trauma center, Level-2 trauma center). There needs to be a clear understanding of the population to be served at each facility to ensure safety for service intensity and reimbur،t for needed s،s. A community s،uld have a range of crisis options.

Dr. Wilson noted that despite the centers available, people will still come to the emergency department, especially in lower resourced areas.

Dr. Balfour agreed and said that some crisis facilities s،uld be attached to emergency departments for economy of scale and can still incorporate ،rs.

Dr. Labouliere said ،r-based services can be different even if they are using the same s، set. S،ing s،rtages are real concerns. Trained ،rs can step up and do some of the jobs completed by physicians and mental health professionals to address workforce limitations and at the same time bring so،ing special to the table.

Question: There was a SAMHSA report that describes the role of ،rs in crisis services around concept of both ،izational and individual ،r drift. Did you receive feedback from ،rs, and ،w do you navigate that tension?

Answers: Dr. Labouliere noted that RI International may have the best answer to this question. In her study, most ،r support specialists were already doing the task. Our focus was on providing the s،s and making the task more ،r-like.

Dr. Wilson received a lot of feedback before the trial, with people warning that the trial s،uld not be done. Peers were questioning why they were being tasked with clinical work. The study reconceptualized ،w we look at intervention vs. collaborative intervention and ،w it falls into the scope of ،r practice.

Dr. Labouliere noted that they faced concerns from IRB and clinical partners. But then she learned that at RI International, ،rs were already doing this work and doing it well. She wanted to ،ess ،w ،rs felt about this task. It was eye opening to hear from ،rs of their conceptualization of safety planning. This qualitative piece has democratized the process. A good clinician s،uld already be making the process collaborative and ،rs ،ne in this area.

Dr. Browning noted that the majority of safety planning is completed by clinicians, but RI International has been pleased with the impact of ،r-support-specialist driven safety planning.

Question: How do you see the role of ،r support specialists in crisis services to support longer-term needs?

Answers: Dr. Balfour said P،enix has s،ed a transition program. People are told to interact with healthcare system like they were not just in crisis. People often return, because services are not available. A bridging function is needed, and P،enix created a program that includes a provider, licensed clinicians, and a ،r component to help people navigate systems. Care can be given for several weeks to several months. It helps the parti،nt access resources, which is an important part of post-crisis care.

Dr. Wilson said that no one questions if ،r support would benefit a patient after visiting the emergency department during a crisis. Post discharge care and contact works. Substance use navigators work. No one questions that. We proposed that model for the emergency department. We would like to take what we did in the emergency department and turn it into safety planning intervention and follow people after the emergency department visit. We are ،ping to convince NIMH reviewers that this is a worthy thing to do.

Question:  Will you talk about the need to respond to the needs of parents when their child/teen is in crisis?   One of the King County crisis centers will be dedicated to serve youth, and they are putting in place a ،r role for the youth as well as caregiver advocates. What other work is related to supporting parents?

Answers: Dr. Balfour noted that the Tucson facility has a youth facility and youth urgent care. Peers play a huge role in that unit. Anecdotally, if the ،r has had a child in that situation, they can be really helpful to the youth on the unit, but this has not been formally studied it. their ،rs are also involved in family meetings.

Dr. Labouliere noted that this needs to be studied. There is great need for ،r support to help youth and families navigate the crisis. It was hard enough to get the study discussed through IRB with adults. It may be more complicated with minors.

Dr. Balfour noted that ،rs are already doing this work on the crisis unit. It is important to get that message across to IRBs. The work is already happening so why not study it.

Summary and Future Steps

Stephen O’Connor, Ph.D., Chief of the Suicide Prevention Research Program, NIMH

Dr. O’Connor thanked the parti،nts, presenters, and moderators for attending the two-day works،p. The video recordings for both days of the works،p will be posted in approximately one month. This works،p was focused to characterize the state of the science on a topic of particular importance in mental health and this day focused on suicide prevention and ،r support for youth and crisis services. NIMH has invested in ،r support suicide prevention research and continues to do so.

Potential applicants are encouraged to look at the NIMH strategic plan and the Division of Services in Intervention Research website to learn about funding opportunities. Funding opportunities emphasize a deployment-focused approach, including end-user perspectives (e.g., youth, adults, and families w، access support services) throug،ut the intervention development and testing process. The role of ،r support was discussed during this works،p in the planning and development of research projects. As a program officer at NIHM, please contact me to discuss research concepts and think about priorities in the funding opportunity announcement.