Implementation of the Federal 988 Suicide and Mental Health Crisis Hotline Policy: Determinants and Effects of State Policy Implementation Financing Strategies

联邦 988 自杀和心理健康危机热线政策的实施：州政策实施融资策略的决定因素和影响

• 批准号: 10563424
• 负责人: Jonathan Purtle
• 金额: $ 41.8万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10563424
• 关键词: Accident and Emergency department; Adopted; Adoption; Age; American; Area; Authorization documentation; Cellular Phone; Cessation of life; Characteristics; Code; Data; Databases; Digit structure; Distal; Ecology; Effectiveness; Emotional; Ethnic Origin; Evidence based intervention; Exploration, Preparation, Implementation, and Sustainment; Feeling hopeless; Fees; Foundations; Funding; Future; Health; Heterogeneity; Hotlines; Interview; Knowledge; Laws; Leadership; Legal; Maps; Measures; Medicaid; Mental Health; National Institute of Mental Health; Outcome; Perception; Policies; Policy Analysis; Process; Psychometrics; Public Health; Race; Reporting; Route; Self-Injurious Behavior; Services; Statutes and Laws; Strategic Planning; Structure; Suicide; Suicide prevention; Surveys; System; Time; Training; United States; United States Agency for Healthcare Research and Quality; Violence; acceptability and feasibility; authority; contextual factors; effectiveness outcome; evidence base; falls; federal policy; implementation determinants; implementation fidelity; implementation outcomes; implementation science; implementation strategy; improved; innovation; instrument; prevention service; psychological distress; reducing suicide; response; success; suicidal; suicidal morbidity; suicide rate; telephone based; trend

PROJECT SUMMARY On July 16, 2022 “988” will become the national toll-free dialing code for the National Suicide Prevention Lifeline (Pub. Law 116-172). The Lifeline receives 3.5 million calls annually and has demonstrated effectiveness at decreasing suicidality, hopelessness, psychological distress, and suicide death. The transition from the current 10-digit Lifeline dialing code to 988—a three-digit code like 911—is projected to potentially triple call volume. The impact of 988, however, will likely be determined by state policy responses to financing its implementation. The federal law that creates 988 encourages states to pass user fee legislation (e.g., a flat fee monthly per every cellphone plan holder in the state, identical to how 911 is financed). The current state policy landscape is extremely varied. As of January 2022, four states had passed user fee legislation and many others were considering such legislation. The proposed policy implementation project focuses on the characteristics, determinants, and impacts of 988 user fee legislation and other policy strategies used by states to finance 988 implementation. The project’s Specific Aims are to: 1) Characterize states’ 988 implementation financing strategies and identify determinants of implementation strategy adoption; 2) Explore perceptions of the financing determinants of 988 policy implementation success and acceptability and feasibility of legislative financing strategies to improve implementation; and 3) Determine the effects of 988 user fee legislation on the policy implementation outcomes of fidelity (Lifeline in-state answer rates) and reach (Lifeline state call volume rates), the effectiveness outcomes of suicide death and emergency department use for mental health crises and self- harm, and assess effect heterogeneity across demographic groups. These aims will be achieved by a legal mapping study, national surveys of 250 suicide prevention stakeholders (e.g., Lifeline call center leaders), 60 semi-structured interviews, and a difference-in-differences analysis comparing trends in implementation and effectiveness outcomes pre (2015-2021) and post (2022-2025) 988 implementation between states that did and did not pass 988 user fee legislation. The project team has expertise in policy implementation science (Purtle, Raghavan), suicide (Lindsey), law (Pomeranz), and quantitative policy analysis (Stuart). Practice partners include Vibrant Emotional Health, which administers the Lifeline, and the American Foundation for Suicide Prevention. The project is innovative because it advances the understudied area of policy-focused implementation science. The project is significant and will have impact because it focuses on a major federal policy in the early stage of implementation and because it will generate knowledge to inform implementation financing decisions related to 988—which is likely to be a primary gateway to mental health crisis and suicide prevention services for the foreseeable future. The project is aligned with NIMH’s Strategic Plan, which prioritizes suicide prevention, and the NIMH pledge to reduce the suicide rate by 20% by 2025.

项目摘要 2022年7月16日“988”将成为全国预防自杀生命线的全国免费拨号代码 （Pub.法律116 - 172）。生命线每年接到350万个电话， 减少自杀倾向、绝望、心理困扰和自杀死亡。从目前的过渡 10-数字生命线拨号代码到988-一个三位数的代码，如911-预计潜在的三倍呼叫量。 然而，988的影响可能取决于国家对资助其实施的政策反应。 创建988的联邦法律鼓励各州通过用户收费立法（例如，每月固定费用， 在该州的手机计划保持器，与911的融资方式相同）。目前的国家政策格局是 非常多样化。截至2022年1月，四个州已经通过了用户费立法，其他许多州也在 考虑到这样的立法。建议的政策实施项目侧重于特点， 988用户费用立法和各州为988提供资金所使用的其他政策策略的决定因素和影响 实施.该项目的具体目标是：（1）确定各州988项执行筹资的特点 战略，并确定实施战略采用的决定因素; 2）探索融资的看法 988政策实施成功的决定因素以及立法融资的可接受性和可行性 改善执行情况的战略;以及3）确定988用户收费立法对政策的影响 保真度（生命线州内接听率）和覆盖范围（生命线州通话量率）的实施结果， 自杀死亡和急诊室用于精神健康危机和自我的有效性结果， 危害，并评估人口统计学群体之间的效应异质性。这些目标将通过一个法律的 地图研究，对250名自杀预防利益相关者的全国调查（例如，生命线呼叫中心领导人），60 半结构化访谈，以及差异中的差异分析， 执行前（2015 - 2021年）和执行后（2022 - 2025年）的成效结果 没有通过988用户费立法。项目小组具有政策执行科学方面的专门知识（Purtle， Raghavan），自杀（Lindsey），法律（Pomeranz）和定量政策分析（Stuart）。共修者 包括管理生命线的活力情绪健康和美国自杀基金会 预防该项目是创新的，因为它推进了以政策为重点的未充分研究领域 执行科学。该项目意义重大，将产生影响，因为它侧重于一个主要的联邦 因为它将产生知识，为执行工作提供信息， 与988相关的融资决定-这可能是导致心理健康危机和自杀的主要途径 在可预见的未来提供预防服务。该项目与NIMH的战略计划保持一致， NIMH承诺到2025年将自杀率降低20%。