Defining a Crisis: Engagement with Crisis Call Centers and Mobile Crisis Teams

7.项目摘要/摘要 2022年7月，988将成为全国3位自杀预防电话接入全国 自杀预防生命线(NSPL)。国家认可的零自杀(ZS)模式支持危机呼吁 中心(CC)和流动危机(MC)是预防自杀的关键策略。危机服务也被设想为 这是一种增加获得护理的机会的手段，这些人群在接受护理方面历来面临障碍， 包括黑人/非裔美国人、无家可归者和生活在农村地区的人。什么时候 988上线后，NSPL预计将超越目前自杀热线的角色，转变为 是应对一系列心理健康危机的切入点，也是派遣MC团队的一种手段。然而，几乎没有 知道什么类型的呼叫可能达到988，或者需要考虑什么因素才能最好地发展 危机分类决策的实践。迫切需要扩大证据基础，以便最好地提供信息 CC和MC环境中的做法，这两个环境通常会照顾自杀风险较高的人。为了填补这一空白， 这项研究将利用佐治亚州全州危机系统的大型、全面的临床数据集-这 被广泛认为是危机服务的全国领导者-以确定CC和MC实践的特点并提供 随着美国开始推出988，对危机计划的指导。在目标1中，我们将进行潜在类分析，以 定量描述通过全州CC获得危机服务的成年人的常见临床表型 2016至2018年间(n=235,762)，这可以告知988呼叫需要解决哪些类型的危机 中锋。在目标2中，我们将检查社会人口学、临床和地区性因素，这些因素可能与 格鲁吉亚CC(n=235,762)和MC(n=34,371)的转介决定，特别侧重于差异 在历史上获得医疗保健机会较差的群体中。最后，在目标3中，我们将利用佐治亚州对 一种称为护理利用水平系统(LOUS)的临床决策支持工具，用于检查以下病例 实际的CC转诊不同于Locus建议的最合适的护理级别，即 允许检测转介选择可能受到限制的情况。这些研究将填补这方面的关键空白 证据基础，以促进我们对危机服务中预防自杀的最佳做法的理解，并将 帮助美国为988等重大危机体系转型做好准备。以下数字如下： Gcal数据库中2016年1月1日至2018年12月31日之间的移动危机访问实际次数。

7. Project Summary/Abstract In July 2022, 988 will become the nationwide 3-digit suicide prevention phoneline to access the National Suicide Prevention Lifeline (NSPL). The nationally recognized Zero Suicide (ZS) model has endorsed crisis call centers (CC) and mobile crisis (MC) as key strategies to prevent suicide. Crisis services are also envisioned as a means of increasing access to care for populations that have historically faced barriers to receiving care, including Black/African Americans, people experiencing homelessness, and people living in rural areas. When 988 goes live, the NSPL is expected to expand beyond its current role as a suicide hotline and transform into an entry point for a range of mental health crises as well as a means of dispatching MC teams. However, little is known about what types of calls may come to 988 or what factors will need to be considered to develop best practices in crisis triage decision-making. There is an urgent need to expand the evidence base to inform best practices in CC and MC settings, which are routinely caring for people at high risk of suicide. To fill this gap, this study will leverage a large, comprehensive clinical dataset from Georgia’s statewide crisis system—which is widely regarded as a national leader in crisis services—to characterize CC and MC practices and provide guidance to crisis programs as the US begins to roll out 988. In Aim 1, we will conduct a latent class analysis to quantitatively describe common clinical phenotypes of adults accessing crisis services through a statewide CC between 2016 and 2018 (n=235,762), which can inform what types of crises need to be addressed by 988 call centers. In Aim 2, we will examine sociodemographic, clinical and regional factors that may be associated with referral decisions by Georgia’s CC (n=235,762) and MC (n=34,371), with a particular focus on disparities among groups that historically have poorer access to care. Finally, in Aim 3, we will leverage Georgia’s use of a clinical decision-support tool called the Level of Care Utilization System (LOCUS) to examine cases in which the actual CC referral differs from the most appropriate level of care recommended by the LOCUS, which allows for detection of cases where referral options may be limited. These studies will fill critical gaps in the evidence base to advance our understanding of best practices for suicide prevention in crisis services and will help prepare the US for major crisis system transformations such as 988. The figures presented below are the actual number of mobile crisis visits between 1/1/2016 and 12/31/2018 in the GCAL database.