Implementation of Safety Planning at 988 Crisis Centers in Missouri: A Mixed Methods Study

Area of Science:

• Behavioral Health
• Public Health
• Crisis Intervention

Background:

• The United States is experiencing a significant behavioral health crisis.
• The National Suicide Prevention Lifeline launched 9-8-8 in July 2022 to improve crisis service access.
• Understanding the quality of care, specifically the use of evidence-based practices like Safety Planning, on 988 crisis lines is crucial but limited.

Purpose of the Study:

• To examine employee attitudes toward Safety Planning on Missouri 988 crisis lines.
• To investigate how Safety Planning is operationalized in practice.
• To identify factors influencing the implementation of Safety Planning.

Main Methods:

• A convergent triangulation mixed methods design was employed.
• Quantitative data collected via surveys assessed attitudes using IAM, FIM, and AIM.
• Qualitative data from semi-structured interviews explored staff experiences in depth.

Main Results:

• High average scores for appropriateness, feasibility, and acceptability of Safety Planning were reported.
• Graduate-level education was negatively associated with these scores.
• Interviews revealed strong support for Safety Planning, with barriers and facilitators linked to caller circumstances and organizational supports.

Conclusions:

• Safety Planning is positively viewed by Missouri 988 crisis line staff, supported by organizational factors.
• Barriers to Safety Planning's utility include caller circumstances and the phone-based care model.
• Further research is needed to refine quality metrics and understand evidence-based practice variation across 988 centers.