Introduction

The Kristin Brooks Hope Center is a public benefit corporation that administers the National Hopeline Network 1-800-SUICIDE (the Network). The Network exists to quickly connect callers to an American Association of Suicidology-certified crisis center. By working to optimize the reach and impact of the 750+ crisis centers in the United States, the Network ultimately seeks to make the services those centers provide more accessible to those who desperately need them, regardless of where in the U. S. the call originates.

The purpose of this document is to describe the technology initiative currently underway to develop call management and data-gathering tools. We will share the vision, goals, and objectives of the Network and briefly discuss the tools and options to enhance the depth and breadth of each crisis center within the Network. 

The Vision 

Make the services of the nation’s community-based crisis centers universally accessible, no matter where a call originates. 

A fundamental vision of the Network is to harness the tremendous base of knowledge, skill, and resources that is present in existing crisis centers. Using that collaborative power, facilitated by reliable and proven technology, the Network intends to work toward making appropriate and critical crisis services universally available.

Employ state-of-the-art tools to manage routing of crisis calls and to collect data related to those calls.

The Network is working with various technology providers to develop advanced application and telephony services that are typically far beyond the financial reach of local crisis centers. These infrastructure services will ensure that crisis calls are answered promptly by a crisis line worker, and yield data that will be invaluable in supporting research. Data, securely collected and stored by the Network, would also provide the basis for measuring and monitoring the effectiveness of individual centers and of the Network as a whole.

Provide value-added services that enhance the ability of crisis centers to fulfill their mission.

Ultimately, the aim of the Network is to put access to a broad spectrum of specialized services at the fingertips of crisis line workers. Crisis centers could quickly dispatch professional emergency services in highly lethal situations. Crisis line workers could easily tap into sub-networks of workers with language, culture-specific, or other specialized skills.

Implicit in the overall mission of the Network is to enhance the effectiveness of crisis center services. An important challenge is to entirely avoid or minimize disruption to individual crisis centers and crisis line workers.

The Goals

Minimize disruption to crisis centers and crisis line workers

In providing tools, technology, and services to crisis centers, it is most important that crisis centers and line workers are not distracted or burdened with tasks that remove the focus from their mission. The intent of the Network is to amplify the ability of a crisis line worker to assist crisis callers.

Application and telephony services should be highly reliable and available. Workflow implementations should always allow crisis line workers to keep the focus on the caller and ultimately on saving lives. Data collection activities should not place increased administrative burden upon crisis centers.

Employ a centralized database and real-time electronic communications to support secure, universal, and constant access to crisis center data.

A large part of the focus of the Network is to obtain data about crisis lines that will be used to determine their effectiveness in preventing suicide attempts and completions. This database will represent the first valid source of such data. 
The design of the database that will store this information must address privacy and security concerns of callers and crisis centers alike and must conform to any governmental standards, such as HIPAA. 

Apart from the research value of data collected, the database will be a component of a browser-based call center application that would be available to each crisis center. This application could provide a net gain to local crisis centers by improving data collection, record-keeping, and reporting capabilities.

Create tools to measure and report on the effectiveness of crisis centers

In order that the value of data collected can be realized, the Network seeks to create tools for reporting and data analysis. The information provided could be used to improve techniques, identify gaps in services, and support the development of new programs and legislative initiatives to further the cause of suicide prevention on a national scale.

Ensure that all crisis calls are answered in a timely fashion by a crisis line worker

Trained crisis line workers should answer calls 24 hours a day, seven days a week. People in crisis calling 1-800-SUICIDE should reach a line worker within 20-30 seconds from the moment the number is dialed. The Network would supply a means for local crisis centers to extend its hours when they or it cannot provide 24-hour coverage with available staff.

The Objectives

The business objectives are defined as the high-level, measurable outcomes for this initiative. Business objectives drive functional requirements and imply design considerations for the solution. The objectives may suggest the continuation of certain current crisis center practices and the introduction of other new practices enabled through the use of new technologies. The Network has four major business objectives for this initiative.

Development and maintenance of a secure database of call and caller data

The database will be designed to meet the security and privacy needs of the Network and participating crisis centers. The data gathered will assist crisis centers and researchers in measuring the efficacy of prevention techniques. Similarly, the data will be used in assessing the effectiveness of crisis line workers, crisis centers, and the Network as a whole.

By using this database, individual centers will have reliable and secure access to information that may augment and extend data that is currently being gathered. Reporting and record keeping can be simplified and streamlined. Security features, designed into the database will prevent unauthorized access to crisis center data and may better secure that data than is currently possible. Centralization of the data will allow for regular backups that will eliminate the possibility of data loss.

Creation of a secure browser-based call center application

The call center application will be designed as the primary means of gathering all data associated with a crisis call or caller. All data communication will be secured through use of a private network. The application will be browser-based, and unlike older client/server applications, will maintain the ability of a center to continue functioning in the event of a network outage. 

Application software will reside centrally, along with the database, although it could be deployed locally to a crisis center where necessary. Where crisis centers may prefer to continue using an incumbent application, (such as IRis), it will be possible to develop application interfaces and bypass the Network application, although this approach will add to the cost of implementation.

Crisis line worker profiles will be maintained via a separate component of the total application. Tools will be provided to search for and collaborate with available crisis line workers possessing specialized skills or experience in dealing with a particular issue.

Both the database and the call center application developed for the Network will adhere to the privacy and confidentiality standards of the Health Insurance Portability and Accountability Act (HIPAA). These standards outline specific rights for individuals regarding protected health information and obligations of healthcare providers, and health plans. This will grant the healthcare consumers a greater level of control over the use and disclosure of personally identifiable health information. Healthcare providers and/or health plans are prohibited from using or disclosing health information that may include personally identifiable health information, irrespective of form, except as authorized by the patient or specifically permitted by the regulation.

Assembly and maintenance of an effective telephony network

The largest part of the technology initiative for the Network is concerned with the assembly and upkeep of an effective telephony network. The telephony network will need to provide for and eventually enable live call tracing for highly lethal situations. This feature will be critical in quickly dispatching emergency services via the Public Safety Access Point (PSAP) nearest to where the call originates.

The telephony network must be able to handle volume spikes without blocking calls and must provide uninterrupted access to both callers and crisis centers. Calls should be answered no more than 30 seconds from the moment the number is dialed.

Crisis centers across the nation use a wide variety of telephony systems to handle crisis calls. Some are using outdated equipment that will not be compatible with the requirements of the Network. However, the telephony network will be designed to inter-operate with broad range of systems of various vintage, capacity and capability. This approach will minimize infrastructure changes to crisis centers and position the Network to serve an increasing number of crisis centers over time.
In designing the telephony network, a minimum standard will be defined for hardware (primarily telephony equipment). This standard will seek to preserve existing crisis center equipment wherever practical, and ensure, for the most part, that centers will not have to immediately upgrade or make new investments in software and hardware. More advanced equipment will better position crisis centers to take full advantage of the Network and maintain optimal service levels to crisis callers.

Occasionally, it may be useful or even critical to have conferencing or call transfer functionality available to handle a crisis call. The telephony network will allow crisis centers to leverage transfer and conferencing functionality where necessary. Transfer and conferencing should be seamless to the caller and there should be no possibility of dropping a call.

Finally, the telephony network, along with the database and call center application, should provide tools to securely report on call routing performance, call and caller data and meet reporting requirements of individual crisis centers.

Effective management of call routing to avoid blocked, delayed, or dropped calls

Crisis calls will be routed through a national network that will contain a flexible means of defining exactly how those calls should be routed. Rules for call routing should be center-specific and simple to maintain. The telephony network should be able to identify available crisis line workers within each center and route accordingly to prevent any blocked, dropped, or delayed calls.

Underlying considerations

In assembling the solution, a modular design will be employed that loosely couples the ability of the Network to provide service to any particular vendor, component, or technology. This modular approach will, over time, tend to minimize any switching costs associated with updates, enhancements, and other modifications. 
Open or non-proprietary architecture will keep the solution optimally inclusive of technologies and practices currently in place in individual crisis centers. These techniques will best position the Network to leverage and incorporate new technologies as they become available. The crisis center application will be designed to meet all the data gathering needs of a crisis center.

Potential Implementation Scenarios

There are three fundamental ways in which Network technology could be integrated into a crisis center operation. These three scenarios are presented below from least costly to most costly.

Crisis center chooses full implementation of Network technology

From a crisis center perspective, this is the least costly option. The crisis center would use the centralized crisis center application as diagrammed in System Architecture in the appendix. Call and caller record keeping and reporting needs would be satisfied by the Network crisis center application.


Calls coming into the center via 1-800-SUICIDE could be from individuals within the geographic reach of the center, or from that of another center that is unable to answer that call. Similarly, calls that could not be handled by the center could be routed elsewhere, in keeping with the standard of getting an answer with 30 seconds. Call origination information would serve to identify what type of call is coming into a center.

To receive calls from outside a crisis center designated area, the crisis center must choose to be a part of the Safety Net Backbone (SNB). No calls will be routed to a center that has not agreed to receive these calls. At present, a defect exists within the SBN that allows the unintended routing of calls to centers that have not agreed to accept them. The new switching technology will address that issue. The Network intends to launch the HELP technology with a minimum of 100 available crisis line workers in the SNB. 

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If a crisis center is unable to access the private network or if its telephony equipment is not compatible with that of the Network, the ability to route 1-800-SUICIDE calls to that center will not be affected. In the event that a crisis center is overloaded (busy) or does not answer, a call will be routed to an available crisis line worker in a center with fully-compatible HELP technology.

The HELP technology will provide a safety net, designed to raise the call completion rate, currently at 70-75%, to 100%. It is not intended to take calls away from any networked crisis center. No crisis center should experience a reduction in calls handled.

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A crisis center with telephony equipment compatible with that of the Network could potentially receive two classes of calls from 1-800-SUICIDE. Calls from within or near the geographic reach of the center would be routed if there is an available crisis line worker. Calls intended for other centers that could not be answered could also be routed to telephony-compatible crisis centers.

This configuration will call for telephony equipment compatible with Network equipment, workstations with web browsers and Internet access. It is the aim of the Network to achieve a solution that would interoperate with most of the telephony equipment currently in place at crisis centers across the nation. Older or outdated equipment, however, may not be compatible and could require an upgrade.

Crisis center uses existing application and feeds Network database

Many crisis centers may prefer to maintain incumbent applications, such as IRis, to minimize the disruption and change to the workflow of crisis line workers. This need could be met by developing an application interface to feed the Network database. 
Interfaces with more widely used applications will tend to cost less than those with less widely used or custom-built applications. There is a potential need in this configuration for some local application reengineering where certain data elements are not currently being captured. Basic incompatibilities between the Network’s open architecture and older, less open applications could serve to expand the cost exponentially. In some cases, components of the application could be deployed centrally with minimal effect on line workers. For example, tools to search and tap into line workers with specialized skills will be made available as a component separate from the data collection functionality of the Network application.

Telephony functions would be identical to a full implementation. 
This option would be more costly to both the Network and the crisis center than a full implementation, particularly if reengineering of the incumbent application is needed to satisfy the data requirements of the Network.

Crisis center deploys Network technology locally & feeds Network database

To maintain maximum control over its environment, larger funded crisis centers could choose to fully implement Network technology locally. This would amount to an exact copy of the Network data center and would require a large investment on the part of the crisis center. The crisis center would use the same crisis center application that the Network supplies centrally, and feed data to both a local database and to the central Network database. This would require a telephony and application infrastructure similar to that of the Network’s centralized service. The initial and ongoing costs of this configuration would very likely be prohibitive for most crisis centers. 

In the appendix to this document is an illustration of what that infrastructure would include.


Summary

In this document, we have described the vision, goals, and objectives of the technology initiative that the Network has undertaken to raise the availability and effectiveness of suicide prevention efforts in the US. 

The intent of the Network is to create a toolset of options that enhance the depth and breadth of each crisis center. The Network has taken an important step toward realization of that vision by compiling the overarching business requirements that define the application needs of the solution. Based on this requirements definition, the major functions of the data network, the telephony system and the application have been identified. Additional work performed in this phase has outlined the diverse set of application and telephony solutions currently in place in a cross-section of crisis centers across the nation. 

Certainly there will be significant obstacles and challenges encountered throughout this initiative. The National Hopeline Network, along with its technology partners, is committed to overcoming each challenge and fully realizing the vision of combining the collaborative force of crisis centers across the nation with technology to provide high-quality emergency hotline services to those in need.

The primary core value of the Kristin Brooks Hope Center is “At First, Do No Harm”. This value relates to a person calling into the Hopeline Network and to the crisis centers that receive those calls. Each crisis center in the Network is a partner of the Kristin Brooks Hope Center. That partnership is required for the HELP technology to grow and provide quality response to the millions of Americans who need the services community-based crisis centers (CBCC) provide.

There are funding sources for CBCC that may think the Network negates the need for continued funding of those centers. In all cases the Kristin Brooks Hope Center will vigilantly work with each center within the network to make certain that no funding source will be compromised. We will advocate on a national and state level with our friends in Congress and those developing state plans. We will go to any hearing, testify and provide support in any way possible to fulfill this promise.
The Kristin Brooks Hope Center will not enter into any agreement or obligate the National Hopeline Network to any services without express written consent from our member agencies. To this end, we will develop an executive committee, made up of Hopeline Network member executive directors and voted upon by all of our members and our Board of Directors. The Executive Committee will be charged with reviewing all contracts and agreements to expedite the growth of the National Hopeline Network.

APPENDIX - Network infrastructure illustration
This diagram illustrates the major components of the application and telephony infrastructure.


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