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.

项目概要 2022年7月16日“988”将成为全国预防自杀生命线的全国免费电话号码 （公共法 116-172）。生命热线每年接到 350 万个电话，并在以下方面显示出有效性： 减少自杀、绝望、心理困扰和自杀死亡。 10 位生命热线拨打 988（类似于 911 的三位数代码）预计会使呼叫量增加三倍。 然而，988 的影响可能取决于国家对其实施融资的政策反应。 创建 988 个州的联邦法律鼓励各州通过使用费立法（例如，每个月收取固定费用） 该州的手机计划持有人，与 911 的融资方式相同）。 截至 2022 年 1 月，有四个州通过了用户收费立法，还有许多州正在通过。 考虑到此类立法，拟议的政策实施项目侧重于其特点， 第988章 被人欺负了 第988章 该项目的具体目标是： 1) 描述各州 988 实施融资的特征。 战略并确定战略实施采用的决定因素；2) 探索对融资的看法； 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 改进实施的策略；以及 3) 确定 988 使用费立法对该政策的影响 保真度（生命线州内应答率）和覆盖率（生命线州呼叫量率）的实施结果， 自杀死亡和急诊室用于心理健康危机和自我治疗的有效性结果 伤害，并评估不同人口群体的影响异质性，这些目标将通过法律来实现。 绘图研究，对 250 个自杀预防利益相关者（例如生命线呼叫中心领导）进行的全国调查，60 半结构化访谈，以及比较实施和实施趋势的双重差异分析 第988章 实施前（2015-2021年）和实施后（2022-2025年）的有效性结果 没有通过 988 用户收费立法 该项目团队拥有政策实施科学方面的专业知识（Purtle， Raghavan）、自杀（Lindsey）、法律（彭慕兰）和定量政策分析（Stuart）。 包括管理生命线的充满活力的情绪健康组织和美国自杀基金会 该项目具有创新性，因为它推进了以政策为中心的研究领域。 该项目意义重大，并将产生影响，因为它关注的是一个主要的联邦科学。 政策在实施的早期阶段，因为它将产生为实施提供信息的知识 与 988 相关的融资决策——这可能是导致心理健康危机和自杀的主要途径 该项目与 NIMH 的战略计划相一致，该计划优先考虑。 预防自杀，NIMH 承诺到 2025 年将自杀率降低 20%。