When the 988 Suicide & Crisis Lifeline launched nationwide in 2022, it brought new resources and greater standardization to crisis hotlines across the country. For counselors answering those calls, it also meant balancing new performance expectations with the needs of people in distress.
A new study from the WashU Brown School and Bursky School of Public Health finds that transparent management helped keep frontline 988 counselors’ morale strong as new performance metrics rolled out.
At the same time, counselors also relied on their clinical judgment to adapt to the situation when necessary. For example, standardized measures didn’t always fit a caller’s needs, so they sometimes stretched recommended call limits or adapted safety plans for people in distress.
“They weren’t necessarily ‘breaking rules,’ but rather adapting their expertise to fit the needs of the callers they served,” said Theresa Anasti, an assistant professor at the Brown School and lead author of the study.
Researchers gathered data by interviewing 28 crisis hotline workers in Missouri — seven managers and 21 frontline counselors — about their experiences following the national crisis line launch.
The study shows how frontline workers can help shape the way new policies work in practice, particularly when standardized measures don’t fully capture the complexity of crisis calls, Anasti said.
Morgan Shields, an assistant professor at WashU Bursky Public Health, was senior author on the paper. WashU co-authors are Gabriela Musickant, Zohra Kantawala and Rachana Cheu, graduate students at the Brown School; Ryan Lindsay, a professor of practice at the Brown School; and Byron Powell, a professor at the Brown School.
