Rapport Building in Written Crisis Services: Qualitative Content Analysis.

BACKGROUND: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE: This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.

Psychiatric diagnoses, somatic disorders, and emergency dispatches among individuals who used a national suicide crisis line.

Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care.

Covid-19 hotlines, helplines and call centers: a systematic review of characteristics, challenges and lessons learned.

BACKGROUND: During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristics, challenges and lessons learned of implementing Covid-19 hotlines/helplines/call centers during the pandemic. METHODS: PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched between 1st January 2020 and 31st December 2023 to retrieve relevant articles published in English. The quality and risk of bias of the studies were assessed using the Appraisal tool for Cross-Sectional Studies (AXIS), the Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) Checklist. RESULTS: In total, 43 out of 1440 articles were included in this study. About half of the hotlines/helplines/call centers were launched in March 2020 (n = 19). Providing psychological support (n = 23), reliable information about Covid-19 (n = 10), healthcare advices about Covid-19 (n = 8), and triage (n = 7) were the most common purposes of implementing these services. The most common challenges included a lack of physical examination, unavailability of hotlines/helplines/call centers at the point of need, and delay in updating Covid-19 information. The most common lessons learned were employing qualified staff, providing proper training, and getting feedback from the callers and operators. CONCLUSION: According to the results, most of the Covid-19 hotlines/helplines/call centers were launched in the early months of the pandemic, and about half of them were active seven days a week. Most of the operators were mental health providers and clinicians. The findings show the importance of continuous psychological support during crises, particularly when adequate information about the situation is not available. The challenges experienced by the callers and operators as well as the lessons learned by the service providers also need to be considered for future crises to increase the effectiveness of similar services.

An analysis of the contents of the young-onset dementia helpline: profiles of clients who consulted the helpline themselves.

BACKGROUND: Young-onset dementia (YOD) community care requires personalised approaches. Yet, the specific details of YOD consultations are unclear. This study explored how initial consultations correlate with client profiles. METHODS: Data from regional YOD helplines were used to analyze the main characteristics of people living with YOD or who had concerns about the possibility of YOD (n = 132). Among several categorical variables, the following were used for analysis: age group, sex, type of living arrangement, employment status, presence of dementia, and content of the consultation. To identify groups of items that frequently occur together, strongly connected rules were identified using association rule analysis with the a priori algorithm. To focus on the characteristics of clients, rules related to client characteristics were extracted based on the type of consultation. RESULTS: A total of 51 rules were identified for the consultations. These rules fell into two categories: (1) consultations for medical matters, which mainly involved employed individuals with undiagnosed dementia, and (2) other consultations on daily life or work, which mainly involved individuals diagnosed with dementia and were characterised by the influence of sex. These rules indicate the importance of medical involvement in confirming the diagnosis and specific individualised care following diagnosis for people living with YOD. CONCLUSION: Clients with or without a dementia diagnosis were consulted differently in the YOD helplines. Before receiving a diagnosis, medical matters were the main theme of consultations, whereas after receiving a diagnosis, adjustments to daily life or work were the main themes. The results of this study suggest that the needs of people living with YOD and the services they require may vary depending on their backgrounds.

Trends in Crisis Hotline Call Rates and Suicide Mortality in the United States.

OBJECTIVE: Utilization of the 988 Suicide and Crisis Lifeline (Lifeline; formerly called the National Suicide Prevention Lifeline) was analyzed in relation to suicide deaths in U.S. states between 2007 and 2020 to identify states with potential unmet need for mental health crisis hotline services. METHODS: Annual state call rates were calculated from calls routed to the Lifeline during the 2007-2020 period (N=13.6 million). Annual state suicide mortality rates (standardized) were calculated from suicide deaths reported to the National Vital Statistics System (2007-2020 cumulative deaths=588,122). Call rate ratio (CRR) and mortality rate ratio (MRR) were estimated by state and year. RESULTS: Sixteen U.S. states demonstrated a consistently high MRR and a low CRR, suggesting high suicide burden and relatively low Lifeline use. Heterogeneity in state CRRs decreased over time. CONCLUSIONS: Prioritizing states with a high MRR and a low CRR for messaging and outreach regarding the availability of the Lifeline can ensure more equitable, need-based access to this critical resource.

Laypeople's activity for seeking telephone number of EMS before and during the COVID-19 outbreak: An analysis of web search data.

OBJECTIVE: To explore trends and patterns of laypeople's activity for seeking telephone number of emergency medical services (EMS) based on analysis of online search traffic, including changes of the search activity with onset of the coronavirus disease 2019 (COVID-19) outbreak, in five countries - the United States of America (USA), India, Brazil, the United Kingdom (UK) and Russia. METHODS: Google Trends (GT) country-level data on weekly relative search volumes (RSV) for top queries to seek EMS number were examined for January 2018-October 2021, including a comparison of RSVs between pre-COVID-19 period (January 2018-October 2019) and COVID-19 period (January 2020-October 2021), and evaluation of temporal associations of RSVs with weekly numbers of new COVID-19 cases. RESULTS: The countries demonstrated diverse patterns of the search activity with significantly different mean RSVs (the USA 1.76, India 10.20, Brazil 2.51, the UK 6.42, Russia 56.79; p < 0.001). For all countries excepting the USA mean RSVs of the COVID-19 period were significantly higher compared with the pre-COVID-19 ones (India +74%, Brazil +148%, the UK +22%, Russia +9%; p ≤ 0.034), and exhibited positive correlations with numbers of new COVID-19 cases, more pronounced for 2021 (India rS = 0.538, Brazil 0.307, the UK 0.434, Russia 0.639; p ≤ 0.045). CONCLUSION: Laypeople's activity for seeking EMS telephone number greatly varies between countries. It clearly responds to the spread of COVID-19 and could be reflective of public need for obtaining emergency help. Further studies are required to establish the role of GT for conducting real-time surveillance of population demand for EMS.

Association of Logic's hip hop song "1-800-273-8255" with Lifeline calls and suicides in the United States: interrupted time series analysis.

OBJECTIVE: To assess changes in daily call volumes to the US National Suicide Prevention Lifeline and in suicides during periods of wide scale public attention to the song "1-800-273-8255" by American hip hop artist Logic. DESIGN: Time series analysis. SETTING: United States, 1 January 2010 to 31 December 2018. PARTICIPANTS: Total US population. Lifeline calls and suicide data were obtained from Lifeline and the Centers for Disease Control and Prevention. MAIN OUTCOME MEASURES: Daily Lifeline calls and suicide data before and after the release of the song. Twitter posts were used to estimate the amount and duration of attention the song received. Seasonal autoregressive integrated moving average time series models were fitted to the pre-release period to estimate Lifeline calls and suicides. Models were fitted to the full time series with dummy variables for periods of strong attention to the song. RESULTS: In the 34 day period after the three events with the strongest public attention (the song's release, the MTV Video Music Awards 2017, and Grammy Awards 2018), Lifeline received an excess of 9915 calls (95% confidence interval 6594 to 13 236), an increase of 6.9% (95% confidence interval 4.6% to 9.2%, P<0.001) over the expected number. A corresponding model for suicides indicated a reduction over the same period of 245 suicides (95% confidence interval 36 to 453) or 5.5% (95% confidence interval 0.8% to 10.1%, P=0.02) below the expected number of suicides. CONCLUSIONS: Logic's song "1-800-273-8255" was associated with a large increase in calls to Lifeline. A reduction in suicides was observed in the periods with the most social media discourse about the song.

Mental health concerns during the COVID-19 pandemic as revealed by helpline calls.

Mental health is an important component of public health, especially in times of crisis. However, monitoring public mental health is difficult because data are often patchy and low-frequency1-3. Here we complement established approaches by using data from helplines, which offer a real-time measure of 'revealed' distress and mental health concerns across a range of topics4-9. We collected data on 8 million calls from 19 countries, focusing on the COVID-19 crisis. Call volumes peaked six weeks after the initial outbreak, at 35% above pre-pandemic levels. The increase was driven mainly by fear (including fear of infection), loneliness and, later in the pandemic, concerns about physical health. Relationship issues, economic problems, violence and suicidal ideation, however, were less prevalent than before the pandemic. This pattern was apparent both during the first wave and during subsequent COVID-19 waves. Issues linked directly to the pandemic therefore seem to have replaced rather than exacerbated underlying anxieties. Conditional on infection rates, suicide-related calls increased when containment policies became more stringent and decreased when income support was extended. This implies that financial relief can allay the distress triggered by lockdown measures and illustrates the insights that can be gleaned from the statistical analysis of helpline data.

Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study.

BACKGROUND: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. OBJECTIVE: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. METHODS: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). RESULTS: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. CONCLUSIONS: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases.

[Place of coordination of complex pathways in oncology by coordinating private nurses]. / Place d'une coordination de parcours complexes en cancérologie par des infirmiers libéraux coordinateurs.

BACKGROUND: The complexity of the hospital-city care pathway is a real challenge because of the lack of coordination and communication between many stakeholders. As part of a call for projects from the General Directorate of Healthcare Provision, an experiment involving private oncology coordinating nurses was developed to address this issue. To our knowledge, there is no evaluation so far of such a protocol . METHODS: This single-center retrospective study focused on data from the ONC'IDEC program between 2015 and 2018, where 28 private nurses provided a 24/7 hotline. The objective was to qualitatively assess the coordination of this system. The nature and number of calls, patient satisfaction and medico-economic parameters were assessed. RESULTS: More than a hundred patients (n=114) were included in this device (mean age: 72 ± 12 years). The most frequent reasons for calls concerned the patient's general condition (35 %) and home treatment follow-ups (13 %) but also referrals to the primary doctor (4 %), which helped avoiding hospitalizations. The patients were satisfied with the experiment (overall score of 8.4/10). DISCUSSION: Thanks to the ONC'IDEC program, patients were able to benefit from more appropriate care through a privileged interlocutor by making their care pathway more fluid and avoiding hospitalizations. It would be interesting to confirm these results by means of a study with a higher level of evidence, by comparing this protocol to conventional hospital coordination.

Use of Kids Helpline by Children and Young People in Australia During the COVID-19 Pandemic.

PURPOSE: The benefits of helplines are particularly valuable during a pandemic when face-to-face services and natural supports are difficult to access. Kids Helpline, Australia's national youth helpline, provides children and young people with free 24/7 information and counseling through telephone, WebChat, and e-mail. We aimed to examine the use of Kids Helpline during the COVID-19 pandemic. METHODS: We analyzed monthly and weekly time trends of demand for and response by the Kids Helpline. The frequency of counseling contacts by common concern types, age, and gender were also examined. We used Joinpoint regression. RESULTS: Analyses of weekly demand for Kids Helpline showed an increase when the pandemic was declared, followed by a gradual decline. A second rise from 12 July 2020 when parts of Australia experienced a second wave of infections, followed by another decline, occurred more recently. Increased demand was almost entirely in the WebChat modality. Most answered counseling contacts were from girls and those aged 13-18 years. The number of contacts about mental health, suicide/self-harm, and family relationships increased, with mental health contacts also increasing as a proportion of total contacts. COVID-19-related concerns were the most common reason for contact in April 2020. CONCLUSIONS: In Australia, the COVID-19 pandemic saw a rapid increase in demand for Kids Helpline, mainly by WebChat, with the virus itself, mental health, suicide/self-harm, and relationships common reasons for contact. Responding to rapid changes in demand for particular modalities is challenging and understanding of the use and effectiveness of different modalities is needed.

Beyond Sociodemographic and COVID-19-Related Factors: The Association Between the Need for Psychological and Information Support from School and Anxiety and Depression.

BACKGROUND In addition to sociodemographic and COVID-19- related factors, the needs of school support, including material, psychological and information support, have seldom been discussed as factors influencing anxiety and depression among college students during the COVID-19 pandemic. MATERIAL AND METHODS In this cross-sectional study, 3351 college students from China were surveyed through questionnaires about their sociodemographic and COVID-19 characteristics, the needs of school support, and their experiences with anxiety and depression. RESULTS Anxiety and depression were reported by 6.88% and 10.50% of students, respectively. Married, higher education, non-medical, and urban students had significantly higher risks of anxiety or depression. Additionally, symptoms such as cough and fever, especially when following a possible contact with suspected individuals, quarantine history of a personal contact, going out 1-3 times a week, not wearing a mask, and spending 2-3 hours browsing COVID-19-related information were significantly associated with the occurrence of anxiety or depression. Those who used methods to regulate their emotional state, used a psychological hotline, and who had visited a psychiatrist showed higher anxiety or depression. Those who used online curricula and books, used preventive methods for COVID-19, and who had real-time information about the epidemic situation of the school showed lower anxiety and depression. CONCLUSIONS In addition to sociodemographic and COVID-19-related aspects, students' needs for psychological assistance and information from schools were also associated with anxiety and depression among college students.

On the Front (Phone) Lines: Results of a COVID-19 Hotline.

BACKGROUND: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and use systems that effectively manage the demand for services. METHODS: This was a cohort study using electronic health records at a health care system in northeast Ohio that examined the effectiveness of the first 5 weeks of a 24/7 physician-staffed COVID-19 hotline including social care referrals for patients required to self-isolate. We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. PARTICIPANTS: In 5 weeks, 10,112 patients called the hotline (callers). Of these, 4213 (42%) were referred for a physician telehealth visit (telehealth patients). Mean age of callers was 42 years; 67% were female, 51% white, and 46% were on Medicaid/uninsured. RESULTS: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 patients (7%) had a subsequent emergency department visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported, with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency department use (odds ratio = 4.73, 95% confidence interval = 1.37-16.39, P = .014). Only older age was associated with having a positive test result. Patients with social needs and interest in receiving help were offered services to meet their needs including food deliveries (n = 92), behavioral health telephone visits (n = 49), and faith-based comfort calls from pastoral care personnel (n = 37). CONCLUSIONS AND RELEVANCE: Robust, physician-directed telehealth services can meet a wide range of clinical and social needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

Launching a Statewide COVID-19 Primary Care Hotline and Telemedicine Service.

To respond to the COVID-19 pandemic and recover from its aftermath, primary care teams will face waves of overwhelming demand for information and the need to significantly transform care delivery. INNOVATION: Oregon Health & Science University's primary care team envisioned and implemented the COVID-19 Connected Care Center, a statewide telephone "hotline" service. RESULTS: The hotline has taken more than 5825 calls from patients in 33 of Oregon's 36 counties in less than 3 months. In preliminary survey data, 86% of patients said their questions were answered during the call, 90% would recommend this service, and 70% reported a reduction in stress levels about coronavirus. In qualitative interviews, patients reported their questions answered, short wait times, nurses spent time as needed, and appropriate follow-up was arranged. CONCLUSION: Academic health centers may have the capacity to leverage their extensive resources to rapidly launch a multiphased pandemic response that meets peoples' need for information and access to primary care, while minimizing risk of infection and emergency department use and rapidly supporting primary care teams to make the necessary operational changes to do the same in their communities. Such efforts require external funding in a fee-for-service payment model.

Violence against children during COVID-19: Assessing and understanding change in use of helplines.

BACKGROUND: Many of the measures taken by countries to contain the spread of COVID-19 have resulted in disruptions to child protection services. Despite this, many countries have worked to ensure that child helplines remain operational, making such mechanisms even more critical for reporting and referring cases of violence and for providing support to victims. OBJECTIVE: The purpose of this paper is to document what has occurred, and been reported, to child helplines during the COVID-19 pandemic. PARTICIPANTS AND SETTING: The study entailed primary data collection from child helplines and a search of media articles and news stories. METHODS: Child helplines submitted data on the contacts received during the first six months of 2020. Data on contacts related to violence were also available from 2019, and used as baseline. The media search used a combination of search terms to identify relevant articles and news stories published between March 1 and June 17, 2020. RESULTS: Overall, the number of contacts to child helplines seems to have drastically increased since the beginning of the pandemic. However, the number of contacts related to violence has increased in some countries, while it decreased in others. CONCLUSIONS: While a mixed picture emerges with respect to violence, the increase in overall contacts made to child helplines provides evidence that such services are a critical lifeline for many children and women during times of crisis. Child helplines should be strengthened; and child protection services should be designated as essential during emergencies to ensure children receive the support they need.

California Poison Control System Implementation of a Novel Hotline to Treat Patients with Opioid Use Disorder.

INTRODUCTION: In response to the opioid epidemic, California state officials sought to fund a variety of projects aimed at reducing opioid-related deaths. We describe the California Poison Control System's (CPCS) successful effort in integrating itself into the state's public health response to the opioid epidemic and describe poison control center staff attitudes and perceptions regarding the role of poison control centers at treating opioid withdrawal and addiction. METHODS: The CPCS created a leadership team and a separate 24/7 hotline, called the CPCS-Bridge line, to field calls from frontline health care providers interested in initiating medications for opioid use disorder for their patients. The implementation process also included training of all CPCS staff. In addition, the leadership team conducted an anonymous survey study to analyze attitudes and perceptions of poison center staff on the role of the poison center in the management of opioid use disorder. Descriptive statistics were used to characterize the data. RESULTS: Calls to the new hotline increased over time, along with CPCS-initiated outreach and advertisement. A majority of questions received by the hotline were related to uncomplicated buprenorphine starts in special populations. A pre-training survey was completed by 27 (58%) of CPCS specialists, many of whom had no prior experience treating patients with opioid use disorder. Only one specialist (2%) did not believe that poison centers should play a role in opioid addiction. CONCLUSIONS: The California Poison Control System successfully created a hotline to assist frontline health care providers in treating patients with opioid use disorder and highlight the critical role of poison centers in the public health domain. Increased federal funding to poison centers is likely to be mutually beneficial to all parties involved.