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The purpose of this program is to improve Guam's response to 988 contacts through calls, chats, and text. Funding will be used to accomplish the following: 1.) Enhance workforce and technology to meet the 988 demand and fully support the 988 infrastructure and coordination across the crisis continuum, 2.) Identify and address gaps in current 988 services and protocols in collaboration with the Suicide Prevention Coalition, and 3.) Develop and implement a comprehensive 988 communications plan to increase community knowledge and understanding of 988 services.

The purpose of the North Dakota Department of Health and Human Services' (HHS) 988 Improvement grant is to increase Lifeline call center capacity to manage 988 and 211 call chat and text demands, expand statewide 988 communication and media and strength program evaluation and data collection. To accomplish the first goal to identify strategies to maintain and expand workforce within the Lifeline call center, the following, summarized objectives were identified: 1) Enter into contract with FirstLink to provide grant funding in support of increased workforce capacity and 2) Meet monthly with FirstLink, the HHS Human Service Centers (mobile crisis) and the HHS Behavioral Health Division (BHD) Team to review recruitment and retention strategies, training needs and other supports. To accomplish the second goal to increase statewide communication and media campaigns utilizing SAMHSA's 988 Partner Toolkit, the following, summarized objectives were identified: 1) Develop and implement a comprehensive statewide 988 communication plan; 2) Gather input of community based leadership from across the state to identify unique needs of underserved or at-risk populations; 3) Enhance statewide data collection to improve 988 services and communication with a specific focus on high-risk populations; 4) Enter into contract with a program evaluator to assist with multiple program goals and objectives and 5) Enter into contract with a media firm to produce communication tools and media placement. To accomplish the third goal to expand collaborations with Mobile Crisis Units, 911 and Tribal Organizations, the following, summarized objectives were identified: 1) Develop a report outlining North Dakota's current mobile crisis service options to improve post-referral communication and connections between FirstLink and mobile crisis; 2) Develop a joint report to the ND 911 administrator regarding current 988 and 911 structures and collaborations across the state; 3) Develop a plan to engage and support all Tribes and Tribal organizations within ND to ensure effective 988 services are communicated to and provided for Tribal members and 4) Enhance ND's capacity to ensure referral connections post-988 contact. To accomplish the final goal to develop and implement plans for 988 sustainability, quality assurance and substance use resource development, the following, summarized objectives were identified: 1) Develop a sustainability plan for how ND will sustain FirstLink's workforce capacity and maintain the KIP metrics; 2) Develop a comprehensive quality assurance plan and 3) Engage the HHS BHD's substance use policy team, HHS Human Service Centers and FirstLink to develop protocols and referral resources for 988 contacts requiring substance use crisis care.

New Jersey (NJ) is committed to improving the response to 988 calls, chats and texts originating in this state. This project will increase the capacity of NJ's Lifeline Centers and improve access to 988 services including linkage to appropriate post-contact supports. NJ's 988 Suicide and Crisis Lifeline system will be designed to serve all individuals who are experiencing thoughts of suicide, mental health or substance use crisis as well as their family and friends. In the first nine months of 988, NJ has received 45425 calls. According to the Growth Model offered by Vibrant, it is expected that NJ will receive between 119000 and 187900 calls annually by year five of 988. Comparing data from June 2022 and April 2023, NJ saw a 106% increase in text demand and continues to receive an average of 1500 chat contacts per month. Meeting this demand will require a significant increase in the 988 workforce. To ensure all NJ residents are accessing and receiving appropriate services through 988, staff will be trained to respond to contacts from the diverse populations in NJ and be provided a comprehensive Resources and Referral Database for use by all NJ 988 Lifeline centers. Project goals include increasing workforce to support the growing 988 demand in NJ, improving the public communication of 988 services including for high-risk populations, and expanding post-contact support connections with services such as mobile crisis outreach and crisis stabilization services. Measurable Objectives: By October 31, 2023, NJ will begin its statewide Communications campaign. By November 30, 2023, NJ will publish a funding opportunity for funding from this grant. By December 31, 2023, NJ will submit a report of the state's current mobile crisis service options. By February 29, 2024, NJ will submit a joint report to the 911 administrators. By March 31, 2024, NJ will award funding for expansion of 988 Lifeline center capacity, have established its 988 Resources and Referral Database and submit a plan to engage and support all Tribes and Tribal Organizations. By June 30, 2024, NJ will estimate 24/7/365 in-state backup call coverage for all 21 counties, achieve and maintain a 90% in-state answer rate for 988 calls, train all 988 Lifeline center staff on use of the 988 Resource and Referral Database, estimate 24/7/365 in-state coverage of 988 chats and texts, and achieve and maintain a 90% in-state answer rate for 988 chats and texts. By August 31, 2024, NJ will develop and submit a comprehensive quality assurance plan. By February27, 2026, NJ will submit a sustainability plan.

The Maryland Department of Health is Behavioral Health Administration (BHA), in partnership with jurisdictions and Maryland Lifeline crisis centers, will build local 988 capacity with the $9,728,112 ($3,242,704 per year for three years, contingent on annual Federal appropriations) FY 2023 Cooperative Agreements for States and Territories to Improve Local 988 Capacity (SAMHSA FG 23-006). This project will increase the state's responsiveness to 988 contacts, including calls, chats, and texts, originating in Maryland. Maryland's Lifetime call, text, and chat volume has significantly increased since 988 launched in July 2022. Grant funds will be used by Maryland Lifeline crisis centers to maintain and expand their workforce to respond to this increase in need and to ensure that 988 services are accessible, responsive and effective in serving the needs of all Maryland residents. During the project, BHA will be working with Lifeline crisis centers and other stakeholders to: * Enhance recruitment, hiring, and training of the 988 workforce to meet at minimum 90 percent of the state calls, chats, and text demand; * Implement additional technology and security measures to fully support 988 infrastructure and effective coordination across the crisis continuum; * Improve 988 support and service for high-risk and underserved populations; * Develop and implement comprehensive quality assurance plans, to include identification and review of critical incidents; and * Continue to develop and implement comprehensive 988 communication plans in alignment with SAMHSA's 988 partners toolkit. The state will measure its project success in this grant using the following key performance targets: * 90% or more of calls, chats, and texts originating in Maryland will be answered by Maryland Lifetime crisis centers. * 95% of answered contracts in Maryland are answered within 20 seconds. * 90% of answered of answered contacts in Maryland are answered in 15 seconds. * Less than 5% of contacts disconnect prior to being answered by a Maryland crisis center. * Less than 10% of Maryland phone contacts rollover to a non-Maryland backup center. Maryland has currently achieved, as of April 2023, a 90% average in-state answer rate for calls, a 49% average in-state answer rate for texts, and a 42% average in-state answer rate for chats. For that same month, our current contact abandon rate is 10%, and our average speed-to-answer is 30 seconds.

PROJECT ABSTRACT SUMMARY Project Name: 988 Behavioral Health Crisis Contact Center Process Improvement The purpose of this application for the SAMHSA 988 State Cooperative Agreement funding opportunity is to request funds for the much-needed expansion and transition of the existing behavioral health crisis call center to the behavioral health crisis contact center. Funding would be used to increase the workforce to meet current and future 988 response for the entire State of Hawaii. Funding will also allow for support of the expansion of crisis contact services, including 24-hour chat and text capabilities, follow-up contact for those that experience suicidal ideation, increased collaboration and connection with post-contact supports with 911 and other crisis services that include crisis mobile outreach, crisis stabilization, and crisis support management. Funding will also support efforts to increase public awareness and communication of 988 crisis services especially to high-risk populations such as the Native Hawaiian and other Pacific Island communities; teens and adolescents; Service Members, Veterans, and Family Members (SMVF); and Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, and Intersex (LGBTQI+) individuals. Hawaii is the most diverse state in the USA and includes AANHPI populations that are at risk for mental health and substance use disorders. The Adult Mental Health Division (AMHD) of the Hawaii State Department of Health (DOH) is responsible for coordinating public and private services into an integrated and responsive delivery system for behavioral and mental health needs. AMHD services promote consumer stabilization into recovery and independence, and include a safety-net of crisis intervention and support services in order to effectively treat individuals experiencing a crisis. Total calls to the main Hawaii CARES crisis call center line (e.g., 808-832-3100) increased by 11% from 2021 to 2022. Additionally, calls transferred from the 988 National Suicide Prevention Lifeline (NSPL) increased by 52% for the same year-to-year comparison. The implementation of the nationwide 988 NSPL number in July 2023 partially accounts for this substantial increase in call volume. However, awareness and education about mental health and substance use disorders also will likely lead to a continued increase in call volume in the future. The goal of this application is to provide funding to improve the capability of Hawaii CARES 988 crisis contact center to meet the current and future needs of 988 response for Hawaii, improve the standard of care provided to individuals in crisis, and improve access to and public awareness of 988 services especially for high-risk and underserved populations. The objectives of this project include increasing the workforce, establishing and implementing communications and marketing of 988 Lifeline, establishing agreements with key stakeholders, and implementing mechanisms to track and trend data for post-contact care and sentinel events.

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is seeking $2,246,946 to expand the local 988 capacity through the Oklahoma Comprehensive Crisis Response (OCCR) program. This additional funding will provide Oklahomans with greater access to mental health crisis services when needed and create a single statewide call system for emergency services. The plan emphasizes a full continuum of crisis services, from providing immediate help to those in need to link different crisis resources for the most appropriate housing option along the continuum of care. ODMHSAS will also create crisis coordination toolkits to support law enforcement, jails, courts, private hospitals, private practitioners, and other related organizations with step-by-step processes for responding to mental health crises. We target these investments to decrease the risk of suicide, homelessness, mental health issues, and providing robust support for the recovery process. ODMHSAS has outlined five goals to build the state capacity to provide comprehensive services to those in need. The goals supplement the funding already put into place. The five goals are: (1) Coordinating housing placement for those leaving crisis, local hospital, and outpatient services; (2) Increasing housing and transition support for people leaving inpatient and crisis facilities; (3) Strengthening statewide crisis staffing knowledge and skills; (4) Developing crisis coordination toolkits; and (5) Providing outreach to 988 callers not engaging in treatment services. Objectives include expand the full housing continuum to improve the quality of life of individuals admitted to or discharged from mental health facility; establish processes and rates to provide supportive services such as job training, education, and counseling to encourage community integration and reduce homelessness by at least 50%. Integrate three current SAMHSA TTI projects targeting crisis workforce capacity and increase behavioral health crisis and outreach capacity with Oklahoma City Police Department, Oklahoma Sheriffs Office, Oklahoma City and Tulsa 911 PSAPS, courts, private hospitals, and private practitioners. Improve the outreach and access of frequent 988 callers and transportation vendor users to treatment services offered by mobile crisis teams.

Through the Louisiana 988 Cooperative Agreement to Improve Local 988 Capacity, the Louisiana Department of Health, Office of Behavioral Health (OBH) will improve Louisiana's response to 988 crisis calls, chats, and texts originating in the state to meet or exceed SAMHSA's target goals. Each year the project will serve approximately 36,000 Louisiana citizens including the general public with a focus on individuals considered at high risk who are experiencing suicide, mental health and/or substance use crisis. OBH will work closely with Louisiana's two Lifeline contact centers, VIA LINK and the Louisiana Association on Compulsive Gambling (LACG) to achieve the following goals: 1. By 9/29/2026, at least 90% of calls (total # routed), chats and texts originating in Louisiana will be answered in-state. 2. By 9/29/2026, OBH will develop and implement a comprehensive statewide communication strategy. 3. By 9/29/24, both crisis centers will improve the collection of demographic, resource referral and utilization data with a focus on high-risk populations. 4. By 12/31/2023, OBH will submit a report to SAMHSA on crisis services with 988 integration and ways to improve connections. 5. By 12/31/2023, OBH will submit a report with a trackable improvement plan to the 911 administrator equivalent. 6. By 11/30/2023, OBH will submit a tribal engagement and support plan to SAMHSA. 7. By 9/29/2025, the call centers will improve their referral connections after contact with their center. 8. By 3/31/2026, OBH will submit a sustainability plan to SAMHSA for workforce capacity and KPI metrics. 9. By 9/29/2024, OBH will submit a comprehensive quality assurance plan to SAMHSA including protocols for identifying and reviewing critical incidents. 10. By 9/29/2025, call centers will implement their quality assurance plan. 11. By 6/30/24, call centers will develop policies and protocols for referrals to substance use crisis care. 12. By 9/29/2024, the call centers will implement policies and protocols for referral to substance use care.

South Dakota 988: State Improvement is a continuation of the joint venture undertaken by the state's only Lifeline crisis center, Helpline Center, and the Department of Social Services (DSS), Division of Behavioral Health (DBH) to assure calls, chats, and texts from South Dakotans experiencing mental health crisis are assisted by in-state resources. The South Dakota 988 State Improvement project will dedicate resources to assuring statewide awareness of available resources to all South Dakotans including Native American and high-risk populations across the state. DSS will allocate funds to launch statewide marketing campaigns. DSS dedicate additional funds to assure comprehensive evaluations of mental health crisis services will be complete as part of this project. Additionally, DSS will continue to engage the Behavioral Health Crisis Response Stakeholder Coalition (BHCRSC), formed in February 2021 as part of the 988 Planning Grant from Vibrant, to inform the evolution of the state's 988 and mental health crisis response systems. This project builds upon the work completed and outlined by the 988 planning coalition, and the 988 implementation and supplemental grants. The Helpline Center is the only entity in the state accredited by the Alliance for Information and Referral Systems, and the only entity in the state that provides a certified crisis line through the American Association of Suicidology. In July 2022, The Helpline Center launched a separate division to house the 988 call center, with shared administration services provided by existing Helpline Center staff. The new 988 call center is housed in the same location as the existing 211-based information and referral call center, but staff separately due to the unique staff and qualifications required for answering 988 calls. The service continuation and improvement approach centers on four key goal areas, all of which build off of initial planning efforts outlined in the state's 988 implementation plan. Key areas of focus center around workforce capacity building, statewide targeted communication plans, evaluation of services including the three pillars of the Crisis Now model (1-Someone to Talk To, 2-Someone to Respond, and 3-Somewhere to Go), and building relationships across mental health crisis response services providers including 988. All four goals will be managed by the Project Director and Co-Director, with considerable input from the Lifeline crisis center / Helpline Center leadership and 988 call center staff. The BHCRSC will continue to convene as an advisory resource for the Directors and Helpline Center team and will be instrumental in ultimately increasing access to quality, responsive behavioral health care for South Dakotans experiencing crisis. Key performance indicators and other measures have been identified in alignment with existing 988 metrics, the required SAMHSA infrastructure, the prevention and promotion indicators, and those that will aid the state in understanding 988 call center workforce staffing, partnership development, and the disposition of people supported by 988 call center staff as capacity expands and public awareness increases.

California's project, the California 988 Suicide and Crisis Lifeline, serves all Californians by providing immediate, one-on-one support with trained crisis counselors to those in crisis. California's priority for this grant is to enhance the 988 programs in California by expanding the workforce and maximizing call, chat, and text response, thereby increasing access to the crisis care system in the State of California and improving outcomes for high-risk populations. As the nation's most populous state, California experiences the highest volume of 988 calls in the country. California experienced an initial, rapid 28 percent increase in total 988 contacts received when 988 went live on July 16, 2022, rising from 23,950 National Suicide Prevention Lifeline contacts in June 2022 to 30,681 988 contacts in August 2022, the first full month after 988 implementation. The State is currently on track to exceed 339,000 total contacts received from July 2022 through June 2023, State Fiscal Year (SFY) 2022-23. Combining a linear regression analysis based on contact trends and Vibrant Emotional Health's volume projection estimates, the California Department of Health Care Services (DHCS) projects the annual total contacts received in California will increase to 378,603 in SFY 2023-24, 423,557 in SFY 2024-25, and 468,511 in SFY 2025-26. Between July 1, 2022, and April 30, 2023, California reported state answer rates ranging from 87 percent to 90 percent with an average answer rate of 88 percent. The answer speed ranged from 32 seconds to 40 seconds with an average answer speed of 36 seconds. Only five 988 crisis centers in California offer 988 chat and text. Currently, no 988 crisis centers in California have the workforce and/or funding capacity to operate 24/7 for chat and text or offer follow up services. DHCS has the following goals for this grant: 1) Recruit, hire, and train behavioral health workforce to staff California's 988 crisis centers to increase the capacity to respond, intervene, and provide follow-up to individuals experiencing a behavioral health crisis; 2) Enhance coordination among 988 crisis centers, 911, and mobile crisis services across California; and 3) Develop and implement a comprehensive 988 communication strategy, informed by enhanced statewide data collection. The following objectives are derived from the aforementioned goals: 1) Expand workforce, including the utilization of credentialed peers, to enhance operating capacity to achieve at least a 90 percent answer rate; 2) Develop a sustainability plan for maintaining Key Performance Indicators (KPIs); 3) Deliver trainings relevant to high-risk populations and referral options; 4) Develop and submit a report to SAMHSA detailing mobile crisis service options; 5) Develop and submit a report to SAMHSA on current 988 and 911 structures and collaborations across the state; 6) Develop a plan to effectively communication 988 services to tribal populations; 7) Develop a statewide 988 communication plan; and 8) Enhance demographic data collection. If awarded this grant, California's 988 network will expand access and increase crisis support services for Californians. DHCS will work with county governments, providers, community organizations, foundations, and other key partners as part of a collaborative effort to improve local 988 capacity within California. The grant will aid in reinforcing the 988 network's presence in all 58 counties by funding efforts to support coordination of behavioral health services, creating project sustainability, and increasing awareness of the behavioral health crisis resources in California.

The Department of Behavioral Health (DBH) is the state agency responsible for providing prevention, intervention, and treatment services and support to children, adolescents, and adults with mental health and/or substance use disorders in the District of Columbia (DC) and is the applicant for the 988 State and Territory Cooperative Agreement grant. In the District of Columbia, there is only one National Suicide Prevention Lifeline (Lifeline) member center, Access HelpLine (AHL), reporting to the DBH. The AHL provides a behavioral health crisis hotline 24 hours a day, 7 days a week, staffed by behavioral health professionals, who will direct callers to immediate assistance or ongoing care when clinically appropriate or necessary. In this capacity, the AHL call center answers calls to the National Suicide Prevention Lifeline for the District of Columbia. DBH plans to add chat, text, follow-up, and training capabilities to AHL's workforce and capabilities to be better equipped to handle contacts across the modalities. DBH and AHL will develop plans to maintain staff capacity, meet key performance indicators (KPIs) and explore the need for a national backup call center. DBH seeks to strengthen their existing efforts in expanding AHL's workforce and increase the confidence of call takers to appropriately respond to high acuity suicide calls. We want to align our clinical practice with advance technology to promote and educate others on 988 and to also create additional avenues of access to the residents of the District of Columbia. We are looking to reinforce our data collection efforts in producing data that will consistently inform our quality assurance protocols and assist in the creation of tracking critical incidents. Lastly, we are poised to implement our communication plan by utilizing many of the recommendations provided in the SAMHSA toolkit and are eagerly awaiting direction regarding geofencing as guidance regarding this will heavily impact and direct what and how we communicate more about 988 access to District residents.

Kansas Department for Aging and Disability Services (KDADS) currently partners with three National Suicide Prevention Lifeline (NSPL) contact centers for 24/7 coverage specific to 988 calls, chats, and texts. Reports have shown an increase in 988 services since the implementation date of July 16th, 2022. In collaboration with KDADS, the Kansas crisis call centers will have measurable improvements to the in-state answering rate for calls, texts, and chats as well as workforce development. The NSPL contact centers in Kansas are Johnson County Community Mental Health (JCCMH), Sedgwick County (in which Comcare responds to NSPL calls), and Kansas Suicide Prevention HQ (KSPHQ). Healthsource Integrated Services (HIS) is currently a statewide back-up contact center and Wyandot Behavioral Health Network Inc. is in the process of gaining certification. Currently, the average in-state call answer rate is above the targeted rate of 90%. However, the chat and text in-state answer rate has stayed at 60% for April and May 2023. Challenges to increasing chat and text answer rates are primarily related to staffing and technology. To increase in-state chat and text answer rate, Comcare, JCCMH and KSPHQ will need to increase the number of volunteers, staff counselors, and peers available. As volume and staffing increases, so too does the need for increased supervision of volunteer, staff counselors, and peers for the purposes of support and quality assurance.

The 988 Crisis Systems Section provides behavioral health workforce capacity and services that are culturally, geographically, and linguistically specialized and relevant for people in Washington who experience a behavioral health crisis. Data-driven efforts have led to the creation of the first Native and Strong Lifeline in Washington State; however, additional capacity is continuing to be needed to provide additional relevant services to the communities we serve, and to ensure capacity can continue to scale at the same rate as call, chat and text volume of the 988 Lifeline. With this funding, Washington crisis centers will work to increase their staffing capacity to continue meeting the 90% in-state answer rate, build capacity within student intern programs and follow-up programs, and retain in-house training capacity to help develop the behavioral health workforce and recruit and retain employees. The project team, which includes members from the Department of Health (DOH), all three Washington crisis centers, Health Care Authority, and Washington 911, will continue to work together on capacity building, sustainability, and service coordination. Over the course of the project years the team will submit Washington’s sustainability plan for crisis center workforce capacity and key performance indicators (KPIs). This team will evaluate monthly, quarterly, and annual data including the KPI data to identify solutions to address capacity challenges. This team will also work together to develop and implement a statewide 988 communication plan, joint reports on current 988/911 structures and collaborations, as well as current Mobile Crisis Outreach options. Furthermore, in year one of the project, all three crisis centers will work in collaboration with DOH to review and improve programmatic quality assurance plans and develop standardized protocols and referral resources for 988 contacts requiring substance use crisis care. The Native and Strong Lifeline, in collaboration with DOH, will continue the work to enhance the engagement of all Tribes and Tribal Organizations within the state of Washington. Over the course of year one of the project, these teams will meet to discuss communication strategies and identify gaps in training opportunities to improve 988 services to tribal communities. Washington will also utilize funding to foster the development of Community Crisis Response Teams (CCRTs) to address gaps in the crisis system created by historic and current systemic racism that has created fear in some communities to reach out to the crisis system. These CCRTs will operate independently of the crisis system and be operated by trusted community leaders who will support their communities by responding to people in crisis in their communities. This will improve access to traditionally underserved areas and improve outcomes for people in crisis. The Washington State team is prepared to initiate work, if funded, without delay. Team members have laid an important foundation to build out thus far and if funded, are excited to further support capacity building efforts.

Florida Cooperative Agreements for States and Territories to Improve Local 988 Capacity project will address the need for additional workforce for answering 988 calls, chats, and texts. These funds will be distributed to the 13 accredited Florida 988 Suicide and Crisis Lifelines based on their call volume since volume and the ability to improve in-state answer rates determines staffing needs. Funds will flow through the seven regional Managing Entities the Department of Children and Families is required by statute to contract with to manage the behavioral health system of care in Florida. No administrative funds will be allocated to the Managing Entities. In addition, Florida will also use funding for creating a state-specific marketing campaign for 988. The Department will also focus on improving data collection and analysis, interoperability with 911 PSAPs, tribal engagement, and furthering policies and coordination between 988 Suicide and Crisis Lifeline Centers and state Mobile Response Teams. The following are the four goals for year one. 1) Expand existing workforce to improve in-state answer rates, support increases in call volume and acuity, and statewide coverage without compromising quality of service. 2) Unify and standardize the efforts of the Florida 988 Network through development and dissemination of guidance documents and training materials. 3) Establish formal partnerships across the three stages of the 988 Crisis Care Continuum, for example call centers, MRTs, and CSUs. 4) Construct and disseminate trauma-informed, evidence-based trainings on intervening with high-risk and underserved populations.

The Virgin Islands Behavioral Health 988 program aims to improve the Territory response to 988 contacts from call chats and texts. The Virgin Islands Behavioral Health Division is charged by Act 4039 Title IXX in the VI Codes with establishing administering and regulating programs designed to offer prevention treatment and recovery intervention in areas of substance abuse prevention and treatment.

The State Mental Health Agency - The North Carolina (NC) Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) purpose to improve local 988 capacity and single NC Suicide and Crisis Lifeline Call Center to meet current and future 988/Lifeline response (call/chat/text/follow up and related functions) North Carolina is geographically diverse state that is currently home to over 10.6 million residents (2020 Us Census). North Carolina Department of Health and Human Services (DHHS), DMHDDSAS, is partnering with the one statewide 988 Suicide and Crisis Call center, REAL Crisis Intervention, Inc (REAL) in Greenville, North Carolina, REAL is a long-standing proficient (formerly of the National Suicide Prevention Lifeline) Suicide and Crisis Lifeline network member and accredited by the American Association of Suicidology (AAS) and International Council for Helplines. Since 2012, the DMHDDSAS, has partnered with REAL in implementing the Lifeline call center 24/7 in all 100 Counties. The NC call center provided services to 60,999 callers in 2022 with an average answer rate if 84%. REAL became a chat/text support center 12-15-22021 using the Vibrant Pure Connect platform and on July 16, 2022, with the launch of 988 REAL became a 24/7 chat/text center and continues to be a backup chat/text support center. REAL became AA certified which included Online Emotional Support (OES) in February 2021 and became accredited in November 2021 which also included OES. The NC DMHDDSAS is committed to working collaborative with REAL, to continue to meet and exceed all standards set by 988 Suicide and Crisis Lifeline, Vibrant Emotional Health and SAMHSA for calls/chats/texts.

The New York State (NYS) Office of Mental Health (OMH) is committed to ensuring that New Yorkers experiencing a behavioral health crisis have equitable access to inclusive, high quality 988 services from NYS Crisis Contact Centers (Centers) that are familiar with and dedicated to their community. This will be done by expanding a diverse workforce, 988 Centers capacity, linkages to community supports and interventions, and comprehensive community education and marketing throughout NYS. This project will serve all individuals whose calls, chats, or texts originate from NYS that are experiencing a behavioral health crisis and contact 988. NYS estimates that contacts made to 988 will continue to expand by another 30% in the second year of operation with projections of up to 50% annually thereafter. Because this project will touch all facets of NY's 988 operations, including other components of the crisis response system, we estimate that between 2-4 million people will be served throughout the duration of this project. NYS has developed seven goals for this initiative. These goals are related to access, capacity, sustainable funding, consistent standards for follow-up, data and quality assurance, stakeholder involvement for the developing comprehensive crisis response system and community linkages, and a thorough communication strategy at the core of planning. To achieve these goals, NYS has outlined 18 objectives which set priorities and targets for progress and accountability. The themes depicted in the objectives include 24/7 in-state primary and back-up coverage for call/chat/text, target percent and answer rates, standardized data collection and quality assurance practices, follow-up and linkage procedures, targets for expanded connectivity between 988 other crisis services, and a comprehensive communication strategy. The intention of all goals and objectives is to focus on three specific areas: 1. Expansion of 988 Centers' diverse workforce to respond, intervene, and provide follow-up to all individuals experiencing a behavioral health crisis. 2. Engagement of 988 Centers and other components of the comprehensive crisis response system. 3. Education of 988 to all communities in NYS, especially high-risk populations and underserved communities, through a comprehensive community education and marketing strategy. When NYS successfully achieves the goals and objectives outlined in this project, we expect that all calls, chats, and texts originating in NY will route to a NY 988 Center (primarily and secondarily), in-state response rates to 988 contacts will reach and sustain at 90% and NY's capacity to respond to the unique needs to diverse communities of New Yorkers experiencing behavioral health crises who contact 988 will increase. For an in-depth review all goals and objectives, please Section B.

The State of New Hampshire (NH) has two (2) accredited Lifeline centers. The primary center is operated by Headrest, Inc., a nonprofit located in Lebanon, NH. This call center operates 24/7 to answer 988 Crisis and Suicide Prevention Lifeline (Lifeline) calls. NH is committed to collaboratively increasing in-state answer rates and building capacity for continued increases in contact volume. NH established a centralized crisis hub, New Hampshire Rapid Response Access Point (NHRRAP), which is working closely with the primary Lifeline call center to answer in-state crisis calls as a secondary Lifeline in NH and NHRRAP is also able to dispatch mobile crisis teams through NH's ten regional Community Mental Health Centers. NH also utilizes 211 call center through Granite United Way to answer substance use disorder and social determinant of health calls. NH's Department of Health and Human Services (DHHS) will lead this grant through existing in-kind staff time, DHHS will be responsible for all grant reporting requirements. The grant funding will be focused on the Headrest Lifeline center to build needed capacity. The work will be a collaboration with Headrest, NHRRAP, Institute for Health Policy and Practice, and other pertinent stakeholders participating in the NH 988 Coalition.

The Mississippi Department of Mental Health's (DMH) FY 2023 Cooperative Agreements for States and Territories to Improve Local 988 Capacity is designed to improve the state's response to 988 contacts, increase public awareness of 988, increase collaboration with crisis system partners, and enhance statewide data collection. Mississippi has 24/7 primary and backup coverage for all 82 counties in the state for calls through its two 988 Lifeline Crisis Centers, CONTACT The Crisis Line and CONTACT Helpline. DMH's partnership with the 988 Lifeline Centers will allow the state to achieve the following goals: (GOAL 1) Increase the capacity of the Lifeline Centers to meet crisis contact demand for the projected volume of texts and chats initiated in Mississippi. (GOAL 2) Increase community awareness and understanding of the 988 Suicide and Crisis Lifeline through a 988 educational campaign in line with SAMHSA's 988 partner toolkit. (GOAL 3) Increase collaboration among Mississippi 988 Lifeline Centers and crisis system partners to unify 988 response. (GOAL 4) Improve data collection processes to effectively track post-988 call referral and utilization data to improve 988 response and communication. CONTACT Helpline and CONTACT The Crisis Line will receive funding through subawards from the Department of Mental Health to meet the required activities of this project.

Connecticut (CT) endorses one statewide 988 Suicide and Crisis Lifeline (Lifeline) provider, the United Way of CT/211 (UWC), which is funded through the CT Department of Mental Health and Addiction Services and the CT Department of Children and Families (DCF). Together, these two sister-state agencies oversee the statewide crisis service system across the lifespan. The UWC is the state's 211 Information and Referral provider, is accredited by the Alliance for Information and Referral Services (AIRS) and the American Association of Suicidology (AAS), has years of experience as a Lifeline network provider, and serves as the mobile crisis service system call center for youth and adults. These phone lines function 24 hours a day, 7 days a week, 365 days a year and provide quality services to various types of callers from those searching for basic information and referral up to those in imminent risk crisis. For those in crisis, they provide support, screening, referrals, warm-transfers to statewide adult and youth mobile crisis services, warm-transfers to 911 Public Safety Answering Points (PSAPs) for active rescue as needed, and follow-up contacts upon caller consent. they also attain caller disposition from mobile crisis services and PSAPs following warm-transfers. From July 2022 through April 2023 the UWC answered 28,123 988 calls with an in-state answer rate average of 98% and an average speed to answer of 4.2 seconds, all well within the target Key Performance Indicators (KPIs). However, call demand continues to increase and the UWC will need to increase workforce capacity to maintain quality services and the KPIs. CT has yet to initiate in-state 988 text or chat services, but plans to within state fiscal year 2024 with the additional funds made available. It has been determined that the UWC Crisis Contact Center will also provide the 988 text and chat services. They have developed a plan to address implementation of these services through enhancements to the management and supervisory structure, onboarding, recruitment, hiring and training of staff, and the development of new procedures to ensure quality services are provided the call services and to attain and maintain the KPIs. New 988 grant resources will be used to facilitate workforce expansion to maintain the high in-state call answer rate and speed to answer and to add the additional text and chat resources. Funding will also support staff training and continuing education to serve diverse populations, especially high-risk populations and populations with high numbers of suicide deaths and attempts.

Montana's 988 Capacity Improvement Project will serve Montanans at risk of mental health crisis and suicide by continuing to improve its implementation plan that consists of eight overarching goals, involving capacity-building, funding, the maintenance of evidence-based performance standards, the improvement of crisis referral pathways and marketing. These goals will reduce the rate of suicide in Montana by providing 24/7 in-state coverage of calls, in all counties, at the 90 percent answer rate standard, or above; provide for sustainable operations by ensuring adequate, diversified, and sustainable funding streams for Lifeline member centers; by preventing the degradation of crisis services due to spikes in call volume; by reducing the risk of suicide by supporting crisis centers in meeting Lifeline's operational standards, requirements and performance metrics; by reducing the rate of suicide across all populations by ensuring stakeholder input from all communities; by reducing the rate of suicide and self-harm due to mental health crisis by formalizing crisis referral pathways and maintaining a constantly updated referral service database, in coordination with 911 PSAPs; by decreasing the likelihood of subsequent crisis response by providing best practice follow-up services for 988 callers and by implementing a comprehensive 988 marketing strategy.

Since the mid-2000s Kentucky has worked steadily to increase the capacity of crisis call centers located within the community mental health centers (CMHC) to answer 988 calls. Kentucky department for behavioral health developmental and intellectual disabilities (KDBHDID) contracts with the 14 non-profit CMHCs to serve as the state public behavioral health safety net and provide mental health and substance use prevention, treatment, and recovery services. This application to SAMHSA by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (KDBHDID) is in response to SAMHSA announcement FG-23-006, FY 2023 Cooperative Agreements for States and Territories to Improve Local 988 Capacity. Calls to 988 has increased 30 percent since June 2022 prior to the 988 launches. Since then, Kentucky based call volumes have averaged 2403 calls a month with an average answer rate of 76%. As of May 2023, most Kentucky 988 centers, nine of the 12 have answer rates for 988 calls below 90% and therefore do not have the capacity to add chat and text services. Kentucky currently has only one 988 accredited center which has chat and text capabilities. The center responds to both 988 and non-988 chats and text. From July 2022 through May 2023 there was a 113% increase in text (452-965) and a 271% increase in chats (333-1236). Latest in state answer rate for text was 36% and chats was 41%. Pennyroyal has staff available for only 15 hours a week to answer chat and text messages. To expand and enhance Kentucky's dedicated staffing to address and to support the current and projected volume of calls, text and chats as well as to address referral and follow-up processes for callers, DBHDID will also focus on increasing awareness of 988 as a resource and evaluating the quality of services provided through the commonwealth's 988 network.

The MA988 Improvement Project will reside within the Massachusetts (MA) Department of Public Health (MDPH) Suicide Prevention Program (SPP). MDPH SPP funds five crisis call centers that operate 24/7 to handle 988 Lifeline call responses. All 988 Lifeline calls are routed on a county-level basis to provide statewide coverage. With grant funding, MDPH will improve its response to 988 phone contacts, localize response to chats and texts, fulfill required activities outlined in the NOFO, and address operational gaps due to systems challenges, workforce shortages, and training needs through five goals with associated objectives. MDPH anticipates serving a minimum of 55,000 individuals in the first year of the project and 165,000 individuals over the total project period (3 years). MDPH aims to achieve and sustain a minimum in-state answer rate of 90% for calls, chats, and texts received on the 988 Lifeline (Goal 1) through the following objectives: distribute grant funds to five Lifeline centers; identify a chat/text vendor and collaboratively work with SAMHSA and Vibrant to locally provide these services; support centers in developing the capacity to report on workforce data, including but not limited to recruitment activity, staff hired, staff trained, and staffing vacancies; require centers to conduct an organizational scan to identify workforce gaps and create a staffing and hiring plan that identifies the positions, FTEs, and resources needed to achieve and maintain a minimum answer rate and 20 sec. avg. response speed; review the statewide 988 Lifeline routing map and adjust as necessary based on capacity and performance indicators; and develop a statewide sustainability plan to maintain workforce capacity and performance on key indicators on all calls, chats, and texts. MDPH aims to create a robust, coordinated, and comprehensive crisis service system that ensures services for anyone, anytime, and anywhere (Goal 2) through the following objectives: develop a report of the state's current mobile crisis system that identifies existing integration with 988 Lifeline and proposed improvements for connection; produce a joint report on the current 988 and 911 structures and collaborations across the state, including a trackable process improvement plan for the grant project period; engage with the funder and administrator of the MA Substance Use Helpline to review and modify appropriate protocols and referral resources for 988 contacts requiring substance use crisis care; have centers conduct an IT security audit and implement the best practices of infrastructure and site reliability to safeguard information and information systems against outages or threats; and deploy centralized training to the workforce that supports statewide policies and procedures. MDPH aims to improve 988 Lifeline services for high-risk and underserved populations (Goal 3) through the following objectives: centers will train their workforce on collecting demographic information and call disposition status; MDPH will submit a Behavioral Disparity Impact Statement; centers will develop the operational capacity to conduct follow-up activities on 988 contacts, including those in imminent danger or referred for mobile crisis support or crisis stabilization services; develop a plan to engage and support all Tribes and Tribal Organizations within the state to ensure effective 988 services are provided for tribal members; and collaboratively identify gaps in continuing education opportunities for the workforce and develop a universal training plan with Vibrant and centers. MDPH will increase awareness and utilization of 988 services among MA residents (Goal 4) by launching a comprehensive and informed statewide awareness campaign that aligns with the SAMHSA 988 partner toolkit. MDPH will deliver Lifeline services to reduce the incidence of suicide attempts and deaths across MA (Goal 5) by developing a comprehensive quality assurance plan.

Since its national launch in July of 2022, the 988 Suicide & Crisis Lifeline has played a vital role in providing rapid access to crisis services for individuals experiencing mental health, suicide, or substance use crises. In Missouri, the Department of Mental Health (referred to throughout this application as Grantee), alongside behavioral health providers and community partners, has been working diligently to establish a comprehensive “no-wrong-door” integrated crisis response system. This collaborative effort aims to prevent tragedies, save lives, and optimize resource utilization. Missouri’s vision is to build an evidence-based care continuum to deliver high-quality community based crisis services statewide with the 988 Suicide and Crisis Lifeline at its core. Since implementation, Missouri has witnessed a steady and continuous rise in the demand for 988 services. From July 2022 to April 2023, Missouri’s 988 Centers received 41,779 calls, 5,756 texts, and 9,195 chats. Notably, call volume alone increased by 65% from April 2022 to 2023. In the short time since the introduction of statewide 988 text and chat routing, text volume has risen by 41% and chat volume by 126% between November 2022 and April 2023. Conservative contact volume estimates indicate that the number of people to be served annually is approximately 52,800 and the number of people to be served throughout the lifetime of this project is 158,400. Considering the rising demand and projected needs for SFY24 and beyond, Grantee is proactively assessing and monitoring the necessary funding and support required to sustain a 90% or higher in-state call answer rate and improve state response to 988 texts and chats. As a grant recipient, Grantee will aim to leverage the funding received from state appropriations as well as the achievements of the 988 State and Territory Capacity Cooperative Agreement to strengthen 988 Center response and enhance and integrate crisis response services available for all Missourians in crisis. Upon completion of grant activities, Grantee will have achieved the following goals: 1. Support coordination across Missouri’s crisis continuum to facilitate seamless connection to appropriate care and improve access to community-based crisis services. 2. Strengthen 988 implementation fidelity through the establishment of quality assurance practices and improvements in data collection efforts. 3. Increase awareness and education of the 988 Suicide & Crisis Lifeline and crisis services through a comprehensive statewide public awareness campaign. 4. Enhance state 988 response for high-risk and underserved populations through expansion of text and chat workforce capacity and specialized training for crisis specialists. By accomplishing these goals, Grantee, in collaboration with 988 Centers and dedicated partners, will build upon the foundation established during the initial year of 988 implementation. Ultimately, the aim is to ensure that all Missourians, especially high-risk populations, have equitable access to vital services when in crisis or needing support. Grantee is committed to supporting the expansion of life-saving interventions and fostering the overall well-being of the state’s population. The efforts undertaken through this grant will have a substantial impact on strengthening Missouri’s crisis system of care.

Rhode Island's (RI) 988 Connect to Care project is designed to serve the entire state, by expanding the RI 988 Lifeline Center ability to answer calls, texts, and chats to the 988 Suicide and Crisis Lifeline. Goals of the project focus on increased access, workforce development, education, and data collection quality improvement. Project planning efforts will rely on stakeholder collaboration, coordination throughout the statewide crisis care continuum, and integration into the buildout of the Certified Community Behavioral Health Clinic (CCBHC) model in Rhode Island. Since 2019, the RI 988 contact center has served over 10,000 Rhode Islanders through call, text, and chat services, an average of 2,200 individuals annually. Almost half (45%) of these contacts occurred after the July 2022 launch of 988. We aim to serve a total of 20,000 Rhode Islanders during this grant period. Individuals experiencing a mental health or substance use crisis, seeking a referral for behavioral health services, or seeking other information/resources make up a majority of 988 contacts, 77%, 2%, and 8%, respectively. Additionally, target populations include people of color, individuals identifying as LGBTQ+, men, and middle-aged individuals, all of whom experience a greater risk of suicide in RI. In order to promote cultural competency, an enhanced training program will be offered to 988 crisis counselors. This training program includes trainings relating to working with special populations such as LGBTQ+groups, Indigenous/Tribal affiliated individuals, and various other populations. Strategies to achieve our goals of increasing access and capacity to serve through 988 focus on workforce augmentation, formalized recruitment and retention program building, and enhanced training initiatives. Communications strategies include launching a community-reviewed campaign, and community engagement grass-roots efforts that can enhance the reputation of 988 and build trust with hard-to-reach populations. Improved data collection efforts will allow for enhanced service levels and inform quality assurance and improvement measures. Goal 1. Provide immediate access to crisis intervention and support. 1.1) By the end of Y3, 90% of texts will be routed and answered in-state; 1.2) By the end of Y3, 90% of chats will be routed and answered in-state 1.3) By the end of Y3, less than 20% of individuals enrolled in follow-up services will report a suicide attempt since their initial contact. Goal 2: Expand workforce capacity through improved recruitment, retention, and training. 2.1) Within two weeks of hiring, 100% of crisis counselors will complete the required Lifeline counselor training 2.2) By the end of Y1, 80% of counselors will complete at least one cultural competency training 2.3) By end of Y1, perform at least 6 employee retention activities 2.4) By the end of Y3, onboard at least one contact center intern. Goal 3: Educate Rhode Islanders on 988, what services it provides, and when to call 988. 3.1) By the end of Y3, launch a statewide public awareness campaign that reaches 75% of Rhode Islanders 3.2) By the end of Y3, conduct at least 360 outreach activities. Goal 4: Enhance contact center data collection and quality improvement. 4.1) By the end of Y1, 100% of eligible contacts will be asked to complete the end-of-call demographic survey 4.2) By the end of Y3, 90% of eligible contacts will receive three follow-up attempts.

Georgia’s 988 Community Expansion Project will use grant funds to maintain and enhance staffing for the Georgia Crisis and Access Line, mobile crisis teams, Peer Warmlines, and Care Coordinators follow-up work as well as supporting mass marketing efforts. Prior grant funding allowed Georgia to expand call center staffing by 16 positions which led to a significant decrease in average speed to answer and abandonment rates. Ongoing funding will be needed to maintain those positions and funding for 16 new call center staff is needed to continue to provide access to help as call volume increases. Georgia will begin statewide mass marketing of 988 this year and plans to use a portion of this grant funding to support the mass marketing campaign. Projections of the impact of mass marketing on call volume suggest the potential to double current call volume. Call volume from July 16, 2022, to June 1, 2023, totaled 255,953 calls. If volume were to double with mass marketing of 988, Georgia could receive over 500,000 calls during the same time period next year. The downstream impact of increased call volume means that additional people will need support through the Peer Warmlines and mobile crisis services. Georgia will use the funding to increase positions at the Peer Warmlines by contracting with the Georgia Mental Health Consumer Network and the Georgia Council on Recovery for 8 additional certified peer specialists to staff the Peer2Peer and CARES Warmlines. Further, Georgia will use the funding to enhance Certified Peer Specialist coverage for mobile crisis services by contracting with Behavioral Health Link and Benchmark Human Services to hire 14 new certified peer specialists. DBHDD recognizes the need to enhance internal capacity to manage the 988 rollout and the services identified in this grant. Prior grants have allowed DBHDD to hire a Project Analyst to manage data and a 988 Community Liaison to enhance community outreach. Funding will be used to sustain these positions. Additional staffing positions, to include a Project Director and Project Evaluator, will be funded with this grant to enhance oversight of grant activities, ongoing 988 rollout, and Georgia’s overall crisis system. The Project Director and Project Evaluator will ensure Georgia is meeting metrics set forth in this grant as well as identify quality improvement efforts. Further, these positions will develop and monitor a return-on-investment plan as it relates to services funded through this grant as well as the other portions of Georgia’s crisis system. Project Goals: 1. Maintain current capacity to answer 988 calls with an average speed to answer of 30 seconds or less, an abandonment rate of 5% of less, and 90% of calls originating in Georgia with increased volume expected to result from 988 mass marketing. 2. Begin Georgia’s statewide mass marketing campaign to educate the general public about 988 and continue community outreach to groups at highest risk of suicide and those who have been historically underserved. 3. Enhance Peer Support staffing on Georgia’s Peer Warmlines and mobile crisis teams to address the downstream impact of increased call volume in the crisis system. 4. Maintain current capacity for post-crisis follow-up for calls resolved by the Georgia Crisis and Access Line, callers who are transferred to 911 for active rescue, and monitor outcomes of follow-up for mobile crisis teams and community crisis centers. 5. Develop and monitor a return-on-investment study related to services funded through this grant as well as the overall crisis continuum. Federal funding request for this application: $ 4,988,884.00.