988 Crisis Counselor Model Training Development

Background

In August 2024, the Washington State Department of Health (DOH) worked with 988 Suicide & Crisis Lifeline crisis center training supervisors and coordinators to co-develop an ideal training model with a Community of Practice (CoP).

The CoP identified gaps in consistent training around care for agricultural communities, people with intellectual and developmental disabilities, American Indian and Alaska Native (AI/AN) communities, and mobile team referrals for youth and families. The team also identified a gap in consistent training for counselors working on Mental Health Crisis Call Diversion Initiative (MHCCDI) partnerships. These partnerships allow behavioral health crisis calls made to 911 to be warm transferred to 988 when appropriate. The CoP worked to develop a 988 Crisis Counselor Model Training Program to provide more consistent care. This training program aligns training efforts with national best practices while meeting existing requirements.

Following the creation of the training program, DOH completed a curriculum review of the training programs for the 988 Lifeline crisis centers in Washington:

  • Crisis Connections
  • Frontier Behavioral Health
  • Volunteers of America Western Washington

The curriculum review focused on aligning the 988 crisis counselor training curricula to help make sure people in Washington who contact 988 get consistent, high-quality care.

The current 988 crisis counselor training programs meet the standards of the centers’ accrediting bodies. They also meet standards set by state legislation and Vibrant Emotional Health, the national 988 administrator. Each center’s training curricula also emphasizes regional needs.

All future 988 Lifeline crisis center training must align with the requirements of the 988 Crisis Counselor Model Training Program to better meet the needs of agricultural communities, people with intellectual and developmental disabilities, American Indian and Alaska Native people, and youth and families.

Required Knowledge and Qualifications

Before they can support help-seekers, 988 Lifeline crisis counselors must be able to work with people in different situations experiencing a range of concerns.

All 988 Lifeline crisis counselors are required to have knowledge in these areas:

  • Addiction and recovery: This includes general information about substance use and how substances can affect the behavior of people in crisis.
  • Working with AI/AN communities: This includes knowledge about culturally appropriate practices in suicide and crisis intervention, government-to-government training, and Washington’s Tribal Crisis Coordination Protocols.
  • Working with agricultural and rural communities: This includes knowledge around appropriate support, referrals, and resources for members of the agricultural community and their families.
  • Counseling on access to lethal means: This includes knowledge about ways to reduce access to methods of self-harm to support people at risk and their families.
  • Working with communities of color: This includes knowledge about systemic racism and an understanding of how to develop an anti-racist approach, address health disparities, and promote racial equity.
  • Community resources: This includes information about appropriate behavioral health and general support resources in communities.
  • Crisis intervention: This includes knowledge of the principles of effective responses to people in crisis and ways to reduce long-term trauma to someone affected by a crisis.
  • Critical thinking: This includes knowledge of processes to analyze, evaluate, and make judgments based on evidence by questioning, interpreting, and considering alternative points of view.
  • Cultural awareness: This includes knowledge of equitable services and cultural responsiveness to support everyone regardless of race, ethnicity, gender, sexual orientation, country of origin, socioeconomic class, language, faith, traditions, or disability.
  • Intimate partner abuse: This includes ways to recognize signs of domestic violence, effectively communicate with abusers and survivors, assess potential danger levels, and use safety planning strategies.
  • Follow-up care: This includes ways to recognize when a person in crisis may benefit from follow-up services and knowledge of how to connect people to these services.
  • Working with intellectually and developmentally disabled people: This includes information on best practices for serving people with intellectual and developmental disabilities.
  • Working with LGBTQIA2S+ communities: This includes an overview of suicide and other behavioral health crises among lesbian, gay, bisexual, transgender, queer, intersex, asexual, and two-spirit (LGBTQIA2S+) people, including contributing risk and protective factors, a statistical landscape of LGBTQIA2S+ populations in their communities, and definitions of language within the community. In addition, crisis counselors should have knowledge of gender identity, gender expression, and attraction, as well as intersectionality, systemic discrimination, microaggressions, and gender-affirming health care.
  • Mental health disorders: This includes information on how to recognize common mental health conditions and how to respond appropriately to help-seekers with these conditions.
  • Secondary trauma: This includes information about the direct effects of secondary trauma and strategies to promote personal wellness.
  • Serious mental illness (SMI): SMI includes mental, behavioral, or emotional disorders that cause serious functional impairment and substantially interfere with or limit one or more major life activities.
  • Suicide intervention: This includes guidance on understanding the complex nature of suicide and how to assess and determine a person’s risk.
  • Trauma-informed care: This includes knowledge on how to prevent, assess, recognize, and respond to the effects of traumatic stress.
  • Working with veterans: This includes knowledge of specific considerations for care of veterans, service members, and their families.
  • Working with youth and families: This includes knowledge of youth behavioral health best practices.

Required Skills

All 988 Lifeline crisis counselors must have skills in:

  • Active listening: This means tuning in to someone’s feelings and views, demonstrating unbiased acceptance and validating their experience.
  • Assessing immediate safety: This means evaluating the threat of immediate harm to a person to determine necessary interventions and make safety decisions.
  • Building rapport: This means establishing a connection and actively engaging people in crisis.
  • Confidentiality: This refers to maintaining professional integrity, trust, and ethical standards in handling confidential information.
  • Crisis intervention: This means being able to effectively respond to people in crisis. Note: This includes the required completion of all 988 Lifeline Core Clinical Training Courses.
  • Crisis stabilization: This means de-escalating the severity of a person’s level of distress associated with a mental health crisis, substance use disorder, or other mental health concern.
  • Critical thinking: This includes observing, analyzing, interpreting, reflecting, evaluating, inferring, explaining, problem-solving, and decision-making.
  • De-escalation: This means reducing the intensity of emotionally charged or potentially volatile situations through effective communication and behavioral techniques.
  • Documentation: This refers to properly documenting encounters with people who contact the 988 Lifeline.
  • Emotional intelligence: This means perceiving, understanding, and managing one’s own emotions and the emotions of others.
  • Problem-solving: This includes knowing how to identify solutions to difficult or complex issues.
  • Motivational interviewing: This involves using evidence-based practices to counsel people around ambivalence toward behaviors that prevent change.
  • Reflective listening: This involves actively demonstrating empathy and understanding toward the help-seeker by repeating or paraphrasing their thoughts, feelings, or ideas.
  • Responding to imminent risk: This involves taking immediate action to protect safety or health when there is a danger of death, serious injury, or illness.
  • Safety assessment: This involves identifying potential hazards, evaluating their likelihood, and determining their potential effects.
  • Stress management: This involves using cognitive, emotional, and behavioral strategies to reduce the negative impact of stress on mental and physical health.
  • Suicide intervention: This means putting into practice strategies like safety planning, lethal means counseling, and crisis response planning.
  • Suicide risk assessment: This involves using validated tools to identify a person’s risk and protective factors, conduct a suicide inquiry, determine risk level and intervention, and document these appropriately.
  • Trauma-informed care: This involves understanding paths for recovery, signs and symptoms of trauma, and ways to avoid re-traumatization.
  • Third-party care: This means knowing how to support crises involving multiple people, including appropriately assessing each party.

Skills-Based Requirements

According to policies set by Vibrant, 988 Lifeline crisis counselors must also demonstrate the following skills-based requirements and abilities:

Skills-based requirements include:

  • Practical sessions: Crisis counselors must complete a minimum of 8 live roleplays with a qualified trainer or supervisor, addressing different types of conversations and individual needs. At least one of these should focus on working with a youth help-seeker, and at least one should focus on providing service through a language interpreter.
  • Simulated conversations: Crisis counselors must complete a minimum of 2 simulated conversations using the Lifeline Simulation Training. These simulated conversations should include both direct and third-party contact.
  • Live observation: Crisis counselors must complete 10–20 hours of live observation of experienced crisis counselors providing services to contacts of various modalities as appropriate for their role. This includes help-seekers who contact 988 by phone, text, chat, and videophone.

Abilities include:

  • Critical thinking: This includes interpretation, evaluation, and analysis of information to form a judgment.
  • Cultural competence: This includes understanding, communicating, and interacting with people across cultures.
  • Emotional intelligence: This means knowing how to identify and manage one’s own emotions as well as the emotions of others.
  • Empathy: This means engaging with and building an understanding of the feelings of others.
  • Problem-solving: This means identifying problems, brainstorming appropriate responses, and putting the best solutions into practice.
  • Resilience: This means adapting to challenging life experiences, specifically in relation to supporting people in crisis.
  • Safety planning collaboration: This means collaborating with people in crisis to develop coping strategies and sources of support.

988 Lifeline Crisis Counselor Model Training Program

The 988 Lifeline crisis counselor model training program includes:

Vibrant 988 Suicide & Crisis Lifeline Clinical Training

  • Fundamentals of Crisis Counseling (1.5 hours)
  • Essential Skills in Crisis Counseling (2.5 hours)
  • Assessing Safety and Suicide Risk (2.5 hours)
  • Imminent Risk of Suicide (2.5 hours)
  • Familiar Callers (1.5 hours)
  • Conversations in Chat and Text (2.5 hours)

Live Roleplays

Roleplays are 30 minutes each, and crisis counselors must complete a minimum of 4 hours of roleplay training. Roleplay topics include:

  • Establishing connection and active engagement
  • Active listening
  • Assessing immediate safety
  • Conducting a full safety assessment
  • Responding to imminent risk
  • Collaborating on a safety plan
  • Local needs and specialties of the center’s choosing:
    • A minimum of 2 completed simulated conversations using the 988 Lifeline Simulation Training (1.5 hours each)
    • 10–20 hours of live observation of experienced crisis counselors providing services over call, text, chat, and videophone.

Required Courses

In addition to clinical training, 988 Lifeline crisis centers must include the following courses in their training programs:

  • AgriSafe FarmResponse
  • We Are Still Here: A Guide for Non-Native People Serving Native Communities

Required Topics

988 Lifeline crisis centers must also include the following topics in their training programs:

  • Counseling on access to lethal means
  • Working with communities of color
  • Cultural humility
  • Domestic violence
  • Working with intellectually and developmentally disabled people
  • Working with LGBTQIA2S+ people
  • Mental health disorders
  • Mobile resources
  • Secondary trauma
  • Substance use/recovery
  • Trauma-informed care
  • Working with veterans
  • Working with youth and families

Questions?

If you’d like to learn more, reach out with any questions to 988 program staff.