States are currently in the process of implementing the 988 National Suicide Hotline Designation Act, passed by Congress and signed into law in October 2020, and they must ensure they are meeting the needs of children and their families through these systems from the start. Children’s needs can be very different from adults’, and states, with assistance from the federal government, must design and create these systems to meet the needs of youth and families from the beginning rather than to retrofit them later. To date, 16 states (Colorado, Illinois, Indiana, Kansas, Maryland, Michigan, Mississippi, Nebraska, Nevada, New York, Oregon, Utah, Virginia, Washington, and West Virginia) have enacted legislation to implement 988. Unfortunately, of these, only three (Nevada, Oregon, and Washington) have implemented one or more child- or youth-specific planning provisions included in their legislation1.
Recommendations for 988 Planning
Below are some of the child- and family-specific recommendations that must be included when designing 988 systems that can adequately and equitably respond to the needs of children and youth. The federal government can provide guidance and technical assistance to states to implement these recommendations.
Ensure that Youth and Family Voices are Included in Planning
Children, youth, and their families should be at the planning table when states are designing 988 systems. Their interests and needs are unique and should be a formal and integral part of the system-building process. It may be late for this to happen in some states, but there are certainly many states that will not be ready for the July rollout and they should involve these important voices as soon as possible.
Additional Providers and Services, Including Mobile Response
Children and youth in crisis must be able to access pediatric-specific care in a timely and equitable way. Demand for pediatric providers and services is already high, and it could potentially increase with the start of 988. The current shortage of these providers is likely to increase. Integration and use of services like mobile response and stabilization, home- and community-based services, as well as inpatient beds are needed. Mobile response and stabilization services are particularly well-equipped to meet the behavioral health needs of children and their families, as they provide an immediate response that doesn’t involve law enforcement, de-escalates crises, includes family engagement, and identifies other supports, resources, and services in a community that a family can be connected to. It is critical to avoid law enforcement involvement in responding to youth behavioral health crises, especially for children of color who are more likely to face harsh consequences like school exclusion and arrest. To date, several states have implemented mobile response successfully with good outcomes for youth.
Youth Crisis Lines
Several youth crisis lines currently exist across the country, including Oregon’s YouthLine, that are staffed by highly-trained youth peers who, with supervision from trained professionals, can answer calls, texts, chats, and e-mails from their youth peers in crisis. These existing resources should be included in the planning and staffing of the new 988 response lines.
Require pediatric training for 988 and mobile crisis staff
The counselors and staff responding to calls and texts via 988 and providing mobile crisis response must have pediatric-specific expertise. They must be provided with trauma-informed training, as well as training in speaking and working with youth and in making pediatric referrals for services. The staff responding to calls must be well-versed in the pediatric resources available in their communities.