Decreasing abandonment of calls to the 988 Suicide and Crisis Lifeline

Last registered on July 28, 2023

Pre-Trial

Trial Information

General Information

Title
Decreasing abandonment of calls to the 988 Suicide and Crisis Lifeline
RCT ID
AEARCTR-0011638
Initial registration date
July 25, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 28, 2023, 2:01 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
University of Houston

Other Primary Investigator(s)

PI Affiliation
Office of Evaluation Sciences
PI Affiliation
Office of Evaluation Sciences
PI Affiliation
Office of Evaluation Sciences

Additional Trial Information

Status
On going
Start date
2023-07-25
End date
2023-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
This study will evaluate whether changes to the integrated voice response (IVR) system and messages that callers to the 988 Suicide and Crisis Lifeline hear can decrease the proportion of callers who abandon their calls (i.e., hang up) before being connected to a person at a local call center. The intervention involves changing the message script and voice recording that callers hear during the initial IVR (before a call is routed) and the script, voice recording, and waiting music that callers hear while waiting to be connected to a counselor. Callers will be assigned to either the control or treatment condition based on a randomization of the last 4 digits of 10-digit phone numbers. During the approximately 3-week study period, calls with the 5000 randomly selected 4-digit sequences will be assigned to the control version of the IVR and queue message, and the other 5000 will be assigned to the treatment version. All phone callers to the line during the study period will be included in the evaluation. We will compare outcomes for incoming callers who are randomly allocated to hear either the current version or the intervention version. The primary outcome of interest is the likelihood that a caller stays on the line and is connected to a crisis counselor. Secondary outcomes include whether a caller remains on the line until being routed, call duration (time until abandon or connection), use of the 988 text option from the same phone number, whether a caller connects to a counselor via text or phone, repeat call to 988 within 24 hours, and selection of IVR menu items.
External Link(s)

Registration Citation

Citation
Debroy, Pompa et al. 2023. "Decreasing abandonment of calls to the 988 Suicide and Crisis Lifeline." AEA RCT Registry. July 28. https://doi.org/10.1257/rct.11638-1.0
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2023-07-25
Intervention End Date
2023-08-17

Primary Outcomes

Primary Outcomes (end points)
- fraction of calls connected to a counselor.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
- likelihood that the call is routed
- time elapsed from start of the call until disconnection or connection with a counselor
- use of the 988 text line within 1 hour of the initial call
- likelihood of follow-up calls back to the 988 line within 24 hours of the initial call
- likelihood that a caller connects with a counselor via phone or text within 24 hours of the initial call
- likelihood that someone selects IVR option “0” during the call
- likelihood that someone selects IVR option “1” during the call
- likelihood that someone selects IVR option “2” during the call
- likelihood that someone selects IVR option “3” during the call
- likelihood that someone selects IVR option “4” during the call
- time point during the IVR message when a call disconnects
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Some callers to the 988 system will hear the existing 988 IVR messages and content and waiting messages and content; others will hear revised messages and content designed to reduce dropped calls. Which version of the messages and content a caller hears will be based on a randomized allocation of all possible last-4-digit sequences of 10-digit phone numbers. Then we will compare outcomes for incoming callers who hear the two versions.
Experimental Design Details
The Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA) and Vibrant Emotional Health (who implements and administers the 988 system) aim to make changes to the integrated voice response (IVR) system and messages that callers hear when calling 988 and attempting to reach a crisis counselor. The intervention involves changing the message script and voice recording that callers hear during the initial IVR (before a call is routed) and the script, voice recording, and waiting music that callers hear while waiting to be connected to a counselor. We will evaluate whether changes to the IVR and waiting message content increase call connections.
To do this, the evaluation will compare outcomes for incoming callers who are randomly assigned to hear either the current version of the 988 IVR and queue messages (the control condition) or a revised version of the messages (the treatment condition).
Control condition: Callers initially hear an automated message with options the caller can choose by pressing the appropriate number. The full initial IVR message callers hear if they do not choose any IVR menu option is approximately 45 seconds long. If the caller remains on the line to the end of the IVR message they will be routed to a queue while the system finds an available counselor. After a brief pause the caller hears music after the call is routed and hears cut-in messages at 18-second intervals.
Treatment condition: Callers initially hear an automated message with the same options as the control condition. The message has been revised to be shorter and increase clarity. If the caller remains on the line they will be routed to a queue while the system finds an available counselor. After a brief pause the caller hears a message indicating that the system is checking for available counselors and they will hear music while this happens. Music plays after an initial post-routing message of what to expect, and then the caller hears cut-in messages at 30-second intervals. The messages are recorded with voice talent that was selected to sound more like someone a potential caller would want to have a conversation with. Minor changes have been made to the wording of the messages to reduce length. Post-routing cut-in messages have been revised to include affirmative messaging encouraging callers to stay on the line and highlight other resources available to callers (including chat 988, text 988, and 911 if necessary). The wait music has been changed.
The intervention does not change the messages or content that callers hear if they select any of the IVR menu options. Those messages and content after selecting an IVR option will remain the same for both the control and treatment conditions.
Callers will be assigned to either the control or treatment condition based on the last four digits of their 10-digit phone number. The randomization of 4-digit-sequences is stratified by the 8th, 9th, and 10th digits to ensure balance across treatment and control for any patterns in assignments of these digits. Once the study period begins, calls from numbers with any of the 5000 control-assigned last-4-digits will be hear the control version of the IVR and queue message, and those with the other 5000 will be assigned to the treatment version.
Randomization Method
Randomization done in office by a computer
Randomization Unit
Last 4 digits of phone numbers
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
10000
Sample size: planned number of observations
Approximately 315,000 calls
Sample size (or number of clusters) by treatment arms
5000 intervention (new IVR), 5000 comparison (status quo IVR)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials