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Crisis Centers and Follow-Up Care

Many of the local crisis centers in the Lifeline’s national network of service have taken the lead on creating new partnerships to provide follow-up services with patients recently discharged from inpatient or Emergency Department settings. For many crisis hotlines, follow-up is viewed as an integral part of service provision.

What is involved in a follow-up program? While models may vary, certain elements are essential to effective follow-up care:

Create Clear Criteria for Enrollment


Clear enrollment guidelines are established to determine appropriateness of care. Criteria may differ across Crisis Centers though in general, Centers base criteria on:

  • Setting: Callers to the hotline, those recently discharged from an emergency department or inpatient setting, following missed clinic appointments
  • Degree of Risk: Range from low to high suicide risk (though not imminent)

Establish Clear Program Protocols

Clear program protocols ensure that a consistent quality of service is provided across staff and referral type. While center protocols are not rigid (i.e. individualized call schedules can be developed based on a caller’s needs), they do focus on structure. So while details of a caller’s follow-up plan may vary depending on risk level and the goal of follow-up (i.e. follow-up until relinked to treatment – or follow-up until specific stressor has passed) the overall approach typically remains the same.

Lifeline centers providing follow-up services are guided to establish the following:

  • Minimum number of follow-up contacts made to each participant
  • Maximum number of attempts to reach an individual before it is assumed they have dropped out of the program (typically three to five attempts are made)
  • Maximum duration (in days or weeks) of program involvement
  • General guidelines on content of follow-up calls
  • General goals for the follow-up care with room for individual needs

In general, follow-up involves:

  • Letters, phone calls, emails, chat or text
  • Assess well-being, level of risk, and linkage to care
  • Usually by telephone 24 –48 hrs after initial contact
  • Calls are structured, brief and focus on continued assessment of risk
  • General steps:
    • Mood check and risk assessment – assess need for immediate intervention
    • Review safety plan (revise if needed), discuss access to means
    • Discuss treatment engagement and problem solve
    • Obtain consent/willingness for additional follow-up

Follow-up period can end when individual

  • Is engaged in treatment
  • Risk is reduced or no longer wishes to be called

Describe Protocols and Gain Consent


Ensuring that the participant clearly understands how the follow-up program operates is essential for program retention. Participants are made aware that follow-up is designed to be time limited and not designed to replace short-term treatment. This sample consent form provided highlights much of the information a center will review as they obtain consent to reach out.

SAMHSA/Lifeline Follow-Up Grant Recipients

Partnerships between crisis centers and emergency departments are already underway. Follow along with us as we profile SAMHSA/Lifeline crisis centers and emergency department Follow-Up Grantees, as they develop their processes and partnerships over time.

Contact Community Services is partnered with Upstate University Hospital and St. Joseph’s Health.

Dupage County Health Department is partnered with AMITA Health Adventist Medical Center GlenOaks and Northwestern Medicine Central Dupage Hospital.

Common Ground is partnered with Beaumont Hospital Emergency Department in Royal Oak, MI and McLaren Oakland Hospital Emergency Department in Pontiac, MI.

FrontLine Service is partnered with Fairview Hospital, Lutheran Hospital, and Cleveland Clinic in Cleveland, OH as well as Marymount Hospital in Garfield Heights, OH, and Euclid Hospital in Euclid, OH.

Bridging the Gap

Crisis centers can become an important bridge between emergency departments and individuals in need of care.

Examples of Formal Agreements

Centers across the Lifeline network have varying levels of engagement with EDs and inpatient facilities. These partnerships can be informal or formalized by memoranda of understanding (MOU).

As you establish commitment to promoting the use of follow-up services, it is important to develop a formal agreement around partner roles. For many, this is secured through a Memorandum of Understanding (MOU), which outlines the minimum expectations of each party. The following sample MOUs highlight how agreements between crisis hotlines and three different facilities can be executed:

There are many ways that crisis centers can support emergency departments in the care of those at risk of suicide.

Crisis Center Materials

Crisis center materials such as business cards and brochures can be placed in the ED or inpatient facility. Staff social workers and discharge planners at the partner facility can also include these materials in discharge packets. The materials will build community awareness about the programs and services the center offers.

Suicide Risk Assessment Training

All Lifeline crisis centers are required to adhere to established standards in both risk assessment and imminent risk processes.

Crisis centers can provide suicide risk assessment training and consultation for ED staff. These assessments can be done in person (at the hospital) or by phone.

Read more on the establishment of Lifeline Risk Assessment Standards and Imminent Risk Guidelines.

Many crisis centers have established contracts with their local ED, inpatient facility or State to provide suicide risk assessments for ED patients at admission

Aftercare and After Hours Services

Aftercare and after hours services are highly effective to help link patients to outpatient care and divert these patients to more appropriate services.

Schedule Follow-Up

EDs and inpatient facilities can obtain consent from patients to send crisis centers their contact information for follow-up services. These follow-up calls can be scheduled by the discharge planner, or they can simply ensure the patient that someone from the crisis center will follow-up with them to check in about how they are doing within 24 to 72 hours.

Helpful Resources

Look over the following resources: many (though not all) can be adapted and customized to suit the needs of your ED and your partner Lifeline Network Crisis Center.

A survey of the Lifeline Network indicated that:

91% of Lifeline centers provide some form of follow-up to callers.

38% of Lifeline centers have a formal relationship with one or more EDs.

Use our map to find your local Lifeline crisis center and begin a partnership.