Setting limits with Helpline callers is one of the most difficult tasks for a new helpline worker to master. It may go against a volunteer’s nature for them to be required to end calls with callers who still feel they need support or to set limits with callers who may be struggling with mental or cognitive disorders that make it more difficult for them to understand these limits.
The opposite side of that coin is that if volunteers do not set adequate limits with their callers, they will experience increased levels of burnout as they handle calls that are upsetting or even abusive; additionally, if limits are not placed on regular callers, they will “crowd out” crisis callers who may have less of an opportunity to receive support while at imminent risk because a repeat caller is using a disproportionate amount of service delivery.
5 Step Limit Setting Process
There is a 5-step process to setting limits with callers that is commonly used at the Distress Centre and I imagine other helplines or organizations where limit-setting is required. The five steps are as follows:
Identify the inappropriate behaviour
Identify what correct behaviour is
Indicate the consequences for failing to change behaviour
Give the caller an opportunity to change their behaviour
Follow through on consequences (e.g. hanging up) if behaviour does not change
Let’s examine each of these steps in sequence:
Identify the inappropriate behaviour
The first step is to identify what inappropriate behaviour is. This can be an agency limit such as a prohibition on the discussion of sexual explicit content or of a caller masturbating on the phone, or this can be a personal limit like a volunteer being uncomfortable with a caller swearing.
The volunteer will identify the inappropriate behaviour, e.g. “I recognize you’re very angry but I need you to refrain from swearing during our conversation”
Identify what correct behaviour is
In a situation where there is a correct behaviour, the volunteer should indicate that. For example, “We can discuss this sexual experience but I need to stay focused on the emotions and not the physical elements of the act.”
Indicate the consequences for failing to change behaviour
This identifies what happens if a caller does not change their behaviour. “If we can’t stay focused on the emotions, I’m going to have to end the call.”
Give the caller an opportunity to change their behaviour
This is to allow the caller to show us they have recognized the issue, such as by refraining from swearing.
Follow through on consequences (e.g. hanging up) if behaviour does not change
In this step, the caller has not changed their behaviour so the volunteer ends the call. “I’m sorry, but I asked you to refrain from discussing the physical elements of this call. As you have continued to do so, I have to end the call now.” This should be followed by the volunteer hanging up!
This limit setting procedure can be used in a variety of settings, both in person and on the phone.
Call Restrictions
Call restrictions are different from in-call limits (described above), and instead describe things such as a caller being put on a 20 minute time limit per call, or being limited to one call a day. These limits are best deployed when a caller is using significantly more service than average.
One way that Distress Centre determines limits is by examining how often a caller uses our services and for how frequently. Our goal is to limit most callers (who have limits) to one call, once per day, and then to decide on how long. For instance, if a caller tends to call twice a day and speak for 30 minutes, we may set their restriction to one call a day, for 30 minutes.
This restriction is always suspended when a caller is in crisis so that we can de-escalate them or connect them to emergency support.
When placing a caller on restrictions it’s important to speak to them about the rationale for that. A caller who calls repeatedly is likely getting less out of each call than they would otherwise. One focused 30 minute call may deliver much more support to a caller than three 10 minute calls, for instance. One focused hour long call will provide more support to a caller than three hour long calls.
Speaking to the caller, you can explain that we want to make sure our service is available for that caller and help meet their needs but also meet the needs of our other callers and volunteers. If a caller is upset, we can help them find additional supports in their community in addition to the Distress Centre that can help meet their needs.
Working with Abusive Callers
Abusive callers can be very challenging. These are callers that frequently disregard the Five Step Limit Setting Procedure above and instead abuse volunteers by being insulting, sexually graphic or simply by disregarding their time limits consistently.
Abusive callers may need to be temporarily blocked until a staff member can speak with them, in order to reign in that behaviour. If a caller continues to be abusive, the best option may be to simply block that caller from using your service, referring them to alternates in your community.
Winding Up on Text and Chat
Text and chat is a different beast from the telephone. Conversations can stretch much longer if your responder is not careful. Fortunately there are a variety of winding up strategies that can be used on text and chat conversations.
When it comes time to wind up a conversation, you have a few options:
We’re just coming up on (45/60/75/90) minutes so we’ll need to wrap up soon. I’m wondering if there’s anything else on your mind?
We’ve been talking for (45/60/75/90) minutes, how are you feeling?
I’m going to have to open up our queue soon, is there anything you haven’t told me yet that you want to?
We’ve been talking for about an hour now so I’ll have to let you go for now
In situations where someone is using the service multiple times per day, you may wish to try things like:
I saw that you’ve spoken to one of our responders earlier today, how did that conversation go?
I’m wondering if we can focus on some coping strategies that can help you get through the rest of the night
In my experience most visitors respond positively to these gentle wind-ups and allow you to move towards wrapping up the conversation at the appropriate point.
Call Blocking
In a future post I will discuss the technological options available for call blocking; it’s a good idea to check with your telephone provider about the option of blocking abusive or harassing callers from your helpline.
Conclusion
Limit setting can be a challenging task for your volunteers to master but is essential for their continued success on your lines!
Do you want to start your own suicide hotline, crisis line or helpline? This is an extremely ambitious and admirable goal and I admire you for thinking about your community! Thousands of suicide lines listen to millions of people across the globe every year, preventing thousands of suicides and making the world a better place.
While some areas have lots of crisis lines and supports in place, other communities have a complete lack of them. Especially outside of North America, crisis lines can cost money to call, or may not even exist at all.
Most crisis lines are started by volunteers like yourself, who took the task upon them for the good of their communities. Eventually most lines receive some form of funding, but in the beginning they’re often run out of churches and with volunteer labour.
A few of the things you’ll need to start your own crisis line include:
Office space
Phone Service
Helpline Software / Computers
Crisis Line Training
Hotline Evaluation
Office Space / Phone Service
These may seem daunting, but they’re not as complicated as they may initially seem. Office space, for instance, is often donated by churches or other community groups for fledgling non-profits. All you really need is an area for taking calls, and an area for performing administrative work. This can be in a single room to start, and could be someone’s house.
Phone service can be expensive, but using VoIP services can help reduce the cost and improve the accessibility to your volunteers. Something to keep in mind is the possibility of doing call forwarding. What this means is that if your volunteers are at home, the calls can be forward to their home or cell phone and they can answer them from there.
Helpline Software / Computers
Initially your helplines can use paper call reports to record information, later switching to a database, or if you can afford it you can subscribe to an online web-based software like iCarol that will give you much more freedom and flexibility.
It may be helpful to get in touch with local crisis lines in your area (or in larger cities) to learn about the way they code calls. This will help you to understand the basics, before you create your own call report that uniquely captures your population.
Crisis Line Training
Crisis line training is probably the most difficult element to starting a crisis line. Working with a neighbouring crisis line to undergo their training is helpful. Additionally, a lot of crisis lines have local mental health professionals work as clinical supervisors until the organization has enough institutional expertise to provide their own.
Tools that can be used to assess crisis line volunteers include the Suicide Intervention Response Inventory (SIRI) or the Crisis Center Discrimination Index (CIDI). Suicide risk assessments are also an important element of starting a crisis line because you’ll need to respond in an effective and reliable method for determining a caller’s suicide risk.
Some suicide risk assessment tools. include the CPR Model (Current Risk, Previous Exposure, Resources), the DCIB (Desire, Capability, Intent, Buffers) Model and the NGASR (Nurse’s Global Assessment of Suicide Risk.)
Helpline Evaluation
Evaluating your hotline is an important element of operating it. If you ever want to receive funding, you need to show that your line is actually beneficial.
This can be as simple as establishing standards for your volunteers (e.g. all volunteers will undertake a 40 hour training session, all volunteers will fill out detailed call reports with outcomes measures, etc.) or as complex as having a silent monitoring system to allow supervisors to listen to calls or research where callers are contacted afterwards to find out their experiences.
Risk management is the process of assessing and taking steps to mitigate areas where things that might go wrong in your organization. While we all hope that nothing would ever go wrong, it’s important that we are not caught blindsided. Some of these issues are within our control (e.g. helpline quality issues) while others, like natural disasters are not.
A helpful way to look at this, which came up at a conference that I attended recently, was to imagine you are being interviewed by the media because something has gone wrong. What would you tell the journalist that you currently do to avoid this problem? If the answer isn’t good enough, perhaps looking at where you can improve.
Failures in Risk Management
Failures in risk management can have wide-ranging impacts. They include a drop in morale of your volunteers, financial penalties resulting from lawsuits, a reputation hit among the community, even loss of funding and closure of your helpline.
Probability/Impact Heat Map
An interesting concept I learned in a conference was the idea of a “Probability/Impact” heat map. This was a simple way to envision the various issues that could affect your helpline. Here is an example of a simple heat map with two items, Natural Disaster and Helpline Quality Issue.
The Natural Disaster (let’s say, a hurricane) would have an extremely large impact on the helpline’s ability to operate, however hurricanes (at least here in southern Ontario) are extremely rare so their probability is low. While it might be helpful to write policies in case of a potential natural disaster (some of which are detailed in the below sections) they can likely safely be reviewed on a yearly-basis, perhaps at a Board Meeting – unless a hurricane is imminent.
On the other hand, while helpline quality issues do not have as big an impact on the helpline’s ability to operate (although still substantial, if they are widespread), they are much more common than hurricanes.
For that reason, you will likely spend more time in your day-to-day implementing policies, regular supervision and monitoring, and (ideally) having a detailed performance improvement program for volunteers identified as falling below standard. This, combined with a strong training program and an awareness in the volunteers of what is expected of them should help to mitigate issues resulting from poor quality volunteers.
As you proceed through each section, keep in mind what elements you already implement to mitigate risk and where you can improve.
Recruitment and Screening
Recruitment and screening is your first opportunity to meet potential volunteers and learn about issues that may present themselves later in their volunteerism. By taking a keen interest in the volunteers you are recruiting now, you can be better prepared for issues later.
Interviewing
Almost all helplines involve some kind of interview process for potential volunteers. Do you use a structured interview process, or wing it? If a potential applicant feels discriminated against during your interview process you can open yourself up to legal or public relations issues.
Risk Management for Interviewing:
Create a structured interview with specific questions asked of every candidate
When conducting interviews, write down notes for each response and store them in the volunteer’s file
Write a protocol explaining in what interview responses (if any) lead to supervisor review or automatic discontinuation of their application
Include questions on areas such as sexual assault, self-injurious behaviour, suicidal thoughts – ask volunteers if they have any exposure to these potentially “triggering” topics and discuss with applicants how they will be impacted
Police Checks
Police checks are the most obvious form of screening for helpline volunteers. In Canada, a Vulnerable Sector (VS) Check provides both a regular criminal record check, as well as information on sex crimes and other records relevant to working with vulnerable clients, even if they have received a pardon or they were not convicted.
In the UK, this is known as a DBS (Disclosure and Barring Service) check, and it works in a similar way, showing crimes that would be excluded from a normal criminal record check.
It’s important to remember that a criminal record check is not a guarantee against crime, because volunteers may become involved in the criminal justice system after the start of their volunteerism, or may have committed crimes for which they were not caught or convicted.
Risk Management for Police Checks:
Require police record checks for all volunteers
Require an updated criminal record check every several years (covered by the helpline if within your budget) or as a low-cost alternative, have volunteers sign an attestation that they have not been arrested in the previous year
Create a protocol for what offences you will allow on the helpline and when; for instance, you may be okay with offences that occurred more than 10 years ago, or you may only allow crimes that were not “moral turpitude” offences (drunk and disorderly may be okay, theft or assault may not be.)
If you allow volunteers on the lines with these crimes, document your decision to do so and have them sign a document certifying their requirement to stay “crime free” in order to continue being involved with your line
Reference Checks
Reference checks, like police checks, are common for both employees and volunteers on helplines. References allow us to learn more about a person from their peers and previous supervisors. This can be illuminating.
Reference checks should be conducted with a standardized form and specific questions looking at a potential volunteer’s interpersonal skills and how they work under stress. Examples of questions can include, “How does this person interact with other people in their life?” and “Have you ever seen this person react under stress? How did they perform?”
One misconception about references in Canada is that if an employee gives a poor reference about a colleague they are opening themselves up to legal liability. This is untrue; in fact, reference checks are considered qualified privilege (Dunlop, n.d.)
Risk Management for Reference Checks:
Use a standardized reference check form and record the answers; make sure to document the method of communication, the date, and the title and name of the person you spoke to
Ask volunteers for a minimum of two references. This shields you against problems if one reference has been “coached” to only speak positively about volunteers
Create a policy regarding how you will proceed if references are inaccessible; will you allow volunteers to continue during the process with only one submitted reference, will you ask them for another reference or discontinue their application?
Volunteer Training
Training is arguably the most important element to protecting callers and clients from poor quality volunteers. By providing a strong training system, volunteers are able to provide consistent service to all callers.
Emotional Reaction of Volunteers
While everyone thinks about the service to the callers, there are also risks of harming potential volunteers during training. It is important to recognize that they may be impacted or triggered by roleplays, by discussion around topics like suicide, abuse (including self-abuse) and sexual assault.
There are a number of steps you can take to protect the emotional health of your potential applicants.
Risk Management for Volunteers during Training
Ask volunteers who identified as undergoing counselling or therapy to provide your helpline with a letter confirming their suitability for volunteering. At Distress Centre Durham, volunteers are provided with a letter that lists the potential impacts of volunteering and clinicians are simply asked to sign the document certifying that volunteer work will pose no harm
Have volunteers or staff ready during the training to debrief in private with volunteers who are negatively impacted participating in roleplays
Closely monitoring the non-verbal signs of volunteers during discussions and documenting the results of those observations. Document everything! This way if you need to later release a volunteer from their commitment, you have evidence to support your decision
Security (Physical and Electronic)
Physical and electronic security is an important element of risk management. Many helplines are in spartan circumstances, in industrial parks or the basements of churches where there is not a lot of vehicle or person traffic. Additionally, late night shifts can have volunteers leaving at midnight, 2am, 4, 6, etc., where they could be in danger.
Risk Management for Physical Safety
Ensure a floodlight is available for the front door and parking lot; a peephole allowing volunteers to see out the main door will allow them to ensure the area is clear before departing to their vehicles
Having two volunteers on staff. By making sure that (where available) two volunteers leave and enter the building at a time, you can ensure they feel safe
Installing cameras or other surveillance equipment can be both a deterrent and helpful in the aftermath of a physical safety incident.
Multi-layered alarm systems allow you additional forms of protection. For instance, in addition to having a front door with a master key, you can install an alarm system with a code. This mean that even if your keys are compromised or the lock is picked, individuals are not able to enter your building without tripping the alarm system.
Establishing protocols for locking doors help volunteers ensure that they know something is amiss. For instance, if the front door is to be locked at all times, except for 5 minutes before and after a shift, a volunteer who enters the building and finds the door open at an irregular time knows to be on alert.
Informational Security
As more and more information is stored digitally, the impact of “hacking” and data theft becomes bigger and bigger. Crisis lines in particular may store a lot of information on their callers and this may be vulnerable to theft.
Risk Management for Information Security
Encrypt information on hard drives, using a tool like Microsoft’s free Bitlocker, so that if the hard drive or computer is stolen the information will be inaccessible without the password
Disconnect computers where helpline work occurs from the internet, or use a web blocker to prevent access to all non-essential websites
Develop information protection policies, such as locking all volunteer and caller files in keyed cabinets (and limiting access to who has the keys)
Consider using an online helpline management software like iCarol; all information transmitted with them is encrypted at both ends and stored offsite in secure data warehouses where security is the priority. This can help both your funders and callers feel more secure.
Natural Disasters
Natural disasters are also a concern depending on where your helpline is located. It’s important that you put in place policies to help mitigate data loss and allow your helpline to function in times of disaster, when you may find yourself a crucial source of information, emotional support and crisis intervention in the aftermath.
Risk Management for Natural Disasters
Develop policies on how your helpline will respond during disasters; will you forward your lines to cell phones so volunteers can take calls off-site, or will you shut down for safety?
Backup information on to external hard-drives or other external data sources that can be removed, or completely outsource back up to an offsite data provider so you are protected even in case of sudden disasters
Keep physical copies of information such as volunteer and staff contact information securely stored for emergencies
Direct Service (On the Helpline)
Sometimes risks occur from the work that your helpline workers are actually performing on the phone. These are the most worrying to volunteers, callers and managers because of their contact with often vulnerable clients.
There are a number of risk management techniques that can be put in place to help mitigate the risk poor delivery of helpline service has on your line.
Risk Management for Helpline Service Quality
Perform regular supervision of volunteers; this can include reading their written call reports, randomly listening to their calls live, meeting with them for weekly or monthly supervision meetings and ad hoc meetings if callers report concerns with specific volunteers
Establishing very clear standards and protocols around breaches of confidentiality, meeting callers offsite, giving advice, or other concerns that your helpline may face. Explain the behaviour, give examples of behaviour that falls below the standard, and explain the consequences, up to and including being released from their volunteering duties
Conduct regular surveys with callers. For instance, a yearly or semi-annual survey with callers can help you identify issues that may slip through the cracks if you don’t perform live call monitoring because of budgetary or ethical concerns
Using a tool like Chronicall can help you see patterns in call data that you may not have been aware of before. For instance, I developed a tool that allows me to input shift coverage data from iCarol and call data from Chronicall, and identify areas with high rates of shift coverage and a large numbers of missed calls. This could mean that some volunteers missed that shift, were ignoring calls or were dealing with crisis calls that required them to not answer incoming calls.
Conclusion
Hopefully some of these risk management techniques will have been new to your crisis line; implementation of a comprehensive risk management process in cooperation with your administration and Board of Directors is essential in mitigating potential disasters before they happen.
Do you have any recommendations for risk management methods I may not have thought of? Suggest in the comments.
Helplines are a strange beast: if their utilization is high, one can assume that either the community is really in need of their service and they deserve more money. On the other hand, if they are effective at diffusing crises, one might see their usage drop as fewer people in the community need them.
Most helplines, though, are seeing calls go up year after year, as their populations get bigger and more people find themselves dealing with mental and physical health, financial and relationship issues, suicide and bereavement and all the other things that bring a person to call.
One way that helplines can improve their position is via funding for grants to meet particular populations needs. For instance, Distress Centre Peel operates seniors services, launched in part with funding from the New Horizons for Seniors program.
So here are some marketing ideas you may not have considered for your helpline:
Host a contest – Have individuals in the community (they could be high school students, community college or University students or even adults) participate in building a part of your organization. Offer a prize equal to a little more than you would have paid. For instance, for a $250 prize have individuals suggest a new slogan for your helpline. Work with local media outlets to popularize the contest – which will also popularize your helpline in the process.
Real Time Tweeting – Each time your helpline intervenes in a crisis (for instance, you dispatch an ambulance or police to someone’s location), tweet using your organization’s Twitter. This is a very “in your face” way of letting people know the impact you are having in your community.
Magnets – For organizations who produce magnets with their phone number on them, get creative. For instance, you can place the magnets on pay-phones in your community so that individuals in crisis can still reach you, especially if you have a toll-free line available.
Giving away products – Produce a guide on deep breathing, cognitive thought distortions or stress management (or maybe you already produce these for your workers to use on the phone) and give it away to local community agencies. They’ll be able to support their clients and your organization’s name gets out there.
Reach out personally – This one may run up against some ethical boundaries at your organization so you’ll want to check with your Executive Director/Board of Directors first, but if you see someone in the newspaper or in the community who you think would benefit from your service, reaching out to them rather than you reaching out to you can be very lucrative. I know of one helpline that runs a suicide survivor support group (not Distress Centre Durham, where I currently volunteer now work) that reads the obituaries looking for individuals who have died by suicide, to offer supportive phone calls and a spot in the next support group. Because all of the services are free, they’ve heard nothing but good from this move.
At the end of the the day, it comes down to being proactive rather than reactive. When people are in crisis you don’t want them to have to find you, you want your information already in their pocket, on the payphone, or in their Twitter feed so that you become a no-brainer.
One advantage of this is that if you target your approaches to particular groups (e.g. seniors or youth) you can see a quantifiable increase in the number of calls from those individuals.
There are a number of tools that can be used to monitor workers on your helpline. While we all want to believe that workers will do everything they are supposed to do, sometimes people can find themselves falling below the standard you’ve set.
Whether workers are using computers to access websites unrelated to the business at hand, failing to record the information they are supposed to, refusing to talk to certain callers or not picking up the phone enough, some simple tools can be used to monitor their behaviour to ensure that everyone has your helpline’s goals in mind.
It’s important to keep in mind the legal implications of these tools; they should be used only with the knowledge of your workers and with clearly defined protocols for their implementation and execution.
Monitoring Computer Usage
For web browsing, a simple tool aptly called BrowsingHistoryView will help you see what workers are doing on your computers.
From their website: “BrowsingHistoryView is a utility that reads the history data of 4 different Web browsers (Internet Explorer, Mozilla Firefox, Google Chrome, and Safari) and displays the browsing history of all these Web browsers in one table. The browsing history table includes the following information: Visited URL, Title, Visit Time, Visit Count, Web browser and User Profile. BrowsingHistoryView allows you to watch the browsing history of all user profiles in a running system, as well as to get the browsing history from external hard drive.”
This software can be used to see the browsing history of workers in Centres where open access to the internet is permitted, and can also be used to see when workers started or stopped using their workstations if they are limited to browsing a helpline caller management system such as iCarol.
While you can use the history tools attached to each browser normally, BrowsingHistoryView simplifies the task by bringing all the data together in one dashboard view.
BrowsingHistoryView can show only a limited period of time or the entire browsing history chronologically.
Monitoring Telephone Usage
Installing a system like Chronicall can help you monitor when your telephone is in use. Essentially Chronicall is a server that monitors every call that comes into your Centre. Using their “Cradle to Grave” interface and the reporting options, you can see when workers stopped picking up calls, when they ignore calls from certain callers and whether they are fabricating any information about the calls they’re taking (such as taking calls from callers who are blocked from using your service.)
From the Chronicall website: ”As soon as Chronicall is installed, it begins recording detailed information about every call that enters or leaves your phone network. Cradle to Grave is an intuitive and simple way to view this information. It shows you exactly what happened to any call on your system from beginning to end.”
Monitoring Off-Site Usage
If your workers frequently take calls at an off-site location such as their home or an office not owned by you, tools such as Chronicall may be ineffective. In this situation, you can take advantage of additional call-forwarding technology.
For a small fee (the service I trialed for an unrelated usage was approximately $10 per month, plus the cost of calls), you can purchase a toll-free phone number (of the 1-800 or 1-855 variety.)
Traditionally when calls are taken at an off-site location, a dial code such as *73 (Star-Seven-Three) is used to forward the calls from your local number (say, 416-555-1234), to the offsite location (say, 416-555-6789).
Instead, use your Star-73 to forward to your recently purchased toll-free line, 1-800-555-1234. Then, the toll-free number is set to forward to the off-site location, 416-555-6789.
The result of this is that phone calls are received and recorded at the 1-800 number before being forwarded to the offsite location. Using the data provided by the 800 company, you can see the phone number and duration of the calls, allowing you to cross-reference them with the information provided by your worker.
The downside of this, for organizations who frequently engage in calltaking at off-site locations or who take long calls is that if local calls were previously not paid for by your organization, they now would be; this can add up to a significant expense. Your individual requirements will determine whether this is a problem or not.
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