Sometimes when supporting mental health in the community, we run into situations where a particular practice or program isn’t getting the results we’d hoped for, and where there aren’t any other tested or suitable alternatives. In these cases, we need to innovate – to try something new and different. In this story, we describe how the Distress Centre Calgary (DCC) did exactly that. Realizing their telephone-based teen distress line was underutilized, DCC decided to try something new, and became the first organization in Canada to offer an online peer chat and texting service for youth in distress, now known as ConnecTeen.
“We were the first in Canada. It was exciting!”
[Jerilyn Dressler, Executive Director, DCC]
The impetus for change: Low call volumes in a telephone-based teen distress line
The DCC introduced its telephone-based distress line for teens, called Teen Line in 1983. In 2009/10, the DCC reviewed its data regarding the nature and number of calls received by the program. They learned Teen Line was averaging less than 1000 calls a year – a fraction of the DCC’s total annual volume of 75-80,000 distress calls.
In reflecting upon the low call volumes for Teen Line, DCC leaders briefly contemplated shutting the program down. However, they agreed that supporting teens was critical and in fact, supports should somehow be broadened. Recognizing the growing preference of youth for online interactions, they decided to explore the notion of online chatting and texting.
Finding a workable solution and “just starting”
To inform this effort, the DCC scanned the literature to see what people in other jurisdictions were doing to support youth in crisis – and found very little of relevance. They did, however, discover a texting program in Reno, Nevada and contacted the program to learn how it worked. Deciding to implement something similar in Calgary, the DCC worked with their IT vendor to select a chat and texting interface. And that’s where the real learning – and the sharing of lessons learned with others – began.
Jerilyn: “There was nothing out there… There was very little of it happening across North America. So… we kind of just went into it and started learning for ourselves and started sharing what we were learning.”
“A whole new ball of wax”: Revisiting assumptions and changing course
The DCC started out small with online chats, and subsequently added texting. An initial assumption was that chat and text interactions could be managed in the same way as phone calls. But almost immediately, this assumption was shattered. Online chatting and texting with youth turned out to be a “whole new ball of wax” and it was clear that assumptions about how things would work, and implementation plans needed to be re-crafted. Here are four examples of how things needed to be changed.
- Expecting teens in high risk situations to phone the distress line was not realistic. It was originally planned that if teens were in a high-risk situation, they would be asked to phone the distress line. But it was soon learned that youth would not talk by phone – that’s why they were chatting or texting in the first place! And so, volunteers needed to learn how to support youth in high risk situations via the online environment rather than by telephone.
Jerilyn: “We thought we were just going to re-create what we do on the crisis lines on chat and text. Well, it was very, very different. It was so different. We were like, ‘If it’s a high-risk situation, we tell them to call the phone.’ We say, ‘No, you’re going to have to call the line.’…[Teens] wouldn’t do it. They would not do it. They don’t want to call; that’s why they’re chatting or texting… because they don’t want to pick up the phone and call. And that’s why we created the program. Why would we force them to phone? If there’s a high-risk situation, it just doesn’t make sense.”
- Building rapport in an online environment is different from telephone and appropriate language is important. Initially, DCC volunteers found it difficult to build rapport with teens in the online environment. This was largely because they were communicating too formally, using the professional language they’d been trained to use when documenting telephone distress calls.
Jerilyn: “Because we’re training people for professional documentation, they were not building rapport. Rapport was next to impossible to build online because they were very formulaic and using very perfect grammar – not reflecting peoples’ language back to them. We were taking the good things about peer support out of it by training them on professional documentation.”
Once this challenge was recognized, the DCC developed new communication tools and strategies (e.g., “tips and tricks”, a list of acronyms) and trained volunteers how to connect with people online. Volunteers were encouraged, for example, to reflect teens’ language back to them and to write in a conversational tone that would build rapport. Once this happened, they realized it was actually easier to build rapport with teens online.
Jerilyn: “It’s very, very different. Very different. Like, the use of short quick terms… the acronyms. We have a whole cheat sheet on the acronyms. It’s reflecting their language back to them, you have to somehow build rapport. And it’s actually easier when you know the tips and tricks, it’s easier to build rapport online.”
- Online chat and text conversations are more likely to be of a high-risk nature. Another early insight was that chat and text conversations were also much more likely to be of a high-risk nature. In fact, when the DCC analyzed data about ConnecTeen contacts, they found that chat and text conversations are over ten times more likely than phone conversations to be related to self-harm, and more than twice as likely to be related to suicide. This is related to what is known as the “online disinhibition effect”:
Jerilyn: “About 10 percent of our phone calls and about as high as 24 or 25 percent of our chats and texts are related to suicide. And it’s the online disinhibition effect.”
Jerilyn pointed out that in part, these results are related to the fact that youth are more likely to talk about self-harm and suicide, but even when age is accounted for, the percentage of contacts related to suicide and self-harm is still significantly higher in chat and text contacts than in phone contacts. What this has taught the DCC is that online chat and text are valuable toolsfor getting at risks that people often aren’t willing to talk about in person or by phone. The Centre suspects that youth who text and chat are not more likely to be suicidal, but rather that they’re just more comfortable talking about these matters online.
Jerilyn: “People are more likely to share more openly [online] because it’s less scary.”
- Chat and text conversations can be super-long. Another unanticipated consequence was that chat and text conversations can go on for hours. Having to stick with one conversation that could have prolonged periods of silence left volunteers bored and disengaged. They asked to be able to engage in more than one conversation at a time, but this didn’t jive with an established principle of “no juggling of text conversations” – one conversation at a time. But, in consideration of the volunteers’ request, the “no juggling” principle was revised to allow them to conduct two chats at a time. This has worked well to keep volunteers engaged and satisfied.
Jerilyn: “We said, ‘No juggling of text conversations’. Well, the volunteers were like, ‘Ugh’. They were so bored. If you have ever been to an empty restaurant, you get the worst service because the server is not engaged in what they’re doing. They’re chatting with the bartender, whatever. So, it was the same thing for our volunteers. They weren’t engaged… So, okay, you can do two chats at a time. And that actually really helped them get engaged.”
As the DCC continued to collect data about the number and nature of ConnecTeen contacts, and spoke with volunteers and staff about their experiences, a great deal of learning and troubleshooting occurred. Things that weren’t working well were identified and rectified, and today, the program runs smoothly.
- Today, peer support by phone, chat and text is available from 5 to10 PM, Monday to Friday, and from 12 PM to 10 PM Saturday to Sunday. Youth can contact the DCC during these hours to talk with highly trained youth volunteers.
- ConnecTeen volunteers offer a confidential and non-judgmental space for teens to talk about what is going on in their lives. They don’t tell teens what to do but rather, encourage them to make safe decisions; they often suggest connecting with a trusted adult. Volunteers will also connect teens to relevant resources if they want additional supports.
- Teens can also text or chat from 3 to 5 PM on weekdays, but during those times, adult volunteers or staff will respond.
- The telephone distress line is available 24/7 for teens but outside of peer support hours, adult volunteers answer the calls.
It’s working! Evidence from ongoing monitoring
- In 2017, demand for ConnecTeen services grew by 82% and demand for texting increased by 148% over the prior year.
- By 2018, demand had tripled from 2584 contacts to 7699. However, this massive increase appears to be an anomaly as the number of contacts in 2019 stabilized at 5528 total contacts.
- Nevertheless, in 2019, the number of ConnecTeen contacts was more than twice the number
of contacts in 2016.
Some other interesting statistics include:
- In 2019, 43% of all contacts came through text messaging and another 21% were through
the online chat feature.
- Text and chat conversations are 4 to 5 times longer than phone calls. More resources
(volunteers, computers, physical spaces) are required to manage this volume of contacts.
- Self-harm is a presenting issue on approximately 20% of all contacts. Anecdotally, many
youth use ConnecTeen as a coping method in place of self-harm.
- Approximately 3% of contacts in 2019 required emergency intervention to ensure the safety
of a service user.
Foundations of successful innovation and implementation
By “just starting” – just trying something new and collecting information about how things were going along the way, the DCC successfully innovated and implemented Canada’s first peer chat and text service for youth in distress. Here are some reflections on factors that seemed to promote the DCC’s success (and there are likely many others!).
- A culture of ongoing learning and improvement. Jerilyn notes that as a social work agency, the DCC has, “always been a teaching and learning agency that emphasizes human connection, supervision and reflection”. This culture seems to include some of the following key characteristics of psychologically safe organizations for learning: leadership that encourages and makes space for reflection and learning; openness to (and actively seeking out) new ideas; comfort with challenging assumptions; willingness to take risks, to experiment and to fail; and the ability to learn by doing.
- Consideration of the unique needs, concerns and preferences of teens. By recognizing teen preferences for communicating, the DCC was able to develop something that teens would actually use. And when they learned more about teen preferences for interactions (i.e., little or no interest
in using the telephone for high risk situations), they adapted their practices accordingly.
- Courage, patience and persistence. It took significant courage to try something almost entirely new and untested. Implementing chat and text was a difficult journey but the DCC found ways to address emerging challenges and better prepare volunteers for the nature of texts and chats, including their higher risk nature. Now, they are well-trained to manage these dynamics.
Jerilyn: “We knew we had to do this; this was a trend in communication, we should probably jump on that and be an early adopter. It was hard. I hope we did more good than harm in those early days. It was, at the time, very hard to build rapport because we hadn’t equipped people …we didn’t know the differences. We didn’t know how different it would be… Now we train people for that and prepare them for the higher risk nature of chats and texts…
We didn’t know any of this before we started. It’s like we went in totally blind. Went in like, ‘This is good to do because youth don’t like calling anymore and they want to text and chat so let’s go’, and it’s a totally different ball of wax.”
- Collection and use of data about services provided. Finally, the DCC is dedicated to collecting data about their services, and this data has been instrumental in guiding implementation and improvement efforts. Jerilyn explained that while personal information isn’t collected from ConnecTeen users, DCC volunteers and staff do record a “guesstimation” of age and the general nature of each conversation. This focus on data collection and analysis is part of the DCC’s culture of ongoing learning and improvement.