Safer Diversion: Adapting Scalable Crisis Response Interventions for People Involved in a Criminal Legal System Diversion Program
Phase: NA
Conditions: Suicide, Overdose Accidental, Overdose Antidote, Crisis Response Plan
Sponsor: RAND

Study Protocol with Statistical Analysis Plan and Informed Consent Form 
 
 
 
Last Updated: 11/3/2025

OVERVIEW OF STUDY PROCEDURES 
We will pilot test the acceptability and feasibility of peer support worker delivery of the combined 
CLF + THN intervention to adults involved in BCRI’s pre-booking diversion program (N = 30). 
RAND staff will train and supervise BCRI peer support staff in the delivery of the intervention. 
BCRI staff will recruit participants from the Law Enforcement Assisted Diversion program. Peer 
support staff will deliver the intervention; they will coordinate with BCRI’s 988 and harm 
reduction staff to ensure that study participants have the chance to practice utilizing crisis 
interventions (i.e., engaging in a practice 988 call and practicing naloxone administration steps). 
Participants will also have access to treatment as usual through the Law Enforcement Assisted 
Diversion program including trauma-informed intensive case management services.  
  
We will use a mixed methods approach for evaluating the CLF + THN outcomes and processes. 
We will use pre- and post-intervention surveys to assess the acceptability of the combined 
intervention from the perspective of service recipients. Other outcome measures will include 
changes in self-reported knowledge about crisis resources, barriers to the utilization of crisis 
resources, and likelihood of using crisis resources. Surveys will be delivered on BCRI devices 
through REDCap. Participants will receive a $30 gift card upon completion of the post-
intervention survey. 
  
Quantitative process measures of feasibility will include the number of trained BCRI staff, the 
proportion of eligible participants who agreed to participate in the pilot intervention, and the 
proportion of eligible participants who completed the pilot intervention. We will use semi-
structured interviews with BCRI staff who were trained in, delivered, or administered the 
combined intervention to evaluate its acceptability and feasibility from the diversion program 
perspective. We will also assess ways the diversion program could leverage or create data 
resources to identify and follow pre-booking diversion participants who may benefit from CLF 
and/or THN.  
 
EMERGENCY & DISTRESS PROCEDURES 
Interviews will occur by telephone, Zoom, or Teams, without any knowledge of where the 
interviewee is physically located. 
1.    DISTRESSED PARTICIPANT 
Distress related to the interview is possible, and expected to be mild and temporary.  Distress 
may be observed in the following ways: 
 
Interviewee becomes so emotional (angry, sad) that they are unable to continue the interview  
 
Interviewee becomes very withdrawn to the point they are not engaged in the interview 
 
You may say: “We appreciate your participation in this interview, as it will help us 
improve services at the clinic. However, I also would like to reiterate that your 
participation in this interview is voluntary and you can end at any time.  
 
Interviewee ends participation abruptly 
 
You may say or text/leave a message if they hang up abruptly: 

Thanks for doing the interview. It can be hard to talk about these kinds of things, but most people 
feel better pretty quickly.  Remember, you can always call 988 or text 741 741 for support that is 
available 24 hours a day and 7 days a week. 
2.    IMMEDIATE INTENT TO ENGAGE IN SUICIDAL BEHAVIORS 
If an interviewee indicates that they are currently considering killing themselves at that time, or thinking 
about taking their life, or have a current active death wish, research staff should immediately follow these 
procedures. 
  
Example of statements that meet this criterion include: 
“I’m thinking about suicide/killing myself/ending it.” 
“I feel like I want to kill myself.” 
“Nothing is going to get better, I hate this, I don’t want to live anymore” 
  
 
Record on paper verbatim what the respondent reported, and call consulting Co-Investigator as 
soon as possible (Julie Cerel at [phone number]). 
 
You may say to the participant: 
 “You said (repeat what they said).  
  
“Sometimes these thoughts and feelings are normal responses to what you experienced. However, 
sometimes these thoughts can lead someone to harm himself or herself.  I want you to make sure you are 
safe. Let me ask you some questions so we can figure out a plan to keep you safe. 
  
 
Assess risk using Columbia-Suicide Severity Rating Scale 
(https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Suicide-Risk-Assessment-C-
SSRS-Lifeline-Version-2014.pdf) or similar risk assessment questions. 
  
  
 
Depending on suicide risk assessment, discuss next steps: 
  
“I want to make sure you are safe.   
“Do you have a doctor / therapist you can call?” 
“Is there anyone with you that I could talk to, to help keep you safe?” 
[If none of these options seem to be working] “Can you go to the ER?” “Do you want to call 911 for 
immediate help?” [talk through steps] 

  
“I’d also like you to write down these numbers you can call so that you can talk to someone if you think 
you might hurt yourself later. 
  
 [Provide participant with the contact number for crisis text line repeat if they don’t have them handy 
from the interviewer, make sure they have a pen and are writing the numbers down,].   
  
“Will you call someone?” 
  
 
If interviewee has said it is okay, notify their clinician. 
 
If there is imminent risk to the interviewee (e.g., lethal means and imminent intent), call 911 to 
initiate a wellness check on the study participant, and stay on the call until help arrives.  Work 
with interviewee to restrict access to lethal means. 
 
File incident report and consult with HSPC (RAND IRB) to consider other steps. 
  
 
3. REPORTED CHILD ABUSE OR ELDER ABUSE 
No questions in the interviews ask directly about child abuse.  If an interviewee spontaneously 
reports that a child, elder, or dependent adult is currently being abused or has been abused in the 
past (including physical injury caused by other than accidental means, sexual abuse, sexual 
exploitation, other emotional abuse, unjustified punishment, and neglect that causes harm or 
threatened harm to the child’s health or welfare), interviewer should immediately follow these 
procedures: 
  
Record on paper verbatim what the respondent reported. 
  
You may say to the participant: 
“That worries me.  I want to make sure you/he/she is safe, so I’m going to talk about this with my 
supervisor so we can be sure everyone is safe.” 
  
Complete an incident report and call Child Protective Services if advised by HSPC to make a 
report. 
  
 

DATA ANALYSIS PLAN 
As described above, we aimed to take a mixed qualitative-quantitative approach to data analysis. 
We calculated descriptive statistics to assess participants’ perceptions of the intervention’s 
acceptability and appropriateness. We also calculated descriptive statistics to assess participants 
level of satisfaction with the intervention, knowledge about 988, and knowledge about naloxone. 
To assess changes in knowledge and comfort using 988 and naloxone, we conducted paired t-
tests with pre- and post-intervention survey measures. 
Our survey included several open-ended questions that solicited qualitative information about 
participants’ perceptions of the intervention and ways it may be improved. Few study 
participants responded to these items and the responses that were provided were very brief (e.g., 
one to two words.) While we planned to conduct a Rapid Qualitative Analysis of these data, we 
ultimately decided not to analyze this very limited set of data and to rely, instead, on quantitative 
assessments. 

CONSENT SCRIPT  
 
Introduction: You are being asked to participate in a new Crisis Ready Training and to 
complete two surveys about the training.  
  
Who are we? This research project is being conducted by RAND, an independent, nonprofit 
research organization. Researchers from the University of Michigan are also part of the 
research team.   
 
Purpose: Suicide and overdose are a serious problem in our community. The National Center 
for Health and Justice Integration for Suicide Prevention funded RAND to explore ways to test a 
training about two crisis resources called Crisis Ready training. The Crisis Ready training is 
experimental. You and about 30 other people who receive services from Baltimore Crisis 
Response, Inc are invited to participate in an evaluation of this training. We invite you to 
participate in and to complete two surveys that will ask about your knowledge, experiences, and 
opinions about the training. You will complete the surveys before and after the Crisis Ready 
training. 
 
Training Length: The Crisis Ready training will take about 45-60 minutes and the two surveys 
will take about 15 minutes each. 
 
Voluntary Participation: Your participation is completely voluntary, and you may stop at any 
time. There are no consequences for deciding not to participate, for skipping questions, or for 
deciding to stop the surveys after you begin. If you need to break off before completing the 
surveys, you can take a break and come back to it. If you decide to quit the training or the 
survey, the questions you have already answered will be retained.    
  
Incentive: You will receive a $30 Walmart gift card for completing the two surveys and 
participating in the Crisis Ready Training. You will receive the gift card after you finish the 
second survey. 
 
Privacy:  Some of the questions in the surveys will be personal. For your privacy, you may want 
to take the surveys where other people won’t see your paper. To protect your privacy, we won’t 
write down your name or any information that could be used to identify you. The information you 
share during the Crisis Ready Training or on the survey will be treated as confidential. However, 
if we learn that you are a danger to yourself or another person, or if we learn about abuse of a 
child or elderly person we may be required, by law, to notify someone who can help.  
 
This research project is part of the National Center for Health and Justice Integration for Suicide 
Prevention (NCHATS). The de-identified information in a final de-identified database will be 
shared with the NCHATS methods core (Michigan State University, Brown University, and 
Henry Ford Health System). This database may be used for future research studies or 
distributed to another investigator for future research studies without additional informed 
consent from you. Individuals with oversight of research responsibilities at RAND, our partnering 
institution Michigan State University (MSU) along with the funding agency the National Institute 
of Mental Health (NIMH) may have access to the research records.  
 
We may present findings from the surveys in scientific journals or presentations but we will not 
share your name or any other information that could be used to identify you. 
   

Risks of Participation:  The primary risk associated with this research project is a loss of 
confidentiality. We have taken many steps to protect your confidentiality (see above).    
 
The training and surveys talk about overdose and suicide prevention. Some people might find 
the training or the survey questions upsetting. These questions are included to make sure the 
survey will accurately measure the needs and experiences of people who participate in the 
training. If you become upset while completing the surveys, you can access support by calling 
988 to get information about crisis services.     
 Who do you contact if you have questions or concerns about the training or surveys?    
 
Questions about the overall project or RAND: Contact the RAND research team by 
emailing the project leads, Dr. Alison Athey at aathey@rand.org or Dr. Sapna Mendon-
Plasek at smendon@rand.org  
 
If you have questions about your rights as a research participant or need to report a 
research-related injury or concern, you can contact RAND's Human Subjects Protection 
Committee toll-free at (866) 697-5620 or by emailing hspcinfo@ rand.org . If possible, 
when you contact the committee, please reference research project 2024-N0187 .   
  
  
Do you agree to participate in the Crisis Ready training and surveys?