WEBINAR 3C SESSION

SAMHSA’s 988 Crisis Systems Response Training and Technical 

Assistance Center: Crisis Community Collaboration

January 16, 2024
Crisis Systems Response TTAC

The Substance Abuse and Mental Health Services Administration (SAMHSA) 

has selected Altarum to provide training and technical assistance support 

to states, territories, tribal organizations, and community partners across the 988 

Suicide and Crisis Lifeline and crisis continuum of care. Along with our partners, 

W2 Consulting Corporation and Change Matrix, LLC, who have extensive 

experience with crisis services, technical assistance, and health equity, the 

Crisis Systems Response Training and Technical Assistance Center (TTAC) was 

formed to support the continued growth of 988 Lifeline and build a more robust 

crisis care system.
Agenda

• Welcome

• Introductions

• Updates from the 988 & Behavioral Health 

Crisis Coordinating Office

• Equity Update

• Thought Exchange Session

• Technology Update

• General Communications Update

• Mindful Minute

• Moderated Question & Answer session 

related to the information shared

• Time for reflections about webinars and 

activities within the last month

• Preview of activities to come
SAMHSA 988 & BHCCO Leads

Monica Johnson, M.A., 

LPC

Director of the 988 & 

Behavioral Health Crisis 

Coordinating Office

John Palmieri, M.D., 

M.H.A.

Deputy Director of the 988 & 

Behavioral Health Crisis 

Coordinating Office

Jill D. Mays, M.S., LPC

Division Director of Crisis 

System Transformation for 

the 988 & Behavioral Health 

Crisis Coordinating Office

Charissa Pallas

Division Director of 

Communications for the 988 

& Behavioral Health Crisis 

Coordinating Office
Guest Speaker

Laura House. Ph.D., M.S.W, 

LCSW-C

Engagement & Equity Officer 

for the 988 & BHCCO, OAS

• Dr. Laura House is the Equity and Engagement Lead for the 988 and Behavioral Health Crisis Coordinating Office (988 & 

BHCCO). In this role, she is a senior advisor to 988 & BHCCO senior leadership on equity and strategic engagement efforts. 

Throughout her federal career, Dr. House has managed large-scale strategic planning, national program evaluations, research, 

performance management, information dissemination, technical assistance, training, engagement, partnership, and coalition 

building efforts, grants, and contracts certified as a Contract Officer Representative-Level III. 

• Prior to her current role at SAMHSA, Dr. House served as the Region 3 Regional Administrator at the Administration for 

Community Living (ACL) representing the ACL Administrator in providing oversight to states and areas and conducting 

engagement, partnership and coalition-building, and grant oversight and support. Subsequently, she served as a Senior 

Management and Program Analyst in the Center for Policy Evaluation in ACL leading the development of a national 

performance reporting system for grantees, provision of technical and programmatic training and guidance to stakeholders 

nationally, and the agency-wide learning agenda. 

• Dr. House began her federal career at SAMHSA in the Center for Substance Abuse Treatment as a Public Health Advisor 

and Public Health Analyst and then joined the federal Pretrial Services Agency as a Senior Management and Program Analyst 

and Team Lead managing program evaluations, performance management, and agency-wide strategic planning efforts. Laura 

has also worked detail assignments at ASPE, OMB, and CDC supporting key projects, including the current HHS strategic plan, 

the implementation of the GPRA Modernization Act, and a community monitoring study for a HIV/AIDS clinical trial in Botswana,

Africa. 

• Dr. House received her Ph.D. from Howard University, M.S.W. from the University of Pennsylvania, and B.A. from The 

American University. She was a Minority Fellows Program (MFP) Pre-Doctoral Fellow and a National Institute on Drug Abuse 

Post-Doctoral Research Fellow and Investigator at Washington University in St. Louis, MO where she focused on health 

disparities in behavioral health service utilization. Licensed as a Clinical Social Worker (LCSW-C), she has worked as a clinician 

and direct practitioner during her career and is currently an Adjunct Professor at a local university. She resides in Washington, 

D.C. with her family.
Guest Speaker - Elizabeth

Elizabeth Waetzig, J.D.

 Managing Partner, Change 

Matrix

• Ms. Waetzig is a Founding and Managing Partner with Change Matrix, LLC, a minority- and 

women-owned small business that motivates, manages and measures change to support 

systems that improve lives. She partners with individuals, organizations and systems as they 

define, create, measure, and sustain change. She brings substantive experience in the areas 

of children’s mental health, a public health approach to mental health, early childhood 

systems, culturally responsive and equitable evaluation, child welfare, cultural and linguistic 

competence, conflict engagement, change management, youth engagement and systems 

building.

• Currently Ms. Waetzig serves as the Field Director for the National Technical Assistance and 

Training Center for the Mental Health of Children, Youth, and Families and serves on the 

Leadership team for the Early Childhood Systems Technical Assistance Coordinating Center 

in addition to supporting the work of other training and technical assistance centers. She also 

co-directs Expanding the Bench and Transforming Academia for Equity.

• Ms. Waetzig is particularly focused on leadership in change, has developed a leading through 

change framework used across multiple initiatives and has managed the Collaboration LAB 

since 2009 to increase the capacity of individuals and organizations to collaborate, uniquely 

tailoring support to build their collaborative structure, conflict engagement interventions to 

repair their structure and coaching to further the growth and learning from training.
Guest Speaker - Stephanie

Stephanie Grosser, MA

Technology Lead for 

the 988 & BHCCO, OAS

• Stephanie Grosser (she/her) is the Technology Lead of the 988 & Behavioral Health Crisis 

Coordinating Office. Stephanie previously served at the US Digital Service (USDS) from 2015-2023 

delivering improved digital products and policy improvements across several large departments 

including the State Department (PRM), the Small Business Administration, and the Department of 

Homeland Security (USCIS). Stephanie finished her term within OMB’s Federal Workforce Branch 

leading a hiring reform team in partnership with OPM working to build and implement modern tech and 

new policies to ensure only qualified applicants make it through the federal hiring process.

• Prior to serving at USDS, worked at the U.S. Agency for International Development (USAID) from 

2010-2015 as Senior Advisor for Technology, Data, and Communications. In that role she launched 

open data initiatives involving crowdsourcing the geocoding of critical datasets, ran real time 

evaluations using instant feedback through mobile devices, and partnered with the United Nations 

Global Pulse to use big data to inform future USAID programing. While at USAID, Stephanie served a 

6-month detail to OMB’s Office of the Federal CIO to launch the federal Open Data Policy. She began 

her federal career as a Presidential Management Fellow.

• Prior to joining the U.S. Government, Stephanie spent 5 years as the Assistant Director of the 

Hebrew Immigrant Aid Society (HIAS) as an advocate for comprehensive immigration reform and the 

leader of the Interfaith Immigration Coalition. She received her Bachelors in Foreign Service from 

Georgetown University and her Masters in Government from Johns Hopkins University. She lives in 

Bethesda, MD with her husband and two children. 
SAMHSA’s Priorities 

 

Equity 

Trauma-Informed Approaches 

Commitment to Data and Evidence 

Recovery 

SAMHSA’s 

Priorities 

Preventing Substance 

Use and 

Overdose 

Promoting Resilience 

and Emotional Health 

for Children, Youth, 

and Families 

Enhancing Access to 

Suicide Prevention 

and Mental Health 

Services 

Integrating Behavioral 

and Physical 

Healthcare 

Strengthening the 

Behavioral Health 

Workforce 
Equity Update 

With Dr. Laura House

Engagement & Equity Officer for the 988 BHCCO, OAS
Why Equity Matters?

• Health disparities

• Differences in access, quality, diagnosis, and treatment 

• Structural barriers and inequity

• Historically marginalized, underserved, under-resourced 

communities

• Social Determinants of Health (SDOH)

• Healthy People 2030
Defining Equity in 988 & Crisis Care 

Equity is:

The right of all individuals, regardless of race, age, ethnicity, gender, disability, 

socioeconomic status, sexual orientation, or geographic location, to access highquality and affordable crisis care services and support. 

Crisis services are for anyone, anywhere and anytime. 

Priority Populations 

• American Indian/Alaska Native

• Asian American, Native Hawaiian, and Pacific Islander

• Black/African American

• Hispanic/Latino

• Lesbian, Gay, Bisexual, and Transgender, Queer, and Intersex (LGBTQI+)

• Older adults

• People with intellectual and developmental disabilities 

• Deaf and Hard of Hearing 

• Rural adults
Vision for Equity in 988 & Crisis Care

• 988 & BHCCO envisions that all populations, regardless of 

demographics or unique intersectionality’s, experiencing 

crises should have someone to talk to, someone to respond 

to, and a safe place for help. This aligns directly with 

SAMHSA’s vision and the inclusion of equity as a priority in its 

strategic plan.
Building an Equitable Crisis System

• Addresses social determinants of health

• Focuses on a social-ecological approach to interventions to enhance equity (e.g., system level, community and 

institutional, individual, and interpersonal)

• Improves access

• Increases integrated care settings and training opportunities

• Increases crisis and community services

• Partners with community-based programs

• Forms community coalitions

• Provides culturally and linguistically appropriate services

• Focuses on pipeline development

• Prioritizes workforce development

• Provides provider education (e.g., bias, reducing disparities, standardized tools, communication, structural 

competency training)

• Focuses on patient interventions (e.g., anti-stigma, health literacy, patient empowerment)

• Alves-Bradford, J.M., Trinh, N., Bath, E., Coombs, A., Mangurian, C. (2020). Mental Health Equity in the 20th Century. 

Psychiatric Clinics of North America 43, 415-428. 
988 Lifeline: Expanding Access

Increased support for priority 

populations 

• Spanish text and chat services, where Spanish 

speakers in crisis can reach trained, culturally competent 

crisis counselors.

• Specialized call, text, and chat supports for LGBTQI+ 

youth and young adults under the age of 25.

• American Sign Language (ASL) and Videophone 

services for people who are Deaf or hard of hearing and for 

whom videophone is a preferred method of communication.

• Dedicated, culturally competent services for American 

Indians and Alaska Natives.
988 & BHCCO Equity Activities 

• Planned 988 & BHCCO Equity Activities in 2024:

• Quarterly Equity Webinar Series

• Equity Learning Collaborative

• Equity Convening

• Summary Report of Learning 

• Historically Black Colleges and Universities, Hispanic-Serving 

Institutions, National Pan Hellenic, and Faith-Based Targeted Efforts

• Listen and Learn Sessions
Thought Exchange Question

What are the most important 

factors to overcome when 

embedding equity in your 

crisis system?
Thought Exchange Process

1) The first step is to share your thoughts to the following question:

What would effective communication and collaboration look like between systems on Federal, State, 

Lifeline, and Local levels for crisis response systems?

2) The second step is to star the thoughts of others.

Ideally you will star 30 thoughts strongly disagree strongly agree

Share as many thoughts as you would like and know that you will remain anonymous. 

As thoughts are shared and starred, they will be organized by theme. The data will show thoughts that 

were offered by the most people and thoughts that rated highly. This gives us thoughts that are shared 

less, but very important.
Technology Update

With Stephanie Grosser

Technology Lead for the 988 & BHCCO, OAS
Geo-routing vs Geo-Location

Geo-routing vs Geo-Location

Geo-routing is a way of directing phone calls locally without including the 

precise location information in the transferred call data. If used, it would 

mean that when a person calls the 988 Lifeline, their call would be 

connected to a crisis center near their physical location. With geo-routing, 

the routing and service providers would not receive detailed information 

about the exact locations of callers.

Geo-location, or automated location information, would include the precise 

location in the transferred call data, so that emergency responders could 

know where to go in case of an emergency.
Pilots and Testing

Pilots and Testing 

Summer 2023

We successfully completed the first test of a geo-routing 

solution with a major wireless carrier. 

We explored other solutions as well to the one we tested in the 

pilot but did not think those solutions were as accurate as this 

solution.
Promising Proof of Concept

Promising Proof of Concept 

The 988 Lifeline has successfully tested a potential solution to route wireless 988 calls to a crisis call center 

near the caller rather than by their phone’s area code. Improved accuracy, as shown in the flow below, is 

achieved when the caller’s cell-site location is translated into a destination code that is used by the 988 

network to select the geographically appropriate 988 center to handle the call.

Caller 

dials 988 

on their 

wireless 

network

Carrier 

generates 

cell-site 

location 

data

Intrado 

translates cellsite data into 

wire-center 

boundary

988 uses 

destination 

code to route 

to the nearest 

crisis center

Requested Format:

Field: PAI portion of the SIP header

Mapping (geographic boundary): NPA-NXX (area code and exchange)

Base for mapping: wire center

Data format: Start with X-988 then 999 to indicate destination code 

followed by 10 digit NPA-NXX area code and exchange. Example: X988: 999 360 436 0000
Translating geographic data into wire-center boundary data

Translating geographic data into 

wire-center boundary data

No precise caller data is 

conveyed to the 988 network
Tested Solution

Tested Solution

In Scope:

988 wireless calls (77%)

Out of Scope:

10 digit numbers (23%)

VOIP

Text to 988

Roaming calls

Other lifeline numbers (Spanish 

10 digit, and 1800 SUICIDE)

Lessons Learned:

1) We can translate location data

into boundary level data for

privacy protections for closer

geographic routing.

2) This test involved one

wireless carrier. The results will

aid further work with service

providers/carriers.

3) Roll out of this solution would

be gradual and we are

inviting invite carriers across the

country to join us in the process.
FCC sent industry a letter to test: 9/28/23

FCC sent industry a letter to test: 9/28/23
Active Testing Underway: Changes to our Network

Active Testing Underway: Changes to our Network

- Since that time, 3 major carriers who cover about 95% of 

the country have been working with SAMHSA and Vibrant 

Emotional Health to test the technologies of translating cell 

tower information to a larger geographic area within their 

networks. 

- This testing revealed that 988 network upgrades were 

needed as well. Those upgrades are underway.
Expectations on Roll out

Expectations on Roll out

- Our network plans to activate geo-routing on a carrier-bycarrier basis as testing is completed. 

- Once a carrier is ready to activate, they may select to 

activate on a rolling basis across the country to mitigate risk.
Expectations on Volume Shift

Expectations on Volume Shift

- Since the roll out will be carrier by carrier, the volume 

change impact to any given center will be gradual rather 

than all at once.

- Vibrant is looking into volume shift predictions and analysis 

over the next several months.
Looking forward

Looking forward

- We’ve already started conversations with some of the 

carriers on geo-routing for SMS. That is an entirely different 

track. 

- We’ve postponed conversations on geolocation until we 

have geo-routing activated for the entire network. 

- However, moving calls in-state and streamlining parts of the 

PSAP emergency loop up process should save time in case of 

emergencies. 
IVR Changes

Pre-Routing

New Voice

Press 0 to bypass

Reduced length

Tweaked language

Expanded access 

for LGBT 

Eliminate excessive 

pauses

Post-Routing 

New music 

Set expectations

Expanded spacing 

between messages

Affirming messages

Offered resources 

(chat, text, 911)
Initial integrated voice response scripts: Current vs. new

Previous version Jan 4th version

You’ve reached the 988 Suicide & Crisis Lifeline.

We are here to help.

Para espanol oprima el numero dos.

To reach the Veterans Crisis Line if you are a US Veteran 

or service member or are calling about one, press 1.

To connect to specialized support for LGBTQ+ under the 

age of 25, press 3

Otherwise please remain on the line while we route your 

call to a Lifeline crisis counselor.

Your call may be monitored and recorded for quality 

assurance purposes.

You’ve reached the 988 Suicide & Crisis Lifeline.

Para español marque el numero dos.

To reach the Veterans Crisis Line, if you’re a US 

Veteran or service member or are calling about one, 

press 1. 

To connect to support for LGBTQI+ youth and young 

adults, press 3.

Otherwise, to talk with a counselor, stay on the line or 

press 0.

To improve 988, your call may be monitored and 

recorded.
Pre-Chat Survey: Optional vs Required
Communications Update

Communications Update

With Charissa Pallas

Division Director of Communications for the 988 & BHCCO
988 Social Media Awareness Campaign

• 988 paid media campaign to run from Jan. 9 – Feb. 

23, utilizing videos and graphics that highlight the 

Reasons to Connect to 988.

• Running on Meta (Facebook and Instagram), 

Snapchat, YouTube, and TikTok and have an 

estimated reach of over 87.5M.

• Focus on the audiences included in the 988 formative 

research:

• AI/AN youth and young adults

• AANHPI youth and young adults

• Black youth and young adults

• LGBTQI+ youth and young adults

• Hispanic youth and young adults

• Middle-aged white men
Mindful Minute
Upcoming

Webinar Series:

•“Embedding Equity Across the Crisis System Response 

Continuum”

•January 31, 2024, at 1:00 pm EST.

•“Connecting to Serve: Promising Practices for 988/911 

Collaboration”

•February 15, 2024, at 1:00 pm EST.

“3C” Session: February 20 @ 2:00-3:00 PM EST

Policy Academy: April 1-2 in Tucson, Arizona
Upcoming (cont.)

Webinar: “Celebrating Black History Month: Behavioral Health Equity Best 

Practices for African Americans”

•February 5, 2024, at 1:30 pm EST

•Registration available soon
Policy Academy 2024

Title: Crisis System Design for States/Tribes/Territories

Objective: To support States, Tribes, and Territories in coalition building, role 

clarity, and application of systems engineering/design principles to develop 

and improve policies and practices in the design of Crisis Systems

Location & Dates: April 1-2 in Tucson, Arizona

Travel Accommodations: To be supported through the 988 CSR TTAC

Application: Can be found using the QR code to the right! Policy Academy 

Information and Application
Contact Information 

SAMHSA’s 988 CSR TTAC

• support@988crisisttac.org

• 844-464-8338 (toll free)

Subscribe to the CSR-TTAC contact list to get the 

latest 988 news and invitations to our events, or 

use the QR code to the left: 

https://lp.constantcontactpages.com/sl/aUMAyq2

Crisis Systems Response Training and Technical Assistance | SAMHSA

This project is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. The Crisis 

Systems Response Training & Technical Assistance Center works in conjunction with the 988 Suicide & Crisis Lifeline. In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. SAMHSA sees 988 as a 

first step towards a transformed crisis care system in America. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of SAMHSA or the 988 Suicide & Crisis Lifeline.