In 2007, VA established the VCL, a 24-hour crisis line staffed by responders trained to assist veterans in emotional crisis. Through an interagency agreement, VA collaborated with SAMHSA to use a single, national toll-free number for crisis calls that serves both Lifeline and the VCL. Through this interagency agreement, VA and SAMHSA set out to establish a seamless crisis-management system through a collaborative and cooperative relationship between the agencies that would provide consistent suicide-prevention techniques to callers. The national toll-free number presents callers with choices. Callers are greeted by a recorded message that explains the function of the crisis line and prompts individuals to press “1” to reach the VCL. Callers who do not press “1” by the end of the message are routed to one of Lifeline’s 164 local crisis centers. All callers who press “1” are routed first to the VCL primary center. Calls that are not answered at the VCL primary center within 30 seconds of the time that the caller presses “1” during the Lifeline greeting are automatically routed to one of five VCL backup call centers. If a call is not answered by the VCL backup call center that initially receives it, the call may be sent to another VCL backup call center. VA entered into a contract with a firm to oversee the operations of the VCL backup call centers. There are a total of 164 Lifeline local crisis centers, 5 of which also serve the VCL. (See fig. 1.) The number of calls reaching the VCL has increased substantially since the VCL’s first full year of operation. Increases in the number of VCL calls received have corresponded with increased annual funding obligations for the VCL. (See fig. 2.) VA added online chat and text message capabilities to the VCL in fiscal years 2009 and 2012, respectively. The number of online chats and text messages handled by the VCL generally increased every year, though the number of online chats decreased in fiscal year 2015. (See fig. 3.) To determine how well VA performed against its goal for responding to VCL callers, we covertly tested the VCL’s call response time in July and August 2015. During this testing we found that it was uncommon for VCL callers to wait an extended period before reaching a responder since all of our calls that reached the VCL were answered in less than 4 minutes. According to VA officials, VA established a goal that the VCL primary center would answer 90 percent of calls to the VCL within 30 seconds. Our test included a generalizable sample of 119 test calls that can be used to describe all callers’ wait times when calling the VCL during this period. On the basis of our test calls, we estimate that during July and August 2015 about 73 percent of all VCL calls were answered at the VCL primary center within 30 seconds. (See fig. 4.) VA officials told us that, during fiscal year 2015, about 65 to 75 percent of VCL calls were answered at the VCL primary center and about 25 to 35 percent of VCL calls were answered at the backup call centers. These VA-reported results indicate that about 65 to 75 percent of VCL calls were answered within either 30 or 60 seconds. These results are consistent with our test results for July and August 2015. According to VA officials, VA attempts to maximize the percentage of calls answered at the VCL primary center because these responders have additional resources— including access to veterans’ VA electronic medical records—that are unavailable to VCL backup call center responders. All responders receive specialized training to assist callers in crisis. To improve its performance toward meeting the goal of answering 90 percent of calls at the VCL primary center within 30 seconds, VA implemented two changes in fiscal year 2015—namely, staggered work shifts for responders and new call-handling procedures. Staggered work shifts. VA implemented staggered shifts for responders at the VCL primary center on September 6, 2015. Staggered shifts are work schedules that allow employees to start and stop their shifts at different times as a way to ensure better coverage during peak calling periods. Specifically, it helps schedule more employees to work when call volume is highest and fewer employees to work when call volume is lowest. Additionally, staggered shifts help limit disruptions in service as responders begin and end their shifts. By comparing VCL telephone call data from September through December of 2014 to that of September through December of 2015, we found that VA’s implementation of staggered shifts at the VCL primary center had mixed results. Overall: The average percentage of calls answered per hour at the VCL primary center from September through December 2015—after staggered shifts were implemented—was 75 percent, slightly less than the average of 79 percent answered during the corresponding period in 2014 before staggered shifts were implemented. However, the VCL received an average of about 1.3 more calls per hour during this period in 2015 than it received during the corresponding period in 2014 and, according to VA officials, the VCL primary center employed fewer responder staff in 2015 than 2014. By day of the week: The average percentage of calls answered per hour at the VCL primary center increased on Mondays to 89 percent and Tuesdays to 83 percent after VA implemented staggered shifts, up from 78 percent and 79 percent, respectively, during the corresponding period in 2014. These increases suggest that staggered shifts may have helped VA answer more calls at the VCL primary center on these days because VCL call data from our analysis indicate that these days of the week typically experienced the highest number of calls prior to implementing staggered shifts, and VA officials told us that they used the implementation of staggered shifts to schedule more responders on these days. However, the average percentage of calls answered per hour at the VCL primary center decreased on Saturdays to 61 percent and Sundays to 70 percent after VA implemented staggered shifts, down from 78 percent and 80 percent, respectively, during the corresponding period in 2014. By hours of the day: VA answered a higher percentage of calls at the VCL primary center during the mid-day and evening hours after the implementation of staggered shifts. Specifically, from 11:00 a.m. to 4:00 p.m. and from 9:00 p.m. to 11:00 p.m. the VCL primary center answered a higher percentage of calls compared with the corresponding periods in 2014. However, VA answered a lower percentage of calls at the VCL primary center during overnight hours—midnight to 9:00 a.m.—and in the early evening—5:00 p.m. to 8:00 p.m.—compared to corresponding periods in 2014. To address staffing limitations and align the number of responders available for each staggered shift according to demand, VA officials said that VA planned to hire 63 additional responders for the VCL primary center in fiscal year 2016 and assign these new responders to weekend and evening shifts. This change would likely help improve the mixed results we identified in our analysis of VA’s implementation of staggered shifts for responders. As of February 2016, VA officials said that 22 applicants had accepted employment offers and that VA planned to extend employment offers to an additional 15 applicants. These officials also noted that recent attrition at the VCL primary center was largely due to VCL primary center responders being promoted into new positions at the VCL primary center or to VCL primary center responders leaving because their work with the VCL did not qualify as clinical hours required for licensure in their specialties. New call-handling procedures. VA implemented new call handling procedures at the VCL primary center beginning in June 2015 that provided responders with specific guidance to more efficiently handle “noncore” callers—those callers who were not seeking crisis assistance but rather seeking help with other issues, such as help with veterans’ benefits questions. For example, if a caller reached the VCL with a question about VA disability benefits, the VCL primary center responder would verify that the caller was not in crisis and transfer the caller to the Veterans Benefits Administration to address the question. VCL telephone call data provided by VA suggest that the average time VCL primary center responders spend handling noncore calls decreased by approximately 30 percent over a 5-month period after responder training began on these new call-handling procedures. We would expect that as the average time VCL primary center responders spend handling noncore calls decreases, these responders should have more time available to answer additional incoming calls. To determine the timeliness of the VCL’s responses to online chats and text messages, we conducted a covert test in July and August 2015 using nongeneralizable samples of 15 online chats and 14 text messages. All 15 of our test online chats received responses within 60 seconds, 13 of which were within 30 seconds. This result is consistent with VA data that indicate VCL responders sent responses to over 99 percent of online chat requests within 1 minute in fiscal years 2014 and 2015. VA officials said that all online chats are expected to be answered immediately. Although this is an expectation, VA does not yet have formal performance standards for how quickly responders should answer online chat requests and expects to develop them before the end of fiscal year 2016. However, our tests of text messages revealed a potential area of concern. Four of our 14 test text messages did not receive a response from the VCL. Of the remaining 10 test text messages, 8 received responses within 2 minutes, and 2 received responses within 5 minutes. VA officials stated that text messages are expected to be answered immediately, but, as with online chats, VA has not yet developed formal performance standards for how quickly responders should answer text messages. VA data indicate that VCL responders sent responses to 87 percent of text messages within 2 minutes of initiation of the conversation in both fiscal years 2014 and 2015. VA officials said that VA plans to establish performance standards for answering text messages before the end of fiscal year 2016.