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<!DOCTYPE HTML>
<html>
<head>
<title>ISACC CARING CONTACTS</title>
<meta charset="utf-8" />
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<body class="is-preload">
<!--Menu-->
<section id="sidebar">
<div class="inner">
<nav>
<ul>
<li><a href="index.html" class="smooth-scroll-middle" style="text-decoration: none;">Home</a></li>
<li><a href="GDM1.html" class="smooth-scroll-middle" style="text-decoration: none;">Caring Contacts</a></li>
<li><a href="CCguide.html" class="smooth-scroll-middle" style="text-decoration: none;">Practical Guide</a></li>
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<input type="checkbox" />
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<span></span>
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<ul id="menu">
<li><a href="index.html" class="smooth-scroll-middle" style="text-decoration: none;">Home</a></li>
<li><a href="GDM1.html" class="smooth-scroll-middle" style="text-decoration: none;">Caring Contacts</a></li>
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<!-- Sidebar2 -->
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<div class="inner">
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<ul>
<!--<li><a href="#welcome">Welcome</a></li>-->
<li><a href="#Schedule">1. Structure Caring Contacts Intervention</a></li>
<li><a href="#Schedule">— Identify Recipients</a></li>
<li><a href="#Schedule">— Delivery Platform</a></li>
<li><a href="#Schedule">— Identify Staff </a></li>
<li><a href="#Schedule">— Intervention Length</a></li>
<li><a href="#Delivery">2. Develop Message Schedule</a></li>
<li><a href="#Delivery">— Identify Recipients</a></li>
<li><a href="#Delivery">— Tailor Messages</a></li>
<li><a href="#Delivery">— Frequency</a></li>
<li><a href="#Delivery">— Schedule Builder Tool </a></li>
<li><a href="#Start">3. Delivery Platform</a></li>
<li><a href="#Start">— Options for Implementation</a></li>
<li><a href="#Start">4. Start Intervention</a></li>
<li><a href="#Delivery">— Assign Roles</a></li>
<li><a href="#Delivery">— Identify and Enroll Recipients</a></li>
<li><a href="#Run">5. Running Intervention</a></li>
<li><a href="#Delivery">— Replies from Recipients</a></li>
<li><a href="#Delivery">— Responding to Recipients</a></li>
<li><a href="#Delivery">— Crisis Response Plan</a></li>
<li><a href="#Delivery">— Quick Reference Guide</a></li>
<li><a href="#End">6. End Intervention</a></li>
</ul>
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</div>
</section>
<!-- Wrapper -->
<div id="wrapper narrow" class="divided" style="width: 80%;">
<!-- One -->
<section class="wrapper style1 content-align-left">
<div class="inner">
<h2> </h2><h1>Practical Guide to Sending Caring Contacts </h1>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="Delivery">
<h2>1. Structure your Caring Contacts intervention to fit your organization</h2>
<h3>Identify who will receive the Caring Contacts intervention </h3>
<p>Your organization will need to decide which of your clients/patients should receive the intervention – that is, who are the “recipients” of the Caring Contacts. This will be highly dependent on the population you serve and what their needs and desires are.</p>
<p>Perhaps,</p>
<ul>
<li>You want to send them to individuals tied to a particular event (e.g., patients who are discharged from the hospital, clients who completed behavioral health treatment, veterans who stopped attending programming, first responders working during a pandemic, a service member who seeks help with suicidal thoughts)</li>
<li>You might want to send them based on a rating scale or measure of stress or distress (e.g., veterans who are unemployed or unhoused, patients who report depression or suicidality on a rating scale, staff who report high burnout) </li>
<li>You might want to send them to all participants in your program or at the completion of your program (e.g., send to veterans after a women’s retreat for PTSD, patients after an intensive outpatient or partial hospitalization program, crisis line callers, Employee Assistance program for burnout) </li>
<li>You might want to send them to people who were uninterested or unable to participate in treatments you recommend (e.g., patients experiencing suicidality but uninterested in psychotherapy or medications, rape survivors who could come to treatment any time but can’t face it right now) </li>
</ul>
<p class="major"><b>The Caring Contacts Intervention can be implemented via emails, texts, physical mail, and phone calls. Digital options such as email and text are familiar to the recipient and are easy to track.</b></p>
<p>While it can be more cost-efficient and timesaving to send Caring Contacts through email or texts, it has been theorized that physical mail might carry a certain emotional impact that digital communication does not. While phone calls have been previously tested, they require a greater workload for the organization and can lead to conversations that veer away from the Caring Contacts message. Our team has found that the majority of participants prefer to be contacted via written communication.</p>
<div class="index align-left">
<section>
<header>
<h4>How do you want to send the messages?</h4>
</header>
<div class="content">
<ul>
<li>Best evidence is for postal mail and text messages</li>
<li>Study with email was not successful; perhaps because email has become more about business communication, bills, and spam and less about personal communication</li>
<li>Medical systems have considered using eCare, MyChart, or similar options to send the Caring Contacts, which to them seems simple and appealing, but for the recipient, is neither. They will get a message that requires them to login to the system only to arrive at a message that says, “Hope you are doing well.” We doubt that recipients will have the simple positive response that is intended after the trouble of typing the login and password (especially on their phones), and we suspect they might just stop opening eCare messages.</li>
<li>Phone calls are tricky – if you don’t get voicemail then you are now in a conversation that can quickly (and naturally) veers to other things than the caring message. </li>
</ul>
</div>
</section>
<section>
<header>
<h4>What platform will you use to track and send the pre-programmed messages?</h4>
</header>
<div class="content">
<ul>
<li>Text messages can be sent through a web-app that sends pre-programmed messages on schedule</li>
<li>Postal mail can be tracked with an excel sheet and staff to keep track of when to send letters by hand </li>
<li>Postal mail can also be tracked in an app and pre-programmed letters send via a contract with a postal service </li>
</ul>
</div>
</section>
<section>
<header>
<h4>How do you want to manage replies from recipients?</h4>
</header>
<div class="content">
<ul>
<li>Postal mail can include either a self-addressed stamped envelope or a phone number included if the person wants to respond </li>
<li>Text messages can be sent through a web-app that receive replies and through which you can respond </li>
<li>You can tell them you cannot respond – but this is not recommended as likely to feel less caring and, to date, no study has shown a benefit to this method</li>
</ul>
</div>
</section>
</div>
<h3>Identify who will author the Caring Contacts intervention </h3>
<p>Your organization will also need to decide who will send the Caring Contacts to the recipients, that is, who are the “authors” of the Caring Contacts.</p>
<ul>
<li>You might be considering having authors sending Caring Contacts to their own patients or clients with whom they are working. <b>Don’t Do It!</b> It's a good idea in theory, but it falls apart when you consider how well pre-programmed messages—set up days, weeks, or even months in advance—would need to align with your actual interactions with the recipient.</li>
<li>Can you imagine having an emotional therapy session or having to say “we can’t do that” to a veteran for something that is beyond the scope of your program and then having a pre-programmed message arrive that day from you saying “Just wanted to text you a big HELLO. Hope your day is going well!” </li>
</ul>
<div class="index align-left">
<section>
<header>
<p class="major">Caring Contacts are best sent as a stand-alone intervention by the author.</p>
</header>
<div class="content">
<p>The author has no other ongoing relationship with the recipient – they are an independent person who is there just to be support and connection. This is what the successful research on Caring Contacts is based on. </p>
<p>It is reasonable that using Caring Contacts as aftercare for a hospitalization or outpatient treatment would also be effective where the author knows the recipient but isn’t otherwise interacting with them </p>
</div>
</section>
<section>
<header>
<p class="major">It doesn’t take much time to implement Caring Contacts so one author can serve many recipients.</p>
</header>
<div class="content">
<p>In a large organization with thousands of patients or clients, a substantial amount of staff time might be given to one or two people to program, send, and respond to Caring Contacts with hundreds of recipients </p>
<p>In a small organization with closer to 50 or 100 likely recipients, this could take just a few hours per week for one person. </p>
</div>
</section>
<section>
<header>
<p class="major">Caring Contacts Authors don’t need a clinical degree or experience.</p>
</header>
<div class="content">
<ul>
<li>Each organization needs to use their judgment on authors based on their context and staff</li>
<li>Research assistants supervised by a psychologist sent the original model of Caring Contacts, and this has been replicated in other Caring Contacts studies that have demonstrated success </li>
<li>Peers, mentors, leaders, or elders within a community might be much more powerful and meaningful authors from the recipient’s perspective </li>
<li>The vast majority of replies to Caring Contacts are positive (e.g., thanks to much, 😀, or “same to you”), with some statements of distress that don’t suggest a crisis (e.g., things aren’t great – got laid off) or requests for resources </li>
<li>Across multiple studies, crisis replies or “suicide note” replies occur extremely rarely (less than X%), so they can be handled in consultation with a clinician who doesn’t need designated effort to the Caring Contacts program </li>
</ul>
</div>
</section>
<section>
<header>
<p class="major">Senders – when someone other than the Author does the work to send the Caring Contacts</p>
</header>
<div class="content">
<p>In large systems like the VA, an administrative or other assistant (the “sender”) can support clinicians who are Authoring messages. This can look like addressing and stamping postal mail, setting up mail merges to send all the messages for that day, programming the messages for new recipients into an Excel sheet or online messaging platform, etc. </p>
<p>Technology can replace this effort as described in our messaging platform </p>
<p>If someone is assigned as the Sender, there needs to be a plan for how the Author receives replies and responds. Will the Author dictate their response for the Sender to send, or will replies go directly to the Author’s phone? There are several options. </p>
</div>
</section>
</div>
<p>Regardless of whether Caring Contacts are pre-programmed and sent by a Sender or technology, you will need to establish processes for the Author to stay engaged. You will want a way to alert them when they are sending what messages, so they are ready for possible replies. For instance, an email that says, “You are sending 4 messages today; click here to see what is being sent to whom” </p>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="Schedule">
<!--<h2>Big Picture Overview of Steps to Implement Caring Contacts:</h2>
<ol>
<li>Develop the Message schedule</li>
<li>Decide how to deliver the messages</li>
<li>Start the intervention</li>
<li>Running the Intervention</li>
<li>End of intervention plan</li>
</ol>-->
<h2>2. Develop the Message Schedule</h2>
<h3>Decide how long and how often the messages will be sent</h3>
<p>You’ll need to decide how many messages to send, how often to send them, and for how many months or years. These are your choices; there is no single standard.</p>
<ul>
<li> Based on our interviews with Caring Contacts recipients in research studies, they report being happy with the number of messages they receive, whether 11 or up to 25. </li>
<li>Typically, organizations send between 8 and 25 messages over the course of 6 to 18 months, but we recommend a minimum of 12 months. </li>
<li>Consider more frequent messages at the beginning and tapering off toward the end (e.g., Next Day, then Month 1, 2, 3, 4, 6,8,10, 12 and their birthday) </li>
<li>Consider the message form. Text message schedules might feel more comfortable if sent more often at the start (e.g., weekly) than postal mail. </li>
<li>For suicidal recipients, we recommend a message soon after identification for the program (e.g., after an initial meeting or assessment with the Author), such as the next day or next week. In previous studies where the first message arrived a month later, some suicidal recipients had already re-attempted before the intervention could reach them. </li>
</ul>
<h3>Principles of Non-demanding Caring Contact Message Content</h3>
<p>You should develop your own messages to ensure that they appropriately reflect and respect your local culture(s) and context(s). Here are some thoughts to consider:</p>
<p>First, we emphasize a personal connection as much as possible.</p>
<ul>
<li>This is admittedly a tricky task as many organizations have implemented Caring Contacts with pre-scheduled message systems and/or staff send Caring Contacts to those they don't know. </li>
<li>Taking time to compose a few genuinely compassionate messages will go a long way toward building rapport.</li>
<li>We try to avoid saying, "I hope your day is going well," as it can feel very surface-level and could sound like something routine tacked onto the beginning of an email.</li>
<li>We don't want to assume that their day is going well. The recipient might be having an awful day, and getting a "hope you're well" message could make them feel worse!</li>
</ul>
<p>Second, in following the principle of being non-demanding, we keep the messages to kind reminders that we are thinking of them and emphasize care, support, and inclusion. </p>
<p>This follows Motto’s 4 key principles described in the <a href="GDM1.html" target="_blank">background section</a> to be true to the Caring Contacts model</p>
<p>Avoid messages that ask or demand anything.</p>
<ul>
<li>For example, advice like “be kind to yourself” or “exercise can be helpful” may be said with supportive intent but is often are experienced by stressed or distressed individuals as <i><b>demands</b></i> – “if I could be kind to myself, I wouldn’t be suicidal” or “as if I’m not stressed enough - now I’m supposed to exercise?!”).</li>
<li>Similarly, appointment reminders can often distract from the Caring Contacts message or a reminder of something they don’t want to or must do. </li>
</ul>
<p>We have found that authors often feel compelled to make their messages longer or “more meaningful” in some way, but it is unclear that doing so makes for a better message.</p>
<ul>
<li>Longer Message Example: “We delight in the beauty of the butterfly, but rarely admit the changes the butterfly had to go through to achieve that beauty.” - Maya Angelou. We, too, go through many changes. Hope you are having a good day. - Sasha </li>
<li>Shorter Message Example: [name], you have overcome so much! I believe you’re going to do great things! - Alan </li>
</ul>
<p>Rather than sending “I hope you’re well”, emphasize what you know to be true: </p>
<ul>
<li><b>You care about them, and you are there for them.</b></li>
<li>Consider doing this rather than just saying, "hope you're good!" or even, "I want <i>you</i> to believe in <i>yourself</i>," which puts the onus on them. </li>
<li>We've often gotten positive responses to messages that acknowledged how things might be hard, or that they might be going through a tough time, but that we <i>believe</i> in them.</li>
</ul>
<p>Here are some ideas that we have found helpful in crafting Caring Contacts:</p>
<ul>
<li>The general approach in Caring contacts is to welcome and invite replies to messages but not to expect or demand this – so you may want to include comments such as, “if you would like to respond, I’d be happy to hear from you” or equivalent in various messages from the pre-programmed list. </li>
<li>Depending on the constraints of your chosen implementation platform, we encourage you to ask the recipient to respond to their first message so you know they received it and can reply. Then, you can, in turn, respond with an individualized response to demonstrate that you can receive and will respond personally to their messages. </li>
<li>As this is a request, it should be considered in terms of Motto’s principles. We believe the benefit of them seeing the two-way communication in action is worth the small demand for text messaging platforms. </li>
<li>However, to minimize the demand, we do not remind recipients to reply to the first Caring Contact (beyond the original request to confirm receipt of the first message). </li>
</ul>
<p>If you are sending Caring Contacts by postal mail, consider enclosing a self-addressed stamped envelope or other tools such as a phone number or address to respond that shows you welcome a response as Motto did </p>
<ul>
<li>Your team should also establish the monitoring hours, within which the team can respond, whether every day from 9 to 5 or specific days or times of the week. These hours should be included in the first message so that recipients will be aware. </li>
<li>If your messages will be coming from an unrecognized number, you may want to explain this to the recipient and even have them add the number from the initial contact to their Address Book with yours or your agency’s name so they recognize it in the future. </li>
<li>You might want to make sure that if the recipient’s birthday falls during the projected Caring Contacts period, one of the existing scheduled messages is replaced by their birthday message. </li>
<li>If any relevant holidays or seasonal messages will occur during the recipient’s study period, those messages can also replace the nearest existing scheduled message. </li>
<li>Do you want the last message to say it is the last message? If so, sharing directions for future contact can be helpful </li>
</ul>
<h3>Identify who will get the Caring Contacts intervention</h3>
<p>Your organization will need to decide which of your clients/patients should get the intervention. This will be highly depending on the population you serve and what their needs and desires are. </p>
<p>For psychological screening, you can consider including:</p>
<ul>
<li>Those who screen positive on a suicide history or ideation screener </li>
<li>Only those with Acute Risk Levels</li>
<li>Those with Acute OR Chronic Risk Levels</li>
</ul>
<h3>Tailor Messages to the Audience</h3>
<p>Your organization/agency might consider culturally adapt the messages you team will send to fit the personalities, preferences, and dispositions of your diverse client population (e.g., Veterans, active duty military, healthcare workers, American Indian/Alaska Native communities, Latinx youth, etc.) </p>
<p>Additionally, within an organization, each author sending the messages may want to write their own pre-programmed messages based on the core message principles—so there could be multiple versions of the pre-programmed lists within and across organizations.</p>
<h3>Decide how long and how often the messages will be sent</h3>
<p>You’ll also need to decide how many messages you want to send, how often you want to send the messages, and for how long. These are your choices and there is evidence that recipients are content with a wide range of message numbers. Commonly, organizations send between 8 and 25 messages, over the course of 6 to 18 months. </p>
<p>You may want to review different approaches to messages and different message content at the <a href="https://mirecc.va.gov/MIRECC/visn19/cpg/recs/13/"> VA/DoD Clinical Practice Guidelines for Caring Contacts website.</a>To prevent messages from being perceived by recipients as automated or “spammy,” you may want to send the messages at varying times of day and at varying intervals between messages rather than a set day and time.</p>
<p>In addition, in the section below, the toolkit gives sample lists of messages of different content, frequency, and duration to help you decide.</p>
<h3>Message Schedule Builder Tool</h3>
<p><i>[add instructions for how to use]</i></p>
<a href="https://uwnetid.sharepoint.com/:x:/r/sites/center_for_suicide_prevention_and_recovery/_layouts/15/Doc.aspx?sourcedoc=%7B4F90C6DC-4CC3-4234-8A8F-6E0FADEF89E3%7D&file=Message%20schedule%20templates.xlsx&action=default&mobileredirect=true&DefaultItemOpen=1&ct=1732735175336&wdOrigin=OFFICECOM-WEB.START.EDGEWORTH&cid=b1a0c4af-53bd-488b-b991-9a329cebc447&wdPreviousSessionSrc=HarmonyWeb&wdPreviousSession=95d0af17-b766-419e-ad49-5c5390bd4277" class="button">Schedule Builder Tool</a>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="Delivery">
<h2>2. Decide how to deliver the messages</h2>
<h3>Options for Implementation</h3>
<p class="major"><span class="image left"><img src="images/Lockscreen.png" alt=""></span>The Caring Contacts Intervention can be implemented via emails, texts, physical mail, and phone calls. Digital options such as email and text are familiar to the recipient, and are easy to track.</p>
<p>While it can be more cost-efficient and timesaving to send Caring Contacts through email or texts, it has been theorized that physical mail might carry a certain emotional impact that digital communication does not. While phone calls have been previously tested, they require a greater workload for the organization. Our team has found that the majority of participants prefer to be contacted via written (text or email) communication. </p>
<p>A primary consideration your team will need to take into account is if you are allowed to use an outside party’s program. For teams which are obligated to build their own delivery app, we have provided general guidance on the features and capabilities that are needed for a modern and effective intervention delivery service. </p>
<h3>Decision Flow</h3>
<p>Asking "Can you use tech outside of your system/an external app?"</p>
<p>Why Choose an Existing Service:</p>
<ul>
<li>Adequate funding</li>
<li>Flexibility with using outside systems</li>
</ul>
<p>Why Choose to build a system:</p>
<ul>
<li>Prevented from using outside systems </li>
<li>In-house development team</li>
</ul>
<h3>Finding an Existing Caring Contacts Service</h3>
<div class="items style3 big">
<section class="feature">
<i class="fas fa-book" style="color: #FE8F3E;"></i>
<h3>Mosio/new ISACC</h3>
<p>[Platform] is a pioneering informatics solution that seeks to optimize the administration of Caring Contacts to individuals in need of emotional support and ongoing connection. It has the potential to revolutionize the way we offer care to be proactive instead of reactive with the aim of cost-effectively improving mental health outcomes and overall well-being. We continue to gather valuable insights that inform decisions on how to refine [the platform], ensuring its maximum efficacy to provide compassionate and personalized care to those who need it most. </p>
<p>Our aim is to make sending Caring Contacts almost as effortless as receiving them. Though we may never fully achieve that, [this platform] securely tracks all the necessary details, ensuring that the correct messages are sent to the appropriate individuals at the right moment. It alerts you with a secure link to key information to know what to do when someone responds. [The platform] allows for secure replies from both phones and computers. </p>
</section>
<section class="feature">
<i class="fas fa-book" style="color: #FE8F3E;"></i>
<h3>LifeWIRE</h3>
<p>LifeWIRE is a platform that facilitates communication between clinics and patients through automated tools. It supports text, email, and voice calls, allowing patients to choose their preferred method of interaction. The platform is designed to securely manage health information in compliance with HIPAA standards, enabling clinicians to share updates, gather information, and coordinate care. </p>
</section>
</div>
<h3>Design and Develop Your Own System</h3>
<p>Caring Contacts has also been implemented via methods which require less overhead cost but may require higher costs for fidelity and adherence overtime. These strategies may be more accessible for organizations with smaller client bases or where the ratio of providers to patients is much higher. Message schedules can be built in programs like Microsoft Excel or Google Sheets, and the messages can be manually scheduled and delivered via email or text message. With these implementation strategies, there may be more work required to ensure that the messages are delivered and responded to in a timely manner.</p>
<p>Medical systems have considered using eCare, MyChart, or similar options to send the Caring Contacts, which to them seems simple and appealing, but for the recipient, is neither. They will get a message that requires them to login to the system only to arrive at a message that says, “Hope you are doing well.” We doubt that recipients will have the simple positive response that is intended after the trouble of typing the login and password (especially on their phones), and we suspect they might just stop opening eCare messages. </p>
<p>Recommended capabilities:</p>
<ul>
<li>Pre-program a list of 8-25 messages to be sent on a specified schedule over the year – generally one the next day, then weekly or monthly, and tapering out to every 2-4 months. </li>
<li>If Caring Contacts are coming by text message, the system needs to have a way of assuring these messages are being received and alert the author if there are message failures. We currently use an online messaging platform which tracked failures but authors have to regularly go and check to see what failed. </li>
<li>Ideally, the system would have capacity to send emails or coordinate the sending of postal mail Caring Contacts. (In a current study, participants can choose text, email, or postal mail. Texts and emails are automatically sent by the system. We program system emails to prompt our study staff to send contacts via postal mail by sending an email a few days early (to account for time in postal service) that says please write the following message in a card and send to this participant to arrive on this date.) </li>
</ul>
<p><i>link to Starting Self-Implementation Guide?</i></p>
<h3>Design and Develop Your Own Automated System</h3>
<p>For organizations with the need and capacity to build their own automated system, we have developed a functionality matrix of user needs and intervention functionality solutions based on human centered design in collaboration with experts in Caring Contacts, outpatient clinicians and staff at a service organization. This can be found here. The functionality matrix can provide a blueprint for developers of an internal system.</p>
<p>For organization leadership or potential authors, review of this toolkit and the steps for a manual system will provide a high level overview of what such a system will need to do. </p>
<h3>Documentation</h3>
<p>This is important to think through if you want to be consistent across your Caring Contacts team.</p>
<p>Do you want to document Caring Contacts anywhere other than the platform you're using?</p>
<ul>
<li>In a healthcare environment, it may be important to document in the medical or electronic health record. If so, do you want to document every Caring Contact interaction with a patient? Or a more limited set of information such as the patient’s start and end date of the Caring Contacts intervention.</li>
<li>It might also be important to document any distressed or high risk replies and how they were handled.</li>
</ul>
<p>Outside of healthcare, are there other systems for tracking membership that need to have information transferred or updated if they are in the Caring Contacts program? </p>
<p>Other aspects your team might want to keep track of in order to provide updates on successes and barriers of the intervention at your organization </p>
<ul>
<li>Document number of recipients receiving CC cards</li>
<li>Collect information regarding recipient follow-up contact (i.e., replies to Caring Contacts)</li>
<li>Collect anecdotal evidence (quotes from staff and/or recipients about the initiative/messages)</li>
<li>Identify ways to recognize staff that participate in process (e.g., awards, performance plan)</li>
<li>Consider highlighting on leadership performance plan</li>
</ul>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="Start">
<h2>3. Start the Intervention</h3>
<h3>Assign Roles</h3>
<p>It is important to determine who will do what, so nobody falls through the cracks. Here are a few suggestions from our previous research:</p>
<ul>
<li><b>Author:</b> the person from whom the Caring Contacts are sent. In research studies this was generally a research assistant or research clinician who had no ongoing relationship with the recipient. Authors could be current providers, but this may conflict with their ongoing care. Other authors might be suicide prevention coordinators, Veterans or other peer support, mentors in schools, etc.</li>
<li><b>Recipient:</b> the person who is suicidal and receiving the messages</li>
<li><b>Sender:</b> a person who does the work to send the Caring Contacts who is not the Author (i.e., in larger systems like the VA, an administrative or other assistant may support the Author by actually sending the messages through creating a mail merge to bulk send messages, programming the messages into an online messaging platform, etc.) </li>
</ul>
<h3>Identify and enroll recipients</h3>
<p>Based on the intervention enrollment criteria that your team decided on when planning the intervention, you’ll need to create a process through which recipients are "assigned" to start getting Caring Contacts. This may occur through routine screenings, referrals between from case workers, or other workflows.</p>
<p>Once potential recipients are identified, your team may want to reach out to those clients and confirm their willingness to participate. Then, follow the enrollment steps for whatever system you’re using. [link to section on Mosio/ISACC specific instructions for those that are using our system] </p>
<h3> Reminders for individualizing/starting the Care Plan</h3>
<p>Review all of the dates and times of the messages on the schedule to be sure that they fall on the days and time windows your Caring Contacts team wants them to be sent. </p>
<blockquote>Time and date should be edited for any message to individualize it for a recipient’s needs (e.g., if they work nights and you know they never wake up before noon). </blockquote>
<p>Remember that the messages should appear as if they are sent by your team and come across as natural as possible. Avoid having all of your messages come on the same day or time each week as this can look like spam. </p>
<p>Important reminders:</p>
<ul>
<li>You might want to make sure that if the recipient’s birthday falls during the projected Caring Contacts period, one of the existing scheduled messages is replaced by their birthday message. If their birthday falls on a weekend, your team may decide to adjust the date for the message to a day or two early and adjust the text to say, “Happy early birthday!...” </li>
<li>If any relevant holidays or seasonal messages will occur during the recipient’s study period, those messages can also replace the nearest existing scheduled message. Again, this is to ensure that all recipients receive the same number of messages. Check to see if any of the messages written by your team will apply during the recipient’s study period and schedule them accordingly! </li>
</ul>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="Run">
<h2>4. Running the Intervention</h2>
<p>This is not an automated intervention. There’s a real relationship whether or not the author has met the recipient. The recipient should expect the author is paying attention to their replies and that the author will be sending the messages thoughtfully and with care. </p>
<ul>
<li>For the intervention to be experienced as caring, outgoing messages may need to incorporate the recipient’s replies or other information. </li>
<li>If the author becomes aware of new information about the recipient based on replies or other information, the next scheduled message might need to be changed accordingly</li>
<blockquote>For example, if they replied to a message that their father died, the next scheduled message a few weeks should probably be modified from something like, “hope all is well with you.” </blockquote>
</ul>
<p>Your agency is responsible for monitoring and responding to all incoming messages from your recipients (what we call “replies” to differentiate from what you send which we call “responses”). Here are some points to consider in planning your Caring Contacts program:</p>
<h3>Monitoring</h3>
<ul>
<li>How often will notifications be checked? Who will be responsible for checking them?</li>
<li>Will one person or multiple people be notified? </li>
<li>If a team member is sick or on vacation, who will cover for them?</li>
<li>If/how would you like to communicate among your Caring Contacts team about who is responding to the message? </li>
</ul>
<h3>Replies from Recipients</h3>
<ul>
<li>This is a two-way communication intervention, so recipients can reply at any time.</li>
<li>Outgoing scheduled contacts are often sent earlier in the day to maximize the chance that replies come during that author’s business hours.</li>
<li>The intention is that the messages are non-demanding, so pre-programmed messages are statements of care, concern, and support that don’t require a reply.</li>
<li>To the extent that the author does not want to encourage an extended dialogue, the author can plan a delay of 1-2 hours when responding to messages containing positive or neutral content. (In our previous study, the mean number of messages back and forth, including the pre-programmed message that opened the exchange, was 3.5.)</li>
<li>Nonetheless, 67% of the time in our study, participants replied to messages. The majority were positive or neutral or an emoji that required a comparable simple, polite response, but not immediately. </li>
</ul>
<h3>Responding to Replies from Recipients</h3>
<ul>
<li>Replies to at least some of the pre-programmed Caring Contacts are expected. In our experience the vast majority of responses tend to simply show gratitude (“thanks so much”) or reciprocity (“I hope you have a good day too”) or something general like a thumbs-up emoji. </li>
<li>In the minority of situations, the reply will indicate distress or request assistance. This may occur when they are getting Caring Contacts and no other services from your agency, so this offers an opportunity to support someone who is in distress that might otherwise be missed. </li>
<li>Not responding to a recipient’s reply may well be taken as either uncaring or that Caring Contacts are from a bot, spam, or otherwise disingenuous, so it is important to reply. </li>
<li>Responses do not have to be immediate. It is important to orient recipients at the beginning of the program about how long they can expect to wait for a response. It can also be strategic to let time pass before responding if the agency is less interested in getting into a text dialogue with the recipient. It is common in our programs to hold “by next business day” as a standard for a reply that does not indicate distress. Programs vary in how quickly a response is expected if the message indicates distress or risk. Agencies are advised to follow their existing crisis response protocols. </li>
<li>Caring Contacts is a behavioral health intervention but not intended to function as a crisis line. Recipients should be oriented up front about when to expect a response and when not to. It is important to communicate in advance what recipients should do if they need help at a time no one can respond. We have found that recipients are flexible and respectful of this, and it has not been an issue. </li>
<li>For the majority of replies, the author is just sending an emoji or a “You’re welcome” or a “That’s great!” or a “Hoping things keep getting better this week”… </li>
<li>When someone sounds like things are tough but not anything emergent, the typical response is a message of validation and caring. When appropriate, a separate second message is sent, assuring the recipient is aware of formal support or crisis resources available to the recipient (if they choose). </li>
<li>Since many responses are pretty standard, pre-programmed options that can be sent as-is or edited can reduce the time for author to prepare a response – e.g., a message that has contact information for crisis help, a message that clarifies how to re-engage with care. </li>
<li>Most authors/agencies’ initial concern is responding to recipient replies after hours and on weekends. Most clinics do not respond to recipient contacts at those times, instead orienting recipients on what to do when the clinic is closed. We argue the same should be true for Caring Contacts, which is a long-term psychosocial intervention, not a crisis intervention. In our study, the vast majority of messages came during work hours and it was cost-inefficient to have authors (or a backup clinician) on call for the 38% of the 1% of messages that were time-sensitive that came outside of business hours. </li>
<li>A common strategy for managing after-hours replies is an “autoreply” or “out of office” message that includes who to call in a crisis. However, the vast majority of responses are positive or neutral, e.g., a happy face or thank you to a message that said, “Hope you are doing well.” We are concerned that such a response is invalidating, is inappropriate for 99% of replies, and will communicate that we expect them to be in crisis. Individuals with lived experience of suicidality on one study’s advisory board did not like this idea at all. </li>
</ul>
<h3>Crisis Response Plan</h3>
<p>In the event of a reply indicating suicidality or another crisis, how will this be handled?</p>
<p>Are there specific protocols you expect to be followed or should Caring Contacts program staff follow general protocols for crisis intervention or high-risk circumstances? </p>
<h3>Quick Reference Guide [also make printable PDF]</h3>
<p><i>A quick reference guide intended for the desktop or desk top –
½ to 1 page
Recommended responses
“sticky notes”
Editable doc
Template for them to build their own quick reference
Option to fill in their own agency’s crisis response doc</i></p>
</div>
</section>
<section class="wrapper style1 content-align-left">
<div class="inner" id="End">
<h2>5. End of Intervention Plan</h2>
<p>When creating the Care Plan, your team should have decided what messages, if any, will be sent to the participant at the conclusion of their Care Plan.</p>
<p>Evidence shows that participants prefer to be told that their messages will be ending. </p>
<p>Where should the recipient turn for reconnection with your organization or immediate assistance now that Caring Contacts are over? </p>
</div>
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