As 988 call volumes continue to rise, Nashville, Tenn.-based Centerstone is investing in its “three-legged stool” approach — workforce training, quality improvement and clinical support — to prepare staff for increasingly high-acuity and socially complex calls.
Centerstone operates 988 lifeline services across 20 Tennessee counties as a primary provider and provides backup coverage in Nashville and Memphis. The organization also covers 86 Illinois counties, including statewide backup coverage, and 17 Missouri counties.
Becky Stoll, executive vice president of crisis services at the organization told Becker’s the work now extends beyond traditional mental health crises, requiring staff to navigate social determinants of health, youth outreach, virtual operations and emotionally taxing situations in real time.
“A lot of youth and young adults are reaching out because their lives are a mess,” she said. “It’s not so much that they’re living with a mental health condition that’s not going well. It’s all of these life factors that are causing them a lot of problems.”
That reality has fundamentally changed how crisis workers are trained before taking live contacts, she said. To prepare staff for increasingly complex and emotionally charged interactions, the organization built a highly structured onboarding model.
Centerstone staff complete approximately 120 hours of training, with separate teams handling telephonic operations versus chat and text communications. In addition, an AI-support simulation training, ReflexAI, allows teams to adapt education around emerging crisis trends and operationalize patterns emerging in live calls and texts.
For example, Ms. Stoll said, if staff identify an increase in LGBTQ+ calls centered on high schoolers coming out to their parents, the simulation training platform can create text-based scenarios to help staff prepare before encountering similar situations in live interactions.
Alongside simulations, Centerstone is using AI tools to monitor call quality and identify gaps in crisis response performance. Dedicated quality-improvement teams audit calls and chats against standardized tools, giving staff feedback on what they are doing well and what needs improvement.
To analyze calls at scale, the organization uses a Zoom product that listens to calls and completes quality audits. The platform also tracks metrics tied to crisis intervention performance, such as how long it takes a staff member to ask the first risk assessment question and the percentage of time the caller speaks versus the staff member, Ms. Stoll said.
Crisis work also requires constant clinical support infrastructure, especially in a virtual staffing model like Centerstone’s. The organization has levels of supervision that staff have access to at all times, including dedicated employees focused solely on clinical supervision.
“These stakes are really high when people are reaching out to 988, and you have to make sure the staff know what they’re doing, feel supported, and it does not negatively impact them, because it is incredibly difficult work,” she said.
The organization recently released internal employee wellness guidelines focused on sustaining the crisis workforce. The guidance emphasizes that crisis worker wellness depends on organizational infrastructure as much as individual resilience, including structured onboarding, supervision, peer support and leadership consistency.
Guidance also outlines practices such as “realistic job previews,” resilience training, critical incident debriefing, wellness check-ins, and regular call, chat and text audits tied to coaching rather than punishment.
“We try to be very mindful of the wellness of staff and that goes from we say that goes from the second case you advertise the job, all the way to an exit overview,” said Ms. Stoll.
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