Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

American Foundation for Suicide Prevention (AFSP)

Name of Innovative Program: 
Interactive Screening Program (ISP)
Sponsoring Organization
American Foundation for Suicide Prevention (AFSP)
Name of Innovative Program Lead: 
Ann P. Haas, Ph.D.
E-mail Address of Innovative Program Lead: 
ahaas@afsp.org
Project Description: 
 The Interactive Screening Program is an anonymous, web-based behavioral health intervention that connects people with untreated problems to a counselor who engages them to get help. The ISP is designed to be used in a variety of settings, including colleges and workplaces, and has been adapted for outreach to at-risk groups in the general population.The program provides an online questionnaire that screens for depression, suicidal thinking and behavior, substance abuse, and other behavioral health problems. The questionnaire is housed on a secure website, customized for each participating site, and is completed by users identified only by a self-assigned login ID. Users receive a personalized response from a counselor through the website and are encouraged to engage in open-ended online “dialogue” to discuss next steps.  ISP counselors may offer in-person meetings and ongoing treatment services, or make appropriate referrals and help transition the user to an appropriate treatment option.
Creativity and Innovation: 
 The ISP is based on the premise that at-risk people who do not seek treatment almost always have specific beliefs, attitudes, fears or concerns that create the most significant barriers to help-seeking. The program seeks to provide a safe, user-friendly structure in which these barriers can be identified and discussed while the foundation is being laid for a trusting therapeutic relationship.  Towards this end, the ISP incorporates the following core principles:
  • Ensure users’ anonymity until they are ready to self-identify
  • Connect users to a real counselor rather than providing computerized feedback
  • Respond to the user’s distress and experience rather than suggesting diagnoses or emphasizing the “need” for treatment   
  • Encourage interactive engagement rather than giving one-way information and recommendations
  • Identify, respect and seek to resolve the user’s specific barriers to treatment.
  • Provide as seamless a path as possible between online and in-person services.
Leadership: 
 The ISP was developed in response to national survey findings that, despite the availability of counseling centers on most college campuses, an estimated 80% of students who died by suicide had not used these services. Believing this was not just because at-risk students were unaware of available services, we sought to develop a simple, safe way for troubled students to connect with an experienced, caring counselor who could help them more clearly identify the problems they were experiencing and work through their barriers to help-seeking.  We have now tested the model on many different campuses, where 6,300 at-risk students have been connected to a campus counselor for online support and treatment engagement. Having established the program’s effectiveness, we are now working with other organizations, including the VA, the NFL, police departments and corporations, to develop similar initiatives to identify at-risk individuals and encourage them to seek help. 
Sustainability: 
 AFSP has supported the development of the ISP primarily through contributions from individual donors, and licenses the program to organizations at a modest annual fee.  Fees cover costs associated with customizing and maintaining the ISP website, domain registration and security certificates, and ongoing training and technical assistance for the organization’s counselors. Local AFSP Chapters may provide financial assistance to colleges with start-up fees and sponsor campus suicide awareness walks to raise funds for program maintenance.  While participating sites are responsible for providing ISP counselors, these duties can generally be shared among existing staff at a university counseling center or employee assistance program, requiring relatively little additional expense. Strategies for cost-efficient use of a site’s counseling staff are incorporated into ISP start-up training. Sustainability at participating sites is furthered by keeping the ISP fresh and innovative through regular updates and enhancements to the program as computer and mobile device technology expands. 
Replicability: 
 In 2009, 16 colleges and universities were using the ISP. Currently, the program is in over 60 schools with more to be added in 2013. In 2010, AFSP developed an adaptation of the ISP called the Self-Check Quiz to augment national crisis hotline services. This program is currently used by the Veterans Crisis Line (veteranscrisisline.net) to engage veterans and military service members, and by the National Football League’s Lifeline program (nfllifeline.org) for current and former players and their families. We have just launched an adapted ISP program for the Boston Police Department, and will soon open our first corporate workplace program. In each of these replications, we have worked with the sponsoring organization to customize the screening questionnaire and program procedures for the specific target population and environment. Our experiences to date suggest that the ISP can be successfully adapted to engage at-risk individuals in a wide range of settings.     
Results/Outcomes: 
 Outcomes of the ISP in colleges, reported in several published studies, include:
  • 10-15% of students submit the ISP questionnaire (vs. 15-20% of college students estimated to have significant behavioral health problems).
  • 95% show significant symptoms of a behavioral health problem.
  • 90% are not receiving treatment.
  • 90% return to the website to read the counselor’s response.
  • 30-40% engage in at least one online dialogue exchange with the counselor.
  • 25% attend at least one in-person meeting with the ISP counselor, and 20% enter treatment.
  • Those who engage in at least one dialogue exchange with a counselor are 3-4 times more likely to attend an in-person meeting and to enter treatment.
Based on these outcomes, the ISP has been listed in the Best Practices Registry for Suicide Prevention. Evaluations to document outcomes are being implemented in all of our workplace replications. 
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