Transforming Crisis Line Training and Quality Assurance at Lines for Life with ReflexAI

Lines for Life has been a pioneer in the crisis line space since 1993, operating multiple lines from their headquarters in Portland, Oregon. As the organization expanded in recent years, they faced the dual challenge of ensuring their crisis line responders are incredibly well-trained from the onset, while also providing quality assurance and feedback when individuals are fielding calls every day. 

While the training content could be delivered through online and in-person sessions, none of their existing tools could effectively replace the one-on-one roleplays essential for honing on-the-line skills. These roleplays prepare responders to handle challenging scenarios empathetically and precisely, and the feedback provided after a roleplay is an invaluable part of the learning process. Both parts – as well as scheduling and train-the-trainer activities – required significant trainer time, were difficult to manage, and were challenging to execute consistently.

Once their responders were on the front lines, Lines for Life recognized that their existing quality assurance (QA) processes provided only a partial view of overall call performance. The organization could review approximately 3% of all calls, leading to a limited view of performance and challenges identifying insights across all calls. It also felt like a disservice to the responders, who deserved to receive recognition for their work across all interactions supporting individuals.

To address these challenges, Lines for Life needed advanced solutions that could exceed the effectiveness of manual roleplays and provide comprehensive QA for all interactions—and they wanted to start immediately.

Lines for Life is a national non-profit organization committed to preventing substance abuse and suicide, promoting mental wellness, and providing support to individuals in crisis. With a mission to build resilience and save lives, Lines for Life operates multiple crisis lines staffed by trained professionals who provide immediate support to individuals facing mental health challenges, ensuring they receive the help they need in critical moments. The organization has been a long-time provider of services within Oregon and the 988 network while also running innovative programs such as YouthLine.

Given the life-saving nature of the work, crisis line responders at Lines for Life receive rigorous and ongoing training for their roles. The organization needed a roleplay solution that could simulate the complexities of real-world interactions, provide immediate feedback, and support continuous learning at scale. And they needed to pair the training tool with new capabilities for quality assurance as their responder community grew significantly.

Diverse and Complex Scenarios

Crisis line responders encounter an array of complex and emotionally charged situations, each requiring a nuanced approach tailored to the individual’s specific needs and circumstances. Traditional training methods, such as role-playing with colleagues or learning from recorded calls, provide value but are time-consuming and do not provide the benefits of hyper-realistic scenarios where the trainee is experiencing the full interaction first-hand. Lines for Life sought a solution offering diverse and realistic scenarios to better prepare responders for calls they might receive.

“We need to give our clinicians tools to be able to answer any call, any topic that comes up. So we train on everything from domestic violence to addiction to suicide to aging issues to youth issues. I mean, the whole gamut.” – Greg Borders, Chief Clinical Officer, Lines for Life

Maintaining Consistency Across the Team

Crisis line growth in the last decade – particularly since the rollout of 988 – means that new responders are continually onboarding, both to enable growth and backfill open roles. Ensuring new responders were trained quickly and effectively while maintaining high standards of care was a significant challenge. Additionally, consistent and comprehensive QA was needed to ensure ongoing performance and quality across the team.

Continuous Skill Enhancement

Even experienced responders require ongoing training to stay sharp, adapt to new challenges, and maintain high levels of empathy and professionalism. Lines for Life needed a solution that could provide continuous learning opportunities, allowing responders to refine their skills and stay up-to-date with best practices in crisis intervention.

To address these challenges, Lines for Life partnered with ReflexAI to implement their AI-driven roleplay simulations product, Prepare, and their advanced quality assurance platform, Assure. The combined implementation of these two solutions was designed to meet Lines for Life’s immediate needs for training and ongoing quality assurance, ensuring that their crisis line responders were well-prepared on Day 1 and would continue to grow over time. 

AI-Driven Simulations

Lines for Life implemented multiple AI personas experiencing a wide range of mental health challenges, allowing responders to practice responding to different types of calls in a controlled environment. These simulations were designed to be as close as possible to real-life situations within populations served by Lines for Life, capturing the emotional intensity and complexity that responders face during actual crisis interactions.

Immediate, Detailed Feedback

After each simulation, responders receive immediate feedback on their performance, including an analysis of their empathy, openness, and ability to follow critical protocols such as a clinically-appropriate risk assessment. These dimensions are tailored for Lines for Life and paired with actionable feedback so individuals could learn and improve. 

Scalability and Accessibility

The ReflexAI platform is scalable, allowing many responders to train simultaneously and ensuring consistent quality assurance across all calls. And additional stakeholders – including trainers and leaders – could track progress across training cohorts with intuitive interfaces and analytics. Additionally, the platform’s accessibility also means that trainees and the broader Lines for Life team could engage at times that match their schedules, which is critical for a 24/7 operation in crisis support.

Comprehensive Perspective with Assure

Assure has proven to be an invaluable resource to supervisors and quality assurance team members. The platform analyzes 100% of interactions, offering insights into the highest priority areas such as empathy, risk assessment, and openness. This comprehensive approach provides an accurate and holistic view of responder performance.

Understanding Strengths and Opportunities

Supervisors can review interactions and provide immediate feedback to responders. Supervisors have been able to provide significantly more positive feedback, which contributes to staff morale and retention. Additionally, opportunities for improvement can be identified at the individual level and across the responder population, allowing for data-informed, continuous learning opportunities. 

Implementation

Step 1: Needs Assessment and Customization

ReflexAI conducted a collaborative needs assessment with Lines for Life stakeholders from leadership, training, and quality assurance. This assessment involved reviewing existing training priorities, understanding the types of calls handled by the organization, and identifying critical experiences of the populations they serve. Based on this assessment, ReflexAI developed a series of customized simulations and QA metrics tailored to Lines for Life, aligned with the services provided by Lines for Life during operations 24/7/365. 

“It’s inspiring to support the implementation of ReflexAI tools at Lines for Life. Their team was very clear about a vision that solved operational challenges while enhancing quality, and the results from the first year showed measurable results on training quality and operations while saving hundreds of hours for their staff.” – Amy Garcia, Customer Success Manager at ReflexAI

Step 2: Integration and Training

ReflexAI worked closely with Lines for Life to integrate Prepare and Assure into their existing training and QA programs. This phase included:

Onboarding and Initial Training: ReflexAI provided training sessions for Lines for Life’s trainers and staff, demonstrating how to use the platform, navigate the simulations, and interpret the feedback reports.

Strategic Launch: A tailored deployment included several training cohorts to test the platform’s effectiveness and gather feedback. The results were overwhelmingly positive, leading to a full-scale rollout.

Full-Scale Rollout: ReflexAI was rolled out across the organization, with all new hires using the platform as part of their onboarding process and existing staff incorporating the simulations and QA into their ongoing routines.

Step 3: Ongoing Support and Continuous Improvement

ReflexAI provided ongoing support, including regular updates to simulation scenarios, QA metrics, and technical assistance. ReflexAI continues to work with Lines for Life to refine and improve its training and QA programs based on data-driven insights and responder feedback.

“It’s been very enriching and has allowed our incoming folks to have a lot more practice and better practice, and they’ve really been gaining confidence more quickly in the process.”

Colleen Cadell, Director of Clinical Training

Responders at Lines for Life reported significant improvements in their confidence and preparedness after using ReflexAI’s simulations. The realistic scenarios helped them develop a deeper understanding of handling different crisis calls, and the immediate feedback allowed them to improve their skills continuously. All trainees now engage in three dynamic simulations that cover priority topics, including empathy, risk assessment, harm reduction, means safety, self-injury, and safety planning. In the first year, Lines for Life trainees have utilized hundreds of hours of simulations. 

Prioritized Skill Development

The three simulations utilized in initial training represent individuals from a wide range of backgrounds and lived experiences. In addition, all Lines for Life responders also have access to ReflexAI’s Election Stress Training, which includes a tactical training guide and two simulations designed to provide realistic practice supporting individuals who are experiencing election stress. This hands-on training is available to over 150 Lines for Life team members who can now practice skills including empathy and openness in the lead-up to the next election. 

Consistency and Quality Across the Workforce

The combined scalability of Prepare and Assure ensures that all responders, regardless of their experience level, receive consistent, high-quality feedback. This consistency was crucial in maintaining the high standards of care while Lines for Life grows and evolves, including a transition to remote work. Using ReflexAI tools, Lines for Life quality assurance team members identified many more examples of exceptional performance supporting individuals with complex needs. And the organization identified the opportunity to provide additional, tactical training on using open-ended questions across all call types. 

More Comprehensive Insights

ReflexAI tools have not just impacted daily operations; they have also impacted Lines for Life’s strategic approach. With Assure’s comprehensive monitoring, Lines for Life could expand from reviewing 3% of interactions to analyzing 100%. The data from all simulations with instant feedback can now be used to understand the broader perspective on the path from initial training to long-term engagement as a member of the Lines for Life team. 

Long-Term Impact on Organizational Performance

The simultaneous implementation of ReflexAI’s Prepare and Assure platforms has had a profound and lasting impact on Lines for Life. By investing in advanced AI-driven solutions for training and quality assurance, the organization has strengthened its ability to fulfill its mission of saving lives and promoting mental wellness. The partnership has enabled Lines for Life to maintain high standards of care, even as it grows and operates with a distributed team. 

Growing the Partnership

Due to the success seen since the initial implementation, Lines for Life has expanded use of ReflexAI tools to further support the organization’s mission. For example, Lines for Life deployed a simulation within the hiring process, allowing candidates to demonstrate their skills in a realistic way while getting a taste of the day-to-day work they would do as crisis responders. Additionally, Lines for Life recently added a simulation to the training journey for YouthLine volunteers, so teenagers can benefit from the hyper-realistic practice that is benefitting adult responders. Finally, Lines for Life is adding a feedback dimension within quality assurance for risk assessment to understand strengths and opportunities across thousands of calls each month with a particular focus on this critical conversation component.

Takeaway

The collaboration between Lines for Life and ReflexAI is a powerful example of how innovative technology can enhance the quality of human-centered services in critical sectors like mental health support and crisis intervention. By integrating AI-driven roleplay simulations and comprehensive quality assurance, Lines for Life has improved its crisis line responders’ preparedness, empathy, and effectiveness, leading to better outcomes for individuals in need. This case study demonstrates the potential of AI not only to augment traditional methods but also to transform them, creating new opportunities for growth, learning, and impact in crisis intervention.