Virginia's 988 Capacity Building and Continuous Quality Improvement Project - Abstract: Virginia's 988 Capacity Building and Continuous Quality Improvement Project Virginia's 988 Capacity Building and Continuous Quality Improvement Project will strengthen statewide 988 Suicide & Crisis Lifeline capacity by expanding workforce capacity across voice, chat, and text while building the follow-up, standardization, and quality infrastructure needed to connect a single crisis contact to ongoing care. Targeted investments will expand chat and text capacity and sustain recent gains in voice performance. Between July 2022 and June 2026, routed voice contacts increased 205%, chat 82%, and text 470%, outpacing the workforce capacity established under the 2023 SAMHSA 988 Capacity Grant. As of June 2026, Virginia answered 71.2% of chat and 71.3% of text contacts in state, well below SAMHSA's 90% expectation, and 26.7% of text contacts flowed to national backup, meaning more than one in four Virginians texting 988 reached a counselor outside the Commonwealth. The Virginia Department of Behavioral Health and Developmental Services (DBHDS) will implement the project statewide across all five behavioral health regions through three participating Crisis Contact Centers in collaboration with all 40 Community Services Boards and other crisis continuum partners to strengthen referral coordination, follow-up services, and continuity of care. DBHDS will expand chat and text staffing guided by a Year 1 volume projection and staffing model; strengthen workforce recruitment, training, retention, and wellbeing; deploy the Virginia Crisis Connect follow-up module; standardize referral, 911/988 coordination, and substance use and overdose response protocols; implement statewide quality assurance, continuous quality improvement, sentinel event review, cybersecurity monitoring, and performance evaluation; and develop a long-term sustainability and financing plan. The population of focus includes all Virginians experiencing behavioral health crises, with particular emphasis on populations at elevated risk of suicide and overdose. Suicide disproportionately affects males (78.6% of Virginia's 1,239 suicide deaths in 2023), adults aged 75 years and older (23.3 per 100,000), youth aged 10-19 (deaths increased 25% between 2017 and 2021), veterans (25.0 per 100,000), and rural residents. Nearly 1.5 million Virginians experience any mental illness, and an estimated 1.04 million people who needed substance use treatment during 2022–2023 did not receive it. Project goals are to expand statewide 988 capacity; sustain high-quality voice performance; strengthen workforce recruitment, training, retention, and wellbeing; expand follow-up services across all participating centers and modalities; standardize operational and clinical practices; implement statewide quality assurance, continuous quality improvement, evaluation, and cybersecurity activities; develop a long-term sustainability and financing plan; and fully participate in SAMHSA's National Cross-Site Evaluation. Measurable objectives include increasing in-state chat and text answer rates to at least 90% of routed contacts by the end of Year 2 while reducing flow-out to national backup below 10%; sustaining in-state voice answer rates at or above 90% throughout the project period; implementing statewide follow-up, standardized substance use and overdose response protocols, and 911/988 coordination; ensuring at least 90% of counselors complete standardized specialized training; establishing mortality data linkage, cybersecurity reporting, and a long-term sustainability plan; and meeting all applicable SAMHSA reporting and National Cross-Site Evaluation requirements.
