Crisis Counseling Policy Reform at the American Cancer Society

Introduction: The ACS Call Center and Its HR Policy

The American Cancer Society (ACS) is the largest cancer-related charitable organization in the United States, and probably the world. It is one of the country's two largest healthcare charitable organizations, along with the American Heart Association. It receives millions of dollars a year in donations and provides funding for research, information, and programs for cancer patients throughout the United States. One of the programs it operates is the Cancer Information Center, a call center where specially trained Cancer Information Specialists (CIS) handle calls about cancer. These CIS are college-educated, highly trained individuals with access to a database containing extensive information about cancer. Most have backgrounds in the social sciences — such as psychology, sociology, and social work — and many have experience and training in crisis counseling. In addition, the ACS employs nurses in the call center to handle specific questions that may require additional expertise. The goal of the hotline is to disseminate information to callers, not to provide individual healthcare advice. CIS are prohibited from answering patient-specific questions and are to serve on an information-only basis.

In addition to being prohibited from answering patient-specific questions, CIS are prohibited from providing any type of counseling to a caller, even though it is not unusual for them to receive calls from people who express suicidal ideation linked to a cancer diagnosis. The policy is for the CIS to attempt to transfer the caller to a national suicide hotline or, if that is impossible, to find a supervisor or nurse to take the call. However, the majority of suicidal callers contact the ACS during evening or night shifts, when nurses are not available and supervisor coverage is sparse. Furthermore, even supervisors and nurses are urged not to engage in anything that could be considered counseling. The result is that CIS are placed in the position of telling callers who have already expressed significant depression or suicidal ideation that the CIS cannot help them but can provide referrals to other numbers. When the call ends, the CIS is left wondering whether the caller is safe. If a CIS does provide any type of counseling, they receive a written warning; accumulating three warnings is grounds for termination.

The policy should be changed. Not only should CIS not be punished for providing counseling to a suicidal caller, but CIS who work evening and overnight shifts should be given training to handle suicidal callers, and day-shift staffing should ensure that at least one crisis-trained CIS is on staff at all times.

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