Improving the Lives of 2-1-1 Callers: Call Outcomes and Unmet Needs Sonia Boyum Health Communication Research Laboratory Washington University in St. Louis 2015 AIRS I&R Training and Education Conference Dallas, TX

Call outcomes and unmet needs Call outcomes study What happens after referrals are given? 2-1-1 specialist survey What issues would improve the lives of callers most? Discussion The first part of the presentation will focus on a study of call outcomes for Missouri 2-1-1 callers. The second part of the presentation will focus on a survey of 2-1-1 I&R specialists, managers and call center directors. We asked them what issues they think would improve the lives of their callers most. And the third part will bring up some discussion points for how we can use what we learned to improve not only 2-1-1 service, but also lives of 2-1-1 callers

Call outcomes study 2-1-1 Missouri callers Participants in study on incorporating cancer control referrals into 2-1-1 service Follow up 1 month after original call Results for first service request and up to 3 referrals Part of a larger study we did on incorporating cancer control referrals into 2-1-1 service. For each service request, we measured several outcomes one month after the original call.

Remembered receiving referrals (N=1235) Sample description Original sample (N=1898) Reached at 1 month (N=1379) Remembered receiving referrals (N=1235) Mean age: 43.5 years 86% female 60% African American 27% < high school education Participants were those eligible and consented to participate in the cancer control study. A greater proportion were female than in the larger 2-1-1 caller population, but other demographic characteristics were similar. 1379/1898=73%, 1235/1898=65%

Reason for calling (first request) Utilities – Gas, electricity, water Home and family – holiday gifts, clothing, furniture, school supplies, aging etc.

Outcomes measured at one month For each of 3 referrals Did you attempt to contact this referral? Did you reach this referral? What happened as a result of this contact? Did you resolve the problem? As each question is answered, the sample size gets smaller.

Outcomes Did you attempt to contact this referral? 91% of callers attempted to contact at least one referral Why not contact? Not enough time - 37% Resolved problem another way -16% Lost the numbers - 10% Waiting to call – 8% Already knew the numbers - 6% Referrals not helpful - 6% Other - 37% What are the other reasons? Could indicate more than one reason.

Outcomes Did you reach this referral? 82% who called a referral reached someone

Outcomes What happened as a result of this contact? 36% received assistance Did not receive assistance: No funds available 34% Did not qualify for services 25% Other reasons 7% No reason given 34% 25% of whole sample received assistance

Outcomes What happened as a result of this contact? 36% of those received assistance Did not receive assistance: No funds available 34% Did not qualify for services 25% Other reasons 7% No reason given 34% 25% of whole sample received assistance

Problem resolution Did you resolve the problem? ~50% of participants resolved the problem by one month follow up Received assistance – 70% Did not receive assistance – 41% We asked, “Did you resolve the problem?”

Problem resolution There wasn’t a statistically significant difference between categories.

Unmet basic needs (next 30 days) Not enough money for unexpected expenses Not enough money for necessities Not enough living space Neighborhood safety No place to stay Not enough to eat Physically threatened Wanted to understand what factors were related to resolving problems, other than whether or not the caller received assistance. Unmet basic needs or life circumstances are separate but of course related to the caller’s reason for calling. At baseline (time of original call to 2-1-1) callers were asked how likely it was that they would have the following needs met in the next month.

Unmet Basic needs Participants had on average 2.4 unmet needs % of sample that had each basic need unmet Average number of unmet needs=2.4

Problem resolution Do unmet basic needs, receiving assistance predict whether or not the caller will resolve his or her problem? Logistic regression model controlled for number of service requests, age, sex, race, income, education, employment status, children in the home, study group from cancer control study We estimated a model predicting problem resolution and included the basic needs, age, sex, race, income, educational level, employment status, child in home. We attempted to include type of service request, but it was not significantly related, so we excluded it in the final model.

Model results More likely to resolve problem: Received assistance (3 times more likely) Less likely to resolve problem: Not enough money for necessities (2/3 as likely) Physical threat (1/3 as likely)

Conclusions 2-1-1 Missouri is highly effective in connecting callers to needed services But, need for services greatly exceeded availability Receiving assistance increases chances of resolving problems Limitations – there are more than 200 2-1-1 help lines, but this is only for 2-1-1 Missouri

Conclusions Due to unmet basic needs, some callers may be less likely to solve their problems How can we explain this? Outcomes studies can tell us more than just outcomes of referrals Understand the “why” of outcomes What can we do to improve outcomes? What else can understanding call outcomes tell us? Can we use outcomes studies to tell us more than just outcomes of referrals, but also to understand WHY and WHAT we can do to improve outcomes?

Part II: 2-1-1 Survey results

The survey Washington University staff in partnership with AIRS delivered the online survey Survey invitations sent from AIRS leadership Participants were from across the US and Canada Survey administered between Feb 25, 2013 and March 31, 2013.

Who took the survey?

Who took the survey?

Survey content Resource Availability and comfort Top 3 Need categories (A, B, C) A: Rank Top 3 Sub-categories Resource Availability and comfort B: Rank Top 3 Sub-categories C: Rank Top 3 Sub-categories Participants were asked to rank their top 3 priorities for improving the lives of their callers from a list of categories. For each selected need, they were then asked to rank the top 3 subcategories and then were asked two questions about availability. How would you rate the number of resources available for this subject? And acceptability: How comfortable would you feel bringing up this subject with callers.

What is most important for improving the lives of your callers? Preface: thinking broadly BEYOND things in your current database, or things that you know are already available… what additional resources and skills would REALLY make a difference ? Rank top 3 categories

Needs for those with children Parenting Child health and health care Child care Child development and learning Home and child safety Enriching children’s learning beyond school We will ask you to think about the lives of both adult callers AND callers who have children in the home. We then asked to rank the importance of subcategories within these main categories. As I have limited time, I’m going to on needs of callers who have children in the home today.

Callers with Children % of sample that ranked each category in top 3. Health care and child care are also important topics.

Within the categories you prioritized, what would help callers most? The next section will ask you to think further about what you said is important for improving lives.

Parenting Ranking within top 3 subcategories categories, of those who ranked parenting as a top priority.

How would you rate the number of resources available? The next section will ask you to think further about what you said is important for improving lives.

Parenting resources

If a caller did not ask about this issue, how comfortable would you feel bringing up this subject? The next section will ask you to think further about what you said is important for improving lives.

Parenting discomfort Ranking within top 3 categories, of those who ranked parenting as a top priority.

Child health and health care

Child health and health care

Child health and health care

Child care

Child care

Child care

Summary Parenting, child health and health care, child care were top priority issues Often high priority subcategories have inadequate resources 2-1-1 staff report low levels of discomfort with discussing sensitive topics with callers - how often are these high priority issues also reasons for calling 2-1-1?

Summary Potential proactive role in connecting 2-1-1 callers to resources beyond their primary reason for calling Highly ranked topics adequate resources Highly ranked topics inadequate resources Different approaches needed for addressing those highly ranked topics with adequate and inadequate resources. If adequate resources exist, it may just be a matter of linking those in need with appropriate resources. If inadequate resources exist, partnerships with community organizations will be needed.

Discussion Outcomes surveys 2-1-1 survey results Understanding impact of 2-1-1 referrals What other questions might be relevant to assessing the “why” of call outcomes? 2-1-1 survey results Possibility of proactively address needs of callers How well 211 is doing is more than number of calls or number of referrals – what happens afterwards?