1. 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

2. 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 callers.
The second part of the presentation will focus on a survey of 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 service, but also lives of callers

3. Call outcomes study 2-1-1 Missouri callers
Participants in study on incorporating cancer control referrals into 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 service.
For each service request, we measured several outcomes one month after the original call.

4. 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 caller population, but other demographic characteristics were similar.
1379/1898=73%, 1235/1898=65%

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

6. 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.

7. 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.

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

9. 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

10. 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

11. 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?”

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

13. 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.

14. 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

15. 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.

16. 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)

17. 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 help lines, but this is only for Missouri

18. 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?

19. Part II: 2-1-1 Survey results

20. 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, and March 31, 2013.

21. Who took the survey?

22. Who took the survey?

23. 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.

24. 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

25. 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.

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

27. 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.

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

29. 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.

30. Parenting resources

31. 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.

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

33. Child health and health care

34. Child health and health care

35. Child health and health care

36. Child care

37. Child care

38. Child care

39. 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?

40. Summary
Potential proactive role in connecting 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.

41. Discussion Outcomes surveys 2-1-1 survey results
Understanding impact of 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?