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Calls to action: How 211 became an instant link to health and social services during the pandemic

Photo by Travis Gauthier

Each piercing ringtone signals another call for help. Not from inside a burning building or on behalf of a heart attack victim — it’s a different kind of emergency. But for some, the stakes are just as high.

Operator: “Louisiana 211, what can I help you with today?”

Caller: “I tested positive for COVID. I lost wages because of it. I actually caught it at work.”

Caller: “My dad has COVID-19. He’s not able to leave his home…”

Caller: “I have lost my apartment during COVID. What can I do to get assistance?”

All calls to 211 are confidential. Identifying information and names have been withheld to protect the anonymity of callers.

Since Gov. John Bel Edwards’ emergency response activation on March 11, Louisiana 211 has provided disaster-related information to 260,000 Louisiana residents through live calls and instant-keyword texts. This public service exists thanks to a regional network of nonprofit call centers and dialing codes awarded by the Louisiana Public Service Commission, which regulates utilities in the state. 

In a state ranked as one of the poorest in the nation, where about 18% of residents live below the poverty line, these calls provide a glimpse into what happens when a pandemic strikes communities already on the brink of a breaking point. Respondents in a May 2020 Covid-19 ALICE survey by the Louisiana United Way reported a 42% reduction in household employment, with Black and Hispanic respondents reporting an overall employment reduction of 51%.

“You have people who didn’t realize how insecure they really were with food, or a paycheck away from being homeless or paycheck away from paying their utility bills,” says Tina Shelvin Bingham, executive director of Lafayette’s McComb-Veazey neighborhood association and community development director at Habitat for Humanity. “It’s opening eyes to how stretched we really were as a community.”

She says the Covid-19 outbreak has laid bare one of the biggest healthcare challenges faced by her community — access. Yes, that includes access to health insurance and primary care physicians, but it also means knowing where to go for the specific care you need and the means to get there.

In a televised press conference on March 18, flanked by Attorney General Jeff Landry and LSU head football coach Ed Ogeron, Gov. Edwards briefly looked up from his notes to deliver a message directly to his constituents: “If you have any questions about whether you can and should be tested, please call 211 if you don’t have a primary care physician to call.”

This simple call to action, “call 211,” echoed across the state, from glowing highway billboards to state government websites, press releases and social media accounts. It worked. When times got tough, Louisiana residents knew exactly where to call for help.

Then, on March 23, when the governor issued a statewide stay-at-home order, he cited a grim statistic: Louisiana had one of the fastest coronavirus growth rates of anywhere in the world. A summer surge brought with it another unenviable distinction — first in the nation in Covid-19 cases per capita. Most recently, a punishing hurricane season ushered in two major storms, which rammed into Louisiana’s coast just six weeks and 15 miles apart. The calls haven’t stopped.

Sarah Berthelot, president and CEO of the Louisiana Association of United Ways, serves as the 211 statewide disaster and emergency coordinator. Photo by Travis Gauthier

But through it all, 211 live call specialists connected thousands of residents to health and social services via the system’s vast network of providers. Simultaneously, it collected data and fed information back to those state agencies and nonprofits, scrambling to raise levees against the flood of unmet needs.

When the Louisiana Department of Health’s hotline first became inundated with calls in March, 211 immediately stepped in. To date, 211 has serviced more than 133,000 callers with information on Covid-19, through its partnership with LDH. That’s not including the more than 40,000 who received Covid-19 information via 211’s text keywords. Often, that meant screening callers’ needs, then directly connecting them to health experts at LDH who could answer questions and provide advice about whether to get tested.

Sarah Berthelot, Louisiana Association of United Ways president and CEO who serves as Louisiana 211 director of disaster response during statewide activations, says with the help of LDH experts, 211 has expanded access to accurate, up-to-date health information about Covid-19. She says at the start of the pandemic, 211 published a public, dynamic Google doc that features answers to callers’ FAQs and addresses misinformation about things like access to testing, symptoms and sanitizing groceries. It has also created additional text keywords that seamlessly connect people to rental assistance and food stamp applications.

“As things develop, the number of calls we receive in a given day is indicative of what happened,” explains Berthelot. “Imagine us having 2,000 conversations a day; you’re inevitably going to learn about what those days’ concerns are. It was easy to see how much need existed in such a short amount of time.” 

Berthelot stresses personal details on 211 calls remain strictly confidential. But as a whole, the data provides targets for an already stretched disaster response effort, allowing the state to funnel help where it is needed most. Behind the scenes, 211’s power lies in the grassroots scrappiness of eight regional organizations, whose trained specialists personally answer and respond to each individual call for help.

Chris Roy is the executive director of the Acadiana region’s 211 provider, also known as 232-HELP. Photo by Travis Gauthier

Chris Roy is the executive director of the South Central region’s 211 provider, also known as 232-HELP. His grandmother founded the Lafayette-based agency in 1965 with a $5,000 grant from the Department of Health. Throughout his tenure, he’s responded to all kinds of disasters, from devastating hurricanes like Katrina and Rita to the oil-fueled recession of 2016. He says 2020 is like nothing he’s ever seen. But thanks to his experience on the front lines, he and his team were ready.

“I just kind of put the Bat Signal out — really taking it seriously and being ready for the storm,” says Roy, who trained 20 additional call operators when the Covid-19 emergency response began in March. 

Because of that foresight, his team was in position to take overflow 211 calls from the New Orleans region during the virus’s devastating April surge. “We rose to the occasion, taking 35% of the state’s call volume during the biggest crisis we’ve ever seen,” says Roy.

Throughout the pandemic, Roy has participated in a regular conference call with the Acadiana-area VOAD (Volunteer Organizations Active in Disaster) where he relays the most pressing needs to Acadiana region nonprofits and receives updates on new resources. The calls allow local organizations, like United Way, Habitat for Humanity, Catholic Charities and Second Harvest, to pool limited resources and improvise new solutions. For example, after an influx of calls from quarantined families in need of food assistance, the group created a partnership between United Way and Second Harvest that has delivered hundreds of homebound meals.

Second Harvest Food Bank innovated its distribution model in the pandemic to deliver emergency food boxes directly to individuals isolated in their homes. Photo by Travis Gauthier

Roy says these times of crisis crystalize an all-too-often overlooked reality — that social services are healthcare. 

“Thinking of this as a health crisis that just involves people getting sick from a virus is a limited way of thinking about it,” says Melinda Taylor, executive director of Lafayette Habitat for Humanity. “It’s causing health impacts, and it’s exacerbating health disparities that were preexisting in the community.”

Taylor leads the Acadiana VOAD calls, and says 211 has been crucial to uniting the region’s emergency response because it’s provided real-time data into the community’s most pressing unmet needs. She says their ongoing goal is helping people live a healthy life, which at its most basic level means providing those in need with decent food and safe shelter where they can keep their family isolated.

But, this pandemic is different. After six months, the needs continue to pile up. With no end in sight, and without the case management provided by FEMA in previous disasters, it’s easy for people to fall through the cracks. Roy understands this risk all too well.

“I worked the phones for five years. The most frustrating thing is when you would get a call and give that person resources, but not know what happened after,” says Roy. 

The pandemic has given him an opportunity to stress test a software platform called Unite Us. According to its website, the platform’s mission is to connect health and social care through a shared network. Unite Us currently powers a statewide network in North Carolina that is backed by its 211 call centers. Roy says he thinks something like this could be a game changer for Louisiana.

“We want to be that central nervous system for the body to fight disease,” says Roy. “All these things that are barriers to access are knocked down. We can create a closed loop instead of an open loop.”

In early October, Roy and his regional 211 team officially launched a pilot program of the Unite US platform with the Louisiana Department of Children and Family Services that he hopes will lay the groundwork for a statewide expansion, similar to North Carolina. 

Kisharra Angelety, special projects coordinator at 232-HELP/211, has been answering calls and logging call data throughout the pandemic. Photo by Travis Gauthier

Kisharra Angelety, special projects coordinator at 232-HELP, has been answering 211 calls for more than a year. During the pandemic, she’s used the Unite Us platform to help track callers and follow up to ensure they get the help they need. Instead of putting the burden on the caller, the platform allows Angelety to forward their needs directly to a resource provider who will then contact the caller directly. This has proven more effective than giving people more phone numbers to call.

“When people call, they are looking for a counselor, they’re looking for a friend, they are looking for triage, they need that Step A, Step B, Step C, and that reassurance, it’s going to be OK,” she says. “When you’re in the middle of the fire, you cannot see your way out.”

Angelety says one of the most important parts of her job is being able to tell when someone is asking for one thing, but needs something else. Angelety describes a woman who originally called to inquire about how often she should be disinfecting her house, but after a 20-minute conversation, Angelety realized what she really needed was counseling services. The numbers back this up. Data from 232-HELP’s call logs during the height of the pandemic reveal that at least 12% of people who called for health questions related to Covid-19 were also referred to financial services, 10% to food-related services and 8% to housing-related services.

This analytical, human-to-human interaction is at the heart of 211’s success. It’s why people call, and why they keep calling back. For Angelety, Roy and 211, the real question is not whether their work has an impact. It’s how they can continue to scale, so their impact reaches even more people. Building a statewide social and healthcare services network is one giant step forward in that direction. Angelety says they are already witnessing its potential.

“We may have someone calling for shelter — they are literally on the street, then they’re calling to say, ‘I need furniture in my new apartment,’ and then they’re calling to say, ‘hey I need a mortgage lender,’” says Angelety. “As they call back, we’re able to see the progression and how things have come full circle in people’s lives, due to calling us and getting those resources.” 

UP NEXT IN LIFELINE: Interactive— Calls to 211 Reveal Covid-19’s Impact on Louisiana

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Lifeline: COVID and Solution Hub are supported by founding sponsor LHC Group.