The state’s child abuse hotline wasn’t able to answer about 1,000 calls per month on average in 2016, increasing the possibility of injuries to children that otherwise could have been prevented.

Every year, people place about 55,000 calls to a statewide hotline, available 24 hours a day, because they suspect a child in Maine is being abused or neglected. Those initial calls set in motion a process that may result in an investigation and intervention in the lives of families.

The 1,000 unanswered calls per month are better than the 1,500 calls per month, on average, that weren’t answered on the first try in 2015, but Maine can still improve, according to a national expert.

The Maine Department of Health and Human Services wants to reduce the number of unanswered calls and hired five contracted workers to help, starting largely in 2016. It’s also planning changes to the call-in process with the hopes of making it more structured and efficient.

In addition, other states may offer ideas for how Maine can improve.

‘It’s not good’

About 22 percent of calls, 12,198 out of 54,904 calls in total, to the hotline weren’t answered on the first try in 2016, according to numbers provided by Jim Martin, director of the Office of Child and Family Services, within DHHS.

That counts people who hung up before their call was answered — 7,325 calls — and those whose calls went to voicemail — 4,873 calls. When people don’t reach a hotline worker, they can choose to wait on the line. Or they can choose to leave a voicemail, which workers aim to return within 24 hours, Martin said.

In 2015, 33 percent of calls — 17,907 out of 54,179 — weren’t answered on the first try. And in 2014, 32 percent of callers — 17,514 out of 55,041 — either hung up or went to voicemail.

Martin cautioned that the numbers include people who hung up and called right back, or decided to hang up because they didn’t actually want to make a report. He did not know to what extent those types of calls changed the overall statistics.

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Assessing how effectively Maine handles incoming calls is further complicated by numbers that DHHS reported at the start of 2017.

In a document posted to a state website to back up its desire to spend nearly $700,000 on contracted workers to fill a gap in hotline staffing, the department described “near constant” vacancies, which were causing an average wait time of 68 minutes, with 40 percent of callers hanging up before their calls could be answered.

The numbers, however, were incorrect, said Martin, when the BDN asked about them.

“We can’t back those up at all. My staff, when they created that document, looked at the data and used it out of context,” Martin said. “It’s inaccurate, completely inaccurate.”

He added that the state’s system doesn’t even calculate average call wait times — only the longest wait time in a given day. The listed average wait time of 68 minutes “was pulled incorrectly off a report,” he said.

But it’s clear there’s still a need to fill. “The reporting that’s being driven to this agency is greater than its current capacity to handle it in the most efficient, timely way,” said Vicky Kelly, who used to direct the Delaware Division of Family Services and reviewed Maine’s call statistics.

Maine’s correct unanswered call rate of about 22 percent is “not horrible, relative to some other jurisdictions that I know of,” said Kelly, who is now a child welfare consultant with the Annie E. Casey Foundation. But, she continued, “it’s not good.”

It’s difficult to pinpoint an ideal unanswered call rate, however, because the ultimate goal is to protect children. Even if the state had fewer abandoned calls, what if not answering just one call led to continued or severe harm to a toddler or infant?

“That’s why, in a sort of pure sense, it’s hard to have a metric that says, ‘This is acceptable,’” she said.

The BDN couldn’t independently confirm the state’s corrected numbers because DHHS isn’t required to submit them to the federal government or the Maine Legislature.

‘We wanted somebody to be able to take that call’

It’s common for states to struggle to some extent to staff their hotlines, given the resources they have, according to experts with experience in other states’ child welfare departments. But there are strategies to make reporting systems as effective as possible.

Here are three:

Complete overhaul. In 2015, the situation with Pennsylvania’s child abuse hotline was dire. Twenty-four pieces of legislation took effect, expanding the definition of what qualified as child abuse, and reclassifying who were considered perpetrators and mandated reporters. (Mandated reporters are required by law to report potential child abuse if they have reason to suspect it.)

As a result, the state experienced a dramatic increase in the number of calls to its child abuse hotline. That January, 43 percent of calls were dropped or abandoned, said Amy Grippi, chief of staff for that state’s Office of Children, Youth and Families.

After completing an analysis of the hotline’s workload, she helped bring about a complete overhaul.

One option open to states is to have a backup call answering service that can pick up calls when the hotline gets busy and alert caseworkers if there seems to be an urgent situation with a child. Pennsylvania considered a backup service but decided against it because it wanted to reach high: Its hotline would aim to pick up every call.

“We did not want to do the call answering system simply because if a critical call comes in, we wanted somebody to be able to take that call,” Grippi said.

Pennsylvania expanded its call-in queue, so calls wouldn’t be dropped because too many people were trying to get through at the same time. Today, no calls are deflected because of a system overload.

The state increased its hotline staff to 72, up from 42. The hotline also received four additional supervisors, one of whom focused on improving staff training.

It built in as many efficiencies “as humanly possible” to address the volume, Grippi said.

For instance, mandated reporters are allowed to submit reports of suspected child abuse online. While a call generally takes 20 minutes, it’s possible for a hotline worker to process an online report in about five minutes.

The Pennsylvania hotline doesn’t permit voicemails. “The reason for that is, if it’s an emergency, we don’t want people leaving messages,” Grippi said.

It’s highly unlikely any state could have zero dropped or abandoned calls because people occasionally dial the wrong number or change their mind about making a report. So Pennsylvania set a goal of having only 4 percent of calls go unanswered, which it achieved in June 2016. Since then, it’s maintained a rate of about 2 percent.

It was only possible because everyone saw the need — from the governor and Legislature, down to individual workers, Grippi said.

“With any of those pieces missing, it wouldn’t have happened,” she said. “We had dedicated staff that wanted to make sure it was improved. We had management who prioritized it. We had funders who prioritized it. We had the support of government to make those changes.”

Priority call lines. Some states have designated priority call lines, so mandated reporters can get through quickly and efficiently.

Connecticut, for instance, has given all hospitals and police departments a special number to call, so hotline workers can answer their calls first. (In Maine, there’s an option for first responders to push a specific number to have their call moved up in the queue.)

The Connecticut system, which fielded more than 100,000 calls in 2016, has no voicemail. It relies instead on a call-back feature if no one is available to pick up.

“What that means is they don’t lose their place in line, but they don’t have to sit on the phone and wait for someone to answer. They will be called back,” said Karen Diaz, a program manager at Connecticut’s Careline.

Reducing wait times can have particular benefits for people such as nurses and teachers. Medical and school personnel made up the two referral groups most likely to report potential abuse in Maine in 2015, according to DHHS.

“It creates inefficiencies in those systems when professionals are diverted from their jobs to be waiting to be able to make a mandated report,” Kelly said.

Online reporting. Like Pennsylvania, other states have begun to allow people to report suspected child abuse and neglect online, in addition to offering a hotline.

Texas, for instance, provides a secure website for people to report situations involving both dependent adults and children that are not life threatening. Tennessee allows people to report potential cases of child abuse online and track the status of their referral throughout the life of the case.

The online approach is new, so it hasn’t been tested enough yet, Kelly said. But it can be helpful for mandated reporters who tend to already know what information they’ll need to provide.

It can have drawbacks for a state when used by members of the public who need to be interviewed to best organize their facts, so caseworkers can discern whether real harm is likely happening.

More investigations, fewer workers

It’s important for states to be open to changes because their hotline call volume will increase or decrease based on what’s happening locally, Kelly said. More people could start calling if more mandated reporters become aware of their obligation, for instance. Or the opiate epidemic could put increased pressure on the child welfare system.

Martin provided three years of data, which show the total number of Maine’s incoming hotline calls remaining steady between 2014 and 2016.

But over a longer stretch of time, Maine has seen an increase in the number of cases assigned to DHHS workers for investigation, according to reports the department must file with the Maine Legislature. Calls that ultimately result in an investigation tend to take longer for intake workers — those who answer phone calls from the public — to process, according to DHHS.

And over more than a decade, DHHS decreased its staff slightly: There were 26 intake workers and 119 investigators in 2015, down from 28 intake workers and 129 investigators in 2003, according to federal reports.

Maine has also seen a recent uptick in the number of hotline calls that DHHS refers to outside agencies because the reported situation is considered low risk. DHHS contracts with these private agencies to provide what’s called an “alternative response” — where the groups typically work with families facing more chronic problems, as opposed to acute danger.

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‘A timely response’

Even though the hotline function is “one of the most critical parts of the child protective system,” Kelly said, there’s not much published research to guide states in operating or updating their intake services.

A portion of Maine’s hotline calls have gone unanswered for years — since intake services became a centralized, rather than regional, function in the mid-1990s, said Shawn Yardley, CEO of Community Concepts, a social services organization with programs in Androscoggin, Franklin and Oxford counties.

It’s a problem, he said, “given the often acute nature of these calls.”

He has often been involved in making reports to DHHS of potential child abuse, especially in his nearly 10 years as director of Bangor’s Department of Health and Community Services, a position he left in 2013.

Whether city workers encountered a child in the community screaming uncontrollably and the sounds of hitting, found an unattended child, or came upon a baby with a visibly intoxicated parent, they would need to call the hotline.

“It wasn’t unusual to get put on hold or not even be able to be on hold — being kicked to an answering machine, and they call you back,” Yardley said. “The reality of what you do then is you call the police.”

Martin said the state wants to improve that experience: It has added staff and is trying to make the intake process more structured. Instead of letting callers tell more of a narrative, they will answer more specific questions. The goal is to increase efficiency, Martin said.

(Kelly, of the Annie E. Casey Foundation, said in her experience the more structured questions don’t significantly streamline operations since intake workers still need to spend time gathering as much detailed information as possible.)

DHHS first tapped Community Care, a social services organization for youth with a main office in Bangor, to provide the contracted intake workers starting in 2015 because it already offered alternative response services to low-risk families, according to the state’s documents.

Most contracted staff began work in December of that year, with the contract ending Aug. 31, 2016, said Kate Davis, the organization’s executive director.

Community Care is now working under its second no-bid contract with the department. DHHS will provide the organization with $667,334 to help staff the hotline between Sept. 1, 2016 and June 30, 2018, according to the state’s no-bid contract request form.

The state gave Community Care a no-bid contract, even though other agencies also provide the same alternative response services, because of the organization’s size and location, Martin said. It has staff in the Augusta area who can work at DHHS’ offices.

The state didn’t put out a request for proposals, which would have provided an opportunity for multiple organizations to compete for the work, because children’s lives were at risk, the no-bid contract paperwork stated.

“If we wait to RFP this service, the number of calls missed increases the possibility of a child death or serious injury that could have been prevented by a timely response,” reads the state’s justification for a no-bid contract.

The inaccurate call numbers in the state’s request for a no-bid contract did not change the need for the contract, Martin said.

“I view this as something that’s positive,” he said. “We are constantly evaluating and reevaluating every aspect of this department, and to the extent we recognize a need or a weakness, we’re addressing it, and that’s exactly what we did when we established that partnership with Community Care.”

Maine Focus is a journalism and community engagement initiative at the Bangor Daily News.

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Erin Rhoda is the editor of Maine Focus, a team that conducts journalism investigations and projects at the Bangor Daily News. She also writes for the newspaper, often centering her work on domestic and...