American Democracy & Health Security

American Democracy and Health Security

Lighting a path forward amid pandemic Polarization

Tara Morse
Executive Director, Indiana 211 Family and Social Services Administration, State of Indiana

“To me, the real story in this is that Indiana 211 came into the FSSA agency at a critical time, although we still answer some COVID-19 related calls, Indiana 211 also serves over 20,000 Indiana residents per month to help them connect to services and programs to meet their basic needs. With decreased call volume related to COVID, Indiana 211 has appropriately reduced the number of dedicated staff who answer those calls, however due to existing infrastructure, we can quickly scale up, if or when another public health need arises. For example, potential concerns about Mpox increased, as COVID calls were scaling back, health worked with Indiana 211 staff who were then equipped to provide the most current information to callers by establishing FAQs to inform callers as well as address caller concerns.  We continue to serve our intended purpose of connecting people with resources and programs to meet their needs, while maintaining that ability to scale up as needed for public health concerns or other disaster related events.” 

Creating
A COVID Information Easy Button

With a career spanning nearly 30 years of public service across the Indiana Family and Social Services Administration, accepting her new assignment as the Indiana 211 Executive Director, in October 2020, Tara Morse led the charge to adapt a newly stood up state help line to the changing needs of the COVID-19 response, providing much needed and evolving information and connection for the state’s most vulnerable. Capitalizing on recent legislation that transformed 211 information lines from not-for-profit funded organizations to a statewide, state-funded resource, came the challenge to immediately use the line to respond to requests for information and vaccine scheduling to all residents of Indiana.  Indiana 211 answered more than two million calls in 2021 and multiple lines of service continue today, connecting state residents with critical health information and social support.

Planning Ahead For A Statewide Resource

A prescient move by the Indiana state house to establish 211 as a statewide, state-funded helpline set the stage for the development of a valuable COVID resource. Many 211 programs operate at the local level, rather than under statewide purview. In January of 2020, just as COVID-19 was emerging, new legislation required Indiana’s 211 program (IN 211) to move from a local level program to a state-funded division of the Indiana Family and Social Service Administration.

Nobody knew about the pandemic in January 2020 when that legislation passed. The forward thinking of the Indiana Legislature positioned Indiana, through 211, to provide Hoosiers with easy access to connect to the most current COVID-19 resources. Before joining FSSA, there were multiple 211 call centers throughout the state, but they did not service the entire state. Consolidating into a statewide system has allowed Indiana 211 to maintain funding, to ensure long term sustainability.

Prior to her assignment to Indiana 211, as the pandemic emerged, she began volunteering at an Indiana Department of Health call center. The department was overwhelmed by calls from providers and citizens in the community. The need to expand the call center was evident as needs were ramping up in March of 2020. Morse ran this call center for about a month, which included expanding staffing; ultimately employees were sent home and pivoted to a virtual call center.

At first, Morse used the call center to connect with those infected with the virus, coordinate contact tracing across Indiana’s 94 health departments, and follow up with people and families who tested positive.  

At the onset of the COVID-19 public health emergency, Indiana needed a statewide solution that didn’t exist, which led to Morse establishing an entire contact tracing program for the state.

“Prior to my assignment to Indiana 211, the referral line was part of the conversation because we were reaching out to people who had tested positive, making sure they understood what they needed to do. During that time, we found that, because they were isolated, they had a lot of needs: they needed food, they weren’t sure how to pay rent. Naturally 211 was the perfect resource to establish those connections for people. 

Transitioning from running the Indiana Department of Health COVID19 general public response line to being appointed the Executive Director of Indiana 211, allowed her to continue to identify where IN211 could best serve residents during a time of heightened need.

Pivoting to Vaccinations

Ultimately the state looked to IN 211 as a more consistent and statewide solution for managing the array of needed COVID services – including scheduling vaccinations.

The vaccine was starting to roll out in early December of 2020. Indiana 211 received a call from state leadership about leveraging the service line to not only answer calls about COVID-19 questions, but also support inquiries about vaccines. So, we’re thinking, okay, we can do that! Maybe we need 50 new people to answer those calls. Then a few days later, leadership called again asking if 211 could actually schedule vaccines for people who could not schedule online. Indiana 211 was up to the task but estimated we needed maybe 500 to 1,000 additional staff to support the state’s population of 6.9 million people.

Building on their statewide contracts and experience with contact tracing, IN 211 was able to rapidly expand.

“Indiana 211 had to stand up a new line of business, in partnership with the Indiana Department of Health, while rapidly expanding staffing and the logistics of onboarding.  Because the contact tracing staff were not quite as busy as they had been in the earlier months of 2020, Indiana 211 was able to cross train that team to assist with vaccine scheduling, allowing for a quick solution to address a new priority.” 

“One of the values of being part of the state is that Indiana 211 has vendors that can help with changing staffing needs. For example, they were able to work with a workforce center in Indianapolis that they had already worked with for contact tracing. This vendor was able to provide the state with applicants to stand up a call center by December 22 and we went live on December 24. This was 22 days after Indiana 211 was tasked with a vaccine response.”

The state was quickly able to engage and leverage an existing system that was very easy to use and required training for Indiana 211’s contract staff. We were able to teach them how to schedule appointments but also answer questions that came up like, ‘Do I get this vaccine or this other one?’ Or ‘Why would I want to get two shots when I can just have one?’ Through the very intentional collaboration with the Indiana Department of Health, we believed we were able to provide people with information that would help them make an informed decision. We would make sure our staff knew not to answer questions based on what they had heard, but rather to only answer based on FAQs. And people simply had to dial
2-1-1 from any phone to reach us.

Reaching Everyone, Across The State

Providing easy access to information and vaccine scheduling provided much needed support during a confusing and nerve-racking time.

We had so much positive feedback, especially from the older population. People called us crying when they could get access to the vaccine, saying, ‘you don’t know how much better that makes me feel.’  Even if their appointment was two weeks out, they knew that they weren’t necessarily going to be isolated in their home once they got vaccinated. Then they felt more comfortable going out with a mask, whereas before maybe they didn’t.

“For members of our communities who have some type of physical limitation or mental limitation, they didn’t have to jump through a bunch of hoops for somebody to be able to schedule an appointment on their behalf.”

Morse credits nonpartisanship and constant communications, including from the governor, in keeping people informed.

I can’t tell you what party anybody is affiliated with because it didn’t matter. We had people’s lives at stake. Everybody
was working from home. Not being in a physical environment with everyone was not a limitation for us at that time, we had daily stand-up calls where we would go through what was working, what wasn’t working. We had all the partners on the calls to work out all issues and escalate as necessary. I’m not saying there weren’t contentious conversations that we had to have right before rollout to make sure the system was working, but we all worked through it for the same purpose of providing people seamless, easy access to the COVID vaccinations. We figured out what we needed to do. It was really amazing.

“In early February 2021, the Governor was still hosting daily press conferences. That was significant, I know, for my parents who were in their seventies at the time, and my mom had just been recently diagnosed with metastatic breast cancer, that was really meaningful to them, to have the best updated information, because what you heard at the national level might be relevant to certain things, but maybe on the local level it’s a little different. “

Adding Services

Over time, the IN 211 COVID programming expanded to respond to a wider array of pandemic-related needs. While still answering calls about COVID, the line also responded to questions about MPox, rent support, childcare, the Supplemental Nutrition Assistance Program (SNAP), and mental health concerns. She is now on the national 211 leadership committee and hopes to help bring improvements to the information service across the country.

Because of COVID, we’ve set up two childcare lines as well. We help people apply for the Child Care Development Block Grant. It’s also a family referral line, so if you’re going back to work or moving and you’re not sure about childcare, you can call, and we have access to all those resources that are within our own agency.

“When the pandemic SNAP benefits were enhanced, that’s all information that we were easily able to get and share with our callers. People are confused about it because it went out to a much broader population than the SNAP population. If you’re in school, maybe your family received services they wouldn’t have received otherwise. We were able to coordinate very easily with our Division of Family Resources, who administers the SNAP program for Indiana. We didn’t administer the benefits, they did, but we were able to keep in the loop on everything that was going on.”

When the federal government was rolling out the emergency rental assistance program, it was a significant influx for people who had trouble paying their rent and were still struggling. We worked with the Indiana Housing and Community Development Authority (IHCDA) to set up a line so that, when someone called 2-1-1, it was IHCDA staff who answered those calls and managed the FAQs. Thousands and thousands of calls came into that line.

“Before the national launch of the 988 Suicide & Crisis Lifeline, Indiana recognized the need to provide free resources and support for various mental health challenges due to COVID-19.  With the help of federal funding, FSSA, stood-up the Be Well Crisis Helpline.  By contacting 211 a person could connect with a crisis specialist 24/7″

Meeting Multiple Needs

Morse and her team were able to adapt the call center throughout the pandemic, increase personnel when needed, and establish separate lines for different needs. 

“To me, the real story in this is that we still answer calls for COVID and the Indiana Department of Health, although significantly less, we still have a few people who answer those calls now. When Mpox happened, there was concern over how big it was going to get. Immediately, we had calls with Health. We stood up an FAQ, so people understood what they needed to know about it.  We were able to leverage the infrastructure to adapt to health needs as they arise throughout the state from measles outbreaks to any other health concern that generates significant questions to the Indiana Department of Health.”

The security of having one number that people are used to calling is significant, as a state, we do not need to establish new numbers every time something significant arises, we can advertise to call 2-1-1. Maintaining that relationship with the Indiana Department of Health has never been maintained at this level and continues to be sustainable. The ongoing effects of what we learned in COVID have been significant in making a difference for people and how they get connected to services. It’s been very exciting to be a part of it.

“It has been helpful that we didn’t just walk away. We’re still here. And no, for COVID-19 it’s not thousands of calls, but to those people that call, it’s really important. We’re pleased that we’re able to continue that relationship, even if it’s at a very minimal level, because that door is still open in case something does open that we need much greater services.”

The need is no longer very big for COVID-19, but we’re still there to help people connect to needed services.   If we needed to staff-up at some point – if we had a resurgence or the next outbreak, we learned how to be nimble and react to current needs of Hoosiers to react in a way that’s very meaningful. We assume people would call 2-1-1 because that’s what they’re accustomed to doing.