Child abuse investigations usually begin with a phone call.
More than 400 times each day, someone in Tennessee — a family member, concerned neighbor, teacher, police officer, or doctor — dials a hotline to warn of a child in danger.
More often than not, the call ends up on hold.
During the last two years, the department hasn’t answered its phones as quickly as it used to, so more callers than ever have been hanging up — as many 25 percent in the early months of 2012, department data show. Nobody can say what happens to those thousands of callers and their concerns, or whether chances to help children are being missed.
When callers do get through, they find trained social workers like Amy Taylor on the receiving end, watching the calls appear on a computer screen inside the Department of Children’s Services call center in South Nashville.
“I always apologize to them,” Taylor said. “I just thank them for their patience and explain the unpredictability of call volume.”
DCS officials said they recognize the urgency of the problem.
“We still are struggling,” said Carla Aaron, DCS executive director for child safety and head of the call center, known as Central Intake. “You’d love to answer every one on the first ring. But I think because of the call volume, and not knowing every day how many calls you’re going to get, and trying to predict the staff, that is an ongoing oversight that our management looks at every day.
“We know how important it is to answer that phone call,” Aaron said, “because it could have very critical information about a child’s safety.”
To answer calls faster, the department transferred five case managers to the call center this summer, increasing the staff to 70. The office recently got new computers, with an updated phone system to follow this month.
And a group of national child welfare experts has begun a study of the call center. The group plans to suggest improvements in the next two months.
DCS already knows some of the reasons for the increase in abandoned calls and longer wait times.
First: Tennesseans have been calling in about 15 percent more allegations of child abuse and neglect the past two years.
“Some of that is due to the economic situation,” Aaron said. “Families are stressed, and sometimes that plays out in their interactions with their children.”
The DCS computer system installed in 2010 also requires call takers to spend more time entering information.
For a while, the computers were so troublesome that some social workers across the state were calling the abuse hotline whenever they wanted to reach someone in the center who had more expertise with that computer. Those calls tied up the lines and inflated call volumes. Once discovered, the practice stopped, officials said.
The combination of more calls, slower technology and issues with high staff turnover has made it harder to answer calls, according to officials and an independent review of the system.
In the department’s worst months, including in late 2010 and early this year, a fourth of the calls went unanswered. The numbers improved this summer, possibly after the addition of staff, said DCS officials. Callers who dial the wrong number and hang up immediately are counted as abandoned.
Years ago, until mid-2010 when the new computers arrived, most calls were answered in one minute or less. But the average wait is now closer to three minutes, and sometimes twice that long.
Calls are first step
Abuse phone calls are the first step in launching an investigation. For more than a decade, Tennessee has been trying to launch child abuse investigations more quickly, as demanded by a federal lawsuit settlement known as “Brian A.”
The state has yet to meet those standards.
The calls are “critically important,” said John B. Mattingly, former commissioner for children’s services in New York City and a senior fellow at The Annie E. Casey Foundation, which is reviewing Tennessee’s call center at no cost to the state.
“It’s not simply a hotline the way 911 is, where your job is basically to get some facts and then get the EMS people rolling,” Mattingly said. “This is the question of the possibility of severe abuse and neglect.”
Mattingly said the people answering phones need training and expertise in deciding the level of urgency. Aaron said she has tried to recruit experienced case managers from the field to join the call center.
In Tennessee, call takers must have four-year college degrees and nine weeks of training. They hold the same job title, case manager, as social workers in the field.
Yet there’s little to prepare them for the emotions that come across in the calls, and for the sad, frightening stories they hear — all while trying to capture important details from a caller.
“There have been calls where I had to take a moment afterwards,” Taylor said. “We hear so many sad things, all day, every day.”
Recently, Taylor answered a call about the death of an infant.
Inside her dimly lit cubicle, decorated with family photos and an Employee of the Month certificate, Taylor spoke into her headset and toggled between two glowing computer screens for more than 13 minutes.
On one screen, she filled in information about the family members and child. On the other, she typed notes to craft a narrative of what happened.
To be accurate, Taylor spoke the heartbreaking details back to the caller. Monotone and serious, Taylor probed for details and checked spellings.
She hadn’t had to take a fatal call in more than two years, she said. She has answered five such calls in her five years at the call center.
“I remember each one, vividly,” Taylor said. “But the ones that I have taken that seem to stick out in my mind are just the parents knowing about something happening and they’re not being protective.”
Many callers worry about being identified. Others hardly let Taylor get a word in.
“You have people yelling and screaming in your ear,” she said. “You have to kind of adjust to what the caller is doing. That is one of the hardest things to do here.
“As stressful and emotional as it is, at the end of the day we may have helped somebody.”
At the end of each call, Taylor answers questions on the computer that walk her through the severity of the case to determine risk factors.
Questions include where the alleged abuser might be located, whether the case concerns sexual abuse and whether the child is under age 12.
The computer responds with an urgency level. The most urgent, Priority 1, requires a face-to-face response by a social worker within a day. Priority 2 demands a response in 48 hours, and Priority 3 within three days.
“When in doubt, I always screen higher,” Taylor said.
Supervisors, who review all calls, can adjust the priority response time. Social workers in the field cannot.
Of the 170,000 calls each year, some 65,000 become actual cases. The rest are already open cases, are hangups or do not require DCS intervention.
For most of this year, the department’s computer system hasn’t been able to produce reports showing whether front-line social workers respond fast enough to cases.
Older data show that at the beginning of 2009, case worker response times had improved since the year before. For Priority One cases, workers met the response time goal about 85 percent of the time.
Advances in works
The call center’s new phone system will be designed to give more automated information to callers. For example, a prompt will tell callers that nonemergency situations can be reported online.
Another option will allow callers to leave confidential voice mails.
The system will also produce better statistics, so leaders can keep an eye on changes and potential problems.
The department has started to shift staff to be on hand at peak call times.
In the past year, 10 of the 65 employees left or transferred out.
“You’re answering the phones all day long. For some people it can be not exactly how they want to practice social work,” Aaron said. “They want interaction with families and to be more hands on.”
“These people hear horrific stories,” she said. “They hear of child fatalities and they hear of bruises and burns and horrible things that have happened to children. Some people have a hard time forgetting about what they’ve heard on the other end of the phone.”
Contact Tony Gonzalez at 615-259-8089 firstname.lastname@example.org. Follow him on Twitter @tgonzalez.