In the early months of the coronavirus pandemic, the Veterans Crisis Line was able to handle the increased demand and transition to working remotely for many employees, a government watchdog found.
A Department of Veterans Affairs Inspector General report released Wednesday showed that the hotline was able to balance shifting many of its workers from crowded call centers to avoid exposure risk with meeting a spike in calls and messages from veterans.
"As COVID-19 evolved, many Americans, including veterans, experienced a range of negative effects from fear and social isolation to unemployment and financial insolvency. Because of these and other stressors associated with the pandemic, an increase in the volume of incoming VCL calls, chats, and texts was expected," the report said.
From January through May, the crisis line handled an average of nearly 52,500 calls per month, with a peak in March of more than 56,000 calls. During the same time period, the crisis line handled an average of more than 6,6000 chats and nearly 3,000 text messages per month.
Demand slowed again to pre-pandemic volume as of late May, according to the report.
But employees at the crisis line's three locations in Canandaigua, New York, Atlanta and Topeka, Kansas, were able to meet that demand, though some said the call centers themselves weren't always safe environments for workers.
In most of the call center offices, staff generally worked in close proximity, in shared cubicles, using shared computers and phones, the report said. Before the pandemic, VA considered telework for crisis line operators "too much of a risk" because of concerns about the quality and dependability of workers' home internet or phone service, according to the report. Interrupted crisis line calls or chats could put veterans at greater risk.
As the pandemic spread, however, crisis line leaders began planning for nearly 800 staff to move to remote work in phases.
It took 300 additional computers (plus keyboards and mice), 600 monitors and 300 iPhones, all specially equipped, to make it work. Staff had to be specially trained for telework and contingency plans complete with emergency scenarios had to be developed. A lack of onsite IT staff made the transition and telework more challenging and prompted outside contracting. By the final week of April, all the call center employees who wanted to telework had made the transition, according to the report.
And despite that transition, the Inspector General was not able to identify and was not told of "veteran care being negatively affected" during the move. The crisis lines' rate of referrals to suicide prevention coordinators remained consistent and the majority of those coordinators reported their ability to monitor high-risk cases was the same or better as before the pandemic. The speed for answering calls, chats and texts, the rate of dropped communications and caller satisfaction all met VA's target rates.
Because the transition to telework took time, though, some employees were forced to continue working in the call centers. The Inspector General's report found mixed opinions in a survey of crisis line workers, with slightly less than half saying leadership was prepared for and responded in a timely manner to the pandemic.
Multiple workers said they were concerned about a lack of social distancing and protection for high-risk employees, though 82% surveyed said they were able to maintain social distancing and 88% said there were COVID-19 precautions in place. Leadership created seating charts, stocked supplies, kept up cleaning and sanitization schedules and had personal protective equipment on hand, the report found. Some survey respondents said there were some PPE and cleaning supply shortages at the call centers and delays in beginning social distancing.
The crisis line didn't have to hire any additional staff to help handle the increased demand, though there were plans in place if they exceeded capacity, the report found. When staff were working at home, they accomplished more, leaders found, since fewer employees requested unplanned leave.
The Inspector General's report did not specifically review, but did mention, that crisis line workers reported in their surveys that the increased stress of the pandemic, coupled with the intensity of the crisis response work they did daily, "was overwhelming" and emotional support services normally available at the call centers to balance that burden were less available during the pandemic or during telework.
VA Press Secretary Christina Noel told Connecting Vets on Wednesday following the report's release that the crisis line had seen marked improvements and achievements in 2020, including answering 95% of calls in 20 seconds or less, with an average speed of nine seconds; taking about 1,756 cals per day and nearly 300 through chat and text; submitting more than 370 referrals to local VA suicide prevention coordinators per day; dispatching emergency services to those most at risk nearly 80 times per day; monitoring more than 11,000 calls with 99.7% of those addressing risk of harm to the caller or others; and more.
Overall, the Inspector General found that the crisis line's pandemic response was "remarkably successful" in meeting the increased demand for service from veterans and moving its employees to telework, and the office made no major recommendations for changes as is typical in such reviews.
"The OIG was impressed with VCL leaders’ and employees’ efforts to promote employee health safety and ensure that the VCL met its mission to provide immediate access to crisis intervention services during the COVID-19 pandemic," the report said.