An academic-community partnership between the UIC Center for Clinical and Translational Science and NAMI Chicago seeks to examine helpline data to better serve the mental health needs of the Chicago community as well as reduce burnout among call center staff.
Marc Atkins, PhD
Professor of Psychiatry and Psychology
Director, CCTS Community Engagement and Collaboration Core
Grace Cua
Senior Research Specialist, CCTS Community Engaged Collaboration Core
Graduate Student, Educational psychology, UIC
Jim Poole
Chief integration Officer
NAMI Chicago
To learn more about burnout, you can read this 2016 article from World Psychiatry.
If you would like to see your interdisciplinary team featured on the podcast, reach out to me at laurenw@uic.edu.
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The University of Illinois Chicago Center for Clinical and Translational Science is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
0:00 TEASER, MARC ATKINS
I'll just make the point, which is classic in community engaged research, which is how bi-directional it is. It is the case that we have some expertise- I don't want to deny that, of course. But it is absolutely the case that agencies that we’re working with have enormous expertise, and they're teaching us about what's practical and what's useable. That's what I love about community-based research is we learn as much as we share.
0:25 Voice Over (VO)
Welcome to Collaborative Endeavors, a podcast about how scientists from different areas of research come together to tackle big health challenges, leading to better therapies and healthier communities.
In this episode, we look at how a simple request for UIC’s Center for Clinical and Translational Science to help NAMI Chicago analyze its call center data led to a change in internal processes that ultimately enabled the nonprofit’s helpline staff to better support the mental health needs of the Chicago community.
Contributing to this effort are Dr. Marc Atkins, a professor of psychiatry and psychology at UIC who leads the CCTS’s Community Engagement and Collaboration Core, and Grace Cua, a senior research specialist and UIC graduate. On behalf of the NAMI Chicago team, we have Jim Poole, the organization’s Chief Integration Officer.
NAMI – N-A-M-I – stands for National Alliance on Mental Illness. The local organization is an affiliate of NAMI national and has been around since 1979. One of their core functions is providing mental wellness support to individuals and families, particularly through their helpline. In 2019, NAMI Chicago became the official mental health service provider of the City of Chicago’s 311 line in order to support community members in distress.Jim describes the helpline environment and some of the early drivers behind the organization’s partnership with CCTS.
01:50 Jim Poole
My job at NAMI is really surrounding our data tracking system and our quality assurance of our programs. So my work focuses on making sure that our reporting forms are in order that we're getting the right data that we need both for funders and for our program needs, and really helping our leaders and our program teams think through how they can best analyze what's happening in their work and improve the outcomes that they're seeing in the people they’re working with.
I've been with NAMI Chicago since 2018. That year I think we took about 3,500 calls and when we began our partnership with the city, we doubled to 6300. And we found ourselves with more and more data from our calls that we were tracking and information about what was happening in the community, and we wanted to really make sure that A) we were getting the right stuff and that B) we were understanding what it was telling us. And we needed support to kind of go through that, what was really a very dense data record with now growing numbers of calls to really engage in what are we seeing? What could we say about the callers to our helpline? And then how can we then use that for ourselves and advocacy and building training programs and engagement and recovery programs to really try to meet the needs that we could and understand what was happening on the ground.
03:00 VO:
To understand how the CCTS started working with NAMI, you need a brief history lesson. The CCTS has a long-standing relationship with the Chicago Department of Public Health through a collaboration between several local health research institutions, including Northwestern University and the University of Chicago, known as C3. In addition to this partnership with the city, Dr. Atkins had a professional connection with NAMI Chicago’s CEO, Alexa James. NAMI’s 311 support for the city, coupled with Dr. Atkins pre-existing relationship with Alexa James, ultimately led to a conversation about the organization’s data needs.
03:40 Dr. Atkins
We were talking on the phone and I said, Alexa, NAMI Chicago is so central to the needs of Chicago, the mental health needs and providing services and resources nobody else is providing, how can we be helpful? How can we at CCTS be helpful? And she said, well Marc, could you help us look at our data because we're getting so many more calls now and it would be really helpful to us to have a sense of where they're coming from and what the needs are and so on. And I said to Alexa that, you know, I think we can do that because I have someone on my team who is just amazing at that.
I could tell Grace just lit up when she heard about it. She just got very excited about it. It combined her social work world along with her data analytics interests. And she started digging in and started to look at their data and talk with them, talk with Jim about how the data was structured. Once Grace started digging in, she just started getting more and more interested and excited about what was happening there because the numbers were so large, the needs were so great. And she just got very creative about how she was able to kind of map it in a way to help them see who they were serving, what the needs were and the tremendous increase.
05:00 VO:
Grace and Jim described some of the early conversations around data needs.
05:08 Grace Cua
When we started our collaboration it was in the midst the height of the beginning of COVID and the stay-at-home orders. And I think for me particularly, I wanted to make sure that I could help those who were really in the trenches doing the needed mental health care. And so that was really my biggest motivator to help them tell their story and help them use the data to inform their policies and their practices, particularly during this really huge public crisis. I kept the first meeting really open to understand and hear what they needed from me, and I wasn't trying to dictate a certain research question their way. I wanted to really hear what was important to them, and their community.
05:54 Jim Poole
For us, the helpline has always been the beating heart of the agency. And so it allows us to stay connected, help people navigate the system, which is always so difficult in many cases. And it really informs everything that we do and how we approach what we prioritize, what we engage in. What we were looking for in partnership is just a sound set of data eyes. You know, we're all social workers or practitioners of one kind or another and we really needed that expertise that we didn't have in-house to help assist us in looking through this.
06:24 Grace Cua
Our first initial kind of set of questions that we first looked at are trying to really understand and describe the data and understand where calls are coming from, how many times callers are calling back. And I think one of the biggest things that I believe Jim and NAMI took was to see how to improve their data collection system- to collect data, to be more systematic particularly around how often callers are calling back. And I think that's one of the biggest things that we noticed was that NAMI was a resource during the height of COVID, but then once people noticed that NAMI was a very valuable resource, callers kept calling back and really engaged with the community long term. It wasn't just a one-time call.
07:12 VO:
As Grace mentioned, the CCTS partnership with NAMI could not have come at a better time. The COVID-19 pandemic impacted mental health on a global level and its effects were certainly felt within the organization. Jim painted a picture of what life was like around the call center at that time.
07:30 Jim Poole
As the pandemic kind of took on through the spring and into the summer, we really saw more and more traffic coming to our helpline. We jumped from monthly call counts of somewhere around 700, I think our peak was over doubled at about 1500 in May of 2020, 1500 calls in a month. Our team had to really spring into action. Also, we can no longer operate our office, right, so we were also implementing remote practices for our team and keeping our systems online.
I should also mention that a lot of the systems were failing around us. So I'll give you an example. In a lot of our food security system in Chicago, there are a lot of community-based organizations, including faith-based organizations that run pantry services and run food distribution services. When the pandemic hit many of those are staffed by older people, seniors, and people who do it like volunteer work. When the pandemic hit, many of those simply had to close out of a safety concern. And so as a charity in responding to that, we, we sort of developed funds to be able to do basic interventions to help people. We had a partnership with the Lakeview Pantry and with the University of Chicago sending food to people, there were some people who we were giving some temporary housing too and trying to give them somewhere to be in the midst of this public health emergency. And so, there was a lot of work we were doing and we really wanted to understand- What were the needs we were seeing? How were things changing? And how can we really get a more of an elevated view on that? So I think a lot of our questions coming into it were really making sure that we were maintaining the quality of our service but also that we were understanding what was happening and what was needed from us in that moment?
And in the midst of all these changes, we were continuing to provide support and resources to people. It was an incredibly challenging time, but also for us an exciting time where we were able to grow our program and grow our team and really deepen in our work, especially with the help of Grace and Marc.
09:17 VO:
As the events of 2020 continued to playout, NAMI’s leadership didn’t fail to notice the impact it was having on their helpline staff. According to a 2016 publication in World Psychiatry, burnout has long been recognized as an occupational hazard for those in people-oriented professions, including human services and health care. Burnout is a psychological syndrome caused by prolonged exposure to stressors and can manifest as exhaustion, cynicism, detachment and a sense of ineffectiveness and lack of accomplishment. If you’re interested in learning more about burnout, there’s a link to this paper in our show notes.
Given the critical role of helpline employees, any sense of burnout could be a big problem. Here’s Dr. Atkins…
10:00 Dr. Atkins
One of the things that came out of it immediately that Jim and Ben Frank, his colleague, picked up on was that they were starting to worry about their staff because they were all remote and they weren't able to connect with them. And given those numbers, the question of- how do we anticipate burnout? How can we monitor it? And Grace and I got to work and dug up some measures for them and started thinking a little bit about how they could add a few questions here and there around some key moments when staff are feeling that they're dealing with a difficult call. And they picked up on it right away and started doing that. They were a very advanced organization that way, as one might expect, but they're very in tune with the needs of their staff.
10:48 VO:
Jim elaborated
10:50 Jim Poole
Burnout is a huge issue. I think the more that organizations can think about how they are thinking about that, and how they're preventing that, and how they're responding to it, and supporting the wellness of their employees is also just really important.
At NAMI Chicago we have an amazing team who are just deeply committed to our mission, deeply committed to mental wellness and helping people find their way and find recovery and rise and instill hope. And I think what we ask of our team and what they want to provide is emotional support. But in order to do that, you have to make yourself available emotionally right? It's not a phone call like at a call center with Comcast or something, you really have to try to develop a connection, build trust and rapport and really try to understand where somebody's coming. Our average time today is something like 17 minutes so we take our time with our callers. The effect of that though is that there are secondary trauma impacts, right, with someone telling you a really stressful story. They're having trouble finding food, those things that you carry with you. And then beyond that, imagine an environment where your call volume is doubled and so things are busier and everybody's jumping in and it's just a fast pace. And then the third thing I should mention is that before covid-19 we were a single call center in our office. And so if I knew that my colleague was on a tough call, I could walk over and be of support to them afterwards, we could all take steps to debrief or talk with them right then and there. It's kind of like a side conversation. In a remote perspective, that becomes much more difficult and people become much more isolated. And so it was about how do we support our team in doing this really important work that requires so much of them and just as human beings normal, that it takes a toll. So burnout in Social Services is a is a huge issue and we're not immune to that. I think we began to develop those questions with Grace I want to say around January of ‘21 and begin thinking about how can we begin to measure or ask our team about burnout and assess it and you really give that information to everybody so that we can be of support to each other and help reduce those effects.
12:56 VO:
From her perspective, Grace was more than happy to work with NAMI to create data-driven solutions to support their staff.
13:05 Grace Cua
One of the greatest things about NAMIs organization is that they really care about their employees. I think when I was approached to help out with understanding their staff well-being, and burnout levels, they really wanted it to be really proactive. And they took a very data-driven approach to make sure that they are preventing and supporting their staff before anything got worse.
VO:
Jim added…
13:30 Jim Poole
I want to give a shout out to our Chief Wellness Officer, Ben Frank, who is who is all things wellness, and focused on those questions every day. What we wanted was something really simple that the team could complete that didn't feel burdensome. There's a lot of these batteries that are like multiple questions and, you know, it's hard enough to do the work and then to ask you to do a bunch of batteries doesn’t seem practical. In February ’21, we implemented intensity scores. So we asked our call takers to score the intensity, which is term of art, but think about how it made you feel, how intense was the experience of the call. So it gives us some insight into what's happening. It also is as great supervision tools as you look at it for somebody, you may see that a particular type of need feels more intense for that individual, that may be something we need to process and think about. There may be some additional resources we can give them or information that would make them feel more confident, make it less intense for them. But really, it's a great tool for individual by individual as one thing to use as part of other things in clinical supervision with them to really make sure that they have what they need and that they feel supported as they do their work.
You used to be able to do that with your eyes. Am I talking to someone, engaging with them? And there's a certain amount of you just getting to know someone; thinking about any colleague that you had, you kind of know a little bit about what's going on with them just by the way that they're acting that day, right? So this gave us some ability to have some insight that they were giving us on their experience. And I think it's been very valuable. We still obviously rely on our one-on-ones and all those things but it's just another tool in the toolbox that's been helpful as we all navigate the space.
I think people feel like it's a good way to take stock of the calls, and we recently just added another question with the help of Grace, which is where they rate their ability to help the caller on the call. And so really thinking of going from intensity but then also thinking about how able did I feel to address the needs of this caller. And we're just beginning to see that. I think it's been a good way for them to also have a chance- just in a short time- to reflect on what they just went through, which can be a really helpful mindfulness tool and really helpful way to try to manage stress and manage one's own workload. I think they've found it to be helpful as well, but it hasn't been a burden on them, which I think has been has been great.
15:38 VO:
A key theme behind this collaboration is the need for translational scientists to take the evidence gained through academic study and help organizations on the ground apply it to their day-to-day operations. This process is critical to ensuring that society is able to gain the benefit of health research endeavors. Here’s Dr. Atkins…
16:00 Dr. Atkins
I'll just make the point, which is classic in community engaged research, which is how bi-directional it is. It is the case that we have some expertise- I don't want to deny that, of course. But it is absolutely the case that agencies that we’re working with- the CDPH- have enormous expertise, and they're teaching us about what's practical and what's useable. And I think I think our discussion around burnout was a perfect example. There's an entire literature on burnout, but not the way we needed it, not the way NAMI Chicago needed it. That that took some effort and a dialogue with them to kind of figure out how to do this in a way that's going to work for you all, that's going to be helpful to your staff, and it's going to help you improve services. That's what I love about community-based research is we learn as much as we share.
I think our role, and it’s a very small one, is to be there and provide whatever research evidence we can provide, whatever support we can provide to help guide their thinking. Again, we're not major players in this, I don't want to overstate our role, but I'm honored that we're at least involved in these conversations. So I think, you know, these things take time. They're not quick. NAMI stayed there with us [and they want to keep working with us on it]. We're starting to see some really interesting data come out of it.
I think in terms of the whole concept of translational science- it's getting us out of our silos, almost by definition. That's the reason why there is this concept of translational science. It's NIH acknowledging that the institutes are too siloed and we need a major initiative to bring some of these disciplines together. We are at the outer edge of translational science right, we’re the community facing part of our center and so our interface is not with basic scientists and so on- although we're doing a little of that which is fun- but it's with the public policy and the community agencies in town and the ways that we can provide research support and research information, including aldermen and the mayor's office and CDPH and things like that. I want to stay involved and I would hope to stay involved. Nami is a growing organization, and they're always doing new things, and I think Grace and I are going to stay involved and try to be as helpful as we can.
18:45 VO:
While pandemic-related events created an upheaval in mental health services, the need for wellness support is not going away. Grace and Jim talk about the future of this collaboration and their hopes for the future of mental health programs across the nation.
19:05 Grace Cua
Our collaboration with NAMI Chicago has really evolved over the past two years. We first started with NAMI to really help them understand what was going on in their helpline, understanding call patterns and their call services, and it has really evolved to now working with NAMI with understanding wellness and burnout among their staff, and trying to be proactive in addressing those concerns. And then now, it's evolved to understanding more outcome monitoring data. So understanding- what’s the impact of the helpline? Are the resources and referrals that NAMI’s making, is it making a difference out in the community? And that's our kind of next step as well and it's been really exciting to see our collaboration evolve and grow over the years as well.
19:55 Jim Poole
There’s a narrative about mental health that it's a brain thing. We’re going to go and do things with your brain and that's going to help you with your mental health condition. And what we know now from the latest research is that it's not just that. There's a physical element to it, your environment matters, there's all kinds of crazy things that contribute to mental wellness. What we have that's unique is that we engage holistically, and we're able to because we're not a provider. We may be in a unique space to be able to re-engage holistically and walk with people and not have to be in a defensive position or in a position where we have to defend a system. I think the more that people can take a healing centered and wellness centered approach to the work and really try to focus on building people up and building resiliency, and giving people the space they need, I think we can benefit from that. Oftentimes there’s too much prescriptive programming, too many things that lock people out, too many exclusionary criteria. Particularly for people, in our case, living with a serious mental illness; they can often find themselves unable to find care. And so, I think there's a lot to learn from things like the helpline. It's like creating doors and opportunities in different ways for people to engage. It's really, really important.
There's a lot of energy as you talk about mental health and a lot of investments that’s going in all kinds of different ways. We really want to be deliberate about accounting for how people are able to move through the system- what is working for them? what is not working for them?- so we can better advocate and really inform all these initiatives to make sure that we're doing the most effective things for the community. A lot of this has to be built because there's long legacies here that have to be overcome. I think the insight we can gain next is really what are the right ways to connect people? What are the right kinds of services that feel right? What are the supports that feels best? I think that's kind of where we're going next.
NAMI Chicago and really all NAMIs throughout the State of Illinois are organizations that are committed to recovery and believe in hope and that there's always a way. We do not have much of a mental health care system and we never really have had much of one. And so there is a great energy in building this. I would implore everyone that as we build it to be patient and recognize that this is a large effort that we're engaged in and we need cooperation. And so I think keeping that energy is vital as we continue to make gains and develop new services and and make these exciting investments.
22:15 VO:
Dr. Atkins wrapped up our conversation with the following
22:20 Dr. Atkins
I’m hoping to see a real transformation in the way we understand behavioral health and mental health in Chicago. I'm hoping that we move away from this idea of mental health is the same as mental illness and that we see it’s a continuum and that we need to be very active in prevention and early intervention and building community supports to reduce the amount of significant and severe mental health issues. I'm excited cuz I see this this really starting to happen in Chicago so I'm hoping we stay players in that. I'd like to I'd like to continue to be a partner with them on this.
23:05 Voice Over Outro:
Collaborative Endeavors is produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois Chicago.
To learn more about Marc Atkins, Grace Cua and the NAMI team, visit the links in our show notes.
The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. Opinions expressed by guests of the show are their own and do not necessarily represent the views of myself, the CCTS or our funding agencies.
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