3.5 Million Social Needs Requests During COVID-19: What Can We Learn From 2-1-1?
Miles-long lines of cars waiting for boxes of food. Empty shelves where toilet paper should be. “Closed” notices taped to storefront windows. These images of the social and economic fallout of COVID-19 are powerful. Yet, actual surveillance data documenting the pandemic’s social impact are in shorter supply. With a few exceptions such as unemployment claims, most social needs are not systematically tracked by governments, let alone in real time.
We’ve been monitoring daily calls and requests to 2-1-1 helplines across the US since the pandemic began and offer four observations based on more than 3.5 million requests to 2-1-1s during COVID-19: the impact was immediate and dramatic; needs are changing over time; vary by population and place; and policies influence needs. Implications of these findings for community action, policy evaluation, and ongoing surveillance are discussed.
In the US, the closest we come to a national surveillance system of social needs is 2-1-1, the three-digit helpline available in all states. In a typical year, 2-1-1s receive about 13 million calls and several million more requests by web, text, or chat. Each request is classified using a taxonomy of more than 10,000 categories and subcategories of social and health needs. Based on the needs a caller expresses, 2-1-1s provide referrals to local resources and services.
That’s why in 39 of 50 states, the government response to COVID-19 has included sending residents to 2-1-1s for information and referrals. In 17 states, 2-1-1 is formally designated as the primary information line during the pandemic. That makes 2-1-1s an excellent source for understanding the impact of COVID-19 on a wide range of social needs.
During COVID-19, the volume of requests to 2-1-1s has increased dramatically. Questions about COVID-19 symptoms and testing account for part of this increase, but mostly people need help dealing with the economic consequences of the pandemic. We know this because 2-1-1s in 32 states participate in a daily tracking system called 211 Counts. Since the pandemic began, 2-1-1s in this tracking system have received more than 3.5 million requests for assistance. 211 Counts collapses these into 126 categories such as food pantries, rent assistance, and mental health services. Each request is linked to the caller’s ZIP code. Thus 2-1-1s capture the type and volume of needs being expressed, the neighborhoods most affected, and how needs change day by day.
We have monitored these data throughout the pandemic and are sharing the findings online in more than 65 reports, spanning many dimensions of health, social, and economic impact across the US. Here, we synthesize these findings into four broad observations and discuss their implications.
The Impact Of COVID-19 Was Immediate And Dramatic
The World Health Organization declared COVID-19 a pandemic on March 11, 2020. In the first two full weeks afterward (March 16–29), food-related requests to 2-1-1s skyrocketed, increasing 486 percent. Requests for rent assistance were up 137 percent, and across all need categories, daily requests more than doubled compared to pre-COVID-19 rates in 2020. The overall rate of increase is even more striking given that requests to 2-1-1 for help with some other social needs declined sharply as a direct result of COVID-19. With the closure of schools and workplaces, child care needs dropped 54 percent; with stay-at-home orders and a heightened risk of virus transmission in crowded spaces, requests for transportation assistance, such as bus passes, dropped 35 percent.
Although the volume of food requests to 2-1-1s has retreated from its post-COVID-19 peak, that does not mean that food needs have subsided. Rather, when a person calls 2-1-1 looking for food, they receive referrals for up to three different pantries near them. With that information in hand, most callers won’t need to re-contact 2-1-1 every week, even if their food needs persist. Thus, at least some new people are calling for help all the time. Over four months after the pandemic began, food requests to 2-1-1s remain almost 90 percent higher than pre-COVID-19 rates.
Needs Are Evolving As The Pandemic Stretches On
While food requests and COVID-19 information were most pronounced in the first month of the pandemic, each has generally declined since the initial surge of calls to 2-1-1. During that time though, other needs have emerged. Requests related to housing, employment, and mental health have all increased as the pandemic progressed, either in absolute numbers or as a proportion of all calls received.
Housing-related needs, especially rent assistance, utilities, shelters, and low-cost housing, are top reasons people call 2-1-1. During COVID-19, requests for rent and electric bill payment assistance increased immediately and have stayed relatively high. Requests for help with landlord/tenant issues have increased during the pandemic, and requests for low-cost housing, which include public housing and other options, have risen every month after an early decline.
There have been many reports about the mounting toll of COVID-19 stressors on families as the pandemic continues to disrupt lives and livelihoods. At 2-1-1s, requests for mental health services have been stable across the pandemic. Requests to 2-1-1s for health care services—including eye care, reproductive health, screening, vaccinations, and counseling—are fairly uncommon, but reveal a unique pattern. After declining by 37 percent in the first two months of the pandemic, they rebounded to new highs in the third and fourth months, coinciding with the time many health care providers began to see non-COVID-19 cases in person again.
Needs Vary By Population And Place
Americans’ experience of the pandemic differs by population subgroup, neighborhood, and even local economy. Although food-related requests to 2-1-1 increased for people of all ages, the largest jump came among adults 70 and older. Staying home to reduce exposure to the virus, their requests for food pantries and home-delivered meals rose by more than 400 percent. Women, who account for 69 percent of all requests to 2-1-1 during COVID-19, make up an even larger share of requests for assistance with diapers, toilet paper, and child care (85–87 percent). In contrast, men are proportionately slightly more likely to call 2-1-1 seeking employment assistance and unemployment benefits, transportation services, and COVID-19 information (34–35 percent).
Although 2-1-1s generally do not collect income, race, and ethnicity information from callers, population-level data from callers’ ZIP codes can be obtained from census data and linked to requests. Using this approach, we found that in Washington State, a rise in COVID-19 requests was driven by heavily Hispanic regions of the state. Nationally, those in higher-poverty ZIP codes were more likely to request help with basic needs such as food and housing, while callers from lower-poverty ZIP codes were more likely to call 2-1-1 seeking COVID-19 information. Unexpectedly, there has been a larger pre- to post-pandemic increase in total requests to 2-1-1 in low-poverty ZIP codes. These callers may be what 2-1-1s describe as “newly in need,” people that previously had fewer reasons to call 2-1-1 but have been affected by the pandemic.
Requests to 2-1-1 have also varied by local economies during COVID-19. Counties in Iowa, Nebraska, and North Carolina experiencing COVID-19 outbreaks in meat packing plants saw a near-synchronous rise in requests to 2-1-1, and the number of requests declined more slowly compared to other counties in the same state with no meat packing plant. Tourist destinations and cities that rely heavily on service industry jobs generated more 2-1-1 requests for certain services during COVID-19. For example, we examined how 2-1-1 requests for rent assistance in 164 metropolitan statistical areas varied by percent of the workforce employed in childcare, hair and nail salons, and other personal service jobs. As the percent of the workforce in these types of jobs increased so did the rate of requests to 2-1-1 for rent assistance.
Policies Matter
It is clear from 2-1-1 data collected during COVID-19 that requests for help with the same need can vary widely from community to community. In some cases, differences align directly with the health impact of the pandemic: New Jersey, with the nation’s second most COVID-19 deaths, experienced the greatest increase in requests to 2-1-1 for burial assistance. In other cases, though, systematic variation appears to be linked with prior or new policies.
The Eviction Lab at Princeton University and Columbia Law School’s Professor Emily Benfer created a scorecard that rates each state on its protections for renters, such as policies regulating eviction and availability of short- and long-term support for renters. Using the scorecard, we divided states into those with stronger (> 2.5 stars on a 5-star scale) and weaker (≤ 2.5 stars) protections for renters. During COVID-19, requests to 2-1-1 for rent assistance have increased by 85 percent in states with weaker protections compared to 61 percent in states with stronger protections. In specific cities, as temporary eviction bans expired, requests for rent assistance more than tripled.
State guidelines for reopening economies after COVID-19 shutdowns also appear to be associated with 2-1-1 requests. Among the 32 states for which 2-1-1 data are available, 24 explicitly state that childcare facilities can re-open with limited capacity only, 10 require childcare facilities to favor children of essential service workers, and seven have a phased re-opening plan in which childcare facilities became available at least one phase later than other jobs. Thus, as states began to re-open in May 2020, many workers were returning to jobs before childcare in their community was at full capacity. 2-1-1s captured the effects of this misalignment: Childcare requests dropped every week of the pandemic until May but have been on a steady climb since then.
Conclusion
Collection and analysis of surveillance data are only worthwhile if they lead to action. The potential applications of 2-1-1’s social and economic needs data are many. For a social service safety-net system that is stretched thin in the best of times, COVID-19 presents a daunting challenge and a renewed sense of urgency for investment and improvement. When requests to 2-1-1 double, that means referrals to community-based agencies double as well. Understanding which needs are rising and falling in which neighborhoods should inform community priorities and resource allocation to better and more efficiently meet demand. Just as the field of informatics is helping advance public health and medicine, so too should it be a major part of efforts to modernize the social service sector.
In addition to informing actions, such data could help evaluate the impact of efforts to mitigate the economic fallout of COVID-19. Analyses described here provide hints about the impact of renter protections and phased re-opening of states. 2-1-1 service request data could also help monitor the impact of expanding eligibility for food benefits, extending unemployment benefits, or myriad other social policy solutions being proposed. The same-day availability of 2-1-1 data is an enormous advantage for evaluation, making it easier to determine with precision the lag between implementation and impact, and quickly adjust or change course as needed.
Lessons learned from 2-1-1 data in the first four months of COVID-19 suggest the potential for greater insights still to come. For example, how are different needs interconnected? We found strong associations at the ZIP-code level between post-COVID-19 unemployment claims and rent assistance requests to 2-1-1. Identifying needs that systematically co-occur could provide the basis for strategic, cross-sector, partnerships and solutions. Aberration detection algorithms that signal potentially concerning trends are being applied to public health surveillance data and could be developed and deployed in social needs tracking systems such as 2-1-1.
Finally, the next four months of COVID-19 will likely bring new challenges to monitor. With the return of school, many families will need improved technology and internet access, and help feeding children if learning from home is involved. Polls show happiness at an all-time low in the US; will mental health and substance abuse needs continue to rise? If job loss continues or furloughs become permanent will more Americans be seeking health insurance or assistance with medical bills? All of these needs are captured by 2-1-1.
2-1-1 data are not perfect. Use of 2-1-1s can be greater in urban than rural settings in some states, and 2-1-1s almost certainly underestimate community needs given that some individuals will seek help elsewhere or not at all. It is nonetheless a remarkable national resource that will be essential to understanding and addressing community needs for the duration of COVID-19 and beyond.
Authors’ Note:
Matthew Kreuter and Balaji Golla are codevelopers of 2-1-1 Counts, an open, public data source used in analyses described here.
