FY 2024 Annual Performance Plan and Report - Strategic Goal 3: Objective 3.4

Fiscal Year 2024
Released March, 2023

Topics on this page: Objective 3.4: Increase safeguards to empower families and communities to prevent and respond to neglect, abuse, and violence, while supporting those who have experienced trauma or violence | Objective 3.4 Table of Related Performance Measures

Objective 3.4: Increase safeguards to empower families and communities to prevent and respond to neglect, abuse, and violence, while supporting those who have experienced trauma or violence

HHS increases safeguards to empower families and communities to prevent and respond to neglect, abuse, and violence, while supporting those who have experienced trauma or violence. The Department continues its efforts to promote coordination across the government to address the full range and multiple forms of neglect, violence, trauma, and abuse across the life span. HHS is building a resource infrastructure to ensure equitable delivery of high-quality services to support affected individuals, families, and communities. HHS also leverages data to inform the development of effective and innovative prevention and intervention models to address neglect, abuse, and violence.

The Office of the Secretary leads this objective. The following divisions are responsible for implementing programs under this strategic objective: ACF, ACL, ASPE, CDC, HRSA, IHS, NIH, OASH, and SAMHSA. In consultation with OMB, HHS has determined that performance toward this objective is progressing. The narrative below provides a brief summary of progress made and achievements or challenges, as well as plans to improve or maintain performance.

Objective 3.4 Table of Related Performance Measures

The staff and volunteers of the National Domestic Violence Hotline (Hotline) provide victims of family violence, domestic violence, and dating violence; family and household members; and other persons such as advocates, law enforcement agencies and the general public with crisis intervention, emotional support, safety planning, domestic violence information, and referrals to local service providers as well as national resources. Measurement of the Hotline’s performance has historically focused on the percentage of total annual responses to calls in relation to the number of calls received. This performance measure acknowledges that tracking the answers or responses to calls is a better determinant of the Hotline’s usefulness than reporting the number of calls received (as previously reported).

In FY 2021, the Hotline answered 396,803 total contacts across platforms. The Hotline and loveisrespect (LIR), the helpline targeted towards young people, which is 49,322 more contacts than the Hotline answered in FY 2021. The Hotline’s FY 2021 our overall answer rate was sixty-seven percent (67 percent). On average, callers waited 5 minutes and 37 seconds for a connection to a Phone Services Advocate. Direct connect, which allows an Advocate to connect and transfer a caller to a local provider, was offered by Phone Services Advocates 16,740 times. In FY 2021, the Hotline experienced a significant increase in digital contacts compared to phone contacts. The Hotline’s Digital Services Advocates answered a total of 107,399 Hotline chats in FY 2020, in FY 2021, Digital Services Advocates answered 151,671 Hotline chats. In FY 2021, the Hotline saw an increase in average talk time and wait times during this reporting period, which results in a decrease in advocate availability. The Hotline’s advocates provide survivors with in-depth advocacy, lethality assessment, support, and safety planning which leads to longer interaction times. Less advocate availability does ultimately impact the Hotline’s answer rate and wait times. More survivors are choosing to reach out for the Hotline’s services digitally (for safety reasons, especially during the continued COVID-19 pandemic), and the launch of Hotline text services provided an additional method to do so. On May 13, 2021, the Hotline launched text services by text-enabling the Hotline’s toll-free phone number. On June 14th, the SMS short code- text Start to 88788- for Hotline text services became active. Previously, text services were only available through LIR. The success for answering more contacts can be attributed to efficiencies created through effective scheduling, technological enhancements, and training initiatives for advocates. It is not feasible for 100 percent of calls received to be answered due to unanticipated spikes resulting from media coverage promoting the Hotline phone number and increases in call volume during the rollover of state or local program crisis lines during an emergency or disaster. In addition, some situations require a caller to disconnect before an advocate can answer (e.g. the abuser enters the room). Given the expected continual rise in callers contacting the Hotline, increased hours of training for new advocates, and increased programmatic and financial support to StrongHearts Native Helpline, the Hotline is projected to have a performance rate of 75 percent through FY 2024.

The annual performance measure regarding repeat child maltreatment evaluates the trend in the percentage of children with substantiated or indicated reports who experience repeat maltreatment. ACF has set a target of decreasing the percentage of child victims who experience repeat maltreatment by 0.2 percentage points per year. For FY 2019, the rate of recurrence decreased to 6.6 percent, just missing the target of 6.5 percent. For FY 2020, the rate of recurrence decreased to 6.2 percent, exceeding the target of 6.4 percent. For FY 2021, the rate of recurrence increased slightly to 6.5 percent, missing the target of 6 percent. ACF will continue to support states in their efforts to support children and families who are experiencing a crisis, while ensuring the safety of children. The CAPTA State Grant program provides formula grants to states to improve child protective service systems through a range of prevention activities, including addressing the needs of infants born with prenatal drug exposure, referring children not at risk of imminent harm to community services, implementing criminal record checks for prospective foster and adoptive parents and other adults in their homes, training child protective services workers, protecting the legal rights of families and alleged perpetrators, and supporting citizen review panels. The renewed emphasis on prevention efforts, in tandem with funding for the Community-Based Child Abuse Prevention (CBCAP) program that also assists states in their efforts to prevent child abuse and neglect while promoting healthy parent-child relationships, may also assist in improving performance in this area. By FY 2024, the program expects to work with states in again reducing the rate of repeat maltreatment by 0.2 percent from the previous year’s actual result.

This performance measure demonstrates the continued work of the National Human Trafficking Hotline (NHTH) in identifying potential victims of human trafficking and increasing the number of incoming communications from victims and survivors. In FY 2019, the program funding level was increased by 100 percent and the hotline grantee launched an enhanced Interactive Voice Recognition system to prioritize calls directly from victims and those close in proximity to the potential trafficking situation. That year, the hotline identified 30,684 potential victims of trafficking ³⁸ It is important to note that federal funding represents only 72 percent of the total operating cost of hotline services. . In FY 2020, the total number of potential victims identified decreased to 19,186, a 37 percent decrease from the prior year. However, the total number of potential cases identified (each case could have one or more victims) only decreased by six percent from the prior year (11,852 potential cases identified in FY 2019 and 11,193 potential cases identified in FY 2020). The total number of signals from potential victims increased by 27 percent (10,362 signals in FY 2019 and 13,129 signals in FY 2020). This result indicates that while more signals came in directly from potential victims of trafficking, the cases of potential trafficking may have involved fewer victims per case than in prior years. Some of these results may have also been impacted by challenges related to the COVID-19 pandemic, including quarantine and social-distancing measures. Other pandemic-related challenges that impacted the operation of the hotline included the move to remote operations that may have limited in-person supervisory support, staff wellness and increased turnover attributed to pandemic and/or secondary trauma on calls, increased mental health calls from the public requiring more time per call, and the spread of viral misinformation on human trafficking increasing overall call volume (which increased from 136,990 total signals in FY 2019 to 15,100 signals in FY 2020). While ACF did not meet this particular target for FY 2020, it increased the number of signals received directly from potential victims and responded to a record number of overall signals. In FY 2021, ACF provided supplemental funding for the hotline to increase staffing capacity, recruitment and retention, and mental health and wellness resources.

By FY 2024, ACF aims to increase incoming communications to the hotline from victims and survivors and the number of potential trafficking victims identified by the hotline by ten percent over the average of the previous four years of actual results. This growth is anticipated, at least in part, due to the award of a $1 million contract in September 2021 for Look Beneath the Surface Public Awareness and Outreach Campaign Strategy and Materials. The campaign reflects the diversity of the anti-trafficking community, and messages will be targeted to reach marginalized populations and encourage those experiencing human trafficking to seek help, which will hopefully translate to increased communications to the NHTH.

Since 2014, ACF has expanded its network of care to be able to continue increasing the percentage of placement designation of referrals of unaccompanied children (UC) from the Department of Homeland Security (DHS) within 24 hours of referral. Although the statutory requirement is 72 hours, ACF aims for UC to enter the Office of Refugee Resettlement (ORR) care as soon as possible, recognizing that border facilities are not designed to meet the needs of children). In FY 2017, ACF was able to designate placement within 24 hours of referral to 98.67 percent of the UC referred by DHS. This performance measure is calculated by taking the number of UC who were designated for placement within 24 hours of referral divided by the total number of referrals per fiscal year. In FY 2017, due to a lower number of referrals and a surplus of bed capacity unoccupied, the program was directed to reduce bed capacity by approximately 30 percent. Changes to the overall bed capacity were insufficient in FY 2018 to accommodate the increase in referrals, and ORR was not able to meet this measure. In FY 2021, ORR received an unprecedented increase in UC referrals. There were 122,731 UC referred in FY 2021, compared to 15,381 referrals in FY 2020. This historically large influx, combined with added challenges from the COVID-19 pandemic, placed a strain on existing systems, and ORR was not able to meet the measure of designating 99 percent of referrals for placement within 24 hours.

In order to meet the number of referrals of UC and to ensure the best placement based on the medical and/or mental health needs and safety of the children, ACF has brought on additional bed capacity as needed. The program’s ability to avoid a buildup of children waiting in border patrol stations for placement in shelters is accommodated through the expansion of existing programs through the supplemental grant award process and emergency contracts that will be replaced with competitive multiple-award indefinite delivery indefinite quantity contracts allowing ORR to increase capacity beyond standard beds in the event of an influx without maintaining influx capacity during periods of low referrals. In order to meet targets, ACF continues its efforts in streamlining operations and making changes to existing policies and procedures to decrease the program’s length of stay. The program also continues to experience a higher volume of referrals and is engaged in increasing the overall program capacity needs. ACF will continue to collect grantee-related performance information including: monthly statistical reports, daily programmatic electronic updates and case file information related to admissions, discharges, and length of stay. The ORR Intakes team also tracks the daily number of UC referrals and the number of UC pending placement in excess of 24 hours.

Domestic and intimate partner violence has a disproportionate impact on AI/AN communities. AI/AN women experience intimate partner violence at higher rates than any other single race or ethnicity in the United States. However, intimate partner violence is a preventable public health problem and screening for Intimate Partner (Domestic) Violence (IPV) provides the ability to identify victims and those at risk for injury. The IPV screening measure supports improved processes for identification, referral, and treatment for female victims. Starting in FY 2018, IHS began reporting the IPV screening measure for females (ages 14-46) using the IHS Integrated Data Collection System Data Mart (IDCS DM). IHS continues to monitor and adjust to reporting system changes and provide training for documentation in the electronic reporting system.

Although some IHS Areas met or exceeded the FY 2022 target, IHS did not meet the national target of 36.3 percent. The IHS COVID-19 pandemic response and the transition from in person primary care to virtual care at several sites, may have impacted screening women for IPV. To avoid potential coronavirus exposure risk, there have been fewer in-person visits and many health care services for prevention and health maintenance were postponed by patients during the pandemic. While patients with acute illness or the need for emergency care were still seen at IHS facilities, the COVID-19 pandemic response limited healthcare provider-patient IPV interactions and reduced opportunities to screen women. Due to the sensitivity of the IPV screening, proper administration requires the health care provider to ensure the patient is comfortable responding without external influence. Therefore, the increased use of telehealth visits within a patient’s home is not necessarily meeting the safety and security recommendations for IPV assessments.

Due to COVID-19 response efforts, opportunities for facilities to participate and complete trainings were limited. As in-person office visits resume, IHS anticipates an increase in IPV screening rates. Successful staff training will focus on enhanced communications, frequent data reviews, preparation with specific screening tools, and inclusion of the measure in facility quality improvement projects. In April and May 2022, the IHS Domestic Violence Prevention program awarded 40 new projects for a five-year period that will increase access to forensic healthcare services and support the development of tribal community-based projects to prevent domestic and sexual violence. The projects are culturally appropriate, evidence-based, practice-based models of violence prevention and treatment among American Indians and Alaska Natives. IHS provides outreach and assistance to tribal sites upon request with a virtual training made available in FY 2020 regarding a specific IPV lethality risk screening tool. Additionally, in FY 2022 IHS updated and released two webinars focused on improving the healthcare infrastructure to support victims of violence. IHS will continue to build upon these efforts during FY 2023 and FY 2024.

Strategies drawn from the Preventing ACEs Best Available Evidence resource are being implemented by each of the funded Preventing Adverse Childhood Experiences: Data to Action (PACE: D2A) recipients. This indicator tracks trends associated with implementing evidence-based strategies to prevent and respond to adverse childhood experiences (ACEs) and addresses the effectiveness of CDC’s actions to translate science into action. CDC’s mission with respect to ACEs is to prevent, identify, and respond to them using evidence-based strategies, and this indicator is the most direct measure of CDC success in that regard. The PACE: D2A initiative helps ensure states and intrastate partners have access to the best available evidence for ACEs prevention and response. In FY 2022 15 prevention and response strategies were being implemented by funded recipients. Future targets were set based on an assessment of what realistic growth may look like and recipients capacity to increase strategy implementation.

CDC is leading efforts to prevent violence before it begins and reaching out to audiences with new prevention strategies. CDC adapts and disseminates actionable resources based on rigorous science to equip every available partner with the tools they need to build trauma-informed systems and infrastructure. Equipping partners with the tools and resources they need to move from principle to practice of trauma-informed care in school, healthcare, housing, justice-serving, and other behavioral and mental health service spaces will help amplify CDC’s impact and equip its partners to do the same. This measure ensures CDC continues to push to generate and disseminate resources on trauma-informed care for clinical settings (and other partners), to ensure that its systems responses to people who have experienced trauma is not harmful. Progress on this measure has been slower than expected and the target was not met for FY 2022, however, CDC expects an upward trend in FY 2023. Our perspective on trauma-informed care (TIC) and trauma-informed systems has broadened to recognize that while clinical settings are an essential setting from which to provide TIC, we can also build capacity of all systems (first responders, educational settings, businesses, for example) to operate from a trauma-informed perspective.

Future targets were set based on the products and deliverables expected in relation to CDC’s adverse childhood experiences (ACEs) and trauma informed care work that is underway.

Endnotes

³⁷  The FY 2023 target is to meet the average of the previous four years of actual results.

³⁸  It is important to note that federal funding represents only 72 percent of the total operating cost of hotline services.