Identifying Staff Behaviors and Client Outcomes of High-Performing Staff at a National Homeless Hotline for Veterans

Crisis call centers serve important functions for public health. With the rise of artificial intelligence (AI) and potential roles in crisis call centers, it is important to examine what human behaviors influence the effectiveness of call center outcomes. The authors studied the U.S. Department of Veterans Affairs (VA) National Call Center for Homeless Veterans (NCCHV) to (1) examine differences in staff behaviors between top and average performers and (2) evaluate client outcomes of top-performing and average-performing staff. Of 159 NCCHV staff, 10 top-performing and 10 average-performing staff were randomly selected based on their annual performance ratings from fiscal years 2020-2023. For each NCCHV staff selected, three audio-recorded calls were sampled and blindly rated by researchers on a list of nine coded behaviors (e.g., empathy, thoroughness). Healthcare outcomes of clients served by these NCCHV staff were examined through analysis of their VA medical records data. Results found that top-performing staff were significantly more likely to be rated as tactful and empathetic, thorough with information gathering, and less likely to be rated as providing inappropriate advice and being forceful/rigid with clients than average-performing staff. Clients served by top-performing NCCHV staff showed significant increases in VA healthcare use including outpatient healthcare and homeless services after calling NCCHV which were not observed in clients served by average-performing NCCHV staff. Together, these findings suggest human behaviors of homeless call center staff influence client engagement with care, emphasizing the importance of staff training and caveating any potential use of AI in these call centers.