Practice Title: Leveraging Community Health Workers to Improve COVID-19 Isolation/Quarantine Protocol Adherence
Department: Fairfax County Health Department
Size: Large (Population of 500,000+ people)
State: Virginia
Summary of Practice:
Fairfax County Health Department (FCHD) provides services to 1.2 million residents in the Washington DC area. Residents are ethnically diverse with over 30% foreign born and many not speaking English at home. Since the start of the pandemic, COVID-19 rates in Hispanics and African-Americans were 2.9 and 1.6-times the rate among non-Hispanic Whites. Containment, including isolation and quarantine (I&Q), was implemented to reduce the risk of cases and contacts transmitting infection.
FCHD established a cadre of 80 specially-trained multi-cultural contract Community Health Workers (CHWs) to support residents during I&Q. The program goal is to improve adherence to I&Q and reduce disease transmission by providing culturally competent information and services. To identify needs for CHW services, Containment Team investigators ask cases and contacts whether they have everything need to successfully isolate or quarantine including food, cleaning supplies, diapers, medication, and whether they need assistance with rent, utilities, or COVID-19 testing. If they answer "Yes" to any need or logistical challenge, they are referred to a CHW who can speak with them in their language for an assessment and needed supports. CHWs deliver food provided by community food banks, care kits with masks, hand sanitizer and educational materials to I&Q safely, self-administered PCR tests, prescriptions, cleaning and hygiene supplies, and make referrals for rent or utility assistance through Coordinated Services Planning. CHWs also call clients at 7-days to identify additional needs and answer questions. Overall, CHWs worked with over 18,000 county residents who needed assistance and, including family members, more than 42,000 people were affected by this work.
To assess whether this program was successful at increasing I&Q adherence, we conducted a cross-sectional study. We randomly selected 800 persons served by a CHW between February and July 2021, and 700 who reported that they did not require assistance (controls). Calls were attempted to 1,500 individuals who, if reached, were interviewed by phone. Surveys were completed for 161 persons who received CHW services and 179 controls. Persons receiving services were more often COVID-19 cases (versus contacts), Hispanic, and female (all p<0.05). Services most often provided were information (79%), hygiene and cleaning supplies (75%), and food assistance (56%). 87% of persons receiving assistance reported being satisfied/very satisfied. Among persons who received CHW services, 30.7% left the house at least once during their I&Q compared with 43.9% among controls (RR=0.699, 95% CI: 0.508-0.945). 64.3% of those assisted by a CHW who left home did so to see a doctor or pick-up medications. Of those who left home during I&Q, persons receiving CHW services left a mean of 2.4-times compared with 6.2-times among controls (p<0.01). Our results showing significant impacts are particularly meaningful because CHW clients were those with needs who were more likely to experience the greatest challenges maintaining I&Q.
We attribute CHW success to building trust with clients through compassionate and culturally appropriate communication, timely intervention, and resolute community and interagency partnerships leveraged to address needs. By supporting vulnerable families, largely in higher risk communities, we significantly improved I&Q adherence, likely improving disease prevention.
Leveraging Community Health Workers to Improve COVID-19 Isolation/Quarantine Protocol Adherence
Category
Workforce and Leadership