During the COVID-19 pandemic, the Education and Outreach Branch of the County of San Diego (County) Emergency Operations Center was charged with ensuring that timely and accurate information was distributed to the diverse population of 3.3 million San Diego County residents. The Education and Outreach Branch leveraged the Live Well San Diego collective impact framework and vision so that existing partnerships and sectors could be quickly activated and expanded. The County developed Sector Teams that consisted of subject-matter experts who communicated sector-specific information, virtually, to thousands of stakeholders across the region. The sector model included nine sectors, 12 sub-sectors, and successfully engaged and mobilized stakeholders weekly through live telebriefings, eblasts, and presentations during critical times of the pandemic. The sectors and sub-sectors include:

·       Business  

·       Community and Faith  

o   Community-Based Organizations 

o   Faith-Based Organizations   

o   Rural Communities 

o   Youth 

·       Education  

o   Early Care and Education  

o   K-12 

o   Colleges and Universities 

·       Government  

o   City Managers & Unincorporated Areas  

o   Bi-National Leaders  

o   Legislators 

·       Healthcare 

o   Clinical Providers  

o   Dental Providers 

·       Homeless/Shelters 

·       Long-Term Care & Residential Facilities  

·       Military & Veterans  

·       Older Adults & Disability Service Providers

Throughout the pandemic response, sectors conducted an average of 15 telebriefings per week, 12 community presentations per week, and 18 email blasts per week.

In addition to communicating important and time-sensitive information, Sector Teams built new partnerships and strengthened existing connections among partners and with the County. The Sector Teams also facilitated innovative and productive conversations with partners that led to the creation of tools that were used to support vulnerable communities, businesses, houses of worship, schools, and healthcare providers. From the outset, the sectors engaged vulnerable populations to ensure that the pandemic response was equitable. Those populations included: refugees/immigrants, youth, older adults, and disabled persons. To build upon efforts to support vulnerable populations, a Community Health Worker model was deployed to conduct culturally appropriate COVID-19 outreach to the following populations: African American, Asian and Pacific Islander, Latinx/o, and Refugee.

Utilizing Sector Teams for topic-specific communications represents a promising practice for pandemic and disaster response. By leveraging the existing population health framework, the County was able to 1) communicate quickly to a diverse population during a pandemic and 2) build and strengthen relationships that allowed for the co-creation of outreach materials. These successes ultimately improved the pandemic response and potentially controlled the spread of COVID-19 within the community. 

The existing structure and network of Live Well San Diego lent itself well to the immediate activation for education and outreach related to the COVID-19 pandemic. The four existing Live Well San Diego partner “sectors” – Cities and Government, Business and Media, Community and Faith-based Organizations, Schools and Education – were convened initially, and then quickly expanded to additional sectors and sub-sectors to meet the COVID-19-related needs of community stakeholders. Communication strategies implemented by the Sectors included: sector-specific webpages on the County’s www.coronavirus-sd.com website, ever-growing email lists with weekly “eblasts” of timely information and key updates, sector-specific email addresses for the public to submit specific questions for direct responses, and regularly scheduled live “telebriefings.” In addition to the information generated regularly through the Joint Information Center of the EOC, the Education and Outreach Branch worked closely with the Live Well San Diego communications team and the County Communications Office to develop and disseminate timely and accurate information. 

Each Sector is led by a manager or executive of the County and supported by a team to manage the full-time operations of this work. Co-leads were established early on to assist the Sector lead as sectors grew and expanded into sub-sectors to better align with the needs of the community. The Sector support staff carry out a wide range of duties to ensure the timely communication of information to stakeholders. They collaborate with the Health Education and Training section of the Branch to make real-time updates to the Sector webpages. The County’s clinical team are assigned to each Sector to serve as Medical Subject Matter Experts to ensure that stakeholders have access to clinical expertise; they responded to questions via email and real-time during the telebriefings. As the COVID-19 pandemic response evolved, there was also a need for a Reopening Expert to join the sector teams, who joined telebriefings and responded to emailed questions to give clarity on safe reopening guidelines. 

In addition to managing the Sector leads, the Education and Outreach Branch manager also managed a small “Core Team” dedicated to assisting all Sectors in their operations. This Core Team managed the daily status reporting of each Sector and had a constant pulse on Sector activities and challenges. The Core Team relayed barriers encountered by the Sectors and their stakeholders to the Education and Outreach Branch manager so action could be taken immediately, thus allowing for thoughtful and timely course-correction. The Core Team staffed weekly all-Sector meetings and provided guidance, training, technical assistance, technology expertise, operational planning support, and overall continuous collaboration that strengthened the Branch as a whole.   

Telebriefings- On live weekly sector-specific telebriefings, viewers had access to Sector Leads who were experts in their field, County medical subject matter experts (SMEs), and key community resource leaders. A typical weekly telebriefing was conducted on a virtual platform, and included a welcome by the Sector Lead, a Public Health/COVID-19 update by the SME, a brief presentation by any guest speakers, and then the bulk of the time was dedicated to answering questions that were either submitted ahead of time or submitted in real time via the “chat” feature. 

Eblasts- E-blasts were sent to sector participants up to three-times a week that contained links to updated sector-specific resources, answers to frequently asked questions, and general COVID-19 updates (Figure 3).  

Webpages- Initially, a County specific COVID-19 website (coronavirus-sd.com) was created to provide timely and updated information to the community.  

As the Sectors were identified and the need for information grew, each Sector created a webpage that was linked to the overall Coronavirus website. Since the information was changing frequently, the webpages required constant updating, and included a wealth of COVID-19 information including frequently asked questions that were continuously being added to and updated, and new resources that were being shared. 

FAQs and Emailed Questions- Sector-specific email addresses were created, where sector stakeholders could email any COVID-19-related questions and receive a response from the appropriate subject matter expert. As Sectors received questions via email or on telebriefings, the questions were tracked and over time collected into a “Frequently Asked Questions” (FAQ) list, which was shared on sector webpages and updated regularly. 

Community Presentations- Pre-COVID-19, the Live Well San Diego website included an option to “Schedule a Presentation”. During COVID-19, this feature was used as a way for the community to request COVID-19 focused presentations and was also linked on the County Coronavirus “Resources and Materials” webpage.  

Vulnerable Communities  

Community Health Worker Communication and Outreach Contracts 

Communities that have been disproportionately affected by COVID-19 may respond differently to information, depending on the messenger. For many groups, the person delivering the message is often better received if he or she is from a similar racial or ethnic group, has similar experiences, and/or speaks the same language. The County of San Diego understands that populations and communities may be more responsive if a trusted messenger delivers the message, and has contracted with seven (7) organizations to assist in providing communication and outreach services in a culturally and linguistically appropriate manner, in order to ensure accurate and up-to-date COVID-19 messaging to prevent the spread of the disease. These seven contracted organizations, or partners, provide Community Health Worker (CHW) communication and outreach services to the following communities of focus which have been disproportionately affected by COVID-19 in San Diego County: African American, Asian and Pacific Islander, Latinx/o, and Refugee. In addition, they have formed the COVID CHW Coalition to share information and resources among their organizations as well as with the County, to ensure a robust, 2-way communication channel to address the unique needs of these diverse communities.  

A key outcome of the sector work has been the new partnerships and collaborations that have developed. New stakeholders and organizations from every sector connected to the County weekly through telebriefings, eblasts, and direct questions to their sector. Many stakeholders also created more robust partnerships with their sector such as:  

·       The Government Sector coordinated extensively with the City of San Diego - International Affairs Director on a variety of issues involving the international border. This bolstered information sharing, building strong relationships and assisting in binational efforts. 

·       The Military and Veterans Sector has worked with San Diego Veterans Coalition, Courage to Call, and Armed Services YMCA to communicate and provide resources to over 249 military and veteran serving organizations.  

·       The Business Sector established important new partnerships with business community representatives and Chambers of Commerce, which are now new avenues to disseminate information, especially to/by the Chambers in rural communities. 

·       The Education Sector (K-12) collaborated extensively with the San Diego County Office of Education to redirect funding to support unconnected students, develop drive-up protocol for graduations, and create a COVID-19 Decision Tree that helped students make decisions about what to do if they experience COVID-19 symptoms, test positive, or have been exposed.  

Department collaborations within the County became more robust. Notable internal collaborations include:  

·       The Healthcare Sector’s partnership with the Public Testing Branch ensured that the Nurse Telephone Triage Team (NT3) had adequate training and resources to be effective and efficient.  

·       The Long-Term Care Sector facilitated more in-depth cross-collaboration between the County’s Public Health Services and Aging and Independence Services to understand the nuances of the long-term care facilities. This partnership has been invaluable to assist with public health and/or emergency outreach, education, and collaborative efforts. 

·       The Community and Faith-Based Sector partnered with Partner Relay to share information and promote resources and virtual trainings and events to improve resources for non-English speaking populations, including immigrants and refugees.  

·       The Early Care and Education sub-sector worked with the Office of Emergency Services to develop the Childcare Disaster Council to support the childcare needs of essential workers during the COVID-19 pandemic.  

·       The Homeless Sector and the Education Sector focused on the needs of vulnerable students experiencing homelessness, and disseminated focused information for them through pre-established Homeless Outreach Teams.   

Another notable outcome that came from sector work was the tools that were developed to support vulnerable communities during the COVID-19 pandemic. Some notable tools that were developed include:  

·       The Community and Faith-Based Sector worked with AIS to create "How To" Technology videos to help older adults stay connected and continue to thrive at home, utilizing technology. These videos taught people how to order groceries online, how to order a meal through a meal delivery service, and more.   

·       The Faith-Based Sector developed a guide to assist houses of worship in interpreting the mandatory requirements and recommendations for reopening safely. They also met with faith-based entities one-on-one to give personalized recommendations on how to reopen safely.  

·       The Homeless Sector worked with Homeless Outreach Teams to develop a map of encampments of individuals experiencing homelessness as well as procure, assemble, and disseminate over 20,000 hygiene kits as of December 2020. 

·       The Homeless Sector worked with medical advisors to develop a universal screening tool for homeless outreach workers to assess if homeless individuals need medical referrals. 

·       The Healthcare Sector worked with the Healthy San Diego Health Education, Cultural and Linguistics Workgroup, and the AAP-CA3 to develop a Pediatric Provider Toolkit to support Caring for Children During the COVID-19 Public Health Emergency. This comprehensive toolkit includes resources for providers and organizations to promote pediatric wellness through well-child checks and immunizations. 

Community partnerships were also leveraged to address the needs of vulnerable populations such as refugees, youth, and rural communities.

Refugee/Immigrant  

To ensure the refugee/immigrant population was fully engaged in outreach efforts, sector leadership engaged the County Refugee Coordinator to understand unmet needs and gaps in outreach. It was learned that mental health resources in multiple language, specific to COVID-19 and the current mental health issues affecting refugees/immigrants, was needed. Sector leadership worked collaboratively with County Behavioral Health Services to augment existing resources, adjusting education materials for community perceptions, beliefs, and practices. The updated resources were translated into the following languages: Arabic, Creole, Farsi, Pashto, Somali, Swahili, Vietnamese, and Karen and disseminated through the existing San Diego Refugee Forum (consisting of over 60 local agencies), and throughout the East region, home to the County’s largest refugee and immigrant populations. Sector leadership also collaborated with Partner Relay, a County-led network that improves communication with populations where language is a barrier to getting critical information, to share these and other materials with their cadre of over 450 partner agencies.  

Youth 

While the COVID-19 response needed to include the needs of youth, they were not only considered an affected population but also seen as highly effective partners in the COVID-19 outreach response. Youth can meaningfully engage as educators and change agents among their peers and in their communities. To facilitate this, sector leadership helped create the Youth Emergency Readiness Ambassadors (YERAs) program to outreach to hard-to-reach youth populations in San Diego County to increase their awareness about emergency preparedness for events like earthquakes and wildfires, as well as health emergencies like COVID-19. With the guidance of Emergency Preparedness Experts from the County’s Office of Emergency Services as well as the Community Emergency Response Teams, YERAs worked as a team to develop outreach materials and implement their plan to educate San Diego youth.  

Rural 

The Rural Sub-Sector was created out of the Community-Based Organization Sector to help address the unique challenges of rural communities. One of those challenges is accessing testing. The County is supporting rural communities by ramping up COVID-19 testing and offering testing sites in rural communities in partnership with CalFire and other backcountry community providers. Via this sub-sector’s telebriefings and other communication channels, residents were able to obtain information on a variety of unique challenges related to the pandemic.

A Sector Evaluation Workgroup was convened and led by subject matter experts to identify potential impacts of sector activities. This workgroup was tasked with engaging each sector, learning about their diverse processes and activities, and determining possible measures that could lead to actionable outcomes. Tools that sectors used to capture evaluative information include: 

·       Feedback forms 

·       Pre and Post Surveys 

·       Polls 

·       Key Informant Interviews 

Feedback forms were distributed to sector stakeholders regularly to assess sector needs. These findings were used to guide future Sector efforts, for example, responses to feedback form questions would guide Sector staff to develop new tools, invite specific guest speakers to present to the sectors, and more.

Pre and post surveys were used to measure sector telebriefing participants’ retention of COVID-19 related information from a presentation, and how the presentation changed their intentions to act on the information that they learned.

Polls during telebriefings were a tool that was used to take quick, high-level assessments on the preferences of sector stakeholders. For example, polls were used to assess participants’ preferences for the content of telebriefings, the timing and recurrence of telebriefings, and more.

Key informant interviews were conducted with community leaders in vulnerable populations to better understand the needs of that population during the COVID-19 pandemic. Information gathered from key informant interviews was used to create tools and deploy interventions to better serve San Diego County’s most at-risk populations.

Evaluation work is ongoing as assessments of each sector continue to evolve and guide action plans moving forward. 

Everyday staffing and procedures within the County were adapted to build upon, advance, and maintain the sector work. Departments that originally worked within regional teams, were reallocated to support the sector structure. This reallocation of staff allowed each sector to be robustly supported with appropriately trained staff, medical experts, other subject-matter experts, and sector leadership.

Lessons Learned

A population health response was the County’s most effective strategy to combat the pandemic. Two essential components of the County’s population health response include leveraging existing partnerships and integrating at-risk populations from the outset.  

By leveraging internal and external partnerships, collaboration was bolstered, and new partnerships were developed. This led to the development of helpful tools, programs, and processes that effectively addressed community needs. The expanded sector model will also be integrated into the Live Well San Diego vision into the future. In fact, in October 2020, the County Board of Supervisors approved the development of the Live Well San Diego Youth Sector, to live on beyond the pandemic response. Having topic-specific sectors and sub-sectors proved to be greatly beneficial for stakeholders and partners to expand their collaborations and resources.

To ensure that the pandemic response was equitable and effective in the communities that were most affected by COVID-19, it was essential to integrate vulnerable communities into the outreach approach from the outset. The Community Health Worker Communication and Outreach contractors worked with Sector Leads and subject matter experts to address specialized needs of at-risk communities, which ultimately led to a more informed community response. Based on feedback from Community Health Worker contractors and their need for culturally appropriate outreach materials, the County developed a workgroup called the Translation, Language, and Culture Connection. This workgroup is developing a process for translation and outreach material development that will be standardized across the enterprise. The process will integrate best practices for developing and disseminating culturally appropriate and effective materials for at-risk populations.