The story of this new referral program does not end with it’s initial implementation, quite like most public health endeavors it has continued to change and its use has ebbed and flowed with the local need. Although the overall design of the process has been maintained, aspects have been changed as a result of partner feedback and we continue to stave off hunger within our community as a result of these referrals. In its essence, this entire program is an informal quality improvement endeavor as it was a means to solve the non-coordinated and ineffective referrals from contact tracers for COVID positive Cambridge residents experiencing food insecurity.
Although not intended to be a formal quality improvement project, this program’s activities closely mirrored the PDCA cycle and utilized quality improvement tools and concepts. In the Plan phase, the problem of food insecurity among isolated and quarantined residents was identified, and a team of relevant partners was convened to solve the process-related issues surrounding this. In the Do phase, a pilot was launched that asked case investigators and contact tracers to screen for food insecurity and use a new tool (Google Forms) so that a team could quickly respond. In the Check phase, the collaboration reviewed whether the pilot was effective, finding that more residents were able to receive services in less time. The Act phase led to frequent updates to the Google Form and other processes as feedback was received. In the spirit of continuous quality improvement, this PDCA cycle was repeated numerous times throughout the project. Although some of the original contact tracing team from the pilot has been disbanded, the process of screening for food insecurity and utilizing this referral pathway during contact tracing is now a permanent part of the Cambridge COVID-19 response.
The Plan phase began with the first official meeting between CPHD, CEOC and FFF to discuss the particular need for home delivery of pantry items on December 3, 2020, during which the group brainstormed solutions for the problem. Data collection was done with local partners to determine: the timing and flow of information from the moment a positive case was reported to being contacted by public health officials, number of people being served by the Agassiz Baldwin Community (ABC) pantry and their capacity, and the flow of information within the Cambridge Health Alliance for patients being referred to the ABC pantry. Within two weeks (and multiple meetings later) all the groundwork had been laid to get a referral system organized, and by Christmas we were officially in the Do phase with the system being utilized by local and state contact tracers. As cases were on the rise at the time, all of this moved forward with a sense of real urgency. Stakeholders from other Cambridge food pantries, the local hospital system, internal CPHD partners and others weighed in on the process and needs of the community prior to its launch.
Moving into the Check phase, meetings were slated for follow-up with the internal public health clinical team and state contact tracers as soon as the process was being utilized. The aim of regular meetings with each group was to gather feedback on the process and stay connected to maintain focus on getting food and support to those experiencing hunger related to the pandemic. An initial follow-up meeting with all parties (e.g. CPHD, CEOC, FFF, and the CTC) was held in mid-January 2021 and then again two months later. These meetings resulted in minor updates to the Google form to clarify and streamline, as well as revisions to who had access to the form (as staff changes took place mainly within the CTC).
During implementation the biggest challenge was ensuring that the Google form was being utilized for all Cambridge COVID positive food needs and that referrals to individual pantries and/or mutual aid sites had stopped. In order to keep the program visible for key players, the HEAL team issued email reminders with frequently asked questions. This continues today, with the latest email sent to staff in late 2021. Following the PDCA cycle, there will continue to be quality improvement efforts as we move forward through this pandemic.
Residents served by this program had no route to obtain short-term, home-delivered pantry items while isolating with COVID-19 prior to this endeavor. There have been 159 home deliveries made for Cambridge households since this program began. Of the 159 households, 14 required two deliveries of food and supplies during their isolation period. If there was someone available to purchase food for them, individuals/families were given grocery store gift cards, so they were able to purchase what they desired. The staff at CEOC tailored food provisions were possible (e.g., peanut allergies, Halal, vegan, lactose intolerant, celiac disease, etc.), and families were able to obtain foods that fit their specific needs. In addition to food, many deliveries included diapers, formula, baby wipes, sanitary products, masks, hand sanitizer, gloves, paper towels, toilet paper, soap, household cleaning products, and thermometers. There were many requests for Tylenol or Advil, and Target gift cards were provided for this purpose. CEOC staff also realized that many of these residents spoke a language other than English and were able to assist in Spanish, Portuguese, Haitian Creole and Amharic. Materials detailing other services that CEOC could provide were also included in the resident’s primary language, in order to provide wrap-around services wherever possible. Although the number of residents assisted with additional services was not recorded, CEOC staff report assisted many people from the list with SNAP applications, health insurance assistance and housing supports.