One of the biggest frustrations during the COVID pandemic was seeing health disparities emerge due to income, language, and cultural inequities. Tulsa City-County Health Department (THD) met this challenge with the innovative approach to use Community Health Workers to connect vulnerable clients to concierge level PCR or Rapid Antigen COVID testing. The program, called Rapid Results Tulsa, was privately funded and administered through the nonprofit branch of THD. It was then leveraged into almost $8 million in funding from the Centers for Disease Control & Prevention to continue the work of Rapid Results Tulsa, establish a Health Equity Office at THD, and work with a partner agency to provide interpreter/translator classes to  increase the number of bilingual health workers.

Tulsa City-County Health Department is an independent local health department in northern Oklahoma. Tulsa County has 669,279 residents with 13.3 percent identifying as Latino/Hispanic or Latino, 10.8 percent as Black or African American, 6.9 percent Native American, 6.2 percent as Two or More Races, and 3.6 percent identify as Asian in Tulsa County. 14.3 percent of Tulsa’s children live in families where a language other than English is spoken at home.

Recognizing that people with language and cultural barriers were at special risk of COVID infection, as well as being more vulnerable to income loss from infection and quarantine, the initial target audience of Rapid Results Tulsa were Latinx and Zomi/Burmese populations. As the program developed it expanded to help people of other vulnerable populations, including people fleeing domestic violence, clients entering substance abuse treatment, and homebound or hospice patients.  The new Health Equity Office will also reach out to residents of North Tulsa, which has the county’s highest morbidity and mortality rates, as well as individuals identifying as LGBTQ and/or Deaf and Hard of Hearing.

Though Community Health Workers (CHWs) have been part of the U.S. health care system for decades, their role has been limited. The CHWs of Rapid Results Tulsa were innovative, responsive, and effective. They helped clients and were community ambassadors at events and on social media. They also guided the Rapid Results Tulsa education campaign, did interpreting and translating, were pictured on the website and social media ads, and recruited well known people from the Latinx and Zomi/Burmese community to be part of the campaign.

The program received national attention at an August 24, 2021 webinar with more than 800 participants that was hosted by Healthy Places by Design and County Health Rankings and Roadmaps.

Rapid Results Tulsa not only helped vulnerable populations, it also highlighted the importance of partnerships and showcased the talented workforce the Community Health Workers are in addressing COVID and other public health issues.

In early 2021 the Tulsa City-County Health Department (THD) had bi-lingual phone bank and contact tracing staff in its COVID response. But it was not enough to meet the needs of residents not fluent in English. Recognizing that people with language and cultural barriers were at special risk of COVID and more vulnerable to income loss from infection and quarantine, the Rapid Results Tulsa program was established. It employed Community Health Workers fluent in English, Spanish, Zomi, and Burmese to connect clients to COVID information and concierge level testing.

A Tulsa Board of Health member and the Chief Operating Officer of THD partnered together to establish the program and find private grant funding. The nonprofit branch of THD, Pathways to Health Community Partnership, managed the program to relieve some of the burden to the local health department while providing an enhanced COVID response to people in need.  

Though Community Health Workers (CHWs) have been part of the U.S. health care system for decades, their role has been limited. The CHWs of Rapid Results helped clients by phone, email, text messaging, Facebook, Instagram, and at community events. They also guided the Rapid Results Tulsa messaging, provided translation, were pictured on the website and social media ads, recruited well known people from the Latinx and Zomi/Burmese community to be part of the campaign, and more. Several times clients called and were thrilled to learn the CHW they were speaking with was the person from the ad. It was like talking to a celebrity!

Tulsa is considered the Zomi Capital of the United States, with about 10,000 Zomi and Burmese immigrants from the Myanmar region. At the beginning the ads in Zomi had a similar viewership as ads in Spanish, though Tulsa has nine times more Latinx people. The CHW said this was because Zomi ads had never been seen in the U.S.

COVID testing was provided by a local lab that had bilingual staff, seven locations, and extended hours. Another test provider was a mobile test clinic that went to homes, businesses and other locations. The access code clients used for free testing was “Good” or “Bueno”.  The goal was for Rapid Results Tulsa to be a blessing to people in the Zomi and Latinx community. It made contact tracing easier because the CHWs had a connection with the clients. Often clients would call or text the CHW back right after getting their test results! The CHWs also offered information about COVID vaccinations, help with food, rent, utilities, and other assistance.  

188 outreach visits were made at local events, businesses, places of worship, and more (see attached). Most Myanmar immigrants have a strong connection to their faith communities and the CHW went to services at every Zomi church. She helped set up a vaccination event and shared Rapid Results at the Zomi World Cup Soccer game where Tulsa hosted athletes from 20 states across the U.S.

Though Latinx and Zomi/Burmese populations were the initial audience and Rapid Results expanded to help other vulnerable populations, like people fleeing domestic violence, clients entering substance abuse treatment, and homebound or hospice patients.  

By the time the Centers for Disease Control & Prevention (CDC) was sharing funding opportunities that promoted CHWs as an effective way to provide COVID outreach to vulnerable populations, Tulsa Health Department already had clear evidence it would be effective.

In August 2021 the MMWR also launched the CDC’s Community Health Workers for COVID Response and Resilient Communities initiative. https://www.cdc.gov/covid-community-health-workers/

Tulsa Health Department was able to leverage the success of Rapid Results Tulsa into almost $8 million to establish a Health Equity Office where a corps of Community Health Workers will continue helping the Latinx and Zomi/Burmese populations, as well as expanding outreach to the Black and African American populations of Tulsa. Outreach to LGBTQ or Deaf and Hard of Hearing people will be included if possible, since they often have unique challenges getting quality health care. The CDC funding will not only address the direct impact of COVID, but also co-morbidities that make COVID hospitalization and mortality more likely (heart disease, type 2 diabetes, lung disease, autoimmune disorders, kidney disease, and liver disease).

Improvements in each of these areas will make a huge impact on the public health of Tulsa, OK. CDC funding will also provide trainings for people to become certified interpreters and translators, increasing the number of bilingual health workers. 

A Tulsa Board of Health member and the Chief Operating Officer of Tulsa Health Department (THD) partnered together to establish Rapid Results Tulsa and find private grant funding. That need was met by The Rockefeller Foundation, who was looking for innovative ways to help vulnerable populations in the pandemic. The nonprofit branch of THD, Pathways to Health Community Partnership, managed the program, relieving the local health department of some of the burden of the response.

Two local companies provided Rapid and PCR COVID testing in an accessible way: 1) Access Medical has seven Tulsa locations, including two with Spanish fluent staff; and 2) Tulsa Mobile COVID Testing tests at any location from dawn to dusk each day and has staff fluent in basic medical Spanish. For $200 per test the providers got doctors’ orders, conducted the test, provided results and care instructions to clients in their language of choice, and reported results to the State Department of Health.

The Rapid Results Tulsa program was shared not only through a marketing campaign and by the Community Health Workers, but also at the virtual Community Health Improvement Plan meetings and the Tulsa Latinx COVID Outreach Committee. 

Unexpected partners included the Domestic Violence Intervention Services and 12&12 Substance Abuse treatment facilities, who benefitted from the mobile test provider helping them test new intakes for COVID, relieving a lot of the quarantine burdens.

On August 24, 2021 the project was shared nationally at a Healthy Places by Design and County Health Rankings and Roadmaps webinar. The co-presenter was the CHW Section Chair of the American Public Health Association. Over 800 participants learned how employing CHWs led to increased patient knowledge, access to care, healthy behaviors, and preventive care. Additionally, the use of CHWs is likely to decrease disparities. Over 200 participants stayed for an additional breakout session to learn more about Rapid Results Tulsa.

NACCHO was another partner, sharing information about direct grant opportunities to county and city health departments from the Centers for Disease Control & Prevention. Through the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities, THD received a direct award of $5,975,146 and another $2 million passthrough grant from the Oklahoma State Department of Health. This funding will continue the work CHWs have done in Rapid Results Tulsa and also establish a Health Equity Office at THD.

In less than three months Community Health Worker (CHW) staff was hired and trained, vendors were contracted, a marketing campaign and website were developed and refined by the CHWs, and clients began contacting Rapid Results Tulsa for help with COVID.  The initial target audience were the Latinx and Zomi/Burmese populations in Tulsa, OK but that quickly expanded to people who were uninsured and vulnerable.

The CHW fluent in English, Zomi and Burmese had a unique challenge while working on Rapid Results Tulsa. She and most of the Zomi/Burmese population immigrated from the Myanmar region. Myanmar is the country where most Zomi and Burmese people of Tulsa immigrated from. The CHW, and most of the clients she helped, have family and friends still in the region. But with the coup it became brutal. A CNN report said the security forces in Myanmar were shooting people in the street, laid siege to entire villages, shut down the internet, closed banks and airlines. There are widespread reports of people being imprisoned and tortured. The CHW navigated that difficult situation and posted information about Rapid Results Tulsa in a way only someone from the community could have.

A lesser challenge occurred once the COVID vaccination became available and clients wanted testing for travel. We quickly clarified that testing through Rapid Results Tulsa was only for people who needed a test for non-travel related reasons and those who are uninsured and had no way to pay for a test. 

Another challenge was solved by one of the CHWs. At the beginning of the campaign all printed materials were available in English, Spanish and Zomi. This did not work at a drive-through food bank where the preferred language of individuals could not be known in advance. At the suggestion of a Community Health Worker, a new flyer was printed with one side in Spanish, and the other side in English with a line at the bottom in Zomi saying to call for COVID testing and help. The tri-lingual flyer was so effective it quickly became the preferred option for the CHWs and their clients.

Key takeaways for public health and other organizations considering using CHWs in the outreach to vulnerable populations are: 1) Hire compassionate and results-driven people; they can be trained as CHWs; 2) Pay the CHWs well; the Rapid Results team had a CHW with COVID contact tracing experience, a CHW who was an entrepreneur and realtor, and a CHW preparing for medical school; these candidates would not have been interested in the work if it did not pay well; 3) Play to the unique strengths of each individual; one CHW was extremely quick and accurate on Spanish translation, where another was extremely thorough in vetting the community resources to refer clients; they were encouraged to play to their strengths; 4) Part-time work is not always a bad thing; not all workers want full-time employment and benefits; be open to meeting the needs not only of the program, but also of the individual CHWs; 5) Remote work is not a bad thing; we did require one office day to meet as a team and catch up on paperwork; 6) Facebook and YouTube are the best ways to promote a program, no matter what language it is done in; 7) Technology is your friend; shortly before Rapid Results Tulsa launch Tulsa Health Department implemented an online phone system (RingCentral) where calls and text messages could be received by computer or cell phone so the CHWs could be accessible; make sure to pay the CHWs a good phone stipend since much of their work will be done using their cell phone.

The Tulsa Health Department resources used were infrastructure like office space, IT, and human resources. The goal of Rapid Results Tulsa was to provide COVID support in a culturally relevant way and also to lighten the burden the PODs were experiencing in the response.