The program objectives were to prevent the spread of COVID-19 by improving adherence to I&Q – a key pandemic control strategy – through trusted communications and meeting people’s needs; and to provide employment and career growth opportunities to the CHWs who reflect the populations and communities they serve. Extensive Health Department knowledge of our community contributed to the development of this program and cultivating functional partnerships with community organizations and other county agencies were critical to achieving both objectives.
Before the pandemic, informed by our work with community leaders and organizations, the Health Department’s Multicultural Advisory Committee, and from experience screening for food insecurity among clients at our immunization clinics, we knew that many individuals and families served by the Department had challenges obtaining sufficient food, maintaining stable housing, having access to transportation, and having a medical home. As the pandemic struck and the containment strategy was initiated, we posited that these challenges would limit people’s ability to effectively adhere to isolation and quarantine; this recognition led to the development of our CHW program.
To work with us in developing the program, we established a partnership with the Institute for Public Health Innovation (IPHI), a non-profit organization, which had experience recruiting and training public health workers to address community needs. While IPHI supported other health departments with training CHWs in traditional roles, and case investigation and contact tracing staff, we utilized this partnership not only to identify and train containment personnel but to also collaborate in developing a specialized CHW program for the pandemic response. Jointly, we developed the strategy, training curricula for CHWs and their supervisors, and an approach to hiring a workforce that specifically sought women of color who reflected the communities we serve. One measure of this was language competency with CHWs able to communicate with clients in 12 languages, including Spanish (52% of CHWs), Arabic (24%), Urdu (12%), Farsi (7%), and Korean (4%). We also developed CHW committees to provide program imporvement, development opportunities and increase work satisfaction. Committees included a Program Guidance Committee (develops best practices to improve and streamline processes, standardizes referral processes for partners, and authors Standard Operating Procedures); a Data, Technology, and Success Stories Committee (develops consistent data collection and reporting protocols, provides support for monitoring and evaluation, and gathers success stories to report to leadership); and a Wellness and Social Committee (leads initiatives that focus on mental, physical, and staff well-being). A survey of CHW staff was conducted to measure satisfaction, stress and identify areas for process improvement. Over 90% responded that they felt connected to their work, enjoyed the work culture, and would recommend the organization as a good place to work. More training on community referrals and communications with IPHI leadership were identified as challenges and were addressed.
Partnerships were critical to program implementation, particularly provision of services. Collaboration with county agencies included the Department of Neighborhood and Community Services (NCS) which manages Coordinated Services Planning to assess eligibility for rent and utility assistance. Collaboration with the Office to Prevent and End Homelessness resulted in placement of individuals in contracted hotel rooms if they were unable to safely isolate or quarantine in their home.
Many community organizations were key collaborators including non-profits, faith-based organizations, and businesses. They provided food, including Halal food, baby supplies and clothing, and direct monetary support to people who had been affected by COVID-19. For example, Cornerstones Assistance Services and Pantry Program supported the CHW division by providing emergency food on request (within a two-hour window including on weekends), providing fresh produce and toiletry items, and donating gift cards.
Several examples of interactions with clients further illustrate the work of the program and its partnerships.
Case study 1: During a routine assessment for basic needs, a CHW discovered their client was feeling unsafe in her own home. In assessing the situation, the CHW discovered that the client tested positive for COVID-19 and a family member was forcing her to leave her home at gunpoint. The CHW immediately facilitated a referral to emergency housing at a Quarantine, Protection, Isolation/Decompression (QPID) hotel. Within an hour of referral, the client was able to remove herself from an unsafe and potentially life-threatening situation. Additionally, staying at a QPID hotel enabled her to work with a social worker who provided additional resources on domestic violence, safety, mental health counseling, and long-term housing.
Case study 2: A CHW received a referral for an elderly resident who lived alone and required regular assistance from a home health aide. While isolating, she lacked access to food, groceries, medication, and hygiene supplies. In addition to meeting the client’s needs, the CHW recognized the mental health challenges of living alone and not having the health aide’s support during isolation. The CHW proceeded to have regular conversations with the client, provided counselling, and addressed specific needs like adult diapers, laundry detergent, hand sanitizer, gloves, masks, etc.
Case study 3: The Community Health Division was alerted about a mother and son in isolation/quarantine who were arriving in Fairfax County from New York City after their family recently moved from Ecuador. The clients were unaware of their eligibility for social safety nets and assistance programs in the country. The CHW contacted the mother and during their bus journey to Fairfax County and provided guidance on COVID-19 mitigation measures to ensure they don’t contact others. Upon arrival at Union Station in Washington, D.C., two CHWs met the clients and facilitated transportation to a contracted hotel for I&Q, linked then with a healthcare provider at a Federally Qualified Health Center, and ensured they had the resources and support they needed.
These case studies provide examples of how motivated and compassionate CHWs, working in a structure of effective community and county agency partnerships, assisted clients to both increase the effectiveness of I&Q and support people at a difficult time in their lives.