Case Studies: How Connecting People With the Essentials is Crucial to Pandemic Response

Even before care resource coordinators in Massachusetts make their first phone calls, they take a pledge: “Our commitment is to accompany patients on their journey to health and wellness and link them to available social supports,” the workers assert. “Health is a human right we are all entitled to, irrespective of our ZIP code.” 

As pandemic response efforts like contact tracing ramped up last spring, it became clear that simply identifying people with COVID-19 and their contacts, and explaining the latest health and safety guidelines, was not enough for many people across the country. Individuals and families often required far more help to safely isolate and minimize transmission: they needed food, or a safe dwelling, cash assistance to pay bills, or cleaning supplies -- and they needed someone committed to helping them acquire these basics. Care resource coordinators, individuals who ensure that cases and contacts have the social, material, and other supports they need to safely isolate or quarantine, filled that crucial gap.  

The importance of connecting people to social support during a pandemic was made apparent in a series of case studies that detail care resource coordination in action. Written by Partners In Health’s U.S. Public Health Accompaniment Unit, in collaboration with public health teams around the United States, the studies include deep-dive examinations of programs in Massachusetts, New York City, Immokalee, Fla., and North Carolina. Each reveals a unique snapshot of how resource coordination programs have been designed and scaled up in different regions each operating within their own specific contexts.

Approaches, models, funding streams, and community partnerships vary from state to state and across cities. Even job titles often differ, for example “care resource coordinators,” “resource navigators,” “health promoters” and “community health workers” can all fulfill a similar function.  But the main goal of each of these social support specialists remains consistent across sites: to connect vulnerable individuals and families to the basics they need to stay safe and healthy, and to build trust in local community health systems.

“This system just feels different now,” said one migrant worker from Immokalee, commenting on the resources made accessible to his community through local health promoters. “They speak to me in my language and in a way that shows they understand and actually care; it just feels like family.”

Door-to-Door, Family-to-Family

Immokalee, located 25 miles northeast of Naples, Fla. is home to a large population of migrant and essential workers who have long endured the brunt of systemic health and economic inequalities.  COVID-19 only further exposed and exacerbated these disparities as many residents live and work close to others, putting them at risk for COVID-19 infection and transmission, and have historically faced barriers to accessing healthcare, making them more likely to suffer poor health outcomes after infection. As the virus took hold, the case study says, the “state’s COVID-19 response efforts did not adequately meet the needs of Immokalee’s residents, leaving significant gaps in access to testing, comprehensive contact tracing and case investigation programs, resources to allow individuals to safely isolate or quarantine, and equitable access to vaccination.” 

To help bridge these gaps, Immokalee’s community leaders relied on partnerships between community-based organizations, notably, the Coalition of Immokalee Workers, Healthcare Network, Misión Peniel, Partners In Health, and the Collier County Department of Health.

Unlike some other programs, the Immokalee partners decided to recruit and train a new cadre of health promoters, or promotoras (Spanish for community health workers) specifically to connect farmworkers, laborers and other vulnerable populations in the area to critical resources that would help them safely isolate and quarantine during the pandemic. These new promotoras, fluent in the language and culture of their communities, have become trusted sources of health information and other supports. They travel door-to-door, from family-to-family, providing individualized help to members of the community, from securing transportation to testing and vaccination sites, to food deliveries, housing support, labor protections, and cash assistance to cover costs during isolation.  

Indeed, between July 2020 and early April 2021, Immokalee promotoras visited more than 2,800 households and reached approximately 9,000 people; they helped with disbursement of $482,000 in cash transfers to 400 households, site leaders said.  

Immokalee promotor Osman López Hernández said COVID-19 has devastated his community.

“Sometimes, I will go to a house and the entire family is sick,” he says, speaking through a Spanish interpreter.  “They haven’t gone to the clinic because they don’t have money or transportation, or they think they can’t access services because they don’t have ID.”  

López Hernández, a former community health worker in Guatemala before moving to the U.S. with his wife and three children, says the problem isn’t a lack of education; rather, it’s simply that people don’t have clear, accurate information. They don’t know, for instance, that transportation to the clinic is available or that food can be delivered right to their homes. 

Among the many cases he manages, López Hernández is currently helping a family of five, all with COVID-19. Three of them have died, he said, and one is at home on oxygen. Each week, López Hernández brings them food, bottled water, and financial assistance. But even with all of the illness and death he has seen up close, López Hernández says, “it hasn’t made me more depressed. It has given me more experience, and it helps me continue to do this work for the people here.” 

The virus’ toll on the community has also opened his eyes.  “What is really surprising,” he said, “is that this is happening in America.”

Navigating New York City

In New York City, with more than 8 million residents, the sheer scope of the workforce and response to the pandemic is staggering: 200 to 300 resource navigators employed by 10 community-based organizations completed 195,000 referrals for basic needs as of late February 2021, the case study says. More than 220,000 free “Take Care” packages with masks, hand sanitizer, a thermometer, snacks, games, educational resources, and a pulse oximeter for COVID-19 positive patients were sent to households under NYC’s Test & Trace Corps Take Care Program, funded through federal and city support. Approximately 10,000 individual cases and contacts were able to isolate or quarantine in a free hotel room through the NYC Isolation Hotel Program and many families received food through the Get Food NYC Emergency Home Food Delivery Program.   

When the pandemic hit, Suzan Lam’s community-based organization, the Chinese-American Planning Council, was called into action, and she became deputy director of the group's contingent of NYC’s Resource Navigators. Lam was among the first teams of navigators to staff one of the city’s rapid testing sites, in Sunset Park, Brooklyn, which offered people who tested positive for COVID-19 immediate resource connections, helping them get rides to hotels for isolation, for instance, or setting up food deliveries. 

In these high positivity, high-need areas, Lam said, “finances were a huge struggle,” with people concerned about whether they could go back to work. Amidst the fear and so many unknowns during the early stages of the pandemic, Lam said people were grateful to connect with navigators who spoke their language, explained medical protocols, and also guided them to the services they might need, from childcare to support for survivors of domestic violence. All of this occurred right at the testing site. 

Lam said one of the major challenges was the shifting health guidance around isolation and quarantine. “As we learned more, the resource navigators had to be sure we were providing accurate information. We had to be constantly updating, educating ourselves with the latest guidance. The need to continually adapt was challenging,” she said. 

A Layered Strategy in North Carolina

North Carolina’s approach to resource coordination is unique in its use of multiple interrelated programs, the case study says, including direct financing of social supports, and assistance for COVID-19 cases and contacts outside contact tracing systems.  The state’s Department of Health and Human Services leaned into “layered interventions that built on the state’s successful, pre-existing investments and work,” such as addressing the nonmedical drivers of health and combining identification of social support needs with dedicated financing to help. The USPHAU’s North Carolina team supported this work by helping expand the state’s community health worker program in vulnerable communities, connecting partners to hyper-local community-based organizations and providing overall program evaluation with an eye towards racial equity.

For Idalia Arellano, a community health worker hired in the midst of the pandemic, the most astonishing shift has been a new level of communication, responsiveness, and partnership created between the state, county, and the region’s most vulnerable communities.  Before the pandemic, she said, it was not always easy to get attention and resources for the state’s Latinx and Black communities.

“COVID-19 was for sure a wake-up call. Honestly, if the pandemic wouldn’t have happened, I don’t think the movement toward equity would have happened.”

With the pandemic, she said, “people had to listen, not because they wanted to, but because communities of color were the ones getting sick. Now, they want to hear from people of color, from the grassroots in the trenches, the organizations that are actually doing the work.” 

This new, more powerful support network plays out in important ways, Arellano said— expanded weekend hours at testing and vaccination sites so that poultry and migrant workers have access; culturally appropriate food deliveries to families in isolation; and guarantees that neither identification, nor social security information, be required so that undocumented people can begin to trust the health system. 

Arellano, who works for Southeastern Healthcare of North Carolina, one of the organizations partnering with the state on COVID-19 efforts, added: “There’s so much more work to be done, but at least now we’re moving toward a shared goal.” 

Her field supervisor, Blanca Borceguin, also a CHW, agreed. “I don’t want to say COVID-19’s a blessing in disguise, but one thing it has done is made the state know its community’s needs on a deeper level.”  That means CHWs can help families secure rent or utility assistance in the short-term, for example, as well as support them in negotiating longer-term payment plans with the electric company. 

This stronger statewide partnership gave Borceguin the freedom to visit a local pastor, and, ultimately, plan a mass vaccination event next month with 21 pastors and their congregations at the church with the biggest parking lot.  For the event, Borceguin said, the CHWs are taking care of all the logistics; arranging for free transportation, bags of non-perishable food, securing the vaccines for delivery, staffing the clinic with multilingual workers. She said she told the pastors: “You don’t have to do anything but spread the word that vaccines are here for your people.”

A Patchwork of Programs

Mounting an efficient, equitable response that serves those most in need during a pandemic, is, of course, complicated and rife with obstacles. All of the case studies lay out some of the barriers administrators and resource coordinators faced: Lack of funding or sufficient resources to meet community needs, integrating new and different systems, managing fluctuating caseloads.

It’s worth noting, too, that not all care resource programs are equal. 

A survey of state contact tracing programs conducted by Johns Hopkins, NPR and PIH found that only 52% included scripted questions assessing people’s needs for specific items, such as food, housing, medicine, or personal protective equipment. An analysis of the survey also found that only 39% of contact tracing teams included dedicated care coordinators; and nearly a third of these programs don't do systematic follow-up with people to make sure their needs were met.

A Pioneering Program in Massachusetts

In April 2020, the Commonwealth of Massachusetts, in collaboration with PIH, launched what would become one of the most extensive statewide COVID-19 contact tracing programs in the country. From the beginning, the Massachusetts Community Tracing Collaborative (CTC), which helped support local health departments’ efforts, prioritized care resource coordination as a central component of the program. 

Over time, as the benefits of resource coordination were apparent, the program expanded to accept referrals from sources beyond the contact tracers and case investigators who were part of the CTC, the case study says. Local public health officials, community members, and higher education staff began referring people to CTC resources coordinators. Through all of its work, the CTC prioritized diversity and equity at every level. Recognizing the “historical and ongoing legacies of structural violence and inequality that were laid bare by the COVID-19 pandemic,” the program was “intentionally designed to build strong, diverse, multidisciplinary teams to test, trace, protect, and support communities across MA. Cultural, geographic, and linguistic diversity is especially important for the Care Resource Coordination team, as is deep experience and familiarity with local context and communities.” This focus allowed care resource coordinators to provide the hardest hit cases and their contacts a lifeline to the essentials they needed but could not readily access. 

Since the program launched, Massachusetts care resource coordinators have connected more than 100,000 people in the state to food, housing, medicine, mental health support, and other basics. 

“I think what was the most helpful,” said Nikkia Watson, a care resource coordinator in Massachusetts, “was providing people with support to know they were not alone in feelings of fear and isolation. Many people, especially in the beginning, were so anxious and would often say, ‘I don’t know what’s wrong with me. I’m never like this.’ We assured them that this time was hard, and lots of people were also feeling overwhelmed. That helped to calm some nerves.”  

While COVID-19 has highlighted deep, structural inequities in the U.S., Watson said, the pandemic also offered a unique moment to rethink our current systems. 

“I think there is a real opportunity here for advocacy work and resource coordination for the many people we see struggling with the long-term, non-medical impacts of COVID-19,” she said. “People have lost jobs, housing, and loved ones. Those things mixed with systems of oppression and lack of support for immigrant families need to be addressed and that’s a great place for health care workers and promoters to step in. Targeting these issues will help limit the long-term effects on these communities.”

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