In the COVID-19 response, partnerships are essential to reach underserved communities, maximize resources, reduce duplication of efforts, and improve the delivery of culturally- and linguistically-appropriate services and resources. Community Health Workers (CHWs), community-based organizations (CBOs), and local health departments (LHDs) share goals to improve community health, particularly among disproportionately impacted populations. Collaboration allows limited federal, state, and local resources to be targeted and allocated to areas that need the resources most. Likewise, it is also essential to provide information and services via channels that community members actively use and trust.
Reaching Communities Through Employer Partnerships
Community Health Workers (CHWs) can also be known as community health advisors, cultural or health navigators, health advocates, promotores, or peer health promoters or educators. According to the National Association of Community Health Workers (NACHW),
"CHWs are frontline public health workers who are trusted members of the community they serve. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve service delivery quality and cultural competence. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy."
CHWs are deeply rooted in their communities, often members of the community themselves, and are uniquely positioned to bridge cultural and linguistic knowledge gaps for health departments.
Health departments partner with, and hire, multilingual and multicultural CHWs to leverage trusted relationships within communities disproportionately impacted by COVID-19. Below are some strategies to help identify CHWs who reach RIM communities:
- Connect with health care providers that serve RIM communities, including community clinics and federally-qualified health centers who often have deep community ties, and medical providers with refugee/immigrant backgrounds
- Reach out to community-based organizations (CBOs) and grassroots organizations that serve RIM communities and inquire if they work with CHWs
- Connect with local refugee resettlement agencies and refugee and immigrant coalition groups that serve RIM communities
- Connect with faith-based organizations and ethnic community-based organizations that may provide health and social service support to RIM communities
Clinical Health Navigators in Arizona
The Arizona Department of Economic Security maintains a database of resettled refugees in the state. The Arizona Department of Health Services cross-references that system with their communicable disease database of COVID-19 positive cases, issuing line lists of matches to counties based on the recent case address. The Maricopa County Department of Public Health has created a Refugee Outreach Unit, comprised of clinical health navigators (CHNs) to perform linguistically- and culturally-appropriate outreach through case investigation and contact tracing and provide COVID-19 education. "We wanted to make sure that we were hiring people who were already trusted resources within their communities that could help us get information out. One of our clinical health navigators leads a women's group of 70 women at her church, and she's the first lady of her church," says Ariella Dale, Refugee Outreach Unit lead. In addition to assisting in CICT efforts, they also help translate handouts and visual materials, deliver information and education to community leaders, and distribute masks and alcohol-based hand sanitizers. The CHNs are integrated into Maricopa County's COVID-19 Unified Command Response to ensure the RIM population's unique needs are addressed. That essential cultural and linguistic perspectives can inform the entire response.
Community Health Workers in New York
The SUNY Upstate Institute for Global Health and Translational Science (IGHTS) in New York leveraged its relationship with refugee resettlement agencies Catholic Charities of Onondaga County and InterFaith Works. They developed a clinical-community partnership to promote education around COVID-19, improve access to COVID-19 testing, and support households who became infected. Upstate's medical team and the community partners' 8 CHWs and case managers speaking >30 languages performed education, outreach, regular COVID-19 surveillance, and follow-up for households that tested positive. Family and neighbors of positive households were encouraged to come to the refugee center, where weekly COVID-19 testing was offered. "When you bring trusted people speaking the same language, it provides a safe space to engage, and we can support people so much more… this was our huge success," says Dr. Andrea Shaw with Upstate's IGHTS. The CHWs' invaluable language and cultural congruency, with a trusted position and relationship with the communities, allowed IGHTS to easily follow-up with those tested and conduct case investigation and contact tracing (CICT) as needed. The CHWs also distributed outreach bags with pulse oximeters and thermometers with support and education about using them. These resources were helpful if clients' symptoms worsened and they needed a telemedicine visit with a clinician.
Cultural Navigators in Colorado
Denver Health Refugee Clinic, Colorado Department of Public Health and Environment (CDPHE), the Denver Health Refugee, Immigrant, and Migrant (RIM) Navigation Program and a non-profit organization Immunize Colorado, partnered to outreach to a cohort of refugee arrivals to provide missed vaccinations through patient navigators. A culturally-matched refugee patient navigator initially contacted refugee families to link them to appointments to receive any needed vaccinations at the federally-qualified health center (FQHC). Barriers, including transportation, access to appointments, and any questions about the need for vaccinations or safety to come to the clinic during the pandemic, were addressed and tracked through standard scripting in the FQHC's electronic medical record. Outreach incorporated education on influenza vaccination and linkage to influenza vaccine clinics. Currently, outreach has focused on linking RIM populations identified in the Denver Health and Hospitals EMR to COVID-19 vaccinations.
Partnering with Community Health Workers in Utah
The Utah DOH Office of Health Disparity has contracts with numerous local agencies known for serving RIM community members. Through this partnership, the DOH can work with the agencies' CHWs. To leverage this resource, the Utah DOH Refugee Health Program (RHP) developed a system to connect the database of COVID positive cases with the refugee database so they could perform linguistically- and culturally-appropriate outreach and follow-up with the CHWs. If the community member resided in the US for less than 2 years, the RHP team would directly connect them to their resettlement agency's case managers. If the community member had lived in the US for more than 2 years, the RHP team would perform case investigation and contact tracing and connect them with a CHW. The CHWs identify areas of need and connect them with social support and wrap-around services.