From Food Drives to Front Porches, Health Education and Outreach Prove Key to COVID Fight

Pandemic Coverage


Many people, frightened about the coronavirus and unsure what to believe, are getting accurate, updated information from Catholic health system clinicians and educators who know that many of the most vulnerable they serve can't be reached via a Zoom call or an internet connection.

About 10% of adults in the United States don't use the internet, according to a Pew Research Center analysis published last year. The digital divide of those without the internet tends to include seniors, rural residents, those with less than a high school education and households earning less than $30,000 a year. Individuals that belong to racial minorities, older adults, rural residents and those with lower levels of education and income also are less likely to have high-speed broadband internet at home. Members of those populations are among the most in need of trustworthy information about the COVID-19 pandemic. The elderly and those with pre-existing conditions have been most likely to die from COVID-19. In the United States, not all states are publicizing the racial demographics of those who die, but minority populations are suffering a disproportionate share of deaths. African-Americans make up 13% of the U.S. population, but in the areas of the country that are releasing mortality data, they account for 25% of the deaths.

"It's great to say go to the computer and look at this website, but (a lot of) people don't have computers," said Lillian Schonewolf, vice president of Community Health and Well-Being for Trinity Health Mid-Atlantic. "You have to be out there. You can't sit behind a desk and assume you know what people need." To quell fears and quash misinformation, Trinity Health Mid-Atlantic has taken a multipronged approach to provide good information to residents, particularly in neighborhoods with high numbers of older residents, minority residents and low-income households. The regional health system, with facilities in Pennsylvania and Delaware, has 1.5 million people in its service area.

Clinicians and others who do health education are writing informational flyers using a straightforward tone with clear messages about COVID-19. They've distributed about 3,000 paper flyers since March, including at sites where those in need can pick up food boxes. Trinity employees and community partners both stop by laundromats and corner stores with the information but, knowing numbers are down in those settings, they've also started knocking on doors in some Philadelphia neighborhoods and offering in-person, but socially distanced information.

"Miss Lil, I don't like needles," Schonewolf has heard repeatedly, so she explains to those who may need a COVID-19 test that it requires a nose swab, which can be uncomfortable, but isn't a needle, thus trying to make some people less anxious about the test.

Ministers from churches in their service area share information, even walking alongside the handful of nurses and others doing education, so that residents will see a familiar, trustworthy face. As piles of masks are donated – thousands upon thousands of masks– the same employees doing health education sift through them, routing ones that can be worn by health care workers to their facilities, giving out others in neighborhoods and making more available for patients to wear in doctor's offices and other health care settings. (They also have to discard some that no one should be wearing, whether worn out or too thick to breathe through.) A professional sports apparel business recently donated fabric masks that included the red and white of the Philadelphia Phillies, expected to make some members of the public a little more inclined to wear a mask.

Mobile outreach vehicles serve particularly important functions right now, as they can be brought to neighborhoods at a time when some might be unwilling to venture into a hospital or clinic. A van run by Saint Francis Healthcare in Wilmington, Delaware, allows for people to be swabbed outside on the street. About 700 people received tests that way through the end of April. St. Mary Medical Center in Langhorne, Pennsylvania, is using a mobile home renovated into a health clinic to bring drug relapse prevention services to communities, and COVID-19 education is included in each patient visit. Through a partnership with the Positive Recovery Solutions organization, clients can schedule ongoing therapy, receive assistance with health paperwork and receive shots of Vivitrol, a long-acting medication that curbs cravings for those recovering from alcohol and opioid dependence. Trinity's Preserving Our Legacy Fund, which supports programs to assist poor and underserved populations, provided a grant to buy and modify the motorhome. This mobile program serves as a lifeline for 700 patients a month in three different states.

The health care system also was spreading the word by late May that it has started testing all patients for COVID-19 prior to a surgical procedure. If a patient tests positive, he or she coordinates with their doctor on next steps. (In Pennsylvania, Trinity Health Mid-Atlantic includes the Mercy Catholic Medical Center – made up of the Mercy Fitzgerald Campus in Darby and the Mercy Philadelphia campus – Nazareth Hospital in Philadelphia and St. Mary Medical Center in Langhorne; Saint Francis Healthcare in Wilmington, Delaware; home health and Living Independence for the Elderly, or LIFE, programs in the two states.)

Helplines for Mental Health
In an attempt to help alleviate the stresses, anxiety and depression some essential workers may be experiencing, a new St. Louis-based helpline began taking calls in June. Whether someone is bagging groceries, working on a construction site, serving food in a restaurant or driving a bus, they can call the free helpline. Unemployed workers also can call in, as well as those with concerns about their health and safety as they return to their workplaces. In some cases, an employer might be able to plan an educational session for their employees on building resilience or ways to lower anxiety by first calling into the line.

Clinical psychologist and Saint Louis University professor Terri Weaver is teaching a class that includes supervising seven clinical psychology graduate student volunteers who staff the COVID-19-related mental health helpline. Called Essential and Resilient, with the tagline of "Lend an EAR," calls to the helpline will be answered from 9 a.m. Central to 8 p.m. Central Monday through Thursday and until 5 p.m. Central on Fridays. "The goal of our team is to think creatively about engagement at this time," Weaver said. Weaver said the service is not a crisis hotline. It is not staffed around the clock, but an answering machine will take messages after-hours or when the volunteers are on another call during the day and will follow up with return calls.

In addition to reducing potential stigma about asking for mental health support, Weaver said publicity about the helpline is trying to make it clear that for those who feel they don't have time to ask for support, it may actually be time-saving to reduce a personal stress level. The calls might help someone better overcome what is scaring them or making them anxious, so they can better focus on what they want to accomplish. She said short-term interventions can be effective in helping people access their natural coping skills or to consider other coping tools they may not have considered.

She said at a time when a lot of well-intentioned advice is being given, people can even be overwhelmed by the numbers of tips and helpful resources currently circulating. The difference a helpline may make? "If an individual is experiencing stress, they need something tailored (to the individual)." Callers hear "what they are getting and not getting" – the helpline provides a mental health consultation, but not a continuous therapeutic relationship. They are asked for their consent, and given a brief assessment. As part of that, the volunteer asks about the nature of stressors the person is experiencing and may try to identify the most pressing area of stress and how the person can reduce or manage it. The knowledge and compassion of the helpline volunteers is an important component, so they are able to focus their questions and their approach to what may be helpful to each caller, she said. Weaver said it is possible that group sessions could become available through the helpline, perhaps if an employer wants to offer all employees an opportunity to learn more about healthy coping strategies.

Telephonic assistance is also available in some locations specifically for health care employees. For instance, those who work at three of the SSM Health hospitals in the St. Louis region – SSM Health St. Louis, Cardinal Glennon Children's Hospital and SSM Health St. Mary's Hospital – can call a telesupport line, staffed by volunteer PhD-level psychologists from 8 a.m. to 5 p.m. Central on weekdays. Lauren Schwarz, a Saint Louis University professor and SLUCare clinical neuropsychologist, said callers can receive two sessions of behavioral health support over the phone or through video call. If they need more assistance in the form of psychotherapy, they are referred to the Saint Louis Behavioral Medicine Institute. The telesupport line is free; sessions with the institute are billable.

Words from trusted leaders resonate
Another effective way that health care systems are educating the public is by turning to trusted clinicians to share information and answer questions. In the months since communities began stay-at-home orders for those who are not essential workers, there have been negative comments on social media, on publication websites and on the radio from those who dislike the policies, which have been an enormous adjustment on day-to-day life across the country. Images abound of people not abiding by the basic public health recommendations aimed at containing the spread of COVID-19: maintaining social distance 6 feet apart from those not in the same household, wearing a mask when within close range of others in public, and avoiding large crowds. And comments from those who oppose such practices have certainly been heated in electronic forums.

Catholic health care systems, however, say their executive and religious leadership and their clinicians have not been subject to such vitriol when providing education about the pandemic. As in other times, they say, a doctor, nurse or sister with a knack for communicating clearly to the public remains a valuable asset to getting out COVID-19 prevention methods. Some research has indicated that the public generally doesn't trust doctors to the extent they did 50 years ago, though it's nuanced in that individuals generally still seem to trust their own doctors. It's recommended that clinicians be out in front during major public health events as a reasoned voice to give people practical, scientific and medical information. Health care system executives and frontline care providers in this story said they continue to see that education provided by their clinicians and leadership carries a lot of weight in the communities they serve.

While Catherine Harrell, chief marketing officer for Baton Rouge-based Franciscan Missionaries of Our Lady Health System, said there's "not much of Louisiana that doesn't have the internet," the system has been using multiple communication strategies for health education. It's drawing on long-established relationships with city, regional and state government as well as partnerships with other religious and community organizations and the media. Clinicians can serve as "endorsers," encouraging people to follow the practices most likely to keep them safe and to prevent the spread of disease. They're also able to synthesize shifting information as more becomes known about the virus to update messages to the public and their own patients. Telephone health coaching is offered to some patients with chronic conditions, so those without smartphones or ready access to computers can be reached.

Franciscan Missionaries of Our Lady Health System has revived a hand-washing campaign it created involving Sr. Uyen Vu, a FMOL sister and nurse who encourages people to make hand-washing an easy "habit" while wearing her religious habit. While sending direct, informational messages to patients through emails, social media and during office visits, the system also sees the importance of communications outreach to the broader community in messages that thank health care providers and other staff, that encourage kindness to neighbors and "invite people to their resilience," Harrell said. A key part of education and outreach is leading by example, she said. And the public needs more from its health care system than just health advice right now, including reassurance. "We use our ministry voice to be encouraging to people, affirming and supportive," she said.

BETSY TAYLOR is the managing editor of Health Progress, the Catholic Health Association, St. Louis.


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Copyright © 2020 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3490.

Copyright © 2020 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.