Cross-Sector Partnerships Help Underrepresented Communities SARS-COV-2 Crisis

October 2020

Academic medical centers must establish cross-sector and cross-discipline community partnerships, and these partnerships are critical for effective crisis response in lieu of the COVID pandemic, according to a new paper published in the Journal of American Medical Association by authors from the Department of Pediatrics at the University of Rochester Medical Center (URMC).

The paper, “Leveraging Cross-Sector Partnerships to Preserve Child Health: A Call to Action in a Time of Crisis,” cites several examples of effective community partnerships that the Department of Pediatrics utilized in Monroe County to provide continued pediatric care, behavioral health services, and food/meal distribution during the pandemic. The paper’s co-authors argue that these community partnerships are critical for counteracting the damaging effects that the pandemic has on children and families from underrepresented communities, which include unemployment and reduced income for caregivers, school closures impacting daily schedules, and disruption of critical school wraparound services

“We felt that the emphasis on COVID impact was focused on economic outcomes with adults, so we wanted to give attention to the pediatric community and generate partnerships to address disparities,” said lead author Jeff Yaeger, M.D. M.P.H., assistant professor from the Department of Public Health Sciences. Patrick Brophy, M.D. chair in the Department of Pediatrics, and Jeffrey Kaczorowski, M.D., professor in the Department of Pediatrics, were co-authors.

The study draws examples from past catastrophic events, such as the 1918 influenza pandemic, as well as Hurricanes Katrina and Sandy, to indicate that children and families living in poverty are at the highest risk of experiencing poor outcomes during crisis scenarios, including homelessness, unemployment, food insecurity, and trauma/violence.

The Department of Pediatrics shifted to enhance and leverage existing partnerships on March 11 – when the first SARS-COV-2 resident was diagnosed in Monroe County - so that children and families could continue to receive services they needed. These partnerships were comprised of local school districts, pediatric and family medicine practices, accountable care organizations (ACOs), health insurers, and the New York State and Monroe County Departments of Health.

These collaborations helped support a multi-tiered plan. First, the Department of Pediatrics worked with primary care practices caring for children to limit foot traffic through clinics. This included a transition to telemedicine appointments for everything but essential preventive visits - defined as screenings and immunizations for children up to two years.

This arrangement presented two potential obstacles: Loss of revenue for these pediatric practices due to a decline of in-person visits, as well as challenges to ensure safe transportation for essential visits for families. To address these concerns the Department of Pediatrics partnered with local ACOs and the Monroe County Medical Society to successfully increase reimbursement for telemedicine encounters, and also worked with local banks and small business development corporations to help practices receive grants and loans through the federal CARES act.

To secure safe transportation for essential vaccination and immunization visits, the Department of Pediatrics collaborated with the Rochester Transportation Services (RTS) to coordinate the deployment of eleven vans to provide free transportation for more than 500 low- income infants and children to preventive visits.

“We anticipated that immunizations would drop, but due to these partnerships we actually averted that situation and didn’t see a significant decrease,” said Yager.

In addition, The Department of Pediatrics worked with practices and mental health providers to develop a tiered protocol to assess and manage children and youth with behavioral and mental health concerns, and coordinated this effort with the local school districts, their mental health counselors, and community-based organizations to ensure that behavioral health services could be continued for high-risk children.

For children’s nutrition, staffing shortages and requirements for an in-person interview restricted new applicants for the Women, Infants, and Children (WIC) program - which provides nutritious foods to pregnant, breastfeeding, postpartum women, and infants and children up to the age of five. By collaborating with New York State and the Monroe County Department of Health, the Department of Pediatrics was able to obtain a temporary regulation change so that new enrollees could join through a simple call-in process, and continue to receive food services that were interrupted through the closure of schools.

While data was not available at the time of submission, new information reveals the success of several of these interventions: vaccine rates and lead screening rates stayed consistent, whereas theses rates dropped dramatically at all ages throughout the rest of the country. In addition, behavioral health visits through telemedicine were maintained at 100 percent of pre-COVID, volume, according to Yaeger.

“These results make the case for the integrated-community approach, and since many these partnerships had already been established, it gave us a unique capability in Rochester to implement changes in how to address health related-services in our families,” said Yaeger.

The strong inter-connectedness of these partnerships – and their success in addressing food insecurity, vaccine rates, and behavioral health - also could potentially help the Department of Pediatrics at URMC to continue to address health disparities that affect underrepresented populations, according to Brophy.

“The foundation is there to address another the public health crisis that facing us, which is structural racism,” said Brophy.

The study’s co-authors are currently examining the equity of the community response in all faces, both to inform how to enhance these services in case of another SARS-COV-2 lockdown, and also in continuing these services where needed - such as telemedicine - after the virus subsides.

“We understand more than before the challenges we face to keep our children healthy and maintain community infrastructure. We will continue to look at the data for health promotion and access to care  - see if and where improvements can be made - and partner with our community going forward on behalf of our kids and families, especially those affected by racism and poverty,” says Kaczorowski.