The COVID-19 pandemic has impacted all sectors of health, wellness and care at the community level and the provider level. With a projected national morbidity of 200,000 in September and concerns for a second wave of infections due to unsafe re-opening, lapses in social risk mitigation, and concerns for the upcoming fall flu season, forward planning is a necessity. New York’s experience of COVID-19, as one of the first national epicenters of the disease with the death of 32,295 New Yorkers, demonstrates the local capacity moving from a stage of unpreparedness to developing immediate critical strategies from lessons learned. New York moved from having one of the highest COVID-19 daily death rates of 597 on April 7 to the report of 7 deaths on July 23. In this time span, while local restrictions and daily guidance were put in place to mitigate risk of large community viral infections, health disparity outcomes highlighted clear health inequalities and gaps in care that reflect a national struggle.
While the world waits for a vaccine, immediate and actionable solutions are needed to address the following critical CDC-noted vulnerabilities in minority communities.
- Outcome disparities and gaps in service infrastructures have become apparent in the local experience of the epidemic.
- A disproportionate rate of COVID-19 morbidity among ethnic minority communities exists. African Americans have an elevated risk of 3.57 when compared to the White population, while the Latinx population has an elevated risk of 1.88. Asian Americans have an elevated risk of 4 when compared to the general population.
- Systematic racial barriers are present in social systems.
- There is a lack of healthcare access and utilization.
- Occupational risk due to essential work settings for African Americans and Asian Americans have been documented.
- Social determinants of health (SDOH) impacted by education, income and personal wealth need to be addressed.
Other significant risks and barriers experienced nationally include:
- rise in mental health and substance use disorders;
- increased rise in suicide due to COVID-19;
- lack of proper care coordination post discharge;
- lack of effective contact tracing;
- higher comorbidity for individuals with complex care and co-occurring disorder; and
- incompatible information and data exchange systems leading to operational and preventive care weaknesses.
COVID-19 presents clear challenges at the management and administrative levels. These include the following considerations:
- fiscal stability and sustainability;
- providing effective leadership – maintaining agency culture and values;
- quality control – administrative, financial, and programmatic;
- meeting regulatory, licensing, and contract requirements;
- communicating with staff and community partners;
- overseeing staff performance;
- providing effective supervision;
- on-boarding new staff and other HR-related issues;
- incorporating new technologies and evidence-based, trauma-informed practices;
- caring for staff well-being; and
- planning for the future following the pandemic.
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Implementation Specialists for Practice Innovation:
Kieu Loan Mai, PhD, is an experienced clinician and researcher in implementation science, organizational psychology, and program evaluation with a focus on disparity in care, quality outcome measures, and solutions for barriers to care. She has electronic health information subject expertise in behavioral health, substance abuse and integrated care user analysis for improving technology engagement, workflow design, module launches, and implementation of quality measures for administrative and operational oversight. Dr. Mai is a risk mitigation implementer with direct operational and clinical experience during disasters and service disruptions, including 9/11, Superstorm Sandy, and the Northeast Blackout of 2003.
Fern Zagor, LCSW, ACSW, is a transformation specialist with over four decades of experience providing solutions in non-profit environments. She has extensive leadership experience on non-profit boards helping to develop and implement strategic plans. She also provides leadership on community development and collective impact initiatives to improve health and educational outcomes and address the opioid epidemic. Ms. Zagor specializes in strategic planning, behavioral health integration, program and staff development, mergers and acquisitions, coalition and community building, leadership and board development, grants development, and services for children and families.
Rhonda Bohs, PhD, is an experienced applied experimental psychologist with more than 30 years in the application of evidence-based practice to community-based behavioral health and integrated care programs, community systems transformation, and system/program evaluation and clinical trial research. Dr. Bohs has implemented numerous innovative and evidence-based treatment programs including the integration of primary and behavioral healthcare, implementation of culturally-specific behavioral health interventions, program evaluation of SAMHSA System of Care Transformation Grant initiatives, and the development of managed care pilot projects demonstrating the effectiveness of consumer/peer services and evidence-based practice. Dr. Bohs’ experience working within non-profit community-based programs and community stakeholders, in addition to her research and program evaluation initiatives coupled with her academic background, have allowed her to develop expertise in the areas of Implementation Science, Transforming Systems of Care, Integrated Care, Applied Program Evaluation, Research and Clinical Trials, sustainability of new programs and practices, and the dissemination of lessons learned when clinical trial research is applied to “real world” community-based programs, agencies, and large systems.