Intensifying Community Referrals for Health: The SINCERE Intervention to Address COVID-19 Health Disparities

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PROJECT SUMMARY In an effort to slow transmission of the 2019 novel coronavirus (COVID-19, or COVID), communities worldwide have implemented strict quarantine policies. While these efforts appear to be having a positive public health impact, they are negatively impacting economies, limiting personal resources for both COVID+ and non- COVID infected patients, and exacerbating health disparities. Community service providers report steady increases in calls for resources (e.g., for food, housing, transportation) during the COVID-19 pandemic, particularly from underserved and underrepresented communities, and additional strain is being placed on health systems. There is a critical need to identify how to overcome community service access barriers during COVID-19, particularly for underserved communities. Our program of research has successfully leveraged existing, low-cost technology to conduct social needs screening during busy emergency department (ED) care, follow-up by United Way 211’s community referral service, and data exchange between systems, suggesting it may be a solution for understanding and meeting the needs of vulnerable and underserved patients during the COVID-19 pandemic. However, findings from our recent sample of approximately 5000 patients screened for social needs during ED visits and qualitative data from service providers, 211 community information specialists, ED Staff, and patients reveal that effectively addressing social needs and connecting to community service providers requires thoughtful, targeted approaches in order to develop relationships among patients and those involved in screening and outreach. Using a pragmatic trial approach in a sample of 1500 patients screened for social needs in ED and community-based and mobile COVID testing sites, the objective of this real world efficacy (NIH stage 3) study is to determine whether community service use for those with social needs improves general and COVID-related health outcomes, and whether random assignment to intensive follow-up and collaborative goal setting helps overcome barriers to community service use. We hypothesize that patients who use community services to meet social needs will experience improvement in general and COVID-specific health outcomes, and that patients randomized to a collaborative goal setting process with a 211 information specialist will have greater community service use. Given the unknown timeframe for social distancing measures needed during the months or years ahead, it is critical to broadly understand the barriers to, and facilitators of, COVID-19 prevention; and of how to address effects on social, mental, and physical wellbeing among COVID-19 vulnerable and socioeconomically disadvantaged populations.