A post-COVID-19 public health and economic mobility strategy

The COVID-19 global pandemic is causing dire short- and long-term economic and human consequences for millions of American families. Health, human services, and workforce agencies are seeing significantly increasing numbers of vulnerable individuals and families—many of whom are not accustomed to needing, applying for, or receiving supportive services.

Individuals and families are facing challenges across several domains, including employment, increased incidence of violence and suicide, higher debt, interrupted careers, business losses, substance use, fractured relationships, associated traumas, and poor physical and behavioral health outcomes. If history is a guide, economic recovery for low-income families will take years. Legacy structural inequalities will be exacerbated by the pandemic causing disproportionate negative impacts among those least able to recover.

Leveraging the social determinants of health

The Biden Administration has proposed the “immediate creation” of a 100,000-person Public Health Job Corps (PHJC). The PHJC would advance equity across the social determinants of health by assessing and supporting at-risk populations impacted by COVID-19, the opioid crisis, and social isolation, especially in older adults. If appropriately equipped, the PHJC could also illuminate the impact of disproportional social and health outcomes and create new community pathways to connect vulnerable individuals and families to an identified system of supportive services.

An actionable national strategy

To support building back better, we propose that a series of data-based health and economic mobility practice tools be deployed through the PHJC and other already existing infrastructure. Based on the Social Determinants of Health, this approach advances health and economic mobility through a data-driven understanding of individual strengths and challenges, revealed through a comprehensive appraisal and mitigated through an individualized plan and strategic alignment of services, stakeholders, and funding streams.

This Public Health and Economic Mobility Strategy (PHAEMS) will build critical capacity for a new PHJC to uniformly implement a proven, practical model at national scale by:

• Implementing culturally sensitive and trauma-informed approaches for identifying people at risk of contracting or spreading infectious disease.
• Supporting mental health and reducing social isolation through compassionate care hotlines.
• Supporting local outreach efforts to people who are at high risk of COVID-19, especially low-income families, communities of color, and older adults.
• Leveraging PHJC’s role as community health workers to build longer term community health infrastructure, fight the opioid epidemic, and address inequities across the social determinants of health.

Four primary tasks necessary to facilitate a rapid upskilling and national deployment

Task 1: Convene a national advisory group to guide development, deployment, and continuous improvement

Effective solutions must be built to address the needs and context of the professionals and customers who will implement and be affected by them. We propose that this work be informed and led by a strategic oversight stakeholder/expert group to assure optimum implementation success. Because time is critical, the group must effectively obtain input for timely decisions along with an aggressive, yet doable timeline. A bias for action is needed.

Task 2: Utilize a PAHEMS appraisal tool with at-risk individuals and families impacted by COVID-19, the opioid crisis, and social isolation

Our team has pioneered the use of trauma-informed, evidence-based, comprehensive online employability assessments and individualized recovery plans. Existing assessments cover 10 major domains (education, employment, mental health, substance use, transportation, family safety, clinical health, etc.), and have already been deployed at significant scale. Based on motivational interviewing and trauma-informed practice, these tools auto-generate a Family Recovery and Stability Plan. Using data-based interviewing to understand individual strengths and challenges can transform the professional–client relationship. This allows organizations to connect individuals to resources in an effective order of priority and increase the long-term opportunities for success. 

Since these tools are online resources, they can be administered by the PHJC from a variety of “locations” including call centers, in-office, virtually through remote staff, or even via a self-assessment through a mobile phone. Multiple organizations in a single community can even use the same tool, thus creating a true “no wrong door” portal. By using the tool as a foundational assessment and plan, organizations can coordinate initial services, update the plan as needed, and share data across programs and agencies.

Task 3: Deploy PHAEMS to 50 states and U.S. territories

Create flexible PHAEMS hosting capacity

Access to PHAEMS can be implemented through a national host or by building the capacity of states and territories to host the tool through their platforms. There are several approaches to consider. Initially, the most effective strategy might be to establish a centralized national hosting service. Then, over 3–5 years, allow states and territories to transition the tools to their platforms.

Launch and operate a national call center

Creation of a national “compassionate care” hotline can provide immediate implementation and piloting of the assessment and planning tools, training of staff, as well as initial data analysis. Processes to “transfer” completed assessments and findings for the delivery of supportive services should be handled by customer services management systems directly linked to the states and territories. 

Deploy a national training academy

National use of an effective social determinants of health assessment and case planning technology is critical in order to identify people at risk of contracting or spreading infectious diseases. It also plays a key role in reducing social isolation, reaching people who are at high risk of COVID-19, and leveraging increasing community health worker capacity to fight the opioid epidemic and address inequities across the social determinants of health. However, it is equally critical to build the trauma-informed knowledge and skill of those administering such assessments. The PHJC can successfully apply the lessons learned in the past 15 months about “virtual case management.”

The creation of a national plan to scale this capacity is needed. Strategies will likely include the use of in-person and virtual training, a robust train-the-trainer component, and development of material, resources, and toolkits that can be accessed within the tool and available via an online PHJC capacity center.

Task 4: Create a national health disparity dashboard including provision of data reporting and analysis to each state and territory

An understanding of the impact of COVID-19 on the nation’s at-risk populations is essential for ongoing economic recovery and the advancement of equitable outcomes for all. Our tools provide the ability to extract real-time data using existing report templates or customized reports. These reports are generated automatically from the assessment. Such reports and data visualizations provide a data-informed understanding of individual/family needs and overall populations trends. This data can be sorted and produced as statewide, regional, county, or agency specific and is managed via a PHAEMS dashboard.

Finding the opportunity in the crisis

The COVID-19 pandemic has wreaked havoc across families, departments, and sectors. With multiple strategic and operational implications for state and local health, human services, and workforce systems, stakeholders are working diligently to identify new ways of providing an increased volume of services in a trauma-informed way. These activities provide a window of opportunity in which states and communities can build new strategies beyond traditional program boundaries to help vulnerable families better address immediate needs. They also assist in preparation for recovery while considering how the COVID-19 crisis can be leveraged into new long–term national, state, and local capacity.

Implementation of our team’s recommendations will support a national response to supporting vulnerable populations impacted by COVID-19 while building new, sustainable capacity to reframe and address population health issues. PHAEMS provides the framework for the soon-to-be created PHJC to quickly implement a data-driven solution that identifies individuals and families impacted by COVID-19 and other factors and creates actional pathways for equitable economic and health outcomes.