In an effort to increase COVID-19 vaccination rates among children and families, and ultimately help bring the pandemic under control, the Department of Family & Community Medicine (DFCM) and the Department of Psychiatry at the University of Maryland School of Medicine (UMSOM) are partnering with key community and faith-based groups in Baltimore City to reach the most vulnerable and underserved communities. This partnership will also extend across Maryland, Delaware, Virginia, and West Virginia.
Niharika Khanna, MBBS, MD, DGO, Gloria M. Reeves, MD, and the Rev. Kobi Little.
The Community-Based Workforce for COVID-19 Vaccine Outreach Program at UMSOM will support families with children ages 12 to 15, including those with special behavioral health needs, by addressing barriers to vaccines. It will also provide culturally relevant information, practical support, and one-on-one conversations with trusted community partners about vaccine concerns. The multistate program is funded by a $7.8 million award from the U.S. Health Resources and Services Administration (HRSA). It builds upon community work already underway by UMSOM that is funded by the Maryland Community Health Resources Commission, which aims to reach individuals in vulnerable communities at the grass-roots level across the state.
“It is critical to understand that the objections and concerns about getting vaccinated are real and valid in these communities in order to address them,” said Niharika Khanna, MBBS, MD, DGO, professor, Department of Family & Community Medicine, section chief of population health in the department, and co-principal investigator (PI) for the program. “We must acknowledge them and tailor our conversations accordingly.”
Language and cultural barriers are being addressed by cultural ambassadors and community leadership engagement. Multiple methods of communication are planned, including face to face, virtual, print, live, radio, television, social media, billboards, and other methods. UMSOM’s partners are going into communities that are difficult to reach using a public health messaging truck. Others are reaching the homeless population with street-based outreach and are engaging post-penitentiary populations through behavioral health providers.
“The regions of the four states that have high rates of vaccine hesitancy are in a variety of settings, including rural and urban communities,” said co-PI Gloria M. Reeves, MD, associate professor, Department of Psychiatry at UMSOM, which is partnering with UMSOM's Department of Family & Community Medicine. “Our outreach plans were developed to address specific geographic challenges such as poor internet access, utilize community strengths like coordination with local schools and faith-based organizations, and provide testimonials from community representatives on how they approached vaccine decision-making.”
Partnering with Key UMB Programs and Community Leaders
The program incorporates key community partners already trusted in these communities, such as several Area Health Education Centers (AHEC), including the University of Maryland, Baltimore (UMB) Community Engagement Center (CEC). Other community partners central to this program include the AME Zion Church, the NAACP Baltimore branch, Community Behavioral Health, National Federation of Families, and Family Voices. UMSOM’s partnerships with these community leaders will help to identify those with vaccine hesitancy in a wider swath of the population across four states. These partnerships will be used to develop a family, community, and faith-based approach toward enhanced outreach in these communities. This is not a one-size-fits-all program.
Based on information collected from community leaders and members of each population, the program will be tailored to meet the specific religious, ethnic, and socioeconomic needs of each community.
"Through this HRSA-funded collaboration with UMB and other partners, we will be able to help our communities to overcome vaccine hesitancy by initiating conversations about the very real and certain consequences of COVID-19, including hospitalization, long-term disability, and death," said the Rev. Kobi Little of the Baltimore NAACP.
"The vaccines are our best shot at staying safe,” Little said. “By engaging in frank and honest conversations with friends, family, and neighbors at the grass-roots level, we hope to activate communities to lead efforts to protect our people and get everyone vaccinated."
The goal in Baltimore is to address social barriers to COVID-19 vaccines and develop strategies and infrastructure to address vaccine hesitancy in Baltimore City ZIP codes that have neighborhoods where roughly 70 percent of the population has not been vaccinated. The program will also tap into synergies with the NAACP, AME Zion Church, and the central AHEC to address the need in Baltimore for community outreach and engagement. The DFCM is partnering with the SEED School in Baltimore to provide vaccination, education, and outreach to parents, students, and school staff. The central AHEC will provide navigation and post-vaccine care packages.
Community Outreach Through Largest HRSA Award in Maryland to Reach Vulnerable Communities
A key component to the program involves hiring and mobilizing community outreach workers and family peer specialists, who will serve as trusted messengers to support families in one-to-one relationships. It will also include community health workers, social support specialists, and others to increase vaccine access for the hardest-hit and highest-risk communities through high-touch, on-the-ground outreach to educate and assist individuals in getting the information they need about vaccinations.
UMSOM is one of 14 recipients of funding from HRSA for the $125 million community-based program announced in June by the Biden-Harris administration. It is the largest of two awards granted in Maryland.
A Data-Based Approach Toward Reaching Vulnerable Communities
Khanna has been tracking patient data in vulnerable communities, with the intent of gaining a greater understanding of COVID-19 and how it has impacted patient care. This data tracking helped set the stage to better direct future health care directives, repurpose clinical teams, redesign workflows, ensure optimal patient care for those with COVID-19, and to bring them into or continue primary care. In particular, her team focused on Family Medicine patients largely from West Baltimore as a baseline for building a deeper insight about patient symptoms and transmission.
Armed with this information, Khanna and her team began publishing a monthly COVID-19 Dashboard, which includes a number of data-based perspectives on the emerging trends in unique COVID-19 cases by race, age, and sex. Since the start of vaccination for COVID-19, they also tracked vaccination trends in patients with data collected in the Chesapeake Regional Information System for our Patients (CRISP), the designated Health Information Exchange in Maryland and the District of Columbia. In addition, the team focused on age, race, chronic disease, and socioeconomic predictors of health.
A particular area of interest was socioeconomic factors and how they intersect with COVID-19, for which Khanna and her team used the Area Deprivation Index (ADI) intensity map. The ADI incorporates census data to rank neighborhoods by socioeconomic disadvantage in a region of interest. The resulting data revealed that the most pandemic-vulnerable Family Medicine patients were African Americans living in highly deprived areas within densely populated multihousing units, followed by whites living in areas with low or intermediate ADI ranks.
“This community-based approach is built on our close connections within these communities and is supported by data generated by our own faculty, setting the path toward fighting the COVID-19 pandemic in the broadest way possible,” said E. Albert Reece, MD, PhD, MBA, executive vice president for medical affairs, UMB, and the John Z. and Akiko K. Bowers Distinguished Professor and dean, UMSOM. “We know that vaccines are our best defense against this deadly virus, and they are even more important as we are seeing a rise in cases with new variants.”