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Building Community Resilience to Help Families Bounce Forward

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Robert Johnson:
This is Public Health Review. I'm Robert Johnson. On this episode: teaming up to help children and families recover from the COVID-19 pandemic, public health and community partners powering local solutions.

Elke Shaw-Tulloch:
They think this pandemic has given us an opportunity to shift away from our old way of thinking and to really start focusing on how we can have better dialogs that shift us towards this equitable recovery, helping to build a better community resilience and that ability to bounce forward.

Suzy Sonnier:
When you think about the impact that it’s had on our communities, on our children, and on our businesses, you know, it is only through partnership that we're going to see the kind of outcomes that we want to see, the positive impact and the positive outcomes that we want to see.

Johnson:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, giving children and families the support needed to bounce forward out of the pandemic, working with community partners, finding new ways to fund and deliver critical programs.

There has always been a need for programs that place foster children, prevent domestic violence, and provide temporary assistance to families who have suffered due to job loss. But the pandemic has made those efforts even more important as society reels from a year's worth of illness, shutdowns, and hardship. Vaccines have brought hope, but the needs remain.

Two guests join us to discuss supports for children and families going forward. Suzy Sonnier is vice president of strategy and development for UnitedHealthcare in Nashville. She's along shortly to tell us how to build partnerships where they don't exist.

But first, a conversation with Elke Shaw-Tulloch, public health administrator at the Idaho Department of Health and Welfare, about her state's work to support food programs and child welfare teams.

Shaw-Tulloch:
Within our department of health and welfare, because we are a large organization, we have multiple divisions. The division of public health included that focus on families and children, of course.

And we know that we have seen definitely increased needs as the pandemic has caused issues around school closures, job loss, of course, race across the nation. Idaho hasn't been any different in facing those same experiences. And so, as we look to the programs that we currently have, we know that there are definitely opportunities that need to be addressed and maybe how we can look at the programs that we do differently.

A lot of the work that state public health does in Idaho is done through our local public health partners. And, because local public health was front and center on doing the COVID response, a lot of our programs that we fund out in the local public health districts that support families and children have had to have some—I don't want to call it a timeout, but there's definitely been, you know, all hands on deck for COVID response.

Johnson:
Tell us a little bit about the programs you're talking about.

Shaw-Tulloch:
The program, in particular, that public health provides out in local public health communities is our women, infants, and children program.

And we have seen, of course, situations where some of the clients, which definitely serve low-income women and children as a supplement on nutrition program because offices have closed, because jobs have closed, because people have faced problems with transportation issues and getting to appointments. Switching a lot of those appointments and things, for example, online or over the phone, has caused some decrease in services provided.

I think public health has been very resilient in figuring out new ways to meet people where they are and have really kind of been able to reach out to those people who are in need and help them, and still be able to provide those services locally that are important for them, where they need them.

Johnson:
The WIC program is a food program?

Shaw-Tulloch:
Correct.

Johnson:
What about other programs like those that support foster care placements, or domestic violence prevention, any of those sorts of programs suffering as well as a result of what's gone on the last year?

Shaw-Tulloch:
Well, that's not in the division of public health in Idaho, in particular, but it's still within our agency.

Public health has been supporting our child welfare workers so they can make sure that they still have the ability to go out into their communities and serve families. Funding wise, of course, we have not seen any significant decreases or anything like that, but we have seen increased need.

And so, supporting those social workers that have been out in the field, making sure that they have the appropriate personal protective equipment, that they can still do those jobs and support families, has been front and center in our state. And we've had some really successful interventions with families, we've had some really good support for families and children.

And, of course, we also, you know, when we look at the mental health issues that have also been in the forefront of all of this pandemic, our behavioral health services have also been able to continue to be provided. They are done in a different way.

We're making sure that everybody is safe and that they are able to do all those non-pharmaceutical interventions, we like to call them, while they're doing those jobs, but they're still out there and they're still keeping that really important work going forward.

Johnson:
You know, we've been talking for a long time now about the need to emerge from the pandemic with a system that's better, stronger, more resilient than the one we had in place a year ago. How has that approach being applied to these programs?

Shaw-Tulloch:
Well, I feel that the pandemic has shown us some great opportunities for improvement. And I think that as some of the work that we already had undertaken before the pandemic have been amplified in what we can see.

And so, I'll kind of frame this around the fact that I think this pandemic has given us an opportunity to shift away from our old way of thinking and to really start focusing on how we can have better dialogs that shift us towards this equitable recovery, helping to build a better community resilience, and that ability sort of bounce forward. And it kind of goes back to that ecosystem and realizing and remembering that nothing functions independently.

So, I feel like we have some really tangible examples of some of the underlying issues that we face in terms of equity and communities. And for those who have struggled pre-COVID, to wrap their minds around what tends to become kind of overly complicated concept, equity has been very visible in so many ways right now.

And it's allowed us to really dig into some of those cultural beliefs and fears surrounding COVID, specifically testing and vaccines, limited access to care, and access for issues for those in rural communities or home-bound or disabled.

So, all of this has kind of shown a spotlight on some of those areas that we have opportunities to improve.

So, we feel like this is a really great opportunity for us to think about moving forward and what we might be able to do better. And I think it's the perfect time for us now to kind of come out of this as we're healing to start to convening communities and really listen.

I think we were doing that okay pre-COVID—we were starting to work down some really great initiatives around building healthy and resilient communities, and looking at bringing funding streams together to entrust health disparities, to health equity, and looking kind of further upstream and addressing social determines of health.

But COVID has really given us that—I don't want to say time because it feels like a time warp that feels like it could have been five years or 30 days, depending upon how you feel that particular day—but I feel like it's given us some great opportunities to see how communities and how their health and their personal health and the health of the community is impacted by COVID.

I think this is the perfect time for us to convene communities and really listen. We've seen some of those disparities come out, we've seen some of those preventable issues be highlighted and amplified. But getting into communities now during this time of healing and post-COVID is a chance for us to really listen to the people and listen to the communities and listen to the data.

We need them to tell us how we can support them to become more resilient moving forward. I think getting to the root of those community needs at that very kind of basal level will help us in terms of launching forward.

Johnson:
Do you have any sense for what you might hear when you begin those conversations? When you have those engagements with people across the state?

Shaw-Tulloch:
I think given some of the work that we're doing right now through an initiative we have called Get Healthy Idaho: Building Healthy and Resilient Communities—we have been working with ASTHO and they've been wonderful at helping us kind of get this framed up and moving forward, and we appreciate some of our other state leadership across the nation that's been doing this prior to us—but it's allowed us to look at how we integrate and braid and blend our funding sources to look at place-based approaches to community health.

And so, through some of that work—we're already funding a community in particular, we're just getting into this in the last couple of years—but we do know that we're going to hear, because we've heard this from communities already, that, you know, poverty, community policies, economic growth and development in their communities, city planning, all of those things that we know about that hinder people's ability to remain healthy or get healthy or stay healthy.

We don't think that there is going to be anything hugely different other than maybe COVID is going to have magnified that. There are more people without jobs, there are more people that are struggling to put food on the table or help their kids or help their families, that have moved out of their situation.

And so, I think we're going to have to be thinking even more about what other partners can we bring in to help address the issues as we move forward post-COVID.

Johnson:
It's interesting that you use the word "partners" in the funding response. Are you trying to diversify the number of partners you bring into this programming so that maybe you can reach more people or do more things with the money you've got? Talk a little bit about how you're approaching the partnership side of this may be in the context of money, or maybe not.

Shaw-Tulloch:
Absolutely. We're doing a lot actually to bring in additional partners. And I think, fortunately in Idaho, we are large in size, small in numbers, and so we have a lot of community partners that we work with on a regular basis.

We are working with payers, we work with healthcare systems, and COVID has absolutely highlighted a really wonderful, stronger partnership with healthcare systems now that I look forward to embracing, as we, you know, get out of COVID.

We have community agencies that we're working with addressing housing, commerce, planning. We've been working more with faith leaders and our aging partners, as well as other private and philanthropic foundations and organizations in the state.

So, all of those players and partners and stakeholders together to address a wide variety of topics at the community level.

And then we're also, as we're making investments in communities through our Get Healthy Idaho initiative, we are making sure that the communities also come to the table with some stake in the game, as opposed to just waiting for this partnership to come and give them money and tell them what to do.

They need to help identify what the issues are and we're going to make sure that we give those communities seed money, if you will, to address their own issues and help them kind of prop them up.

But I think the main thing that we have to do with all of these partners that we're bringing to the table is making sure that we find, again, going back to that statement of common ground and what can we all agree on is important, and we can kind of funnel our money in that way.

Johnson:
Is this an approach that was inspired by the pandemic? Or were you on this track before all of this started last year?

Shaw-Tulloch:
We were on a path to this prior to COVID and we were really just right in the exciting part of finding those community partners and building this out. And we thought we were going to have to slow down and maybe not get as far along as we got, but actually COVID really highlighted the need for this type of approach, so our initiative is moving along really well.

It's also given us the opportunities to talk to our partners about what impacts has COVID had on communities, like we've talked about in the beginning of this, because it's highlighted some of those needs and communities. It gives us even more of that common ground and people can really see those tangible impacts when communities are hit by economic situations or poor health outcomes.

And so, while we have this work going on, I think now the pandemic has actually going to be this amazing catalyst for us to bring in even more partners on the other side of this.

Johnson:
Is it encouraging to you that people have stepped up in the spirit of trying to find a better way?

Shaw-Tulloch:
Absolutely.

I think while public health in general and society in general feels, right now, incredibly—I don't know if this is the right way to say it—sort of low on energy, emotions that have been through this incredible roller coaster, and it's easy to feel this sense of defeat, you know, COVID really brought us to our knees. There's also an incredible amount of hope. We've been able to create some amazing partnerships and opportunities and working with partners that we never had this close of a relationship with, but we've had to problem-solve how to address COVID. To me, that brings a huge amount of hope and excitement and energy that we can conquer a lot of things moving forward.

Johnson:
Suzy Sonnier is a leader on strategy and development for UnitedHealthcare. But for many years, she worked in public health in her home state of Louisiana. She's got the view from two important angles and as a champion for partnerships between government, communities, and business.

Sonnier:
Robert, I think there are so many private sector partners who can help our public sector. It doesn't have to be that you do the same type of business or same line of business. It really just has to be that you have a passion for serving your communities within your organization.

And so, you know, I would challenge many and all private industry to think about how they can get involved in helping our communities bounce back from this pandemic.

I think that when you think about the impact that it's had on our communities, on our children, and on our businesses, you know, it is only through partnership that we're going to see the kind of outcomes that we want to see, the positive impact and the positive outcomes that we want to see in our communities.

And it can be as little as—you know, we've seen a lot of elevated food insecurity issues in the community. It can be as much as collecting, you know, food supplies to be engaged and working with food banks who are also partnering with our public health agencies to get folks vaccinated and making sure there's, you know, food boxes available for families, or it can be as much as, you know, creating large investments and working with foundations and other organizations to really increase and change capacity and provide that level of resources.

Johnson:
You've been in some of the same roles that people in our audience have served in. You've been at the state level, working on these programs from that angle. Now, you're in the private sector at UnitedHealthcare.

Putting on that hat that you wore in Louisiana, what would you like to see out of the private sector as we deal with the aftermath and the bouncing forward part of this pandemic response?

Sonnier:
First, let me say, I have such great respect for our public servants. The folks who work in our state agencies, in our community agencies, they are really there very often because they believe in the mission of the work that they're doing, and they really want to see a better life for the people that they serve. So, I just want to say right off the bat that I have such great respect for them.

As far as our private partners, I think that many of them also have that same commitment to the community. So often when you start talking to folks, whether it's public or private, you see that we all want a better life for our children, we all want people to be safe and cared for, we want folks to be healthy.

And so, for our private industry, again, I just encourage folks to think about what are the issues they're seeing in their communities, and how can they be engaged, and who might they engage with in order to be a part of them.

Johnson:
Specifically now, from the perspective of a health insurance provider like UnitedHealthcare, how do you engage in this process? How do you help shore up, stabilize, and advance the cause of children and families in this crisis?

Sonnier:
Well, in the work that we do as a managed care organization—our Medicaid managed care organization in particular—we are constantly working with our state partners to identify trends, to see what the needs are, to communicate with our members and the folks that receive services through UnitedHealthcare and through our partnership. We've invested in a number of really great initiatives around the country in the last several months.

One that I'm really proud of is an initiative that we invested in with federally qualified health clinics. Very often our Medicaid members—I think one out of five members around the country—are served by FQHCs and we invested with our FQHCs is to really look at building capacity in the midst of the pandemic.

We worked with them to identify where they would want to focus—whether that was healthy children, whether that was healthy pregnancies, whether that was specifically targeting a response to the pandemic—and we invested about $20 million around the country in 300 different health clinics to really give them the flexibility to respond and address the needs that were the greatest in their local communities.

So, we've also worked very closely in local communities. For example, right now, as the vaccines are rolling out around the country, we are seeing vaccine hesitancy in some communities, and we know that there's a need for increased education, that there's a need for us to reach out to our members and communicate about the importance of the vaccines and help to answer any questions that may have helped them get spots, to be able to get vaccinated, you know, provide some transportation assistance with that.

So, we've been really engaged with local communities and even community-based organizations as well to really support that effort in communities. So, I think you'll see us, you know, in the pandemic, everything from, you know, large initiatives to build capacity to those initiatives that are, you know, ensuring that people have direct access to vaccines.

I would say, Robert, we also have seen a lot of, when we think about children, one of the things that's worrisome to us is that we know that a lot of children have missed critical well-child appointments over the last several months as our communities were closed and as people how to stay home. And so, we know that that's a real worry for children and for their health and for their outcomes.

And so, we also have really worked at the community level to create opportunities or support opportunities that would get kids vaccinated, or get kids immunized, or get to those well-child visits, whether that be partnering with a local health clinic, and even the food bank, and maybe a diaper bank, and others, to get folks to a drive-through immunization activity, and get kids signed up for those visits, or whether it be other opportunities.

We've really tried to identify those issues that we see particularly having an impact on children and families and get engaged in what we can do to change the outcomes.

Johnson:
Were you invited to support these programs and causes, or did you just decide on your own to jump in and get to work?

Sonnier:
I would say a little of both. I mean, we certainly are in very close contact with providers and with our state partners so that if we can identify needs and working with them, we can think of ways to jump in and be engaged in support.

But we also have identified things on our own as we've seen that there are issues that we need to get involved in. And so, we've looked at the resources that we have or the partnerships that we had that we could bring to the table to try to make a difference.

Johnson:
Does every state reach out to the private sector for help like this? Or are there places where we could coach people along so they can take advantage of these resources sitting out there waiting to be leveraged?

Sonnier:
I think most states have partnerships with private industry. I think it depends on the state, and the community, and the industry itself as far as what that partnership looks like. But I also think there are always opportunities to leverage more and to look at how we can do more by working together.

And so, to that end, I think it's really important to think about what are the needs, be able to identify those needs, and think about who might want to partner with you to address that.

Johnson:
Is it okay to just reach out and ask?

Sonnier:
Well, it certainly is okay to reach out and ask. I was thinking, you know, when you asked that—my daughter had a sign up on her door all growing up through high school, she was a soccer player, and the sign said, "You miss all the shots you don't take."

And you know, if you ask, the worst that you can get as an answer that says, no, it's not the time, or we don't have the resources or, you know, we're not able to help at this point. But if you don't ask, then there's no way, people might not even know that you have a need.

Johnson:
Who's the best person inside an organization like yours to reach out to in the beginning? Is it someone in the government affairs or government relations side of the shop, or is it the CEO, the CFO, who do you talk to?

Sonnier:
You know, I think the most important thing is to try to establish relationships with people in the local offices that can provide that kind of support.

Certainly, if you know someone in governmental affairs and that's the avenue that you have, you can go through that avenue. If you have an opportunity to talk to a CEO, that's great too.

But, you also might be having regular conversations—most of us are having very regular conversations with our state partners, whether it's the chief medical officer who's sitting at the table with the chief medical officers with the state, or whether it's case managers who are working directly with members but that are also in conversations with the state.

I think what you just need to do is ask, and I think you start with the relationships that you have, and you look for opportunities to grow that. Even if they're not the right person who gets to make the decision about those investments or those resources, they absolutely can start the conversation internally and try to begin to find out who that is. And I think it's different in every community, in every organization.

Johnson:
Yeah. And the approach is to come with a plan, a specific need, an ask that needs to be filled?

Sonnier:
I definitely think you have to know what the need is. And I would always encourage people to have data and stories that really tell that story and help people to understand what the issue is.

I would say be open to the solution because I think sometimes we walk in the door and we think this is the answer. And there may be something even better or more innovative that our partners can bring to the table. So, I think you have to have the information that's compelling so that you get folks to the table.

But really beyond that, it's about being open, it's about having that communication with one another and staying in partnership and identifying what that can look like going forward. Certainly, paying attention to health disparities and social determinants of health, which we know have such an impact on the outcomes.

And so, you know, really being open to that when you come to the table and leveraging the strengths that each partner or multiple partners may bring to the table and being open to that as well. Some private industry will have a mission and social responsibility interest that will align very directly, and others may be very open and want to just make a difference in their communities.

I would say, even with private industry, the other thing that's always exciting is that, you know, we want to engage our employees as well and our teams in our communities. And so that's another place where I know we've made a great impact in the community is leveraging the volunteer efforts of our employees and the things and the ideas and organizations that they're passionate about.

And so, you know, again, that's just another opportunity to build on the knowledge of our own teams in the community and bring that to our partners at state and community agencies.

Johnson:
When thinking about these relationships that have been forged or further developed as a result of the pandemic, and then considering that, we hope, in the not too distant future, we'll be out of this mess, do you see those relationships staying where they are? Do they grow even more, do they bounce back to the days before all of this happened a year ago? What's the outlook in your view?

Sonnier:
I think the partnerships often come together in crisis. And I certainly saw that in my previous experience with Hurricane Katrina and other hurricanes that impacted the state of Louisiana. Often, it's the crisis that brings people together, but I've seen those relationships grow and flourish even beyond that. So, we might come together over one particular issue and identify that there are other places that we can work together even over the long term.

So, I think that that's part of our resilient communities, that is part of what helps us to move forward is that the relationships are established, again, sometimes in crisis, sometimes in a situation we didn't plan for and we certainly wish that we didn't have to address, but that those relationships stay way beyond that and can really bring about long-term change and long-term positive outcomes in the community.

Johnson:
Having been on both sides of these issues, do you have any advice for our audience? If they're looking to maintain that momentum, what's the best thing to do as we look toward winding down, hopefully, the crisis part of this situation?

Sonnier:
It's all about relationships, Robert, and maintaining those relationships and understanding the needs of each other as partners and staying in touch. You know, it's not usually valuable if you just come to someone when you have a need or when you're in a crisis, but really staying in touch, keeping those private partners aware of the challenges that you're facing, celebrating accomplishments that you're seeing.

You know, as we move forward, we will see positive things happen in our communities going forward and being able to share that and celebrate that. And, you know, I love getting an email. We've got some community partners here that it makes my day to get an email about the impact of a resource we provided to them.

But I think in the long term it's about relationships. And so those relationships continue beyond a specific initiative or a specific partnership or opportunity. They really grow over time.

Johnson:
And this is a real chance to do great things once the pandemic is over, things you can't even imagine right now, if you keep those relationships going.

Sonnier:
Absolutely. That is something that gives me hope about when I think about the future.

And again, we've seen that we've seen disasters impact our country, we've seen terrible things happen over time. And yet, it is by working together, it is by paying attention to the needs, it is by investing in communities, it is by those partnerships and that deeper understanding of what we have done together and what we might do together that gives me hope.

Johnson:
Before we go, we wanted to make sure to tell you about ASTHO's first COVID-19 Tech Expo, a virtual event coming up on March 31st from 2:00 until 7:00 PM Eastern Time.

As a public health professional, it's your chance to learn more about the latest tools available to help you in your fight against the novel coronavirus. Find out about technology to support case reporting and surveillance, laboratory testing and reporting, contact tracing and case investigation, and more. If you work in government at any level, serve in the military, or are on-staff at a nonprofit or educational organization, your registration is free.

Register for ASTHO's first COVID-19 tech expo, a virtual event plan for March 31st, using the link in the show notes.

Thanks for listening to Public Health Review. If you like the show, please share it with your colleagues. And, if you have comments or questions, we'd like to hear from you. Email us at pr@astho.org. That's PR at ASTHO dot org.

This show is a production of the Association of State and Territorial Health Officials. For Public Health Review, I'm Robert Johnson. Be well.


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