Real-time needs and capacity assessment for local safety net programs during COVID-19 pandemic

When COVID-19 moved from international news to our local sphere, we experienced a mix of emotions — scared for our vulnerable family and community members, uncertainty about the next steps in our training — and unusually empty schedules. With everything changing so rapidly, we began to reflect on our role in the broader system of care. Inspired by other terrific groups of health profession students, who quickly banded together to serve our community, we followed their lead, looking for ways to address the increasing burden that COVID-19 would inevitably have on the most vulnerable in our community.

Together, we are four medical students ranging from first to sixth years in training with backgrounds in public health, drug treatment and policy research, emergency medicine and harm reduction operations. We’ve seen first-hand how strained our local social safety net programs and community-based treatment programs are, on the best of days. The need for these services is far greater than our current capacity. Our marginalized community members — those who experience homelessness, mental health disorders and substance use disorders (SUDs) — are often underserved, dismissed or forgotten by the broader public. But not by our local, community-based organizations. They are deeply committed, in the face of budget cuts and diminished funding streams, to keep our safety-net afloat — whether through hot meals, shelter, low-barrier withdrawal management or the provision of a daily shower. And in the middle of a global pandemic we know that all systems, in particular those who serve the most marginalized of our community, will be pushed to the brink.

Dr. Honora Englander, medical director for OHSU’s Improving Addiction Care Team (IMPACT), recognized that institutional responses to calls for physical distancing would drastically alter the care landscape for people with SUDs, with likely significant disruption in the coordination of life-saving treatment and increasing need for care. After her call to action and with the growing need for additional support in our community, we knew where our time and skills could be put to use. That very same day we formed the Oregon Substance Use Disorder Resources Collaborative. OHSU social worker, Molly Finnegan, laid the initial groundwork for the project, already documenting which local organizations were either no longer operating or were operating with restricted services. Dr. Englander encouraged us to create a centralized resource to keep organizations apprised of others’ operations and needs. We did this by creating a daily survey to evaluate real-time organization capacity and needs of our local safety-net programs. The results are shared on a public-facing document and website, highlighting important changes in service capacity and immediate resource needs.

Broadly, our mission is to support the efforts of local safety net organizations and providers who are courageously working on the front-lines to serve our chronically marginalized community members in the middle of a pandemic, with limited supplies and resources. Our mission is to elevate their efforts and to help them meet their immediate needs as the COVID-19 crisis continues and evolves. To date, our resources guide includes current information on approximately 140 organizations in addition to over 55 links for general community resources and guidelines that we are able to update by sending out twice-daily emails to approximately 90 individuals.

While identifying immediate resource needs in our community, community organizations and safety-net programs consistently ask for two things: personal protective equipment (PPE) and help setting up telemedicine connections with their participants. We are actively coordinating PPE requests by connecting community partners with other student leaders focused on this task. Similarly, we helped to coordinate food deliveries and meals to Portland People’s Outreach Project and Transition Projects, Inc.

The relaxation of federal guidelines regulating telemedicine has provided the opportunity to help community treatment organizations reach our most vulnerable neighbors. Individuals experiencing homelessness, mental health disorders, and SUDs, experience an increased burden to access medical services at baseline, and in the midst of COVID-19 access to care will worsen. Low-barrier telemedicine has the opportunity to mitigate this. We are partnering with OHSU Harm Reduction and Bridges to Care Clinic and Bridges Collaborative Care Clinic to help meet this evolving need. We just purchased our first low-barrier telemedicine setup (a cell phone) and will be piloting the project in the coming weeks and days.

COVID-19 has laid to bare the cruel realities of our society — the inequities, the injustice and the chasms that permeate our “systems of care.” We hope that when the pandemic is behind us, bigger questions will be asked and answered about what it means to promote and support health in the United States of America. And we sincerely hope that our most marginalized community members will not be forgotten as we rebuild.

If you are interested in learning more, contributing to our telemedicine operations or to donate to our community partners, our website is www.orsudresources.org.

Oregon SUD Resources Collaborative Team

Patrick Brown (MS2, MCR student, Class of 2022); @patrickcmbrown
Amanda Graveson, MS (MS1, Class of 2023); @amandagraveson
Rachel Lockard, MPH (MS1, Class of 2023); @rachelanjenee
Kelsey Priest, PhD, MPH (MS3, Class of 2021); @kelseycpriest

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