1. The goal of this initiative was to promote vaccine administration equity by ensuring that all Clay County community members have the opportunity to receive their dose(s) of the COVID-19 vaccine saving lives and reducing the suffering of our community members. To accomplish this end state, the first objective was to initiate a Whole of Community (WC) partnership approach with known and recommended Key Leaders, influencers, and Champions of Clay County's Diverse Communities (DC), Vulnerable Populations (VP), and Access and Function Needs (AFNs) to incorporate their experience and thoughts in developing WC plans and synchronizing WC efforts. The second objective was to identify three types of barriers (actual, perceived, and future) to equal and equitable opportunities to receive the vaccine and develop strategies to overcome the barriers. The third objective was to generate support from diverse community leaders, influencers, and champions to format, translate, and disseminate health-related messaging.
2. Steps to achieve the goals and objectives: Identification of experienced points of contact to work with our vulnerable communities as well as champions for our DC/AFN/VP populations. CCPHC hosted a virtual meeting on January 26th, 2021 to discuss the goals and objectives with a focus on three types of barriers: Actual (A), Perceived (P), and Future (F) Barriers. Actual barriers-barriers that someone knows prevents a person from receiving the vaccine; Perceived barriers- barriers that exist in other regions/communities that may exist in our communities; and Future barriers –barriers that would/could occurs as we move into the next phases of vaccine distribution. Based on barriers identified, champions went to work to develop solutions. Many solutions were rapidly solved with the collaboration of the Operation Safe team. Examples of solutions included how do we (as a Whole Community) solve transportation of our Senior Vulnerable Population (SVP) to the Operation Safe mass vaccination site with our Clay County Senior Services (which had AFN capable vehicles) and using our school district busses. Operation Safe was a high throughput health system composed of CCPHC, Clay County hospitals, city government and CERNER that activated mass vax clinics when vaccines were first rolled out from January to May 2021. CCPHC coordinated with senior housing facilities, schools, and city government to bus in vulnerable seniors with no transportation to Operation Safe clinics to receive their first and second doses of Pfizer vaccines. Schools and city government provided the buses and drivers. CCPHC and partners coordinated with Clay County Senior Services to provide seniors with free rides to Operation Safe clinics to get their COVID vaccines. To increase equitable access to the COVID-19 vaccines breaking barriers identified by DC's key leaders and champions, CCPHC contracted with Heart-to Heart International (HHI) to provide mobile vaccine clinics at or near diverse community or vulnerable population neighborhoods. CCPHC provided HHI with a list of diverse community POCs (shared by partners) and senior housing facilities managers to coordinate vaccine promotion, registration and administration in their community. The Vietnamese POC assisted HHI in promoting and setting up the vaccination event in their community. They also served as an interpret during clinic operations, In addition, CCPHC Planner and volunteer planner worked with diverse community (DC)'s champions to format health messages on COVID mitigation measures and public health emergency orders in a way that is easy to understand by their community members. Some messages were translated and disseminated by community influencers and posted on CCPHC website. DC's influencers in the vicinity of Operation Safe clinic in North Kansas City helped to format, translate in Spanish, and disseminate messages to their community promoting Operation Safe clinics as they deployed mobile wireless IPADs connected to a Live Vaccine trained interpreter to assist ESL clients from the time they arrive at the mass vax site to going through all the vaccination stations.
Results/Outcomes: CCPHC, partners and diverse community champions Identified actual and perceived barriers and possible solutions including: Lack of transportation (recommendations: Contract transportation services to pick residents up to vaccine clinics. Identify free/reduced rate transportation services that will guarantee round-trip for AFN accessible vehicles. Host clinics where vulnerable populations are or congregate); any contact with domestic violence victim's primary care physician could trigger location notification to the abuser if they have access to the health insurance for the family (current CCPHC and HHI registration does not trigger abuser's medical provider); lack of insurance (recommendation: Provide education in multiple languages that the vaccine administered by CCPHC, HHI and most of providers is free and also that some providers may charge an administration fee); language barrier for less than English proficient in: Registration, notification, vaccine reception, and vaccine administration (recommendation: Use interpretative services such as Propio, Stratus video that connect to a live vaccine trained interpreter); general diverse community education: opportunities to get vaccinated -when, where, how (recommendation: Community engagement with Key Leaders to point their communities to visit the Clayhealth.com website- recommended that all partners send Clayhealth.com link to all communities within their social media connections and through all graphic/poster outlets); a lot of our population is only at a 3rd grade reading level (recommendation: Take information from CDC and health department and develop or format materials that are understandable to them); lack of internet access. About 8% of county population does not have Internet or smartphone access (recommendation: Provide alternative methods for registration- preferably voice calls); undocumented residents are fearful to seek any type of healthcare (recommendation: Community engagement with Key Leaders to point their communities to visit the Clayhealth.com website- and highlight that no medical provider is needed to register and send this message via all available communication venues); vaccine hesitancy is an issue with all populations (recommendation: Review CDC websites and MO HSS websites for information on vaccine benefits. Promote vaccine facts and benefits using all means); vision impairment prevents internet access (recommendation: Telephonic registration and notification for 1st and 2nd dose); a degree of uncomfortableness traveling outside of the local community due to language and comfort (recommendation: Go to places where people are by activating fly away clinics); employer may not reimburse employee for lost time/wages to travel to receive the vaccine (recommendation: Go to places where people are, including workplaces by activating fly away clinics); registration that includes address may be uncomfortable for those who were persecuted/threatened in their native country (recommendation: Only request zip code when attempting to measure performance).
Through Operation Safe, 450 vulnerable senior citizens (who were provided a ride) were vaccinated. Through Operation Safe, several English as Second Language resident were served (vaccinated) using Stratus highly effective mobile iPads connected to a live vaccine trained interpreter. As of 11/30/21, Heart-to-Heart International (HHI) administered 2,078 vaccines at many locations throughout Clay County working with diverse community leaders and champions and other community partners. Several health messages were translated in Somali, Spanish, Vietnamese, Arabic, and Chinese and disseminated in these communities by trusted members.
3. The practice is ongoing. The whole of community partnership programming started in January 2021 when COVID-19 vaccines were first made available for individuals in CDC phase 1 category: Long-term care facility residents and staff, health care workers, first responders and high-risk individuals. The meeting with community partners to discuss the goals and objectives of the practice was held on January 26, 2021. Representatives from Liberty School, William Jewell College, Synergy Services, Metro Lutheran Ministries, Life Unlimited, Clay County Senior Services, YMCA, Spanish population, Vietnamese, Somali population, Clay County Emergency Management, CCPHC, and Jewish Vocational Services Vulnerable seniors with no transportation were bused into Operation Safe mass vax clinic on March 1 and 29 2021. Heart-to-Heart international started running mobile COVID vaccination clinics in Clay County underserved areas on behalf of CCPHC in March 2021. They will continue until the end of the contract on December 31st, 2021. Afterwards, CCPHC staff will take over and conduct community vaccination events in areas of need. Prior to the meeting with community members on January 26th, 2021, CCPHC was working Clay County Emergency Management to engage diverse community key leaders to format, translate, and disseminate key health messages. This activity continues as needed
4. a) LHD's role: Clay County Public Health Center's staff and volunteer planner identified key leaders, influencers and advocates of diverse communities, access and functional needs populations and at-risk population. Some of them worked with CCPHC in past initiatives. Other were recommended by partners. CCPHC hosted the community emergency response meeting to strategize and synchronize efforts and plans to give opportunity to all Clay County residents to receive the COVID vaccine. As part of the whole of community partnership and planning practice, CCPHC coordinated Operation Safe vaccination efforts with Clay County hospitals, city governments and CERNER. CCPHC staff took the lead in coordinating transportation of vulnerable seniors to and from Operation Safe mass vax clinics. CCPHC leadership contracted with Heart to Heart International to conduct fly away COVID vaccination clinics in underserved areas where our diverse communities live or congregate. Finally, CCPHC staff engaged diverse community key leaders to process health messages and public emergency orders in a format that is easier to understand and digest. Diverse community champions translated and disseminated health messages in their communities.
Involving and engaging partners with diverse background in COVID response planning help to identify barriers and solutions to providing equitable opportunity to Clay County residents to receive the vaccine.
b.) To ensure equitable, meaningful, and representative collaboration with target populations, CCPHC staff and volunteer planner invited key leaders and champions of our AFN, diverse community, vulnerable, and at-risk populations. Agencies that serve our target population were invited as well to be part of the whole of community response planning team to ensure that the needs of the populations they represent are met. They were given the opportunity to identify actual and perceived barriers that adversely impact vaccine uptake in their community and propose strategies to overcome the barriers. In addition to involving and engaging representatives of our target populations in response planning, they were engaged in the implementation phase. Some of them coordinated COVID vaccination clinics in their community, other helped to format, translate, and disseminate health information to promote vaccine education and uptake
3. There are no start-up costs associated with this practice. Costs associated are staff time of the Epidemiology Program Manager, Health Planner, and the Community Health Promotion Section Chief. Other costs associated with the whole of community programming derive from mobile clinic operations run by Heart to Heart International (HHI) throughout Clay County. CCPHC contracted with HHI initially to vaccinate hard-to-reach, underserved, and marginalized populations where they are at from March 2021 to December 31, 2021. As of 11/30/21, the cost was $109,160. The expenditure was covered by federal grant funding. In-kind costs include volunteer planner hours who helped connect with diverse community points of contact and keep them engaged. He facilitated the whole community planning conference. Other in-kind costs derive from buses and drivers provided by North Kansas City school district, Liberty school district, the City of Gladstone, and the City of Excelsior Springs. The buses were utilized to transport vulnerable seniors with no transportation to Operation Safe mass vax clinics. Other in-kind costs include volunteer time from representatives of diverse communities that coordinated vaccination clinics in their community and help format, translate, and disseminate health messages and info to their communities