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As we have seen in China, Italy, and now in the United States, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has sent shock waves throughout the world, causing significant mortality, the likes of which we, arguably, have not seen for more than 100 years. At the time of this writing, there are more than 700 000 cases of novel coronavirus disease 2019 (COVID-19) worldwide, with more than 35 000 deaths.1 The term social distancing has become part of the daily lexicon and, although essential to curb viral transmission, its indirect effects usher in a stark new reality for children and families. Many caregivers have lost their jobs or had their income reduced, resulting in stress and financial strain. Schools and childcare centers are closed, meaning that daily schedules for millions of children and families have become interrupted, and caregivers must identify appropriate childcare services. Educational curricula have been massively disrupted, as have the services that schools and childcare centers provide, including free or reduced-cost meals, speech therapy services, and individualized education programs for children with special needs. In addition, access to necessary behavioral health services through schools, clinics, or community-based organizations is now limited.
As is almost always the case, the effects of catastrophic events are not uniformly distributed. As demonstrated by events such as Hurricane Katrina and the influenza pandemics of 1918 and 2009, children of racial and ethnic minorities and those living in poverty have the greatest risk of experiencing poor outcomes, including homelessness, unemployment, food insecurity, trauma or violence, and death.2-4 Reaching those who are most vulnerable requires an approach that is collaborative, yet systematic. Health care systems that are able to engage with colleagues in education, human services, and government will be best equipped to develop cohesive, problem-oriented solutions that address the most pressing issues for children and families during times of crisis. With these circumstances in mind, we describe how child health–community partnerships shaped one community’s response to the COVID-19 pandemic, with the hope that the examples we provide here may be adapted to fit the needs of other communities.
As the birthplace of “community pediatrics”5 and the “biopsychosocial model,”6 the University of Rochester in Rochester, New York, has a rich history of cultivating strong relationships with community members and organizations. The university’s Department of Pediatrics has fully embraced this heritage. Grounded in its mission to “help each child reach their fullest potential,” the department has forged a deep commitment to the community as reflected in initiatives targeting population health and community partnerships.7 Inherent in this mission is the recognition that challenges in child health require a comprehensive plan that extends beyond the walls of a hospital and into the community, linking the sectors of health, education, human services, and government. Specifically, over the previous years and decades, the department has established collaborations with community partners to improve the proportion of healthy births, reduce teen pregnancy rates, and ensure children are developmentally on track on entry to kindergarten, among others.
On March 11, 2020, the first person in Rochester was diagnosed with SARS-COV-2 infection. Recognizing the gravity and severity of the impending crisis and its unique position as a community connector, the department shifted its focus to rapidly enhance and leverage existing partnerships so that children and families could continue to receive necessary services. The department engaged leaders from other local health systems; independent pediatric and family medicine practices; accountable care organizations; health insurers; the New York State and Monroe County Departments of Health; 22 superintendents from local school districts; local, county, state, and federal government officials; food banks/kitchens; the regional public transportation system; and numerous community-based organizations. The main objective was to work across sectors to identify issues and develop cooperative and timely plans that address these problems in ways that would not be possible for individual organizations alone.
Within days, we identified several issues and collaborative solutions. First, to prevent viral transmission, we immediately partnered with local accountable care organizations and private pediatric and family medicine practices to develop a unified community-wide pediatric plan to limit foot traffic through clinics. Collectively, practices agreed that in-person appointments would be reserved for essential preventive visits, defined as screenings and immunizations for children up to age 2 years. Almost all other appointments would be conducted by telephone and/or telemedicine. Although necessary and in the best interests of children and families, the implications of this community-wide plan are sobering because practices and health care systems will lose revenue required for their continued operation. With this in mind, we partnered with local accountable care organizations and the Monroe County Medical Society to successfully increase reimbursement for telemedicine encounters. We also advocated to New York State and insurers to reimburse health care professionals based on historical claims and worked with local banks and the small business development corporation to help practices receive loans and grants through the US Federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.8
In addition, we worked with practices and behavioral health care professionals to develop a tiered protocol to assess and manage children with behavioral health concerns. We coordinated this effort with local school districts, their mental health counselors, and community-based organizations. Second, we addressed the issue of children’s nutrition: because of staffing shortages and requirements for in-person interviews, new participants were restricted from enrolling in the Women, Infants, and Children program. By collaborating with New York State and the Monroe County Department of Health, we obtained a temporary regulation change, allowing new enrollees to join by phone. Third, we understood that caregivers would need access to safe transportation to bring children to necessary preventive care and immunization visits. We contacted the regional public transportation system, which coordinated the deployment of 11 vans to transport more than 500 low-income infants and children to preventive care visits during an initial period of 4 weeks, with an agreement to extend services if needed. We ensured the safety of participants by limiting services to preventive care visits, permitting only 1 family per ride, requiring all passengers to wear face masks (if able), and maintaining safe physical distances whenever possible.
The extent to which these solutions are successful remains to be seen. In our anecdotal conversations with colleagues throughout the country, it is apparent that other communities are facing similar challenges. We hope that our experiences may inform interventions elsewhere. Although some may fear that the current social distancing requirement may lead to more electronic interactions and social isolation in the future once this crisis subsides, the Rochester experience provides a counterexample. First, the community’s crisis response was contingent on having established and meaningful relationships across sectors and disciplines. Without this foundation of trust and shared purpose in combination with strong leaders who were willing to be responsible and accountable to create order from chaos, progress would not have been possible. Health is inherently social, and although it is imperative that we keep our collective distance physically, we must continue to develop and cultivate relationships to leverage resources so that health care for children and other vulnerable populations is prioritized. Second, our experience illustrates a cogent example of the important and necessary role that academic medical centers can play in efforts to improve child health. Every institution may not have established cross-sector partnerships, but each can begin to build important relationships. To serve communities, and particularly those who are most vulnerable, these efforts are critical to ensure progress during periods of normalcy and especially during times of crisis.
Corresponding Author: Jeffrey P. Yaeger, MD, MPH, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, PO Box 667, Rochester, NY 14642 (firstname.lastname@example.org).
Published Online: October 5, 2020. doi:10.1001/jamapediatrics.2020.3228
Conflict of Interest Disclosures: None reported.
Additional Contributions: The progress and partnerships described in this article would not be possible without the entire team of collaborators across the Rochester community and the University of Rochester’s Department of Pediatrics. We would like to specifically acknowledge Laura Jean Shipley, MD (University of Rochester School of Medicine and Dentistry), for her leadership in creating a unified community response to coronavirus disease 2019 as well as her contributions in editing and revising the manuscript. In addition, Michael Scharf, MD (University of Rochester School of Medicine and Dentistry), has been instrumental in coordinating the pediatric behavioral health response team. Drs Shipley and Scharf did not receive compensation for their contributions.
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Yaeger JP, Kaczorowski J, Brophy PD. Leveraging Cross-sector Partnerships to Preserve Child Health: A Call to Action in a Time of Crisis. JAMA Pediatr. 2020;174(12):1137–1138. doi:10.1001/jamapediatrics.2020.3228
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