COVID-19: Addressing Community Stress and Resilience

Overview National, state, and local organizations are making tremendous The rapid proliferation of the COVID-19 pandemic represents efforts to address the immediate safety and material needs of our an unprecedented public health challenge for federal, state and communities. Given the confluence of factors impacting our health local authorities. Given the need to control the spread of the virus, and wellbeing, these organizations need to rapidly implement evolving directives for front-line providers, business closures, a broad, coordinated response – including a signficiant virtual and social distancing have been highly disruptive to essential intervention component – to support community stress resilience. healthcare, social services, and economic activities leading to a Guidehouse and the Gretchen Swanson Center for Nutrition significant increase in individual and community stress. The speed (GSCN) have extensive experience developing and implementing and magnitude of change is forcing jurisdictions and communities to community stress resilience strategies for public health priorities. find new ways to cope with stress and build resilience – a challenge Our work with federal, state, and local public health agencies that represents immediate and long-term risks to our individual includes planning, community engagement, and intervention and societal health. This document provides a framework and development. We understand how the social and material strategies that can help government agencies, commercial, and dimensions of stress can vary significantly based on individual and non-profit organizations enhance and support community stress community-level factors, including socioeconomic status, access resilience initiatives using proactive, targeted and meaningful to care, social support, and other factors. In the case of COVID-19, engagement. these stressors are presenting as chronic, ubiquitous, and given the indefinite timeframe of the pandemic, can lead to additional Sources of stress during the secondary stressors that will lead to greater morbidity and mortality coronavirus pandemic: in the mid-to-long term if not addressed. • Uncertainty about risk and exposure • Fear of becoming ill • Limited access to testing and treatment • Overcoming illness Community Stress Resilience for • Concerns around misinformation • Food safety and insecurity Environmental Contamination • Economic insecurity and job loss Guidehouse and GSCN assembled a team • Social isolation to help a federal health agency target • Social fragmentation • Increased burden in caretaking and parenting the intersection of stress, resilience, and • Increased substance use environmental contamination in communities • Domestic violence/abuse experiencing long-term contamination from per- and polyfluoroalkyl substances (PFAS) and related pollutants. Activities included the The Need for Addressing Community development of an evidence-based framework Stress Resiliency for community stress intervention, training, Stress represents a normal response to perceived threats, but it communications tools, and resources for public can negatively impact mental and physical health including anxiety, health professionals. depression, substance use and PTSD, particularly when the stressor is prolonged or chronic and uncertain in duration, such as with natural disasters, environmental contamination, and the current COVID-19 pandemic. Vulnerable and disadvantaged communities are particularly at risk given their disparity in access to resources. Conversely, community resilience refers to the ability to adapt to changing conditions, promote health, and recover rapidly. guidehouse.com Enhancing Community Resiliency Developing and implementing a coordinated response strategy FIRST, DO NO HARM! Remember: for stress resilience will help to proactively reduce risk, decrease public health actions can increase stress stress-related morbidity and mortality, and identify and promote and reduce community resilience. resources for local, state, and national response to the COVID-19 • DO NOT downplay the significance of individual and community pandemic. How your organization chooses to address community concerns. stress in light of this pandemic will depend on community needs, • DO NOT assume your organization’s preferred method of available resources, and public health capacity. There is no single communicating is optimal for all communities. approach to engaging communities; it is necessary to tailor a set • DO NOT overpromise what your organization can do to help of initiatives in close coordination with ongoing response efforts the community. including clinical and social services, and guidance from federal • DO NOT opt out of engaging just because you do not have all authorities such as CDC and FEMA. This also includes the imperative the answers. to ‘First, Do No Harm!’ Guidehouse and GSCN recommend a range • DO NOT include jargon or acronyms in your messaging. of strategies to accommodate agency bandwidth and resources for immediate and secondary community intervention as outlined below.

Key strategies for community stress intervention

Assess Plan Act

• Identify your “community” (e.g., • Develop a community engagement • Provide information that is clear, health workers, newly unemployed, plan that provides basic structure relevant, concise and candid grocery workers) (i.e., frequency and methods) for • Recognize and legitimize community • Develop a community profile engagement experiences based on available data sources to • Share uncertainties around timelines • Set clear expectations of what you understand acute group needs and while affirming commitments CAN and CAN’T do concerns • Identify/establish communication • Engage through established • Understand openness of community channels

Immediate Intervention Immediate channels for addressing stress

• Evaluate baseline levels of stress • Develop a community engagement • Gather information and input from and resilience to address chronic plan and comprehensive course stakeholders to inform response stressors of action with input from key efforts • Develop a detailed community stakeholders • Establish a stakeholder group for profile based on secondary and • Develop a communications plan to shared decision-making with the primary data to understand both proactively maintain relationships with community short- and long-term concerns community and partners • Conduct education and trainings • Identify and map stakeholders to • Implement feedback from to develop skills for enhancing bring community influencers and stakeholders for additional context community resilience and reduce gatekeepers to the table and support stress

Secondary Intervention • Assess lessons learned and identify • Plan for eventual community • Conduct an evaluation of areas for improvement and develop ownership of activities and structures engagement efforts and assess rapid, iterative feedback loop for by including community voice in impact on changes in baseline stress intervention solutions levels to improve future engagement

For more information, please contact: Abdul Shaikh, PhD, MHSc Amy Yaroch, PhD Pavel Zaprudsky, MBA Director Executive Director Partner Guidehouse Gretchen Swanson Center for Nutrition Guidehouse [email protected] [email protected] [email protected]

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© 2020 Guidehouse Inc. All rights reserved. This content is for general information purposes only, and should not be used as a substitute for consultation with professional advisors. GH-161a-PS COVID-19 ACS&R