Promising Practices for Reaching At-Risk Individuals for COVID-19 Vaccination and Information
Background
The COVID-19 pandemic has disproportionately impacted at-risk individuals and underserved populations, including communities of color and low-wage essential workers. To address equity considerations for access to COVID-19 vaccination activities and promote timely and accurate information on protecting one’s health, engaging with Community-Based Organizations is recommended to public health officials and emergency managers as an opportunity for addressing equity towards overcoming barriers to reach underserved communities.
Community-Based Organizations (CBOs) are public or private not-for-profit resource hubs that provide specific services to the community or targeted population within the community. CBOs include but are not limited to aging and disability networks, community health centers, childcare providers, home visiting programs, state domestic violence coalitions and local domestic violence shelters and programs, Adult protective services programs, homeless services providers, and food banks that work to address the health and social needs of populations. CBOs are trusted entities that know their clients and their communities, want to be engaged, and may have the infrastructure/systems in place to help coordinate vaccine administration activities or serve as a trusted source to distribute timely and accurate information.
Promoted by HHS and FEMA, the CMIST Framework is an approach for addressing the access and functional needs (AFN) of at-risk individuals.1 CMIST is an acronym for the following five categories: Communication, Maintaining health, Independence, Support and Safety, and Transportation. The CMIST Framework provides a flexible, crosscutting approach for planning to address a broad set of common AFN without having to define a specific diagnosis, status, or label.
Promising Practices for CBO Engagement
Public health officials and emergency managers should partner with CBOs to support local COVID-19 vaccination activities to address the needs of at-risk to ensure equitable and accessible planning.
Aligned with the CMIST Framework, the following are promising practices for engaging CBOs in COVID-19 vaccination activities:
C = Communication
People with communication needs may have limited ability to hear announcements, see signs, understand messages, or verbalize their concerns. At-risk individuals include those who speak sign language, who have limited English proficiency (LEP), or who have limited ability to speak, see, hear, or understand.
CBOs are trusted entities that have established relationships with their clients. They can be effective partners in disseminating information, contacting clients, and providing timely, accurate, and culturally and linguistically appropriate information. They often have a database of clients and can understand their needs and barriers. CBOs can be a key for addressing equity by identifying and reaching the most at-risk and underserved clients who need additional supports to receive COVID-19 vaccination and information. CBOs can:
- Disseminate clear, timely, and accurate information;
- Disseminate culturally and linguistically appropriate information;
- Provide outreach to verify vaccination completion;
- Assess barriers to accessing vaccination;
- Promote vaccination by distributing promotional stickers and flyers to clients (e.g., through nutritional programs, direct service providers, etc.);
- Provide assistance to bridge the digital divide, whether technical (broadband) or individual technological proficiency;
- Mitigate fear or uncertainty about being contacted (e.g., older adults are often encouraged to avoid being a victim of a scam fraud);
- Mitigate vaccine hesitancy and address concerns about vaccine equity (e.g., which vaccine is being offered and why clients should consent).
M = Maintaining Health
Early identification and planning for AFN can help to reduce the negative impacts on individuals’ health including maintaining treatment for chronic health conditions, minimizing preventable medical conditions, and avoiding decompensation or worsening of an individual’s health status. At-risk individuals include those who may require specific medications, supplies, services, durable medical equipment, electricity for life-maintaining equipment, breastfeeding and infant/childcare, or nutrition, etc.
CBOs often provide case management, advocacy, information, or referral to services. CBOs can:
- Support clients needing to maintain social distancing or complying with other public health measures (e.g., homebound individuals, individuals with complex medical needs or compromised immunity, children with special medical needs);
- Partner with visiting nurses, EMTs, or other healthcare professionals to coordinate vaccination for homebound clients;
- Identify settings to most efficiently reach concentrations of community-dwelling, homebound individuals (e.g., retirement communities, assisted housing for older adults and people with disabilities, group homes, homeless and domestic violence shelters);
- Identify clients in rural locations who may need access to mobile vaccine units due to distance and/or barriers to transportation;
- Coordinate with partners that administer annual flu vaccines to provide COVID-19 vaccination (e.g., Medical Reserve Corps);
- Identify potential vaccination partners that deliver home and community-based services (e.g., home health, visiting nurses, direct services providers, community health workers).
I = Independence
Independence is the outcome of ensuring that a person’s AFN are addressed as long as they are not separated from their devices, assistive technology, service animals, etc. At-risk individuals may include those who function independently with assistance from mobility devices or assistive technology, vision and communication aids, services animals, etc.
CBOs often support client’s independence through providing accessible transportation services, direct service providers, nutritional services, and support for access to assistive technology. CBOs can:
- Provide support for drive up and mass vaccination sites to address functional limitations;
- Provide support for walk up vaccination sites (e.g., for those without personal transportation);
- Coordinate supports to meet requests for accommodation received during vaccine registration (e.g., mobility, translation or interpretation accommodations);
- Identify potential spaces for vaccine sites (e.g., senior centers, community centers, communal dining rooms, recreation spaces, etc.).
S = Support and Safety
Some individuals may become separated from caregivers and need additional personal care assistance and can experience higher levels of distress and need support for anxiety, psychological, or behavioral health needs, or require a trauma-informed approach or support for personal safety. Early identification and planning for AFN can help to reduce the negative impacts of an emergency on individuals’ wellbeing. Some people may have lost caregiver assistance and require additional support; some individuals may find it difficult to cope in a new or strange environment or have difficulty understanding or remembering; and some individuals may have experienced trauma or be victims of abuse.
CBOs often provide staff experts and resources to support clients including social workers, case managers, behavioral health services, and telehealth services. To connect with at-risk and underserved individuals, CBOs can provide outreach to:
T = Transportation
Emergencies can significantly reduce transportation options, inhibiting individuals from accessing services, staying connected, etc. Planning requires coordination with mass transit and accessible transportation services providers. At-risk individuals include those who lack access to personal transportation, are unable to drive due to decreased or impaired mobility that may come with age and/or disability, temporary conditions, injury, or legal restriction.
CBOs often have relationship with local paratransit, transportation systems, or transportation subsidies. CBOs can:
- Support access to transportation services including accessible or paratransit, or other transportation resources (meal or pharmacy delivery) that may be leveraged;
- Support access to subsidized transportation, public transportation, or supplemental funding;
- Support identification of extremely rural locations for which access to transportation may be needed to reach vaccination sites;
CBO Eligibility for Federal Funding/Reimbursement
There are several sources of Federal funding for costs associated with the distribution and administration of vaccinations, including HHS and FEMA.
State, local, tribal and territorial governments, and certain private non-profits (PNP) that own and operate medical care facilities, may be able to apply to FEMA for the cost of work to support the distribution and administration of COVID-19 vaccines under the Public Assistance Program. Work and costs that may be eligible for PA reimbursement are outlined in FEMA guidance FEMA COVID-19 Vaccination Planning FAQ. The work and associated costs must be in accordance with PA program eligibility requirements as outlined in the Public Assistance Program and Policy Guide. For example, work must be the legal responsibility of the Applicant applying for Public Assistance funding, and costs covered by another source of federal funding or insurance are not eligible for PA.
The vaccine is being made available by the federal government. There may be additional costs incurred by state, local, tribal and territorial governments, and certain eligible health-care PNPs to support the distribution and administration of the vaccine. Such costs may be eligible for PA funding when they are necessary to effectively distribute and administer COVID-19 vaccines consistent with CDC guidance and PA program requirements.
Additional Resources
For more information on the role of PNPs in support of the nationwide emergency declaration for COVID-19, including work done under agreement with state, local, tribal and territorial governments, the following fact sheet provides guidance for determining the eligibility of PNP applicants for FEMA assistance and work performed in accordance with the COVID-19 emergency and major disaster declarations.
For more information on the role of the federal government in COVID-19 Vaccine Planning, visit the COVID-19 pages on the HHS and FEMA web sites:
For more information on addressing the access and functional needs of at-risk individuals and operationalizing the CMIST Framework, please see the HHS/ASPR Access and Functional Needs Web-Based Training.
