The Brown School’s Health Communication Research Laboratory (HCRL) has received two grants totaling $1.57 million from the National Institutes of Health (NIH) to understand and address Covid-19 health disparities. The first study will examine how low-income workers have been affected by the pandemic, while the second will develop and test communication strategies to increase Covid-19 testing and vaccination in underserved populations.
The studies will be led by Matthew Kreuter, Kahn Family Professor of Public Health at the Brown School and Senior Scientist at the HCRL. Both studies include cross-disciplinary teams from the School of Medicine (Kia Davis and Amy McQueen), the Brown School (Charlene Caburnay, Niko Verdecias and Jennifer Wolff) and the Department of Psychology (Tom Rodebaugh). “The impact of COVID-19 on the lives and health of low-income Americans and racial and ethnic minorities has been especially severe,” Kreuter said. “These studies will help assure that public health responses meet their needs.”
The communication study, which also involves 2-1-1 helplines in CT, NC, NE, and WA, is part of NIH’s national initiative, Rapid Acceleration of Diagnostics for Underserved Populations, or RADx-UP, which aims to increase access to COVID-19 testing in vulnerable populations. Both studies are 2-year projects. Funding came from the $1.1 billion CARES Act, which Congress passed to accelerate the development of technologies to address the pandemic, primarily through testing and education. The HCRL proposed a series of rapid-cycle studies to inform the messaging of underserved populations about testing and vaccination.
“The goal is to make sure underserved Americans can easily get tested and vaccinated, and we need strategies that will work. Our team will be collaborating with other researchers and community partners around the country to develop effective approaches through science,” Kreuter said. “It is exciting to be part of the solution, helping bring this pandemic to an end.”
Covid-19 has adversely affected millions of Americans who needed help the most even before the pandemic, an impact that has been especially noticeable in the holiday season, according to a Brown School expert who has been tracking calls to 2-1-1 helplines around the nation.
“The normal seasonal spikes in calls for help with holiday meals from low-income families are much lower this year,” said Matthew Kreuter, the Kahn Family Professor of Public Health. “Part of that is that there aren’t as many providers who are offering meals. One of the sad realities behind these numbers is that there may be a lot fewer people able to have a Thanksgiving meal.”
2-1-1 is a free and confidential service that helps people find the local resources they need 24 hours a day, seven days a week, in most communities. A team led by Kreuter, the senior scientist at the Brown School’s Health Communication Research Laboratory, and Rachel Garg, a doctoral student in Public Health Sciences, has been tracking millions of 2-1-1 calls. To do that, they are using 2-1-1 Counts, a unique, daily tracking system that analyzes calls to helplines in 35 states and is updated daily with location-specific data.
When Covid-19 was declared a pandemic in March, the team began analyzing the impact on calls and created Focus-19, a website featuring reports on its findings. The team recently completed its 100th report on trends in calls for needs like food, utility payments, and housing from around the U.S. With a grant from Washington University’s Institute for Public Health, a new site, Focus-19 St. Louis, was created to report on regional trends in line with Washington University’s emphasis on research that benefits its local community. The team has been approached by three other states to produce similar reports for them.
At the end of each month, the team looks back and examines the biggest areas of growth in calls from the prior month. In September, requests for internet service jumped dramatically as schools reopened. “There was a lot of demand, particularly among low-income families,” Kreuter said. “The places where we see the largest increases in social needs requests are the counties that have the most Covid cases, or the highest rates of Covid. There’s a pretty clear connection to how Covid is affecting the social and economic situation of families. Housing, food and utilities continue to dominate the list.”
Kreuter said there has been a four-fold increase in the use of 2-1-1 Counts dashboards around the nation since the pandemic. “That is very encouraging,” he said. “It’s very clear that people are discovering this data source.” Local policies and conditions influence or reveal the demand for certain services, he said. “So when eviction bans start and stop, it really influences people’s requests for assistance.” In North Carolina, some of the first outbreaks were at meat-processing plants and 2-1-1 calls from the counties where those plants were located saw much greater increases in requests for help. That news from Focus-19 was the subject of a newspaper report and soon thereafter a local organization reached out to provide aid to the meatpacking workers.
“Calling attention to these issues is part of our aim, so resources can be allocated more efficiently to help,” Kreuter said. But limited funding has meant that most of the team’s effort is geared to analysis, with less effort at media outreach and follow-up to magnify the impact of the data. “All of our resources are going to generating the reports,” he said. “For full impact, they need to be seen by more people in more places.”
The Focus-19 work is made possible by the 2-1-1 Counts surveillance system. “That puts us in a position to observe these Covid-related changes,” Kreuter said. “But we’re using data that these 2-1-1s work so hard to collect. They are the real heroes here.”
Dozens of Brown School students, staff and faculty volunteered at polls across the St. Louis region on November 3, helping voters to cast their ballots in what would turn out to be the largest vote total in U.S. history and the highest turnout rate since 1900. Heavy voting before Election Day meant the polls weren’t as crowded as had been feared, but volunteers played a key role in keeping lines moving and answering voter questions, a job that proved especially rewarding for many first-time poll workers.
“Oh my gosh, it was the best volunteer experience I’ve ever had,” said Sarah Mosby, MSW ’22, who served as an election monitor to help speed the lines of voters at an elementary school in St. Louis. “I met great people throughout the experience, including a man in his 80s who was voting for the first time.
“It was extraordinarily moving – our community in action,” added Mosby, who was recently admitted to the Graduate Policy Scholar program.
The Inclusive Voting: Key to Democracy Project was headed by Gena McClendon, director of the Center for Social Development’s Voter Access and Engagement Initiative, and Cynthia D. Williams, assistant dean of the Office of Community Partnerships. The St. Louis Area Voting Initiative and the St. Louis Area Election Protection Coalition partnered with CSD for election protection training and volunteer recruitment as poll workers, election monitors.
“For the most part, things went well,” said McClendon, who praised the Brown School and Dean Mary McKay for backing the effort.
McClendon said one purpose of the initiative was to engage social work and public health students with other organizations in protecting the right to vote.“We’re introducing them to the idea that they’re making history, so they will continue to do this,” she said. “They’ll use this exercise as part of their professional development and part of their profession.”
Many students, she said, are so focused on their clinical work that they don’t understand the connection between their work and voting. McClendon will make that connection clear to students next semester in a class she’ll be teaching: Voting, Racism and the Promise of Democracy.
The relevance of voting to social work was brought home years ago to Trish Kohl, an associate professor at the Brown School who volunteered as a poll monitor at a community center in Florissant. “I wasn’t personally civically engaged early in my career working for a non-profit, mental health agency. But a few years into it, I began seeing the impact of policies on families, recognizing the systemic changes that need to happen.”
“It is probably my years of work as a social worker that made it so important to me to work at the polls this year,” she said. “I believe it is critically important for social workers to engage in voting rights and ensuring people have the opportunity to vote.”
For Sicong (Summer) Sun, a PhD student from China, working as a poll monitor at a St. Louis elementary school was her first in-person experience inside the American voting process. “I was glad to see great voter turnout, especially young people and communities of color,” she said.“They showed up and made their voices heard.” She said her focus on the social determinants of health and financial capability as a research associate at CSD will be strengthened by the experience.
Like Sun, Annie LaFleur’s polling experience was a new one. LaFleur, MSW ’21, came to the Brown School from Oregon, where she had only voted by mail. Her experience at the Better Family Life Center in St. Louis was an eye-opener. “I had never been to a polling place before,” she said. “I wanted the experience to see what it would be like. I’m so glad I did it. I felt I was part of something bigger,” said LaFleur, whose concentration is mental health.
The experience gave many first-time volunteers a new appreciation for poll workers. Kevin Brown, MSW ’21, worked a 14-hour shift at an elementary school in St. Louis. “It’s exhausting and consumes the whole day,” he said. “But I would do it again. Ultimately it felt like I was serving a useful function. It was inspiring to see that many voters exercising their right to vote.”
Several students said the high-pressure, divisive nature of the 2020 elections encouraged them to volunteer, as did the pandemic.
“This year is different,” said Madelyn Brandt, MSW ’22, who worked as a monitor at a community center in Florissant. “Older poll workers were not able to be there due to the pandemic. I wanted to get involved. It was really cool volunteering with election protection. I think our presence across the nation helped people feel more comfortable. A lot of people were fearful.”
The potential danger for poll workers was brought home to Brandt in August, when she volunteered during the primary election at a polling place in her home community of St. Charles County. She became alarmed when poll workers were not required to wear masks and alerted a local TV station after receiving an e-mail from county election officials asking poll workers to “act surprised” if voters asked them to wear a mask. Outrage over the ensuing TV story, which featured Brandt, caused authorities to reverse their policy and require masking. But on Nov. 3, a poll worker who had been diagnosed with covid-19 reported to work in the county for a full-shift anyway and died later that day.
“I’m hoping that the new masking policy kept this person from spreading their Covid, or limited the spread,” Brandt said.
Brandt, who didn’t vote until 2016, said she began to get more engaged in part due to her concentration in domestic social and economic development, with a specialty in policy. She thinks greater civic engagement is a trend in the field. “A lot of social workers are becoming more active in their communities,” she said.
One reason for that activity is its relative lack of stress compared to that which many social workers face daily, said Ryan Lindsay, an associate professor of practice and assistant dean for social work at the Brown School who volunteered after running into McClendon at a Sam’s Club. “It’s a function of how exhausted and burned out social workers are in general,” he said. “They’re working trying to fix problems they cannot solve but which create significant pain for people. They don’t have a lot left to give, but this is something they can give. They just have to show up and say, ‘Tell me what to do.’”
Lindsay said his experience at a St. Louis middle school was “super rewarding,” especially a conversation with a 93-year-old survivor of the bombings of London during World War II. “I’m definitely going to sign up for this again. This gave me an opportunity to exercise my social-justice muscle,” he said. An added benefit, he said, was the opportunity to interact with people in person.
“I haven’t been in any place I’ve seen so many humans since the pandemic started,” he said. “It was invigorating.”
When Thomas and Jennifer Hillman Hall was dedicated on Oct. 2, 2015, it was hailed as a roomy addition to the Brown School, a welcoming place designed to encourage in-person collaboration and shared learning. Now, as the school prepares to celebrate the building’s 5th anniversary, the roominess of its 105,000 square feet is being appreciated more than could have been imagined.
The welcoming and in-person sharing, not so much.
“It’s ‘Come in and take advantage of in-person learning, but follow our science-based public health safety protocol,’” said Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School.
The difference, of course, is the COVID-19 pandemic, which has upended higher education around the nation and posed vexing dilemmas for university administrators who want to offer in-person learning options, while minimizing the risk of exposure for students, faculty and staff. The good news is that Hillman Hall and its wide-open spaces have provided the Brown School with the distancing resources and flexibility that have been key to its resumption of select in-person classes that began Aug. 24.
“We cannot imagine navigating the pandemic without the resource of Hillman Hall,” McKay said. “We have this beautiful building that was designed with flexibility in mind, more than our other buildings. Just having that much more space helps us distance ourselves from one another. That’s the silver lining.”
For those returning to Hillman for the first time since the coronavirus hit, the biggest change they’ll see is in the Maxine Clark and Bob Fox Forum, the building’s large and airy focal point on the first floor that features a woodwork ceiling and a glass façade. Created as a premier event space for conferences, lectures and town hall meetings, the Forum has been considered the figurative front porch of the Brown School. Now it has been transformed into a classroom, configured to maintain a safe six feet between students. Grounds for Change, the café adjacent to the Forum, is temporarily closed, with a possible reopening offering a ‘grab n’ go’ selection in the future.
“All of the features that made Hillman a collaborative and social place are detriments in this pandemic,” said Amy Eyler, associate professor and co-director of the Hillman-based Prevention Research Center who led a study of how the building as designed contributed to the well-being of those there. “I am now teaching two in-person classes and there is a whole new meaning of healthy building!”
Figuring out how to resume classes safely and fitting the logistical puzzle pieces together was the job of a large team of faculty and staff, led by committed preparedness, public health safety and administrative leadership teams. Siomari Collazo-Colon, Associate Dean of Administration notes, “We are incredibly fortunate to have some of the best public health faculty in the country. This has allowed us to put science at the forefront of every decision.”
“I was nervous at first but it’s going very well,” said team member Sunghei Han, MSW ’03, the Brown School’s manager of operations. “We’ve all been working to make this happen and we’re very confident that the protocol developed by Brown School public health experts would serve us well.”
When they sat down to plot out classroom floor plans, they quickly realized that many of the school’s classrooms were too small to accommodate six-foot distancing of students. Hence the use of the Clark-Fox Forum (and the Brown Lounge), to host classes too. Also, It was necessary to limit occupancy of the restrooms, which are now restricted to one person at a time and gender-neutral. The academic affairs team worked closely with faculty to decide which of the school’s 200 courses would be taught in person, when, and where. “It was lots of work and a tremendous collaboration,” she said. “It’s all the Brown School community doing it together. It’s been a great honor and a good experience and I’ve learned a lot.”
The building was made possible by the generous donations of Thomas and Jennifer Hillman. Jennifer Hillman was recently announced as a 2020 Woman of Achievement, and Thomas Hillman is president of the school’s National Council. Both have been in close touch with McKay about the changes in the building. “They’re glad about the flexibility and they trust us to make the right decisions,” McKay said. “They’re very practical people and we are lucky to have such Brown School champions.”
Commitment to applying best practices was shared across the school, faculty and staff as it wrestled with the challenges of resuming the in-person learning experience while keeping in mind one of the overarching goals that Hillman Hall was designed to further: the health and well-being of the people who use it.
“We’re protecting lives,” Han said.
Eleven members of the American Indian community will share stories associated with their cultural ties to Missouri as part of a project by the Brown School’s Kathryn M. Buder Center for American Indian Studies. The Digital Indigenous Storytelling Project will premiere on November 17 and highlight stories from across Missouri including Brown School’s American Indian Student Association.
Storytelling is an important tradition in Native communities across the U.S., which have been disproportionately affected by the novel coronavirus. Kellie Thompson, director of the Buder Center, said the project was a way to replace in-person events that the center had to cancel because of the pandemic, including some scheduled for November, Native American Heritage Month.
“We knew we wouldn’t be having in-person events in the fall,” she said. “This is a creative way to continue to engage our staff, students and local people to provide an event for the community.” The project is funded by the Missouri Humanities Council with federal funding from the Coronavirus Aid, Relief and Economic Security Act (CARES Act), which paid for staff to lead the project, honoraria for storytellers and technical equipment and training.
“We’ve been collecting stories from Indigenous people who have lived in Missouri or who are descended from tribes that are traditionally from the region. Their stories tie back to the land, and helps us think about how individuals stay connected to their culture,” Thompson said. “Some talk about how COVID has affected their culture. Storytelling is a way to not only share much about yourself, but often highlights lessons to be learned or knowledge that needs to be passed on to the next generation. It’s about the story, but also about the oral transmission of it.”
The stories will be posted on the Buder website on November 17; that afternoon at 4:00 p.m. the Buder Facebook page will livestream an introduction to the project. Some of the storytellers speak directly to cameras, others are the subject of interviews by Eric Pinto, the project coordinator, and two were submitted in writing and will be read by Pinto. The project hopes to continue collecting Indigenous people’s stories and will invite others to share their own.
Another response by the Buder Center to the pandemic will be a one-hour seminar that will provide culturally relevant health information for members of the Native community. The project, funded by AMB Foundation, will also disseminate health flyers and personal hygiene items such as masks and soap to help people prepare for the upcoming flu season and a second wave of COVID-19. Buder students will assist in the effort.
“The seminar will explain how to reduce the spread of the virus, what to do if you’re exposed, where to get testing, how contract tracing works and vaccine updates,” Thompson said. The seminar is open to all, but will be geared to the urban Indian community. It will be live-streamed through the Buder Center Facebook page from 12 p.m.-1 p.m. on December 2.
The virtual learning necessitated by the novel coronavirus pandemic has been a benefit in some respects to non-traditionally aged students at the Brown School, who enter graduate studies later in life. Erik Strange, a second-year MSW student and the father of a newborn, said the flexibility that online learning offers is a boon to busy students trying to navigate classes, family and sometimes long commutes.
“This model works for us,” said Strange, 35, who leads Next Move, a support group for older students. “The sad thing is not being able to be part of a community on campus. We’re definitely missing that.” Next Move has been providing new students tips on everything from career services to local hiking trails.
The group now includes 27 students and is growing. It’s part of “Washington University for Life,” an initiative the Brown School began spearheading well before the pandemic hit. The group encourages teaching and learning for students older than the traditional ages at the university. Led by Nancy Morrow-Howell, Betty Bofinger Brown Distinguished Professor of Social Policy, it “aims to create a more age-diverse community across the university.”
While diversity is a priority at both the university and the Brown School, Morrow-Howell said age is too often left out of the calculus. “Age diversity is just not on our radar,” she said. “We’re still fundamentally ageist. Life expectancy has increased substantially; yet universities remain age-segregated and fail to educate people across the longer life course.”
“We created an infographic called How old is WashU? to demonstrate that the age distribution of undergraduate and graduate students is vastly out of step with the changing demographics of the country. 99% of undergrads are younger than 25 years; and although the age of the graduate student body varies across schools, most grad students are under age 30. University College has the largest percentage of students older than 30. There is certainly room to increase the range of student ages in many units of the university.”
In 2018, WU joined the Age-Friendly University Global Network, founded by the University of Dublin in 2012 as a vehicle for sharing strategies to increase age-diversity in academia. Morrow-Howell said Washington University was one of the few private research universities to enter into this large learning collaborative. She’s working to expand the effort throughout the U.S. as a member of a national advisory committee for the Gerontological Society of America that focuses on age-inclusivity in higher education.
Through the Harvey A. Friedman Center on Aging, she is launching the Washington University for Life initiative to increase age diversity, and the Center recently completed focus groups with admissions and career services staff across campus to help steer the effort.
“Staff elicited a number of challenges associated with increasing age diversity on campus, but they were quick to identify the assets that older students bring to the classroom – and to campus,” she said. “They found older students to be more intentional in their educational endeavors; and they valued the experience these students brought to the table. Focus group participants also acknowledge the benefits to younger students of having a multigenerational classroom.”
Erik Strange is one of those students. He came to the Brown School after eight years in the military – including two tours in Afghanistan – and two years living and working at a home for intellectually disabled people. “I wanted to enhance my knowledge and skills so that I can create community, connection and purpose for people with intellectual disabilities,” he said.
“Coming to the Brown School, I felt like I could make an impact,” he said. He felt some trepidation entering as an older student, but said his experience so far has been a good one.
Still, he has faced some hurdles as a newly married student with a new baby boy, managing the challenges of school while embarking on a new life course outside the classroom. That’s where the on-line classes come in.
“I have this time in school to step away from my professional life, to focus on what I want to do. I welcome the opportunity to sit in class for three hours but it’s hard not to think of all the other things I could be doing at my house, like calling the carpet guy.”
Strange is continuing the legacy of Lynne Johnson, MSW ’18 and co-founder of Next Move. Johnson currently lives in Dallas and works for The Senior Source, a non-profit that provides services for older adults. She was 50 when she got her undergraduate degree. Due to her mother’s declining health, Johnson simultaneously became her full-time caregiver. After her mother passed away, Johnson began her Master of Social Work studies at the Brown School at age 52. “Social work really called to me, especially after my experience as a caregiver,” she said, and the school’s opportunities helped her change careers with a focus on an aging population.
Like Strange, she faced challenges as an older student.
“The Brown School is part of a very traditional university that caters to students who have followed the traditional path,” she said. “I found it to be frustrating in the beginning; I didn’t feel the staff validated people going back to school in midlife. We had to advocate for ourselves, and there wasn’t a lot of support.” She found ageism in the classroom from both students and faculty who appeared to discount the experiences she offered to provide real-world context to the subject matter at hand.
“If you’re willing to listen to your non-traditional students and their needs, there can be so much richness developed within the classroom through the validation of previous experiences and knowledge,” she said.
With time, Johnson was able to build positive rapport with faculty, staff and students. In her last year, Morrow-Howell approached her to start a group to provide support for non-traditional students and the result was Next Move.
“It was really exciting,” Johnson said. “We had strong support from faculty and staff and an amazing turnout from students. “I felt positive about my overall experience at the Brown School; I received an excellent education and now I get to use a combination of direct practice, programs, and policy skills that I learned at the Brown School.”
In addition to benefiting students, serving students of all ages will strengthen the health of Washington University and society as a whole, Morrow-Howell said, as she argued in a paper recently published in The Gerontologist. She also stated that bolstering the human capital of people mid-life and beyond can ensure the capacity of the labor force, and educate people of all ages to succeed in age-diverse settings, and produce innovation in an aging society. It can also help ensure the supply of students as birth rates decline.
“The transformation of our universities must be done for the sake of society, for younger and older people, and for the self-interest of institutions themselves.”