Moving from parallel play to cooperative play in a time of COVID-19

Strengthening ecosystems of care COVID response

This blog post is part of our series of COVID-19 reflections and updates from our CEO Kathleen Noonan. Read the rest of this series here.

This past November — what seems like a lifetime ago now — the Camden Coalition’s National Center for Complex Health and Social Needs hosted its fourth annual Putting Care at the Center conference in Memphis, TN. In my opening remarks, I observed that while the complex care field talked a lot about ecosystems, health systems, public health agencies, and social services are still, in many respects, working side by side in “parallel play” rather than cooperatively. Cooperative play looks a lot like double dutch — shared goals, clear role definitions, and an assigned lead among diverse stakeholders.

COVID-19 has made painfully clear the importance of coordination — and that our failures in this regard are having devastating effects on already marginalized communities. While there is no simple recipe for instant cooperation, here at the Camden Coalition, our willingness to examine and address some of our own behaviors has helped us better respond to COVID-19.

Like most organizations, the Camden Coalition has engaged in its own form of parallel play over the years. It is, after all, sometimes a lot easier and simpler to work within the four walls of your institution. However, pre-COVID, we made some deliberate decisions to work more cooperatively with local partners, which has proven absolutely critical to our COVID response.

First, we decided it was important to really get to know our county health and housing administrators, their plans for the region, and how we could be relevant and helpful to their work. This meant offering to serve their existing programs, rather than just creating our own.

Second, we agreed to pilot a different type of partnership with one of our region’s nonprofits, Volunteers of America (VOA), in one of their men’s shelters in Camden. For years, our care management team has provided support to men who spent time at VOA shelters. But we’ve recently added an additional and critical element to this partnership by working directly alongside shelter staff.

VOA staff provides much-needed support at the shelters, but did not have the medical training to support residents with complex health and behavioral issues. So, last summer, VOA asked if we would modify our model to both provide care management and also train, coach, and work with their shelter staff. We took cooperative play to the next level with funding from the New Jersey Blue Cross Blue Shield Horizon Foundation and trained select VOA staff on basic health issues, and also — with the consent of our patients — on how to access the Camden Coalition Health Information Exchange so they could understand their client’s health history and follow up care instructions.

Because of our foundational relationship-building work with state and local government administrators and the VOA pilot, when our county health officials called us to ask for help with their COVID-19 community response, we were able to immediately and collectively identify a role for our organization and, with VOA in the lead, have replicated our pilot program at a hotel that is serving as a safe quarantine site for individuals experiencing homelessness.

Of course, building the ecosystems required to address the complex needs of the people we serve doesn’t begin and end with collaborating to stand up temporary shelter sites, but it’s taking us multiple steps in the right direction.

At the moment, we are seeing a dramatic spike in COVID-19 cases in Camden, NJ, and it follows an unfortunate trend across the nation: people of color and individuals with complex needs are disproportionately affected by the virus. CityBlock’s co-founders Toyin Ajayi and Iyah Romm said it perfectly in their recent blog: “existing inequities in our society become magnified in situations of distress and duress.”

Closer to home, the profound impact of COVID-19 continues to lay bare these inequities. One of our Housing First participants, Antonio, was very recently featured on the Tradeoffs podcast. He is at high-risk for serious illness from COVID-19, and he talked about the choices he is making over and over again between keeping himself safe from illness while continuing to take the necessary steps toward managing his chronic conditions. As he points out, every time he gets on a public bus — his only means of travel — to make it to a doctor’s appointment, he is making that choice.

Indeed, as Ajayi and Romm say, “social distancing is a privilege,” and it’s one that will continue to widen the gap between those with access to the tools needed to be and stay healthy, and those without.

An irony of COVID-19 has been that, even as it physically isolates us, it makes painfully clear the acute need for us to come together — not just side by side, but cooperatively. COVID-19 is a global tragedy, but it is also creating opportunities to finally address some of the behaviors in healthcare that result in fragmentation that negatively impacts our clients and instead facilitate deeper and more sustainable partnerships. When we do this, we will not only be able to talk about ecosystems as an aspiration, but point to places where their existence meant better, less divided, and more cooperative care for those in need.

Read more about the Camden Coalition’s COVID-19 response