COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics.

BACKGROUND: Social care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs. OBJECTIVE: To describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting. DESIGN: We used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration. SETTING: Two safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs. PARTICIPANTS: Six physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews. RESULTS: Four major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences. CONCLUSIONS: The COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.

Associations between Teacher Wellbeing and Social Support for Physical Activity in Two Urban School Districts during the early stages of the SARS-CoV-2 Pandemic.

Given physical activity's protective effects on mental health and the potential for school districts to support teachers in this area, we explore teacher wellbeing protective factors including social support for exercise. Specifically, we measured the association between social support for exercise and teacher wellbeing in racially and ethnically diverse urban school districts. Based on a prior partnership with 19 schools across 5 districts, we obtained approval from two districts to outreach to teachers (n=206) and invite them to complete the Teacher Subjective Wellbeing Questionnaire and the Social Support and Exercise Survey during the 2020-2021 academic year. We applied linear regression models for continuous variables with teacher wellbeing as the dependent variable and social support as the independent variable adjusting for teacher- and school-level factors. Teachers (n=121) across eight K-8th grade schools completed the survey. The majority of teachers identified as female (77%) and non-White (84%). In the adjusted analysis (n = 104), there was a positive association between family social support for exercise and teacher wellbeing (ß = 0.31; P Value < 0.05). Thus, for every unit increase in family social support for exercise, a small 0.31 unit increase in teacher wellbeing was predicted. Additional research is needed to better understand this relationship in marginalized school districts as it may yield insights to be applied through multiple channels. District representatives have an opportunity to positively influence teacher wellbeing, an important component to supporting student success, building educational equity, and closing the achievement gap.