By Rose Lewis, Natalie Campbell, Diana Siebenaler, Ryann Grindstaff, and Kate Payne
Introduction
In January 2019, The Design Institute for Health received a grant from a local philanthropic foundation, St. David’s Foundation, to rethink and redesign health at home in collaboration with the Steve Hicks School of Social Work at UT Austin. This project married the strengths of social work with the best aspects of human-centered design to address health outcomes in an affordable housing complex in East Austin. As the project evolved, we watched from a community-based perspective how COVID-19 both exacerbated existing and surfaced new inequities, disparities, and accessibility issues for historically underinvested communities.
Health Starts at Home
As outsiders in this historically underinvested community, we leaned into our collaboration with the social work school to position ourselves and build trust and rapport with the community. Early work delving into the system challenges and complex web of stakeholders in the property supported the path to more deeply connect with residents. Individual contributions from residents in one-on-one interviews as well as a collaborative co-design workshop led us to an initial prototype for services in January 2020.
During this service prototype, our team provided three iterations of in-person, human-centered social services before COVID-19 arrived in our community. Residents shared feedback that allowed us to evolve the prototype each cycle to better meet actual needs. Examples of the services offered include: Coffee Break with Dominoes to address social isolation and create a sense of community; Homework Help as educational support for children; One-on-One Support as an opportunity for short-term case management and connection to a variety of community resources; Nutrition Basics with a local nutritionist who focused on healthy eating education; and many more.
As COVID-19 shut down in-person services in mid-March, we quickly pivoted our programming to address the new and continued needs of the residents through digital platforms.
Meeting Residents Where They Are
As we shifted our service calendar from in-person events to virtual, we attempted to maintain some continuity with the pre-COVID schedule. One-on-one support remained on Tuesdays; a new form of social hour, previously Coffee Break with Dominoes, remained on Thursdays; and we aimed to continue with three to four services offered per week.
Many of our virtual services failed. We put together a detailed presentation that outlined COVID-19 symptoms, precautions, and how to seek care, and not a single resident logged on for the virtual service. We learned that highly successful in-person events did not translate to successful virtual events, like the nutrition class, which flopped virtually but set attendance records in person. How could a successful interaction during in-person services fail so dramatically in a virtual setting? Looking at the drastic shift in resident needs helped us understand the answers.
We learned that residents needed more individualized support, space to process the pandemic, and fewer community-focused activities. We adjusted the one-on-one time to be more flexible with residents’ schedules. We learned that an online virtual platform does not work well with limited technology capabilities or spotty internet connections. To meet residents where they were, we sent out a COVID-19 needs assessment—to better understand the residents’ current needs and challenges as they related to the pandemic. Then we started making phone calls to check in on residents, and we created and delivered to each resident’s door educational flyers with information about current eviction policies and available food pantries. We continued to build out our website with a COVID-19-specific page to provide several options for resident engagement. Despite an initial drop-off in engagement after switching to virtual services, we began to expand our network by reaching new residents who had never engaged with us for in-person services. Having a virtual option reduced any stigma that might be associated with attending services or asking for help. Additionally, it led to greater convenience in creating one-on-one support at a time that worked best for the residents.
Rethinking Technology
We spent a considerable amount of time finding an accessible online platform for our virtual services. Since requiring login through an email account or the downloading of an application could be a barrier to joining the events, we landed on “Lifesize”—a simple online platform that didn’t require a login or an app. Residents could click on a link that would take them to the virtual room in their browser. They could choose to enter their name or leave it blank and join the room. Our Bitly URL was simple and easy to remember, and it was used for every virtual service. We included step-by-step instructions for accessing the Lifesize page on every monthly calendar we distributed with a QR code to help residents easily join.
In January we implemented an opt-in group texting service to send service reminders to residents. When COVID-19 eliminated our presence on site, this communication tool also became an avenue for resource sharing, scheduling, and individual check-ins. We created a separate group on the texting service for COVID-related resources and used it as a vehicle to communicate food, health, and housing resources to the community. We invited residents to sign up for one-on-one support through text messages, and we reached out to residents who weren’t engaging in virtual services.
Lastly, we worked with management to send emails to all residents through an email blast platform. This allowed us to reach everyone in the community, even those who had not opted in to our texting service. All three of these technologies are simple to use and are relatively accessible, which was imperative for remaining connected to the community.
Continuity in Connection
As our grant funding was coming to an end, it was time to begin transitioning a new service coordinator in support of our plan for sustainability and longevity beyond the funding period. In May, we onboarded a licensed social worker, Ryann Grindstaff, who had experience working in historically underinvested communities. We introduced Ryann to the tenets of human-centered design that informed our service blueprint, and shared with her our goals for the program. She joined services we hosted where we introduced her to the residents. Ryann’s active listening skills and trauma-informed approach allowed her to quickly build the trust of the residents and establish rapport. She facilitated a smooth transition and took over all services in June. She has been responding to resident needs ever since.
Human-Centered Design in Action
Since her transition in June, Ryann has successfully created and implemented several initiatives based on input and feedback from residents in the community. We explore one very successful initiative, the distribution of COVID-19 care package and safety kits, as an example of how human-centered design embedded within a social service coordination model supports resident engagement, autonomy, and ultimately, empowerment.
During the COVID-19 spike in Austin in July, a resident expressed concerns to Ryann during one of their one-on-one support calls about the number of people walking around the complex without face coverings and the rumors of several COVID-19-positive residents on site. Ryann realized this might not be an isolated safety concern and need, and decided to engage the entire community. She explored that concern beyond the practical response of providing masks: what else might we provide to help residents feel safe during this current crisis?
Although the catalyst for these safety packages were masks, she knew from resident conversations there was also a need for cleaning products, hand sanitizer, and further education on what you should do if you start experiencing COVID symptoms.
Ryann created a package with masks, hand sanitizer, and disinfectant spray as well as instructions on how to make your own disinfectant—based on CDC guidelines—for each family that requested one. She leveraged community support to get masks and supplies donated through the community platform NextDoor, sourced donated masks for kids, and procured hand sanitizer from a local distillery. This initiative served 40 households and more than 100 unique community members.
A Framework for Human-Centered Community Engagement
After reflecting on the success of the COVID-19 Care Package and Safety Kit initiative, our team identified key factors for success and developed a framework for situating human-centered design within service coordination for community engagement.
This example illustrates success for everyone involved because the initiative grew from an urgent resident need. The combination of the service provider’s role redesigned as specifically resident-need-led, her foundation of trust in the community, and the leveraging of low-tech platforms for connecting with residents can all help support positive outcomes for service coordination efforts in low-income housing communities.
Since the initial COVID initiative, Ryann has continued to use this framework for other programs including a very successful school supply drive.
1. Advocacy: person-to-person coordination
The placement of a committed and receptive resident advocate allows for resident-led initiatives. Ryann has shown the value within our project in employing social workers for service coordinator roles. She listens, empathizes, and tries to understand the root cause behind the expressed concerns. She is sensitive to safety and confidentiality, and always employs a strengths-based approach that is instrumental in engaging with residents who have experienced significant trauma or those who might be experiencing a brain health challenge. As an individual rather than an agency service provider, we were not limited by the scope of services common in agencies. This afforded flexibility, creativity, and autonomy to meet resident needs without scope or funding constraints. This was a game-changer in building rapport and allowed us to adapt and redesign services as we received feedback or the needs changed.
2. Trust: a strong foundation
Delivering value to the residents through meaningful and authentic engagement, consistently and reliably, builds trust among residents and service providers. Trust building within historically underinvested communities must factor in institutional and systemic tensions as well as the broader historical context. Within our project, the many months of working on-site to meet and engage residents were crucial to the success of every initiative, both before and during COVID. Several residents expressed concern about the inevitable staff turnover or us leaving altogether after they built relationships with us. Thus our plan for sustainability and the smooth introduction of Ryann was crucial in maintaining their trust. Our steady and stable monthly schedule as well as the unchanging resident communication channels—door-to-door flyers, texting service, website, and direct email and phone number—led to residents finding us dependable and accessible at any time. Our follow-up for resident concerns was steadfast and unwavering. The COVID-19 safety packages reinforced this trust as a direct response to resident concerns.
3. Collaboration: it takes a village
Supporting the diverse health and wellbeing needs of a community bound only by geographic proximity and not by their individual experiences or challenges within social systems is a significant obstacle for social service coordination providers in low-income housing. A collaborative relationship with the property management team supports cycles of success with initiatives. Based on the dedicated relationship building with stakeholders and management teams within our project, the property manager now refers residents to services and allows Ryann to connect beyond the 25 households who have opted into the texting service to share important information for the community through their email listserv. Ryann and property managers collaboratively brainstorm solutions to community-wide concerns. Beyond collaborations with immediate stakeholders, Ryann’s professional background and experience meant she came to the table with connections to community organizations that have proved invaluable as she tries to meet resident needs sustainably.
4. Access: low-tech yet high-fidelity platforms
When delivering social services in historically underinvested communities, the single most valuable key to success is ensuring that the barrier to entry is as low as possible. We learned that convenience and accessibility matter to our residents. Since many are experiencing challenges to meeting their own basic needs, the process of engaging with our team and Ryann must be easy and free of roadblocks. Residents who don’t have Wi-Fi access in their apartment are able to use Wi-Fi provided in community spaces and on the computers intended for resident use, which opened up access to virtual services. The variety of communication channels we created were intentionally selected to give residents some choice in the way that they feel most comfortable communicating with us. The ability to text, call, email, engage on the Facebook page Ryann created, or connect through the digital messages property management sends out has allowed us to grow resident engagement exponentially.
Conclusion
Human-centered design is the bedrock of our service coordination model, and we believe this community engagement framework could be replicated in other community design projects. The flexibility to meet residents where they are and focusing on the problems they personally find to be the highest priority in their own lives has been instrumental in the success of services delivered within our project. Additionally, a social worker’s skill set founded upon empathy, active listening, and trauma-informed care make these individuals ideal service coordination partners. While social service coordination does not necessarily address the long-term and systemic challenges our residents face or continue to endure, approaching current needs from a human-centered design perspective supports and fosters an environment of autonomy and self-determination.
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