Purdue Public Health study focuses on COVID-19’s effect on area homeless

Written by: Tim Brouk

Among the many unforgettable news media images during the COVID-19 pandemic were images that depicted cities’ treatment of their homeless populations. Painted boxes spaced six feet apart for homeless individuals to sleep in a Las Vegas parking lot to tiny house villages erected in Seattle showed some metropolitan areas’ varying responses to the  disadvantages of people without homes in weathering the coronavirus storm.

Other cities responded by clearing out homeless camps — further displacing men, women and children.

Natalia Rodriguez

Natalia Rodriguez, assistant professor of public health and biomedical engineering at Purdue University, absorbed these images and wondered how Indiana’s Tippecanoe County resources were reaching out to area homeless populations. She also questioned if local people experiencing homelessness were receiving the right information when it came to protecting themselves from the deadly virus.

“This population is so vulnerable, and they’re literally five minutes from Purdue,” Rodriguez said. “These are people who came across hard times for many, many, many different reasons where public policy really failed them. This is a population that is often neglected and falls through the cracks.”

For the past year, Rodriguez has led a public health research initiative, “Homelessness During COVID-19: Community-Based Participatory Research to Inform Pandemic Responsiveness for Vulnerable Populations.” It’s a collaboration with fellow public health assistant professor Yumary Ruiz and several organizations in the city of Lafayette that serve the homeless to ensure local populations are considered and given better care during the world’s most critical health pandemic in more than 100 years. She and Ruiz will be submitting the first part of the research for publication this month, but real-life initiatives have already been implemented in Lafayette.

Data collection began last summer, when pandemic practices had become “the new normal.” Rodriguez led months of community-based research by interviewing dozens of community representatives from homeless shelters, food banks, social and legal services, the local health department, and the city of Lafayette, seeking how these organizations were prepared for the pandemic, what challenges they’ve faced and how they are responding. The responses informed the next steps in the project: talking to homeless individuals themselves.

With help from community health workers hired onto the project thanks to grants from the Purdue University College of Health and Human Sciences, the United Way of Greater Lafayette and the Indiana Clinical and Translational Sciences Institute, Rodriguez’s team interviewed dozens of homeless men and women about their experiences during the first year of COVID-19.

“We’re getting firsthand accounts and stories of what the homeless population faced during shutdowns,” Rodriguez said. “When places closed, where did they go? Were they able to wash their hands when public restrooms closed? Where did they get their masks?”

Recently, Rodriguez, Ruiz and their community collaborators created information campaigns regarding best practices at Lafayette Transitional Housing Center (LTHC) and background information on COVID-19. More public service announcements and digital signage encouraging mask-wearing, social distancing and hygiene became a daily presence around LTHC mealtimes with the goal of centralizing accurate, reliable information to this community.

Community health worker Rebecca Ziolkowski announces important COVID-19 facts to guests at the Lafayette Transitional Housing Center. (Photo provided by Natalia Rodriguez)

“The information changes with what they need to know most and stems from questions they ask during our interviews,” Rodriguez explained. “Recently, we’ve included information about the vaccines — what’s in them, what the symptoms are after you get it and why Johnson & Johnson is only one dose versus two doses from Pfizer and Moderna.”

For individual cases, Rodriguez introduced telehealth opportunities to counteract the halting of in-person services during the pandemic. Mental and physical well-being was something every human needed to monitor during the past year. For the homeless, it was more challenging to do so. Rodriguez issued iPads to her community health workers to facilitate telehealth visits with healthcare providers in private.

COVID-19 testing was also an issue. Most of the men and women whom Rodriguez’s team talked to would have to go to a hospital via an ambulance ride to get tested. The process was unwieldy and the results took too long. The community health workers are being trained and equipped to administer free COVID-19 rapid tests on-site at the shelter with 15-minute results.

While COVID-19 upended the lives of thousands of Hoosiers, Rodriguez foresees her work with the Tippecanoe County homeless to be beneficial beyond this pandemic.

“We should be informing this population. We should be providing them with health education,” said Rodriguez, noting similar work could and should be done regarding flu shots and STD testing. “Whatever it is, how great to have a reliable source of information every day and to have our community health workers help navigate them to the resources that are available to them.”

Continuing critical public health practices

Rodriguez initially began working with this population on an HIV-testing project in collaboration with Purdue biomedical engineering colleague, Jackie Linnes. The current COVID-19 community-based research continued that research target. Rodriguez called it an “evolution” of the work.

“It’s all about how to implement health technologies in vulnerable communities to better address their health needs,” Rodriguez said. “It’s a natural extension of the normal methodologies that I use. It’s bringing diverse stakeholders to the table, including the people themselves that are affected and asking: ‘What are your needs; what is your perception of how to address these needs? What do you think we should do about it?’ Then listening to everybody and putting it together. That’s community-based participatory research. That’s the approach I take to all of my work from designing health technologies to what we’re doing now on pandemic response.

Rodriguez’s project ushered in rapid COVID-19 testing. Pictured are two of those testing kits.

“I’ve really been fortunate to find awesome community partners that makes this work really fulfilling and actionable because they’re so willing to act on those results immediately and put programs into place.”

Jennifer Layton, president and CEO of Lafayette Transitional Housing Center, said Rodriguez has gone “above and beyond” for her organization and its vulnerable guests. Layton appreciates the immediacy of the work, from the public service announcements to getting rapid testing implemented at the center. Layton reported no COVID-19-related deaths at LTHC, and she has been able to continue all of her organization’s programming with much thanks to the work of Rodriguez and her team.

“She’s always looking for new and innovative ways to help people,” Layton said. “There’ve been so many challenges; it’s been just such a crazy time. But (Rodriguez) is one of those people that gets things done.”

Layton noted that “it’s hard to be socially distant when you have no home,” cementing the fact that the homeless were and are in need of assistance throughout this pandemic.

“They just weren’t able to get those basic needs met,” she said, “but having this conduit with Dr. Rodriguez and Purdue has been instrumental in breaking down some of those healthcare barriers.”

Rodriguez is already looking ahead, beyond the COVID-19 pandemic. She wants to improve on homeless women’s health opportunities including cervical cancer screenings. Another collaboration being led by Ruiz is being mapped out as well to explore how homeless families cope with COVID-19’s long-term effects on children, from pandemic-related evictions to missing in-person socialization during e-learning.

Reducing the stigma

A powerful layer to Rodriguez’s work with Tippecanoe County’s homeless is the humanizing of her participants. So many powerful stories have been unearthed. These stories transcend the pandemic. Rodriguez’s team of community health workers revealed disconnects between organizations created to help the homeless and the homeless individuals themselves.

“A lot of the shelter staff say the homeless population don’t wear masks or comply with the rules,” Rodriguez said. “When we started talking to the individuals, they said ‘No one ever told us why we have to wear a mask.’ The issue wasn’t just a lack of compliance but a lack of information, a lack of education.”

Nicholas Nagel, one of the community health workers involved in the research project, experiences many such stories every day.

“I interviewed a young lady that had kids. As a father myself, it rattled me a little bit,” Nagel recalled. “It’s hard enough to be homeless, but to go through that and have to worry about your kids; I couldn’t imagine.”

While he absorbs these stories, Nagel has had to shut down disinformation and conspiracy theories related to COVID-19 and the vaccines. Having accurate, verified information consistently given to his clients has been the most valuable aspect of Rodriguez’s study so far. It helped draw 65 homeless individuals to recent health department vaccine distribution events at LTHC. Nagel initially expected only “a handful” to show up.

“There’s people that come up, ‘Hey, I hear there’s baby fetus DNA in the vaccines.’ Just all sorts of things they pick up online or from talking to people,” Nagel said. “Being able to dispel those rumors and say, ‘here’s what it is’ — that helped tremendously in getting the numbers we’ve been able to get when the vaccine clinic was here.”

Nagel said he and his colleagues fully support Rodriguez’s research project. It is already paying dividends and will continue to do so throughout the pandemic. “Being part of the study, it’s great. I enjoy being able to sit down and actually interview different guests and hear their stories because they are the forgotten population,” Nagel said. “They’re people, too. They have a story, too, and their story is just as important as anybody else’s. When you take the time to sit down and just listen and listen to their needs, it means a world of difference.”

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