When Cindy decided to pursue a college degree after getting out of prison, she faced several obstacles. She needed a place to live, school supplies, and new prescription glasses, among other things.

In September of 2018, Cindy’s student support-services coordinator at Columbia Gorge Community College referred her to the Bridges to Health program. She was connected with Community Health Worker Josh Sendejas, who helped her find an apartment through the housing choice voucher program. Josh also helped her access what she needed to stay in school, like gas for her car and printer ink for research papers. 

When Covid-19 arrived in Cindy’s community in the Columbia River Gorge, she faced new challenges. Her classes moved to Zoom, which has made it difficult for her to hear and engage. Right now, Josh is working with her to get noise cancelling headphones to help with her Zoom classes. Local food pantries have limited hours now because of Covid-19, so Josh has also picked up food boxes for Cindy when she’s working on school projects. 

If it weren’t for Josh, “I would have put my education on hold,” said Cindy (we are not using her last name to protect her privacy).

Because of the broad scope and flexibility of the program, Josh was able to fill gaps that would have otherwise been outside the purview of many social service agencies or medical organizations that have a more singular focus. 

“I really have a heart for connecting people to things they need the most,” said Josh.

Building Bridges Across Sectors

For the last several years, the Bridges to Health program has connected individuals and families to resources in rural Wasco and Hood River counties in Oregon. This year, Covid-19 has required the program to quickly pivot to support those in quarantine or isolation while continuing to serve clients struggling to access resources on their own.

The Columbia Gorge Region, where Wasco and Hood River counties are located, received the Robert Wood Johnson Culture of Health Prize in 2016 largely because of its extensive community engagement and collaboration across sectors. This means medical providers, local government agencies, non-profits, and community members all work together to improve the community’s health. 

Bridges to Health is a cross-sector program that works to improve access to resources, increase collaboration in and out of the healthcare system, and empower community members to improve their health. Its staff, who are community health workers (also known as CHWs), work closely with clients who might have challenges accessing medical or dental care, housing, food, transportation, and other basic needs.

CHWs are employed by local government agencies and non-profits that contract with the Columbia Gorge Health Council, the organization that houses Bridges to Health. Columbia Gorge Health Council staff members serve as the program’s “HUB”, which provides oversight, quality improvement, training, and program evaluation.

Clients get referred to Bridges to Health by a medical or social-service provider and then get connected to a CHW. What makes this program different from other programs is its broad scope and ability to address any issue, from getting into the dentist office to new glasses or roof repairs. Bridges to Health focuses on health and social determinants of health: factors like housing and food access that affect health outcomes. And, the strong connection and trust built between clients and CHWs makes for lasting relationships.

According to another Bridges to Health client named Alicia, “Bridges to Health is like a tree. It’s able to branch, flexibly, from one resource to another as it supports its clients.

Stepping Up Support During Covid

In the spring, when local leaders realized how Covid-19 would affect the community, the health departments in Hood River and Wasco counties reached out to the Bridges to Health program for support.

“On March 15th, Covid hit. By April 15th, we were getting referrals from both public health departments when people needed assistance in isolation and quarantine so that they could stay safely isolated,” said Suzanne Cross, senior program manager with the Columbia Gorge Health Council.

The program had to adapt quickly. Before Covid-19, CHWs worked with clients at a slower pace, building trust and assisting with applications for programs like the Supplemental Nutrition Assistance Program (SNAP) or Medicaid that often require a wait time for approval. While CHWs have continued to do this work through Covid-19, they are also contacting clients in isolation the same day they receive a referral.

“My coworkers and I are able to provide these families a piece of immediate help,” said Katrina Loikkanen, a CHW based at Mid-Columbia Housing Authority. “Just chatting on the phone if they need someone to talk to for an hour, we’re here. It could be buying and delivering groceries, which ultimately makes a huge difference in health outcomes. It not only allows clients to remain isolated and limit spread of Covid, but lets them take care of themselves and their families and put their mental health first.”

Still, a stigma around Covid-19 persists in the region and around the country. Another fundamental part of CHWs’ daily activity is countering this stigma by meeting their clients with empathy, respect, and care. 

“When we reach out and explain how we can support them during isolation, clients across the board have been so hesitant to even accept the help,” said Karen Shultz, CHW based at non-profit The Next Door. Feelings of fear, embarrassment, and shame often accompany an isolation experience, and in many cases, language barriers and cultural differences make accepting help even harder. CHWs, who are skilled communicators with big hearts, regularly put clients at ease. 

Recently, Karen assisted a pregnant mother in isolation who did not speak English. She needed to feed her family but had never used a microwave, which was the only cooking implement in her isolation hotel room.

“We really had to get creative around how to figure out foods that would work for them,” said Karen. While an easy solution would be to purchase pre-made microwavable meals for this family, finding culturally appropriate food for clients is something CHWs prioritize.

When the wildfires erupted in the Pacific Northwest this September, 40,000 Oregon residents were displaced, compounding the challenges presented by the pandemic. CHW Annette Lutgens, also based at The Next Door, helped support a couple who were isolated due to Covid-19 and then had to evacuate because of the fires.

“We were scrambling to get not only groceries, but gasoline [for their RV],” said Annette. After a stressful few weeks, the couple is now off isolation and was able to return to their home.

Many clients in isolation are families with children who are also struggling with basic needs like heat, internet, and food security. This reality has made Bridges to Health leadership realize that many families in the community were not getting the services they needed prior to Covid-19. Many clients stay enrolled in the program after their isolation period, working with their CHW on longer term goals.

This year has not been an easy one, but the program’s cross-sector model, its ability to quickly shift gears, and its resilient staff have allowed it to address the community’s changing needs.  

“As our program started receiving isolation referrals, I began to wonder if we could keep up,” said Katy Williams, HUB coordinator for Bridges to Health. “For anyone who has worked in systems that receive many referrals, you know that same-day response is incredibly difficult. But because of the adaptability, compassion, and perseverance of the CHWs, we make it happen every day.”

Judy Bankman is an Oregon-based consultant and freelance writer focusing on issues of public health, health equity, and sustainable food systems. She received her Master of Public Health from New York University’s School of Global Public Health in 2014.