COVID-19 Needs Assessment of Vulnerable Community Adults in Charlotte, North Carolina

While national level data on social and psychological impacts of the pandemic are beginning to emerge, the unique demography of the Charlotte, NC region necessitates a specific COVID-19 impact assessment. Funded by a grant from Cardinal Innovation Healthcare, Psychology for All in partnership with UNC Charlotte performed a needs assessment with three objectives:

1. To assess COVID-19 specific exposure, stress, and biopsychosocial responses. 
2. To assess psychosocial impacts, namely rates of mental health symptoms, alcohol use, domestic violence, relationship quality, and coping efforts. 
3. To assess interest in and barriers to low cost mental health services utilization. 

Psychology for All and six other regional non-profit partners disseminated a survey, obtaining results from 156 adults in the Charlotte-Mecklenburg region. Key findings include:

• High rates of COVID-19 exposure and related stressors, particularly exposure concerns, lost job/income, and increased home responsibilities. Other themes include high amounts of media consumption and difficulties obtaining basic necessities (e.g., food).
• Notably less social interaction with friends and family, declines in physical activity, decreased use of prescription medication, increases in efforts to cope with stress, and a drop in overall sense of well-being. 
• Concerningly high rates of probable depression, generalized anxiety, suicide, and problematic drinking.
• Of the respondents in an intimate partner relationship, 63% reported domestic violence in their relationship.
• Despite low previous mental health services usage, respondents expressed high rates of willingness to use in-person and virtual individual therapy services. 
• Topics of interest for development of mental health services included financial strain/literacy, coping skills, and mental health symptoms. 
• Finances, fear of COVID-19, and other barriers to mental health service use were reported. 

Based on our findings, we made recommendations for the following areas of COVID-19 related prevention and intervention in the Charlotte-Mecklenburg area: 

Mental Health and Suicide Prevention

1. Regional investment in training mental health providers in leading evidence-based therapies to treat suicide, depression, anxiety, and alcohol use.
2. Gatekeeper training on recognizing suicide risk factors and warning signs, asking questions of someone in need, and assisting in referral. 
3. Promotion of existing virtual alcohol interventions such as virtual 12-step programs or cognitive-behaviorally based therapies.
4. The widespread use of mental health, suicide, and alcohol use screening instruments. 

Domestic Violence and Trauma-Informed Care

1. Services for couples and families as well as individuals, given the link between relationship functioning and mental health/happiness.
2. Partnerships between service providers and local domestic violence centers to connect victims to resources for safety and support.
3. Routine screening for relationship conflict, violence, and dissatisfaction.
4. Given the relatively high level of conflict, violence, and PTSD reported in this sample, all providers might benefit from training in trauma-informed care.

Public Health Approaches to Psychosocial Impacts of the Pandemic

1. Development of public health psycho-educational materials for social media and print distribution focused on mental health symptoms, services information, benefits of therapy, low cost/pro bono mental health services options, and free coping skills resources.
2. A unified public health awareness campaign targeting messages such as the importance of remaining socially distanced yet connected, mental health warning signs and therapy benefits, and free, brief coping skills tools.
3. Development of low or no cost virtual individual and group therapy resources with programming focused on COVID-19 specific stress, coping skills, and financial literacy. 
4. The establishment of a UNC Charlotte campus-Charlotte community taskforce devoted to job creation, skills training, online course design, and other employment opportunity resource development.
5. Investment in new or existing food supply strategies for low income families. 
6. The design of a strategic plan for building social support over virtual platforms and in socially distanced formats.
7. Program development to enhance physical activity via socially-engaged yet distanced means, including identification of social activity agencies or clubs to serve as hubs for building small group social and physical activity.
8. Recent efforts to create free or low cost public WiFi hubs in the city of Charlotte, NC should seek to create free privacy hubs that individuals may use for accessing online mental health services.

Future Research Focused on Underserved and Under Resourced Populations

1. A joint meeting and report review with stakeholders to offer more nuanced assessment of specific research questions.
2. Prospective tracking of regional COVID-19 impacts, including COVID-19 specific stress, domestic violence, mental health, alcohol use, and financial strain/job loss. Comparison with other regions of North Carolina is warranted.
3. Research into the causal links and moderators between the key COVID-19 impacts
4. In light of documented rises in gun sales during the pandemic, COVID-19 related research should evaluate the role of firearm access and storage in relation to matters such as stress, alcohol use, domestic violence, and suicide risk. Prevention strategies should be developed to limit the risk of accidental and intentional firearm injury and death.

Read the full report here.