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Speaker 1: From the campus of Harvard Medical School, this is Think Research, a podcast devoted to the stories behind clinical research. I'm Ovi.

Speaker 2: And I'm Brendan. And we are your hosts. Think Research is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center.

Speaker 1: And by NCATS, the National Center for Advancing Translational Sciences.

Speaker 2: The COVID-19 pandemic has highlighted long-standing inequities and disparities in Massachusetts. On today's episode, Dr. Gina Kruse, the program faculty for the Community Engagement Program at Harvard's Clinical and Translational Science Center and Assistant Professor at Harvard Medical School and Mass General Hospital speaks with Eddie Taborda, Senior Clinical Research Coordinator at Mass General Hospital, Rosie Torres, Patient Service Coordinator at Mass General Hospital Everett Family Care, and Daniel Cortez, Community Engagement Specialist for the Chelsea Police Department about their work with the NIH funded Rapid Acceleration of Diagnostics in Underserved Populations Project, or RADx-UP, which aims to expand COVID-19 testing through community health center, community partnerships in hard hit Massachusetts communities.

They share community and clinical perspectives, highlight the challenges and opportunities of implementing their project during the COVID-19 pandemic and conclude with recommendations for strengthening community academic partnerships, particularly during public health crises.

Gina Kruse: Dan and Eddie, thank you so much for joining us today. I'm really excited about the opportunity to discuss our RADx-UP initiative, which we'll talk a little bit more in a second about what RADx-UP is. To start off with, let's go around and introduce our guests today. Let's start with you Rosie if you wouldn't mind introducing yourself, your role, and institution.

Rosie Torres: Hi. My name is Rosie Torres. I'm from Everett MGH Family Care. I've been here since 2017.

Daniel Cortez: Hi, everyone. My name is Dan Cortez. I'm the Community Engagement Specialist for the Chelsea Police Department. I'm also the Coordinator of the Chelsea Hub and also a member of the Chelsea Project.

Eddie Taborda: My name is Eddie Taborda. I'm the Senior Clinical Research Coordinator for the RADx-UP initiative. And I'm also the Operations Manager for Mass General Brigham Mobile Vaccine Operations.

Gina Kruse: We're going to set the stage with a little bit of background for our discussion today. We know tht COVID pandemic did not affect all communities equally. And 2020 was the year that really highlighted severe disparities in health that afflict our country. And Massachusetts was no exception. To start off with, I want to hear from our partners a little bit about the key challenges that you and your community face with regard to testing and vaccination in your communities over this past 16 to 18 months. Let's start off with you, Dan.

Daniel Cortez: It's been a whirlwind. As many people know, Chelsea was hit probably the hardest or as hard as anybody else in Massachusetts and really throughout the country. Early on, a colleague of mine, Mimi Graney, who is our downtown coordinator. Just an example of how everyone had to wear different hats because of COVID. She reached out to me. And we needed to come up with a plan to assist the city manager and how we were going to develop a COVID response team.

So we did that. And it was all hands on deck. Everybody joined that group. It was a daily call at 4:00, and we just were triaging. We were just trying to figure out what to do in every regard. And that whole team really came together. New partnerships were formed. So while we got hit very hard, we responded, I think, very admirably and developed new ways of doing things in the city.

Gina Kruse: Thanks, Dan. Rosie, can you tell us a little bit about the challenges that you faced you and your team in Everett.

Rosie Torres: Here in Everett, well, first, when the pandemic first started, I was deployed to Chelsea to the [inaudible]. And I was able to see COVID firsthand, how it was affecting different communities and all the initiative there. And then I was redeployed back to my office. And just small things, like they were looking to do a mask up video with someone in the community. Where can we deliver food to?

And I was the to-go person in the office and raised here in Everett. So I was able to use-- my office pretty much looked up to me to help them find and create new relationships. And then when the RAD opportunity happened, my office director, our medical director Dr. Stratton said, you are to-go person how we could form these communities and how we can form these relationships. And that's kind of how I became more involved into the community aspect.

Gina Kruse: Great thanks. So I'm going to talk a little bit about some of the key challenges around testing, primarily in our area and tell folks a little bit more about the RADx-UP initiative that we've all been working together on. So right now, even as things are starting to reopen, testing isn't quite as much at the forefront of people's thoughts but thinking back to a year ago that certainly wasn't the case.

We know initially, as the pandemic started to affect Massachusetts, that testing bandwidth was limited, testing criteria were very restrictive. But as more and more testing volume came online, the challenge was in making it accessible to everyone equitably. Just a look back at the numbers and what's changed in terms of testing volume, which is the main focus of our RADx-UP project, I looked back to see-- a year ago, testing volume was about 17-- according to the mass.gov website, testing volume was about 17,700 antigen tests done on July 6, 2020. Once the testing volume came online, then the challenge was getting the tests to people where the people who needed it most.

Overall, just a huge number of tests have been done in the state of Massachusetts. Overall, as of July 1 data, over 23 million 800 molecular tests have been done in Massachusetts. Those are the PCR tests. Which is just a huge amount of testing. So what the RADx-UP project does with regard to testing and community partners is RADx-UP is a funding opportunity from the NIH. It's part of this series of funding opportunities called RADx which stands for rapid acceleration of diagnostics.

A lot of it was focused on accelerating testing technology, but the RADx-UP piece of the program, the up stands for under served populations. So the RADx-UP initiative is part of those NIH funding opportunities, specifically sought applicants proposing a community partnered approach to accelerating testing and diagnostics in under served communities. It sought to develop strategies to find researchers and research programs to develop strategies to reduce disparities and COVID testing by leveraging projects that had existing community partnerships.

For our proposal we leveraged our Implementation Science Center for Cancer Control Equity, which is a partnership between researchers at Massachusetts General Hospital, the Harvard Chan School Of Public Health and our partners at the Mass League of Community Health Center which is, for folks not familiar, that's the primary care association for Massachusetts Community Health Center. And we leveraged that existing relationship and also recognizing that many of the community served by MGH were especially hard hit by the pandemic. For RADx-UP we also partnered with the community health centers served by MGH-affiliated community health centers in the communities of Revere, Chelsea, Everett, and Charlestown. And that relationship is how we connected with Rosie and Dan.

Our Implementation Science Center for Cancer Control Equity, as the name suggests, is an implementation science-focused research project. So that meant for RADx-UP what we were aiming to do was to study the implementation of expanded testing opportunities. And not only to study testing volume and impact that way, but also to look at the equity of who was being reached with testing initiatives. And the project really focused on three main activities to do that, to expand testing and testing equity.

The first was sending resources to community health centers to expand testing availability and giving them the flexibility to meet the needs of their local communities. So in some centers that was extended hours or weekend hours. In some centers that was mobile efforts, which is the form that it took on in the MGH community health center partnerships. In other centers it was streamlining existing workflows to get more people through with existing services. We really wanted to give them the flexibility to meet the local needs.

The next huge piece was to understand what those local needs were, was to encourage our community health center partners to convene a local advisory group. With the local advisory group, we asked the community health centers to identify partners within their communities. Partners that represented or served priority populations that were disproportionately affected by the pandemic and to hold those meetings to hear from the community, from the people on the ground where the needs are and to generate ideas about how to best address pandemic response, particularly testing, but other aspects of the pandemic response as well.

And then, so the three main activities with RADx-UP were one, this expanded testing. Two, convening these local advisory groups to make those connections and kind of have that ability to have that grassroots response by really hearing what the challenges are. And then the third piece was supporting some communication materials. So either materials given out at the testing site or materials that community partners shared out in those communities to address informational needs around testing and pandemic response.

I'm actually going to hand it over to my partner Eddie now to talk a little bit about-- in our RADx-UP project the process of identifying and working with partners for the RADx-UP activities.

Eddie Taborda: One of the critical pieces when establishing partnerships and identifying our partners was performing a needs assessment, which was to see what the community partners needed, what the populations that we're working with needed. As far as locations-- where to go, what worked for people as far as like weekends or late evening hours. What type of material people needed whether it was language competent-- for anybody that's not an English speaker, the translations that they would need. And also when it came to sub populations, like religious groups, immigrant groups that we've worked closely with in these specific communities that we're in.

So within MGH we already had those established partnerships with the community health centers. With the city of Revere, city of Everett, Chelsea, and the community in Charlestown. And within those health centers they already had partnerships established with local organizations, food pantry organizations, veterans services, disability services, and even with the city themselves from the mayor all the way down to city council, and everybody involved in that including Department of Public Health, Department of Public Works, everybody that had to do with the infrastructure. Knowing where to go as far as locations.

And it all really evolved. Instead of us going through the community health center directly, we would sometimes communicate with our partners themselves. A big advantage that we had during this time frame was actually the use of technology, most specifically Zoom, to be able to hold those meetings, phone calls, given social distancing and all those limitations and barriers that were present at the time. We always communicated sometimes on a daily basis, weekly basis, talking about specific situations with like sub populations, for example immigrant population or unhomed populations, and knowing really how to get there and how to target them. How to communicate with them. How to be culturally competent.

So it was a working relationship between everybody. Obviously, coming from a clinical health setting into a community setting there were things that needed to be learned, things that needed to be thought about. And having that association, that working relationship with community partners, really enhanced our ability to actually try to make a difference in our initiative. So it was a collective effort ultimately, and it all ended up working towards the end. And we're still here, moving forward still with testing, vaccination, and hopefully in the future we'll be able to keep collaborating in other efforts.

Gina Kruse: Thanks Eddie. With that background, let's dive into the conversation a little bit more. To start off with I wanted to hear from Rosie and Dan about your experience working with this team and the academic partners for this testing expansion activity. Why don't we start with you, Dan.

Daniel Cortez: So I always like to use the analogy of the old racist commercials where the guy walking down the street with peanut butter bumps into the guy walking down a street with chocolate, and they get mad at each other for bumping into each other but they quickly realize they developed a really good product, right. And so that's sort of what happened with us.

I mentioned the Chelsea project earlier, what that was was a group that formed as a result of COVID. And it was a very informal group that quickly developed its presence in the community, in particular through an effort we had in monitoring our wastewater. That was a group that was formed between MIT, Harvard, MAPC, and us in the city of Chelsea. I had a previous relationship with Karthik Dinakar from MIT and CCI, the Center for Complex Interventions through the hub, and it's a group that we have here in Chelsea to solve complex issues.

So we formed a group and we were trying to figure out what we could do in the city to support the city manager, the city of Chelsea in this COVID response. And one of the things that we looked at was wastewater monitoring and also a community response to a promotore health worker program as well. So when they had learned about the wastewater monitoring they reached out and that's when the relationship formed. We at the time were looking at ways that we could do mobile testing. There was already ample testing in the city of Chelsea with Stop the Spread sites, but they were not mobile in terms of going where the wastewater monitoring was telling us we should be.

And so that was a perfect relationship that was formed. And we ended up selecting some areas where we considered them to be hot spots, and then also some community events. And it was very, very successful in terms of how we were able to move the van around to meet the particular need.

Gina Kruse: Rosie, can you tell us a little bit about your experience working with the RADx-UP project and the mobile testing efforts?

Rosie Torres: For me it's been a very positive experience. I've been able to be more involved in the community, make new partnerships, form new relationships. I've been able to go to-- just the corner store. It's just going in personally and handing out the flyers, and the information that I've been able to receive from the meetings I've been able to print them out, bring them to businesses. And they've had questions, and it's more of a one on one. It's not oh, he said, they said. It's more, oh this is personal. I can actually get them information, and any questions they have they're able to ask me freely because they see me as more of their partner, their friend. Not being told what to do. It's more, well this is the information. If you have any questions, please let us know. What else can we do to help you?

And the business owners, they really appreciate-- even the workers they appreciate us being able to offer testing sites that was close to them. That they could take a two minute break from work, walk over, get tested. If they had any questions, they know they just could come over, and it's just being able to form those new relationships that many of them already said to me, I know this is COVID but can we continue these relationships? And I said to them, I'm willing to continue the relationship because I think we're going back to the old way of things. Yes, technology is good, but sometimes just having the personal interaction that's very important to keep on having.

Gina Kruse: Now that's great to hear. I'd love to hear a little bit more about how that personal relationship and being able to sort of go talk to people one on one, how that compares or contrasts to other either research projects or other programs or initiatives in Everett.

Rosie Torres: Many people are tired of doing surveys. They feel that you do surveys and for some reason they feel it goes to la la land. They feel that when you go personally and ask them the question you're really there for them and you're on the same level and they feel more personalized. I think that's a difference because many of them said, oh we receive surveys but we don't like to answer them, or I don't know how to answer it. I don't understand those questions that they're asking, it's so vague.

And being able to go personally and if they don't understand the question they could ask you, could you explain that to me? Like one of the main questions is do I still need to get tested? I've been vaccinated twice. And I say yes, if you have any symptoms you should continue to be tested. And then I'm able to give them different sites where they could be tested. So they're able to ask those questions personally and they feel more comfortable.

Gina Kruse: It did seem like just an amazing mash between identifying where the increased testing needs were and having something that could bring the testing there. How has this, the RADx-UP project, how does it compare with other kinds of research projects or other projects or initiatives that you've worked on, Dan?

Daniel Cortez: Well I think everything is different in terms of anything that you may have worked at pre COVID and then since. So I think one of the most, to me, awesome, unique things is how it's partnered these individuals that you didn't think you would ever have a conversation with. Whether they be doctors, high level researchers, really, to a layman like me, really important people. And having them listen intently to what you think should be happening on the ground. So I think those relationships are the future. I think partnering institutions with people on the ground is incredible.

One good example of that is the work of our promotores. These are basically people that we hired from the community with no public health experience, and they went through some training and pretty soon they're partnered up with doctors and nurses and researchers from Harvard, I mean from MGH. Jointly trying to convince people that they should get tested and that's pretty incredible stuff. And that's the kind of health platform that we want to maintain and really grow in the city of Chelsea.

Gina Kruse: That's great to hear. I think from the researcher perspective, that I would also count that in the amazing stuff category. I think that's just what so many people are hungry for is that connection with what's happening on the ground and the ability to really hear what the needs are and try and match the research that's being done to the actual needs on the ground. So yeah, I would definitely count that as amazing stuff.

My next question is to hear a little bit from everyone about what were the biggest challenges or surprises that you've encountered during the project or in the process of implementing this mobile testing operation. Why don't we start with you Rosie.

Rosie Torres: The most challenging part for me was being able to have the relationship with the city. I didn't think it was going to be so difficult to reach the health department, and I didn't realize how many individuals were included in the decision making. So that was a learning process for me. Once we were able to create the relationship and think outside the boxes, go to our local churches, let's go to our local community centers and going for the people and for a different aspect opened up better doors of opportunity to have a better understanding for the need of Everett.

And I can honestly say now we're getting to the point that people are reaching out. Everybody knows about our mobile van. It has opened up a lot of doors. So there was a lot of surprising learning curves and I'm just taking the positive aspect of it. I foresee in the future there's going to be more communication with the community because sometimes people just hear what doctors, researchers say but sometimes they forget that we need to go to our people and ask and figure out what are the needs of our people. And with this project I was able to embrace that and see where the most need has been needed. And now I have community leaders reaching out to me instead of me reaching out to them. So I think that's a positive surprise for me at the end.

Daniel Cortez: I want to echo what Rosie said about the importance of having that community input. We were fortunate to have had that working relationship with our city leadership, with our city manager's office. Tom Ambrosino is just a fantastic city manager and very inclusive in terms of key decision making. I guess it helped that I work for the city. I'm a city employee at the Chelsea police department, so that was helpful.

So I think one of our biggest challenges early on was where to put the van. So we have four places where we pull samples from in the city, and the city is so small that we could have really picked any location. And one of the first locations that we picked was the food pantry, the pop up food pantry that was set up through La Colaborativa on 6th Street. There were a ton of people that were in line to those food pantries on a daily basis.

So the assumption was made that, well, all these people are here. We'll set up the van and they'll get tested. But we quickly learned that a lot of folks they didn't want to be in that line. They wanted to hurry up and get their box and go. And so that didn't necessarily mean that they were also going to wait in another line to get tested.

So as creative as we got, we realized that, while that seemed like a good idea, we needed to shift course. And so we ended up putting the van in our downtown area where there was lots of traffic. And it's also where COVID was spiking in terms of our wastewater monitoring. So that ended up being a really good location and it created a really good vibe in the downtown area where we would easily convince people to get tested.

And one of the other challenges that we had to deal with were people that felt that, well, I was tested months ago I don't need to get tested again. So through our promotores who were there working with the vaccination awareness team, the [inaudible] Vaccination Awareness Team, we were able to have these one on one conversations with passers by basically. And convincing them to get tested. And as our city manager put it, those are people that otherwise wouldn't have been tested that day. So because the van was in a key location and that we had individuals that reflected the community, having one on one engagements with people that were just literally passing by, we were able to convince a lot of folks to get tested. The same is true in terms of vaccinations.

Eddie Taborda: I also wanted to add to Dan. I was also working there at the Chelsea location in the downtown area, and it also helped having, what he said, the promotores being able to communicate with the people that were passing by. Spanish speakers. We had music sometimes playing in the background. So there was a sense of excitement. People wanted to be there. They didn't mind waiting. While our clinical team was focusing on doing registration, collecting social determinants, information, and then the actual testing piece, that collaboration that we had with the partners whether it was the collaborative green roots and those volunteers, that working relationship really enhanced the overall operation and our capabilities.

The volume of people showing up, the kind of questions that were coming around. This was during testing time, but it was also a time where we were communicating with them just like, hey, the vaccine is also coming down the line. How to talk about combating hesitancy a little bit and just building that trust and that relationship between the hospital and the whole academic system and the communities that we were in.

And also wanted to add as far as barriers, one that really stood out to me was when picking locations-- with Chelsea we were very fortunate just because we did have that working relationship, but there was other situations we ran into where we had a location identified, it was heavy foot traffic area. An area of need. But the issue was with getting the van there because there was businesses, lot owners, they started asking about costs, about permits. Who's in the van? What kind of equipment do you have in the van?

And sometimes these would take days, even weeks or even up to a month sometimes actually to be able to just set up the van there just because of that push back we got from whoever owned that land or that lot. And that was just a difficult situation that we had to deal with. And we had to improvise looking for other places or working a little bit closer with the city for them to be able to help us execute what we were trying to do in that specific area.

Daniel Cortez: I just want to also highlight a little bit of what Eddie said in terms of people working together and creating a festive atmosphere. Because people, especially the people we are trying to reach, predominantly Latino individuals. They want to be in an area that is festive. So if you think about it a testing van is the least festive thing that you could possibly have. So we were just having good conversation and talking about music. Let's get some salsa music or some Latin music going. And things like that.

It was a quick response, and everybody, even from the transport company, everybody was involved in conversations that led to really good results. And also it just proves the point that when people are physically together on a regular basis they develop good relationships and they come up with better solutions to complex issues rather than maybe a monthly health meeting or even over Zoom. When you're together you have these wonderful conversations and really good things happen. And you find out the pulse of the community.

Gina Kruse: I love that example Dan. As somebody who often spends some time working on the research logistics and [inaudible] therapies and things like that, I was lucky to be able to go help out on the testing van from time to time. And I remember when the music was implemented and thinking, yeah, of course the research team was not going to think of this. But it completely changed the way it felt and the positive smiles with people coming by whether they were using the service or not.

So yeah, just that feeling on the ground really can't be replaced by just a Zoom meeting, totally agree. I was going to add one more kind of surprise or challenge from the research perspective as well that kind of highlights one of the unique components of this RADx-UP project. As a research project it also had a heavy service orientation in this project, and so it was not just intending to study testing roll out. It also had the ability to sort of send resources out to study what works, to get testing expanded in real time as a service.

I wanted to move on to hear a little bit more about how folks think that the initiative has impacted the communities.

Daniel Cortez: In Chelsea it has helped us tremendously. We not only were able to move the van to key locations but we were able to-- and this is something that the RADx, Eddie and Sam and Priya, did on their own. And maybe it was helped by relationships that were built, but they were able to be part of key events in the community. And it just became this automatic thing. There would be times where I would find out that the van was going to be at this particular event. And it's just amazing how quickly that group adapted to the community. So it was really beneficial in that regard. So if the community wanted either the testing van or a vaccination van in a particular location they knew who to reach out to and it was done pretty fluidly. And that was really incredible for us.

But in addition to that, we've developed a really good relationship with Eddie and with Sam and Priya and they benefited also from the research that is being done through wastewater monitoring. And the folks at MIT, CCI, as well as MAPC. It's just created this team of people doing work. As a matter of fact, we're having an event on Friday where we're bringing together folks that are doing research and response in the community. And what we've learned and how we can move forward in those efforts.

And I think this is just from my learnings about mobilizing communities, it helps when there is a place where something can land. You often hear groups that are trying to attach themselves into a community and they don't know who to reach out to first. Is it the city? Is it the local health institution? I think what was helpful in Chelsea is that there were these platforms where things could easily land. Like for example the Chelsea project, which is that partnership of all those entities, was a place that RADx could additionally land. Obviously, they had already established good relationships not only with the Health Center but also with the city. But it helps when something is happening that you can attach yourself to.

And maybe that's maybe that's a learning for future reference. Who's doing similar work? Because for example, if you attach yourself to one group, it may not yield the best results. And then you may have to spend a lot of time trying to figure out who else you need to attach yourself to.

Gina Kruse: I think it's an interesting point, and I know it kind of echoes something I've heard in earlier conversations with you, Rosie. Is sort of thinking about-- so many groups have come together, and COVID gave us the shared space and the shared mission that we were all working on together with all these different goals and programs in mind. I'm curious what you guys think as the world of pandemic has not going away. It's still very much affecting us in our daily lives.

Are there going to be opportunities to have that same kind of shared space to hook into going forward? And what might those look like? And how might we leverage some of what we've learned either from RADx-UP or the other amazing community based research that's happened through the pandemic to keep the momentum going and keeping this connection with what's going on in the ground and hearing really directly from people what the needs are and how things fit. I guess that's a long winded question just to say how do you think-- do you think there's going to be opportunities for another kind of infrastructure, kind of shared mission for things to plug into to keep these kinds of programs going even as we're not always working on the COVID pandemic?

Daniel Cortez: I think that's our number one goal at least for the Chelsea project. How can we support the city, the public health department, our public health director in any health issue? And how can we take advantage of these incredible teams, incredible efforts that were put together because of COVID? And these silo busting conversations, initiatives that we've had and the improvement of relationships between health institutions and cities and nonprofits. Everybody knows each other now. And if we don't take advantage of that then that would be sad.

I don't think anyone is not looking forward to that. I think everyone is looking forward to it. The concern is complacency when things do-- let's say they magically all go away and variants, nothing. Everything goes away. If we go back into our silos then a lot of this would have been done in vain. How can we take advantage of this real drive to improve public health outcomes in a city? Whether they're-- Sadie mentioned earlier obesity, substance use, mental health. Any health issue. Just regular stuff too like making sure people get their flu vaccine. We're working towards that public health infrastructure.

Rosie Torres: Through this whole process I feel like it's going to be a new future of how are we going to work together. I think that among us in the communities, I think state, local, I think everyone learned that we need each other to make each to make things better and to make things happen. And just like Dan said, the relationships and being able to latch onto another event and just being an extra arm. I feel like in the future I don't see this going away. I think it's going to be a new way of doing things.

We need to work together, communicate. And I see this being the new-- I really do feel it's the new future. Right now I have people in Everett, they're looking out for me. They're seeking out for me. Before they didn't know that we were here in the office. They would walk by. Or next to the post office people would be walking by us all the time. Now people actually stop by, hey can I have the schedule for the testing site? Oh, do you know the schedule for the vaccine? Do they have Pfizer only?

People are more educated now. They know what to ask for, what they're looking for. And one of the reasons is because we had the mobile vans. We had different people walking in the community sharing what was going on. So education is definitely the key. And I feel like this is going to be a new future is communication and I don't see it going away. I really do feel like we're going to be more a team and I think it'll be more group efforts.

Gina Kruse: We've been talking a little bit about recommendations and next steps and what our hopes are for these sorts of partnerships going forward. I'd like to hear from everyone some thoughts on how the research community and academic institutions in particular can be effective partners to local communities. Both in response to public health emergencies like we've been dealing with but other health activities as well.

Daniel Cortez: As I mentioned, that is a big goal of ours. I think what has happened and what should continue to happen is for these relationships that have been formed, that have been developed, to continue. Because without those relationships then you have this effort of academia or researchers or health institutions trying to figure out-- they have meetings on trying to figure out how to better be integrated into the community or how to have a better response from the community or what should we be researching. Things like that.

But when you break bread together and you're meeting on a regular basis out on the street those relationships form as I've mentioned a lot. And that's how new ideas form like the relationship that we have with Priya and Sam through the Chelsea Project is incredible. And we're coming up with different things that we could be doing and how we can use this research better. And again, it's part of the reason why we're putting this form together. So we can take advantage of everything that we've learned and all the great work that everyone has done.

But how can researchers be talking to researchers? So we're not siloed in the work that we're doing. Everybody is using Chelsea as sort of a lab, if you will, and we need to bring all the lab partners together in homeroom and say, all right guys meet each other. Let's get to know each other, and let's see how this work can be done collaboratively and in a way that has a greater broader impact on the community.

Eddie Taborda: And just to echo everything you just said it makes me think a little bit about theory versus practice. There's a lot of ideas out there but once you're actually out in the field and you start working with people, figuring out workflows, protocols, a lot of the ideas that were brought up initially, that were thought of, don't necessarily always work. So there's always that readjustment period. And I believe to really maximize that you need to have that inclusiveness of having both the thinkers also being practitioners and vise versa. And hopefully that will really elevate what we're trying to do ultimately.

Daniel Cortez: One way to say that is from the work plan, that everybody is too familiar with, to the work. Get out there and meet people.

Gina Kruse: That's well said. Yeah, I think it really is just eye opening to be there on the ground and hear from people. I was going to add also from the research perspective, I think one of the things that we found through this RADx-UP project, both through the MGH partnerships and then the other partnerships we're working with through RADx around the state is that one size does not fit all. And even as we've worked with RADx-UP to work with the community health centers to make space for these community partnerships, the way that those partnerships communicate and work together has evolved over the project even in this first year.

And so baking into those activities the flexibility to meet the needs at the moment I think really is important to keeping those relationships relevant and to keeping people invested in the work. And sort of what I mean by that is as this project started we had the partnerships meeting with local advisory groups once a month. As testing needs evolve it's a point where maybe once a month isn't the right fit for what people are thinking about testing or for those meetings to shift over to other topics besides testing and really having the space. Or recognizing maybe that other people need to be at the table in that conversation.

So I think as these relationships and partnerships and the space to have those connections are developed making sure that they can evolve and adapt to the changing needs of the community. Which everything's changed so rapidly through this pandemic, I think that's probably a lesson everybody's learned I suppose. But it seems like it's been really key. And not always something we do in research. Like often you set up your trial and you want to do it exactly the same way throughout the whole study period, and with this kind of implementation work that we've been doing in the pandemic having the flexibility to sort of shift what we're doing as the needs evolve has been really, really important to remaining relevant.

Before we end, any last takeaways or any last thoughts that folks want to share with our listeners?

Rosie Torres: For me, having our monthly meeting has been an eye opener and it's also given me new resources and new ideas. Just listening to Dan, what works in his city, some of the ideas I have been able to bring back into my community. So being able to have these meetings and see different people's points of view I'm able to take what I could do and see different ways of working. So having those monthly meetings has been very successful for me. It's been a learning experience, and I've been able to apply some of the new ideas that I would never have thought about. And it's good that we have different opinions and different people from different resources to come up with new ideas and new forms of working.

Daniel Cortez: I think for me it's ask questions. If you're not sure about something, if you want to know how something can be improved in your community in regards to whether it be testing or vaccines or any issue moving forward, ask questions. You know, who is doing what. You know, who should be working together. What alignment opportunities exist and how can we open up a dialogue that allows or fosters those types of relationships to build.

Because I think once people are put in a room together they quickly realize that they should be working together, that they should align their efforts. And maybe I'm not the person you should be talking to, you should be talking to so-and-so over here. They're great, they're doing similar work. I think when you begin a dialogue, a conversation-- and usually that's by asking a question or entering a room you're afraid to enter, things like that happen. And that's where improvement comes.

Eddie Taborda: When it comes to process improvement and innovation it's something that is continuous. And like Dan said, you just need to keep asking questions and not always just settle with what has worked before, what is working now. Things will always change and there's that flexibility and adaptability component that will just really enhance everything that we're trying to do.

Gina Kruse: Thank you everyone for joining us today for this wonderful conversation and we look forward to continuing to build our partnerships in the interest of community engaged research.

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Speaker 2: To learn more about the guests on this episode, visit our website catalyst.harvard.edu/thinkresearch.