Taking it Online

Closed doors can hide even the most horrific secrets.  Pair that secrecy with silence and the results can be explosive enough to destroy a family.

Jada remembers only too well when her 14-year-old son broke the silence and told her what had been happening behind those doors.  For seven years, Jeremy told her, Jada’s husband and the boys’ step-father, had been abusing both Jeremy and his older brother. 

Tearfully, Jeremy told his mother that when she left for work, their step-father would beat them and humiliate them.  Small infractions of his rules would result in punishment, sometimes forcing them to engage in endless rounds of exercises to make amends.

Jada, who had already divorced her husband, was floored but knew she had to find help for her son.  She also realized that the anger his brother, 16-year-old Jalen, has been displaying could have also been due to his step-father’s abuse.

“I couldn’t be in denial.  I knew that they needed help.”   They’re both angry and confused and need help, she adds.

Luckily, Jada was no stranger to seeking help for a son.  Jalen had begun having difficulties in elementary school and was diagnosed with ADHD.  Jada had worked hard to make sure he was placed in programs she believed would help.

“What I didn’t know at the time was that he was also suffering from abuse from my husband,” she says. “He was crying out for help.  It’s like all he knew how to project was anger.”  

After Jeremy’s disclosure, Jada knew she had two sons who needed help.  It shocked her because Jeremy had always been her “easy child.”  But over the past few months he too had begun acting out and now Jada knew why. 

Compounding difficulties, COVID-19 was devastating Jacksonville, making access to services difficult.

Luckily for Jada and her boys many of the services they needed had been placed online.   Jalen, who had gotten into trouble for marijuana, was dealing with both the court and an educational advocate via online sessions.

Jada is still searching for additional services for both her sons.  Finding services, however, is not easy in Jacksonville, even more so since the pandemic.  Not that the services aren’t available, but people have no idea who to ask to point them in the direct direction, Jada says.

For example, she would like to find online mentors for both her sons, but has been unable to locate them.  She’s also had difficulty finding online tutoring help for them.

She’d also like to find online mental health therapy for Jalen, who currently must conduct therapy face to face. She wonders whether an online delivery of therapy would be easier and more relatable for Jalen. 

“You know what, I think online therapy would actually be better for him.  Jalen would be in his own space.  He’d probably be more open to talking.”

Although Jada says the pandemic has been difficult, the availability of online support has made it easier.  She can only imagine how difficult it would be if she didn’t have a car to transport her boys to programs not offered virtually.

“At one point I had no transportation so I definitely understand trying to get your kids to appointments.  It’s hard.”

————————————

March 2020 was the beginning of an unprecedented period of social disconnection and isolation. “From city-owned sports and entertainment venues to parks, senior centers, schools, and gyms, they all faced immediate closure in an effort to slow the spread of the COVID-19 virus by limiting locations and events that encouraged people to gather in close quarters.”1

Every resident, and every bedrock institution integral to everyday life in Jacksonville was impacted, including the nonprofit and government sectors, the hubs of support and services for Jacksonville’s most vulnerable citizens. Moreover, the closures required to stop the spread of the virus amplified already identified needs and created “unprecedented demands on nonprofits.”2

As a result of the COVID-19 pandemic, services once considered alternative models (like virtual learning and telehealth) immediately moved from optional to essential. And though the transition has been challenging, it has emerged as a potential boon for communities that have less access to services whether due to their rural nature or lack of resources and transportation.3

Although the current pandemic has highlighted the use of online services, many professionals have been utilizing such services for years.  At a 2013 conference of the American Medical Informatics Association4, participants noted that online technology offered an effective method to reach vulnerable and underserved populations with services and urged for the development of a national council to streamline policies to enable the delivery of services.

Progress on adopting changes to enable online service provision, however, has been relatively slow.5 The necessity of adapting to the pandemic changed that in 2020. Within a matter of months, a variety of service providers were forced to consider how to make necessary changes to meet clients’ needs online in order to limit both travel and exposure.

The resulting virtual landscape has bloomed with various approaches to technological adaptations. Today, health providers use videoconferencing or even simply telephone connections to deliver care. Therapeutic services ranging from speech therapists to recreational therapists now deliver their services virtually. Meetings, lectures, group discussions, job interviews, and consumer purchases are all held in the ether.

In many jurisdictions the courts have held trials and proceedings within virtual courtrooms.6 Ombudsmen are holding mediation online. Schools have enacted district-wide virtual learning.Libraries have placed more and more of their catalogues online for easy access. Even grocery and meal provision can be handled online, engaging a provider to deliver the products to people’s homes.

The response to health and social services moving online has been favorable for some, especially since they eliminate the kinds of barriers too often experienced in concentrated urban poverty. Online provision offers a host of advantages, “reducing long waiting times, long travel distances and more personalized care for those that are able to take advantage of this mode of delivery.”7 One JustJax respondent said, “(These) issues often prove insurmountable for many Jacksonville children and families. I think more such online services should be offered for all kids.” 

Multiple studies also have shown that online therapeutic services are just as effective as in-person services for people with depression or anxiety.,,8,9,10 Other researchers have confirmed the effectiveness for the virtual provision of speech therapy, PTSD, ADHD treatments, online addiction help, support groups, career counseling, dyslexia treatment, and so many more.

One of many organizations in Jacksonville that have found success leveraging online resources during the pandemic is the PACE Center for Girls. The PACE Center, established to provide specialized services to girls who became involved with the criminal justice system, pivoted quickly online when COVID-19 shut down everything. Staff described a seamless transition into providing classes and counseling effectively online. 

But not all is rosy, and Jacksonville, like all communities, must continue to build toward equitable access in the quickly evolving landscape of service provision lest more people are left behind. 

The opportunities are tremendous for Jacksonville to leverage technological innovations in service delivery to meet the needs of more residents across ZIP codes. The community is at an important crossroad, which left untended could exacerbate disparities in underserved areas, or, with foresight and comprehensive planning, provide more people with the services they need to keep Jacksonville safer and healthier. 

Determining online needs

We suggest that the community take a comprehensive look at the provision of online human and health-related services, as a way to diminish access barriers that cause disparities of service provision between communities in Jacksonville. COVID-19 has provided the impetus for the creation of expanded technology and it’s a change that will continue once the virus subsides as it provides benefits for both providers and clients.  

Now Jacksonville must decide how the changes wrought in technology by the pandemic should move forward into the future. Because forward movement is inevitable.

The Pew Research Center recently convened a panel of experts in technology, communication, and social change from across the country to offer insights into how the world will respond over the next five years to technological changes wrought by the pandemic.11 Although there was agreement among some that some changes could affect society adversely, many also believed that a new normal would also create a “’tele-everything’ world where workplaces, health care and society activity improve.”

Obviously, these changes are coming – in fact, many are already here – and it’s in the best interest of all of Jacksonville’s residents to carefully consider how to plan for them.

That should entail careful consideration.  That’s why our First Recommendation in this section deals with the planning stage of virtual provision of services. More specifically, we recommend that the nonprofit community empanel a cross-sector group of experts ranging from people within education to nonprofit service provision to physical and mental healthcare.  Also included should be people from local business and industry, and most especially the communication and marketing sectors, as well as integral partnership from people living and providing services within underserved communities.

The goal of the committee would be to put together a framework for incorporating needed virtual services into the city in a meaningful and coherent way. Change is inescapable, and we have seen an outline of how technology can contribute positively to this change during COVID-19. However, that change should be carefully considered before it occurs simply through passage of time.  Planning will help ensure that unmet needs are appropriately met.

Committee members should consider the full panoply of possible online services in drawing up the scaffolding of what such a system in Jacksonville should resemble.  That could include data collection, an essential component of which must include input from residents known for high concentration of poverty and lack of access. It is an important time for Jacksonville to learn what services are most helpful to residents and where gaps in access can be closed. 

Included in the committee’s considerations should be an examination of what types of virtual services were implemented during the pandemic. Were they effective? What were the features that worked for people? Which will be continued? As part of that process, committee members should also look at other existing services that could be provided in a virtual manner.  There are numerous examples outside the community that can provide guidance and inspiration.  At the national level, some of those models include:

  • Numerous services (most for-pay) online that offer individual counseling:  BetterHelp, Talkspace, Teen Counseling, Pride Counseling, Amwell, 7 Cups of Tea, the Boris Lawrence Henson Foundation, and the AAKOMA project, which offers free virtual therapy for black teens.  Perhaps one of these can provide a prototype for a local online therapeutic effort.
  • In addition to one-on-one counseling, there are national services that offer group counseling or discussion groups for people.  These could be designed to offer peer support for specific segments of the Jacksonville community.  For example: Gender Spectrum for Black LGBTQI teens; Therapy Tribe, peer-to-peer support groups for teens; Brother Let’s Talk, a virtual support group for talking about racism and other issues; and Girl Talk, which provides girls a chance to socialize online.
  • There are dozens of online groups that provide socialization for seniors such as Senior.com and SeniorNet.com. Such resources can provide not only peer-to-peer discussion groups but also spaces in which seniors can exchange information.  A local discussion group could be a boon for Jacksonville’s over-65 group.
  • Numerous virtual support groups for both adults and youth exist for people dealing with specific issues.  For example, the Facebook group “Dyslexia support – for parents of dyslexic children” has 58,000 members and offers all types of information and help.  Similarly, CHADD (Children & Adults with Attention-Deficit/Hyperactivity Disorder) offers support groups for adults dealing with the disorder.  There are others.
  • There are scores of parenting groups in the ether that provide help for struggling caregivers.  Online parenting classes can be found at Online Parenting Programs. MensGroup.com offers support groups for dads. These are only two of many.
  • Other avenues for transmitting information also exist on the internet.  For example, the Facebook Watch series, Peace of Mind with Taraji, features frank discussions about mental illness and the online Anti-Racism Education Project (theareproject.org), in which its teen founder invites other teens to discuss books dealing with issues of race.
  • E-mentoring programs could be enormously beneficial for Jacksonville. There are many existing national programs that could be offered as viable places for youth and parents to visit such as mentoring.org, and the National Mentoring Resource Center.  Additionally, such programs could provide prototypes for local mentoring.

As can easily be seen, the opportunities are enormous. But not all Jacksonville residents have the time or expertise to search out these online spots while ensuring quality delivery. We recommend a thorough examination of such groups with the eventual goal to provide people with a well vetted list of available services. This list should be accessible across many Jacksonville institutions, including the City website, local media, libraries, school sites, the health department, nonprofit and healthcare providers, and civic and business organizations.

Additionally, when appropriate, we recommend the Committee identify which of these services could be best provided through local efforts. Although there is no need to replicate many of these national projects, there are cases in which Jacksonville-based outreach makes abundant sense, and where digital provision can, in unique times and for unique reasons, complement locally delivered face-to-face interactions. 

Yet another consideration for the committee is to delineate the communities most in need of particular services.  Some of that information will be spotlighted during the previously mentioned data-collection effort within neighborhoods asking residents which services are most needed but most difficult to access. Other populations of need can be discovered with analysis of already existing data. 

Information from the Youth Risk Behavior Survey,12 for example, clearly shows that girls, Hispanics, and LGBTQI youth respond that they are especially susceptible to suicidal ideation. We need to not only provide online help for these groups but make at-risk individuals aware of the existence of online services through comprehensive marketing efforts. 

But the committee should not stop here.  There are other questions that should be considered:

  • What are the priorities for establishing virtual services?
  • What businesses, nonprofits, governmental agencies and others can be partners in this work?
  • How will the services be marketed and disseminated?
  • How can resources be pooled and maximized and how will these initiatives be funded?
  • How can other information regarding healthcare and service provision be disseminated?
  • How will people be trained to take advantage of these online initiatives?
  • How will services be measured to ensure they remain effective?

Thanks to the crisis presented by the pandemic we’ve become aware that many of the services formerly provided face-to-face are not only possible, but perhaps more effectively and/or expansively presented online or via telephone.  This is an opportunity for change that Jacksonville should seize.

However, with great opportunity comes risk. The PEW Research Group also found that there were problems associated with a growing dependence on technology. For that reason, our Second Recommendation  concerns the need to identify and overcome any barriers to the provision of online technology that exists within the city’s neighborhoods.

Census data has told us, for example, that some 9 percent of Jacksonville households do not have computers. A greater number, 83.7 percent, do not have a broadband internet subscription.13 Even with the availability of smartphones able to access the internet, there are still a great number of households in Jacksonville that do not possess this technology, especially those headed by seniors. 

A Pew Research Center survey found similar disparities in Jacksonville. According to its figures, internet service had been purchased in only 54.3 percent of the Jacksonville households that earned less than $20,000 per year, compared to 84.5 percent of Jacksonville households that earned more than $20,000 per year.14

Further, merely owning a computer doesn’t ensure access in the fast evolving landscape. The Duval County School District had to scramble in multiple ways to attend to the needs of students, yet 43,000 students were unable to participate in their new digital platform, HomeRoom, due to insufficient technology. As described by the DCPS Chief of Technology, “Parents often reported that they had a computer in that home but often that computer did not have the capabilities to run the applications that are required especially when you’re trying to do live streaming of videos from the teachers.”15

And while Jacksonville philanthropy did its part to help span gaps during the Covid crisis,16 thought needs to be given to how to overcome these barriers with a longer view. 

The challenges experienced during the pandemic for students were heightened, but not unprecedented, and not time limited. The lack of access affects student success more broadly, not merely when the schools were required to turn to digital delivery. As noted by Deputy Superintendent Dana Kriznar, “While the district has met the needs of students on an as-needed basis, those without permanent access to the internet are at a disadvantage compared to their more highly connected peers.” 

The disparities were evident before the pandemic. The “homework gap”, which refers to “barriers students face when working on homework assignments without a reliable Internet source at home,” has been an ongoing challenge across the country. In 2016, noting that 5 million U.S. households with school-aged children lacked access to high-speed internet, an NEA report17 sounded the alarm. 

“The homework gap forces students in these households to head over to the library to squeeze in two more hours of homework instead of going home for dinner after a long sports practice. Some may decide to forgo the safety and warmth of their home to venture out to the commercial parking lot with free Wi-Fi access in order to complete and submit their assignment. Or many students are simply unable to finish the work.” 

These kinds of challenges only exacerbate what is already an uneven playing field for educational attainment. 

At several times in its history, people have encouraged the Jacksonville Energy Authority (JEA) to provide broadband internet to its customers. Is that possible? In addition, during the One Spark festival, free internet was provided to festival-goers in downtown. Would that be possible for a larger area? 

Interestingly, the Coronavirus Response and Relief Supplemental Appropriations Act, enacted on Dec. 27, 2020, as part of the Consolidated Appropriations Act of 2021, contains a series of broadband funding opportunities for both individuals and governmental entities to help low-income people.  In addition, the American Rescue Plan, which passed the Senate on March 5, 2021, also contained monies for additional broadband and internet support. Is the Jacksonville/Duval area able to secure any of these emergency funds or other grants?

And, finally, how can the city go about getting hardware to its residents to allow them to access the internet?  There are programs that provide computers for low-income people. In addition, the FOURWARD Fund of the National 4-H Council offers computers for children from low-income families.  The National Digital Inclusion Alliance, which accepts donated hardware from corporate and governmental entities, is distributing laptops and computers to qualified people. 

Even before the pandemic, Urban Mining, a company that recycles and refurbishes technology had already established connections with “many major companies in Jacksonville, including Florida Blue, Black Knight and Acosta, to recycle their end-of-life IT… (and) works with Duval County Public Schools to refurbish the school system’s old technology and sell it to students at half the retail value.”18 The reality, however, is that too many kids and their families simply cannot afford technology, even at half price. As a result, Stem2Hub, a Northeast Florida nonprofit that “seeks to assure that all student have the opportunity to engage in high quality experiences that will open doors to the future STEM2 careers”19 responded and were able to assist with 4,000 laptops. However, the needs are more prevalent, and ongoing. 

There are numerous other business and governmental institutions in Jacksonville that rotate out used computers routinely from their offices and labs. The University of North Florida, for one, rotates out its used hardware every few years then donates them to nonprofit organizations. Is Jacksonville leveraging all of its resources? 

A plan needs to be enacted to connect these programs with individuals and families within Jacksonville to ensure they have needed hardware. 

Our Third and Final Recommendation has to do with what becomes of this initiative once the committee’s work has ended.  All too often in Jacksonville, promising recommendations and projects have been initiated based upon the work of task forces and commissions.  Then … little happens to further that work. We heard this complaint over and over again.

One told us:  “there must be someone specifically charged with holding people responsible if they don’t enact recommendations.”  

For these reasons it will be critically important that a powerful leader and team be put in place to follow through with these suggestions. These kinds of online programs can be lifesaving in a city where too often physical barriers and poverty prevent people from accessing the services they so desperately need. The barriers are also simply unacceptable when they impact student learning. 

And, that leadership must be ongoing.  A program such as what we’re recommending is not a one-time, short-term offering.  These online services must be continuously offered over the long-term to ensure effectiveness.  As one of our JustJax respondents put it:  Actually making a difference in Jacksonville “is a marathon, not a sprint.”

In conclusion, the COVID-19 pandemic has been a perspective-shifting experience for everyone. It is important to take the helpful virtual technology created during the pandemic and apply it in the future. Having online services that increase access and connection to vital programs would improve the lives of many in Jacksonville. 

Citations

1Mathers, S. (2021, March 13). Mayor Lenny Curry marks anniversary of COVID pandemic in Jacksonville. Retrieved March 22, 2021, from https://www.actionnewsjax.com/news/local/mayor-lenny-curry-marks-anniversary-covid-pandemic-jacksonville/BQISD27AWREDXAO3OHMCLDU4JM/

2Florida Times-Union. (2020, July 26). Coronavirus: Most Jacksonville-area nonprofits ‘hanging in there’ amid increased demands of pandemic. Florida Times-Union. Retrieved March 22, 2021, from https://www.jacksonville.com/story/news/local/2020/03/19/coronavirus-most-jacksonville-area-nonprofits-hanging-in-therersquo-amid-increased-demands-of-pandemic/112269482/

3Implementing Virtual Human Services: Lessons from Telehealth (2020, June).  Institute for Research on Poverty, Fast Focus Research/Policy Brief No. 49-2020. University of Wisconsin – Madison. Retrieved March 24, 2021, from https://www.irp.wisc.edu/resource/implementing-virtual-human-services-lessons-from-telehealth/

4Chang, B. L., Bakken, S., Brown, S. S., Houston, T. K., Kreps, G. L., Kukafka, R., Safran, C., & Stavri, P. Z. (2004). Bridging the digital divide: reaching vulnerable populations. Journal of the American Medical Informatics Association: JAMIA, 11(6), 448–457. https://doi.org/10.1197/jamia.M1535

5Centers for Disease Control and Prevention. (2020, June). Using telehealth to expand access to essential health services during the COVID-19 pandemic. https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html#edn10

6Duval County Public Schools. (2020). Duval County Public Schools technology plan 2020-21. https://civicclerk.blob.core.windows.net/stream/DUVALCOSB/b90c2f2fac.pdf?sv=2015-12-11&sr=b&sig=rhTPDhVlP59QiRYqUCAloXlXK%2B3%2FN2HgSW2Iqvo1hbg%3D&st=2021-03-24T16%3A33%3A41Z&se=2022-03-24T16%3A38%3A41Z&sp=r 

7American Medical Association. (2020). COVID-19 FAQs: Health equity in a pandemic. Retrieved March 24, 2021, from COVID-19 FAQs: Health equity in a pandemic, from https://www.ama-assn.org/delivering-care/health-equity/covid-19-faqs-health-equity-pandemic?gclid=CjwKCAjwxuuCBhATEiwAIIIz0TDOsbhlR1ICDN1balymVXBp03luvmcbNEvOskoupcht5qVGdc6oZBoCiS4QAvD_BwE

8Blumenfield, Steve, and Jeff Levin-Scherz. (2020, Dec. 9). Digital tools are revolutionizing mental health care in the U.S.” Harvard Business Review. Retrieved, March 24, 2021, from https://hbr.org/2020/12/digital-tools-are-revolutionizing-mental-health-care-in-the-u-s.

9Sevilla-Llewellyn-Jones, J., Santesteban-Echarri, O., Pryor, I., McGorry, P., & Alvarez-Jimenez, M. (2018). Web-Based Mindfulness Interventions for Mental Health Treatment: Systematic Review and Meta-Analysis. JMIR Mental Health, 5(3), e10278. https://doi.org/10.2196/10278

10Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders, 152–154, 113–121. https://doi.org/10.1016/j.jad.2013.06.032

11Pew Research Center. (2021, Feb. 18). “Experts Say the ‘New Normal’ in 2025 Will Be Far More Tech-Driven, Presenting More Big Challenges.” Retrieved March 24, 2021, from file:///C:/Users/Owner/Downloads/PI_2021.02.18_New-Normal-2025_FINAL%20(1).pdf

12Duval County Public Schools. (2019). “2019 Duval County Youth Risk Behavior Survey”. Retrieved March 21, 2021, from https://dcps.duvalschools.org/site/handlers/filedownload.ashx?moduleinstanceid=41368&dataid=64903&FileName=2019%20YRBS%20Results.pdf

13U.S. Census Bureau. (2019). QuickFacts. Retrieved March 24, 2021, from https://www.census.gov/quickfacts/jacksonvillecityflorida

14Maciag, M.  (2017, Sept. 7).  Digital divide most glaring in low-income communities.  Government Technology. Retrieved March 24, 2021, from https://www.govtech.com/computing/Where-the-Digital-Divide-Is-the-Worst.html

15McLean, J. (2020, July 22). DCPS: Over 43K students lack technology needed for Duval HomeRoom, district eyes purchase of 50K devices. News4Jax.com. Retrieved March 24, 2021, from https://www.news4jax.com/news/local/2020/07/23/dcps-over-43k-students-lack-technology-needed-for-duval-homeroom-learning/

16https://patch.com/florida/jacksonville/dcps-philanthropy-bridges-digital-divide-long-branch-families; stem2hub.org. (n.d.) Closing the digital divide. Retrieved March 24, 2021, from https://stem2hub.org/closing-the-digital-divide/ 

17McLaughlin, C. (2016, April 20). The Homework Gap: The ‘Cruelest Part of the Digital Divide.’ neaToday. Retrieved: https://www.nea.org/advocating-for-change/new-from-nea/homework-gap-cruelest-part-digital-divide

18Stem2Hub.org. (n.d.). Retrieved March 24, 2021, from https://stem2hub.org/stem2/