Community Health Worker Conference 2015

New York Pennsylvania HotelSeptember 11, 2015

Leading Causes of Death, 1900

Leading Causes of Death, 2000

Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

– American Public Health Association, 2008

Outreach/Community MobilizingPreparation and dissemination of materials Case-finding and recruitmentCommunity Strengths/Needs AssessmentHome visitingPromoting health literacyCommunity advocacy

Case Management/Care CoordinationFamily engagementIndividual strengths/needs assessmentAddressing basic needs – food, shelter, etc.Promoting health literacyGoal setting, coaching and action planning Supportive counselingCoordination, referrals, and follow-upsFeedback to medical providersTreatment adherence promotion Documentation

Home-based SupportFamily engagementHome visitingEnvironmental assessment Promoting health literacySupportive counselingCoaching on problem solving Action plan implementationTreatment adherence promotion Documentation

Health Promotion & CoachingTranslation and interpretation Teaching health promotion and preventionTreatment adherence promotion Coaching on problem solving Modeling behavior change Promoting health literacyHarm Reduction

System NavigationTranslation and interpretation Preparation and dissemination of materials Promoting health literacyPatient navigation Addressing basic needs – food, shelter, etc.Coaching on problem solving Coordination, referrals, and follow-upsDocumentation

Community/Cultural LiaisonCommunity organizing Advocacy Translation and interpretation

Participatory ResearchPreparation and dissemination of materialsEngaging participatory research partnersFacilitating translational researchInterviewingDocumentation

Connected to Community

Resourceful, Creative

Mature, Prudent, Persistent

Empathetic, Caring, and Compassionate

Open-minded, Non-judgmental, Relativistic

Respectful, Honest, Patient

Friendly, Outgoing, Sociable

Dependable, Responsible, Reliable

Shared life experiencesMost essential element considered by employersSocio-economic, educational, racial/ethnicSingle largest contributor to success

Personal AttributesEssential to CHW work – relational experiencesNot just anyone can be a CHW

Work Experience Roles, Tasks, Skills

CHW TrainingCore competenciesSpecialty topicsLeast important

Technical – medical, dental, nursing, allied healthValues - academic achievement, credentials, accreditations

titles, status, positionPurpose - service deliveryCharacter - prescriptive relationships - dualistic

Skilled – plumbers, carpenters, actors, iron workers, athletesValues - ability, creativity, performance, talent, efficiencyPurpose – productCharacter - cooperative relationships

Social – clergy, civic leaders, community organizers, CHWsValues - trustworthiness, integrity, ethic, understanding,

compassion, dedication, honesty, resourcefulness, empowerment, self-efficacy

Purpose – empowerment, building community and social capital

Character - peer relationships – relativistic, humanistic

Large body of evidence demonstrating CHW effectiveness across different conditions and settingsImprove outcomesIncrease access Lower costsHealth reform innovations

Patient-Centered Medical HomesHealth HomesDelivery System Reform Incentive Payment (DSRIP)

CHW role as liaisons within and between healthcare system components and the consumer community

Increase access◦ Health insurance coverage increased & more consistent for children (RCT in

Boston)

Lower costs (New York)◦ 63% reduced hospitalization expenses (asthma)◦ 48% reduced ED expenses (asthma)◦ Reduced HbA1c levels by one point in 6 month intervention (RCT diabetes)

Return on Investment ◦ ROI of $2.28 per dollar invested (underserved men in Denver) ◦ $7.00 per dollar invested (Denver Health pregnancy testing program)

Cost savings◦ Decreased per capita expenses 97% in an asthma program (Hawaii)◦ $24 million over 9 years in Georgia private corporation◦ Reduce hospitalization denial of payment - Bronx

Value added◦ Increase care team efficiencies & effectiveness◦ Increase consumer satisfaction◦ Improve chronic disease self-management◦ Lower missed appointments

Paving a Path To Advance the Community Health Worker Workforce in NYS

Establishes the CHW background and business case

Documents a discrete evidence-based CHW scope of practice

Makes recommendations for CHW training programs

Offers guidance for CHW certification

Makes financing recommendations for CHW programming

Matos S, Findley S, Hicks A, et al. Paving a Path to Advance the Community Health Worker Workforce in New York State. October 2012. www.chwnetwork.org. Accessed May 1, 2013 

Ruiz Y, Matos S, Kapadia S, Islam N, Cusack A, Kwong S, Trinh-Shevrin C. Lessons Learned from a Community-Academic Initiative (CAI): The Development of a Core Competency-Based Training for CAI-Community Health Workers. (Am J Public Health, November 2012)  

Findley S, Matos S, Hicks A, Campbell A, Moore A, Diaz D. Building a Consensus on CHW Scope of Practice: Lessons from New York. (Am J Public Health, October 2012)

Zahn D, Matos S, Findley S, Hicks A. Making the Connection: The Role of Community Health Workers in Health Homes. September 2012. www.chwnetwork.org. Accessed May 5, 2013. 

Balcazar H, Rosenthal E L, Brownstein J N, Rush CH, Matos S, and Hernandez L. Community Health Workers Can Be a Public Health Force for Change in the United States: Three Actions for a New Paradigm. (Am J Public Health. 2011 Dec;101(12):2199-203.)  

Murphy M, Matos S. Building Relationships and Changing Lives: A Community Health Worker Story. (J Ambulatory Care Manage. Vol.34, No.4, pp. 375-376.) 

Catalani, C., Findley, S., Matos, S., Rodriguez, R. (2009). Community Health Worker Insights on Their Training and Certification. Progress in Community Health Partnerships: Research, Education, and Action. Fall 3.3: 227-235

Sergio Matos917-653-9699 (mobile)sergio@chwnetwork.org

www.chwnetwork.org

April Hicks912-266-3262 (mobile)april@chwnetwork.org

Sally Findley917-710-5659 (mobile)

sef5@columbia.edu