Diabetes Community Diabetes Community Health Workers: Health Workers:

A Piece of the Health A Piece of the Health Care PuzzleCare Puzzle

Diabetes Partners In Action Coalition (DPAC) Diabetes Partners In Action Coalition (DPAC) Training & Education Program WorkgroupTraining & Education Program Workgroup

PurposePurpose

To provide awareness of and information To provide awareness of and information about the role of the Diabetes Community about the role of the Diabetes Community Health Worker (DCHW) in addressing Health Worker (DCHW) in addressing prevention or self-management of prevention or self-management of diabetes, particularly with underserved diabetes, particularly with underserved populations.populations.

Learning ObjectivesLearning Objectives

1. Describe four skills that are 1. Describe four skills that are demonstrated by an effective DCHW.demonstrated by an effective DCHW.

2. Identify training components required to 2. Identify training components required to become a DCHW.become a DCHW.

3. Explain the unique role of the DCHW as 3. Explain the unique role of the DCHW as part of an integrated diabetes part of an integrated diabetes management management

Who are Diabetes Community Who are Diabetes Community Health Workers?Health Workers?

Diabetes Community Health Workers (DCHWs) Diabetes Community Health Workers (DCHWs) are community members who work as bridges are community members who work as bridges between their ethnic, cultural, or geographic between their ethnic, cultural, or geographic communities and healthcare providers to help communities and healthcare providers to help their neighbors prevent diabetes and its their neighbors prevent diabetes and its complications through self-care management complications through self-care management and social support, including community and social support, including community engagement.engagement.

AADE Position Statement. “Diabetes Community Health AADE Position Statement. “Diabetes Community Health Workers.Workers. The Diabetes Educator. The Diabetes Educator. 2003; 29(5):818-24.2003; 29(5):818-24.

Workforce Size & CharacteristicsWorkforce Size & Characteristics

Michigan-Specific Data Michigan-Specific Data 2,724 total CHW workers: 1,807 paid CHWs 2,724 total CHW workers: 1,807 paid CHWs

(66%); 917 volunteer CHWs (34%)(66%); 917 volunteer CHWs (34%) Occupations: counseling, substance abuse, Occupations: counseling, substance abuse,

educational-vocational counseling, health educational-vocational counseling, health education, and other health/community serviceseducation, and other health/community services

In Michigan: Federally Qualified Health Centers, In Michigan: Federally Qualified Health Centers, Detroit Department of Health & Wellness Detroit Department of Health & Wellness Promotion, University of Michigan, Diabetes Promotion, University of Michigan, Diabetes Outreach Networks, Access, Indian Health Outreach Networks, Access, Indian Health Services, Spectrum and St. Mary’s Hospital, Services, Spectrum and St. Mary’s Hospital, Henry Ford Health System, etc. Henry Ford Health System, etc.

National Pay RatesNational Pay Rates

New HiresNew Hires 64% paid below $13 per hour64% paid below $13 per hour 3.4% paid at or near minimum wage3.4% paid at or near minimum wage 21% paid $15 or more per hour 21% paid $15 or more per hour

Experienced CHWsExperienced CHWs 70% paid $13 or more per hour70% paid $13 or more per hour 50% paid $15 or more per hour50% paid $15 or more per hour

Michigan Public Health Training Center October 9, 2007

DCHWs: DCHWs: Promoters of Healthy LifestylesPromoters of Healthy Lifestyles

Members of target Members of target communitiescommunities

Share cultural beliefs Share cultural beliefs and valuesand values

Share social and ethnic Share social and ethnic characteristicscharacteristics

Eliminate Eliminate communication barriers communication barriers

Act as role models for Act as role models for changechange

Disseminate information Disseminate information and educate familiesand educate families

Recommended Competencies of Recommended Competencies of Diabetes Community Health WorkersDiabetes Community Health Workers

The Final Report Of The National The Final Report Of The National Community Health Advisor Study; Community Health Advisor Study; CHW CHW Chapter Three: Core Roles and Chapter Three: Core Roles and Competencies of Community Health Competencies of Community Health Advisors Advisors

Competencies includeCompetencies include personal personal characteristics, qualities, characteristics, qualities, and and skillsskills that that DCHWs need to be effectiveDCHWs need to be effective

Personal Characteristics of Personal Characteristics of DCHWsDCHWs

Relationship with the community being Relationship with the community being servedserved

Personal strength and courage (healthy Personal strength and courage (healthy self-esteem and able to remain calm)self-esteem and able to remain calm)

Friendly/outgoing/sociableFriendly/outgoing/sociable Patient and compassionatePatient and compassionate Open-minded/not-judgmentalOpen-minded/not-judgmental Motivated and capable of self-directed workMotivated and capable of self-directed work Caring and empatheticCaring and empathetic

Personal Characteristics of Personal Characteristics of DCHWs (cont.)DCHWs (cont.)

Committed/dedicatedCommitted/dedicated Respectful and honestRespectful and honest Open/eager to grow/change/learnOpen/eager to grow/change/learn Dependable/responsible/reliableDependable/responsible/reliable Flexible/adaptableFlexible/adaptable Desire to help the communityDesire to help the community PersistentPersistent Creative/resourcefulCreative/resourceful

Skills of Diabetes Community Skills of Diabetes Community Health WorkersHealth Workers

Communication Communication

Interpersonal Interpersonal

Teaching Teaching

Knowledge BaseKnowledge Base

Skills of Diabetes Community Skills of Diabetes Community Health Workers (cont.)Health Workers (cont.)

Service Coordination Service Coordination

AdvocacyAdvocacy

Capacity-BuildingCapacity-Building

OrganizationalOrganizational

DCHW Training-OptionsDCHW Training-Options

Community Outreach Worker (WSU – 160 hrs.)Community Outreach Worker (WSU – 160 hrs.)

““Empowerment” education (developed at U of M Diabetes Empowerment” education (developed at U of M Diabetes Research and Training Center (DRTC)Research and Training Center (DRTC)

Attend a Diabetes Self-Management Training (DSMT) Attend a Diabetes Self-Management Training (DSMT) program provided by Certified Diabetes Educators (10 program provided by Certified Diabetes Educators (10 hours) hours)

DSMT programs: www.michigan.gov/diabetesDSMT programs: www.michigan.gov/diabetes

DCHW Training-TopicsDCHW Training-Topics

Human Subjects” (IRB) trainingHuman Subjects” (IRB) training Human enhancement skills Human enhancement skills Mental health (signs of depression, stress)Mental health (signs of depression, stress) Case management skillsCase management skills Cultural diversity/ competence trainingCultural diversity/ competence training Conducting assessments and collecting Conducting assessments and collecting

health datahealth data

DCHW Training-TopicsDCHW Training-Topics

Computer skills and use of the Internet Computer skills and use of the Internet Group facilitation/delivery of diabetes Group facilitation/delivery of diabetes

curriculumcurriculum Behavior modification techniques – goal Behavior modification techniques – goal

setting skills setting skills Understanding health disparitiesUnderstanding health disparities Other training needsOther training needs

National and State CHW National and State CHW Organizations/TrainingsOrganizations/Trainings

American Association of Community Health American Association of Community Health Workers (part of APHA, American Public Health Workers (part of APHA, American Public Health Association) Association) pam.chapman@spectrumhealth.orgpam.chapman@spectrumhealth.org

Michigan Community Advocate Association Michigan Community Advocate Association (MICAA) (MICAA)

Grand Rapids, MIGrand Rapids, MI Lisa Marie Fisher @ 616-356-6205)Lisa Marie Fisher @ 616-356-6205) Wayne State University: “Empowerment Skills Wayne State University: “Empowerment Skills

for Family Workers” Training Series for Family Workers” Training Series Joan Blount @ 313-827-7113Joan Blount @ 313-827-7113

Diversity TrainingDiversity Training

Ongoing Competency Ongoing Competency Component to DCHW TrainingComponent to DCHW Training

Ensures that the DCHW maintains current Ensures that the DCHW maintains current knowledge about the treatment and self-knowledge about the treatment and self-management of diabetesmanagement of diabetes

Provide frequent and regular diabetes Provide frequent and regular diabetes education opportunitieseducation opportunities

Suggestions for trainingSuggestions for training

DCHW Personal SuccessesDCHW Personal Successes

Survey showed a significant increase Survey showed a significant increase in knowledge of diabetes and self- in knowledge of diabetes and self- managementmanagement

Learning about diabetes prevention Learning about diabetes prevention and complications and how to educate and complications and how to educate othersothers

Perceive selves as making a Perceive selves as making a difference, influencing change, small difference, influencing change, small steps, “help get over the wall”steps, “help get over the wall”

DCHW Personal Successes DCHW Personal Successes (cont.)(cont.)

Increasing ability to relate to clients and Increasing ability to relate to clients and gain their trustgain their trust

Learning about computersLearning about computers Helping each other with resources and Helping each other with resources and

other DCHW tasksother DCHW tasks Learning to work with people across Learning to work with people across

culturescultures Developing their own healthier eating and Developing their own healthier eating and

exercise habitsexercise habits

DCHW EvaluationDCHW Evaluation

DCHW focus groups and survey administered to DCHW focus groups and survey administered to assess previous and current knowledge of assess previous and current knowledge of diabetes and self-management, attitudes, diabetes and self-management, attitudes, expectations, and assessment of the intervention expectations, and assessment of the intervention

DCHW client file audits, include quarterly review DCHW client file audits, include quarterly review of all files with follow up procedures, including a of all files with follow up procedures, including a specific timeline for completion, second review, specific timeline for completion, second review, and follow up actionand follow up action

DCHW effectiveness phone surveyDCHW effectiveness phone survey

How DCHWs Helped REACH How DCHWs Helped REACH Participants Meet Their GoalsParticipants Meet Their Goals

How FHA Helped Participants Meet Goals

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2

4

6

8

10

12

14

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Type of Help

Nu

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f R

esp

on

den

ts

Menu Ideas

Exercise Information

Exercise Encouragement

Event Information

Regular Contact

Attends Meetings

Attends Doctor Visits

Diabetes Education

Motivation/Support

Reminders

Glucose Monitoring Education

Journey to Health Classes

Health Eating Education

Information about Medications

Recommendations/Referals

Other

Responses To Rating QuestionsResponses To Rating QuestionsE/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable, E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable,

SC/NC=Somewhat Comfortable/Not ComfortableSC/NC=Somewhat Comfortable/Not Comfortable

96% of respondents reported feeling either very 96% of respondents reported feeling either very comfortable or comfortable contacting their comfortable or comfortable contacting their DCHW for needs or services.DCHW for needs or services.

93% of respondents rated their DCHW 93% of respondents rated their DCHW understanding of their experiences as an African understanding of their experiences as an African American or Hispanic as excellent or good.American or Hispanic as excellent or good.

In terms of doing what they said they would do, In terms of doing what they said they would do, 87% of respondents rated their DCHW as 87% of respondents rated their DCHW as excellent or good. excellent or good.

94% of respondents reported 94% of respondents reported either E/G:either E/G: relationship with DCHWrelationship with DCHW satisfaction with DCHWsatisfaction with DCHW

Respondents rated DCHWs Respondents rated DCHWs on their ability to: on their ability to: get them services to get them services to

improve their health improve their health (E/G=85% and F/P=15%) (E/G=85% and F/P=15%)

help them with help them with relationship with their relationship with their doctor (87% and 12%) doctor (87% and 12%) and communication with and communication with doctor (E/G=76% and doctor (E/G=76% and F/P=16%).F/P=16%).

FundingFunding

Private foundationsPrivate foundations

Federal (CDC, NIH, USDA)Federal (CDC, NIH, USDA)

State and local agencies and State and local agencies and health departmentshealth departments

The DCHW and the The DCHW and the Diabetes Care TeamDiabetes Care Team

Team care is a necessary component of Team care is a necessary component of effective chronic illness management per DCCT* effective chronic illness management per DCCT* and UKPDS** (NDEP*** Team Care booklet)and UKPDS** (NDEP*** Team Care booklet)

Skills and roles of different health care providers Skills and roles of different health care providers should be integrated and coordinated should be integrated and coordinated

The DCHW is an important member of this team, The DCHW is an important member of this team, particularly for high risk populations. particularly for high risk populations.

*The Diabetes Control and Complications Research Trial Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329 (14): 977-986.

**UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in subjects with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853.

***http://ndep.nih.gov/diabetes/pubs/TeamCare.pdf

The DCHW and the The DCHW and the Diabetes Care TeamDiabetes Care Team

DCHWs augment DCHWs augment the role of the diabetes educator the role of the diabetes educator

and other diabetes care team membersand other diabetes care team members

Promote trust to promote access to DSMT Promote trust to promote access to DSMT and other health care servicesand other health care services

Provide Provide diabetes self-management supportdiabetes self-management support after Diabetes Self-Management Trainingafter Diabetes Self-Management Training

Help diabetes educator provide culturally Help diabetes educator provide culturally sensitive care/educationsensitive care/education

DCHW: An DCHW: An Important Piece of Important Piece of

the Health Care Puzzlethe Health Care Puzzle

Important role of the diabetes health care Important role of the diabetes health care team, esp. for vulnerable populationsteam, esp. for vulnerable populations

Provide access to and act as liaison with Provide access to and act as liaison with diverse populationsdiverse populations

Serve as resources to their communities Serve as resources to their communities and to the advocacy and policy worlds*and to the advocacy and policy worlds*

*Perez LM and Martinez J. Community Health Workers: Social justice and policy advocates for community health and well-being. Am J Public Health. 2008; 98:11-14.

Thank you!Thank you!

For more information, contact:For more information, contact:

Dawn CraneDawn Crane

(517) 335-9504(517) 335-9504

craned@michigan.govcraned@michigan.gov

oror

REACH Detroit PartnershipREACH Detroit Partnership

www.reachdetroit.orgwww.reachdetroit.org