REACH: Engaging the Racial/Ethnic Population in Community Health Using Promotoras/Community

Health Workers

RACHEL KUTCHER; BONNIE LOCHNER; JASMINE MEYER; JACKIE MUNRO

04/02/14 THIS PRESENTATION WAS SUPPORTED BY COOPERATIVE AGREEMENT 1U58DP004710 FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION, THROUGH A CONTRACT FROM HIDALGO MEDICAL SERVICES CENTER FOR HEALTH INNOVATION. ITS CONTENTS ARE SOLELY THE RESPONSIBILITY OF THE AUTHORS AND DO NOT NECESSARILY REPRESENT THE OFFICIAL VIEWS OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION NOR THE HIDALGO MEDICAL SERVICES CENTER FOR HEALTH INNOVATION.

What does racial health equity mean to you?

History of REACH

Racial and Ethnic Approaches to Community Health Funded by Centers for Disease Control and Prevention(CDC)

Began in 1999 with REACH 2010.

Address health disparities in underserved racial and ethnic communities

Current REACH grantees working in over 80 communities nationwide.

Philosophy of REACH Community driven

Based in broad based community leadership teams with diverse membership

Mutual respect

Transparent process

Community and culturally relevant

Making healthy choices the easy choices in communities with historic lack of access

CHW component in 22 of previous 40 REACH US projects

In your experience, what is the work of promotoras/

community health workers?

% of Cost

POPULATION FOCUS

INDIVIDUAL / FAMILY SUPPORT AND EDUCATION

INTENSIVE INTERVENTION

The Bell Shaped Curve

% Population

Policy, Systems, Environmental Strategies (REACH)

Health Education Outreach Clinical Support

Care Coordination

Why Promotoras/CHWs?

•Already address social determinants of health through direct services: health education, insurance and other benefit enrollment, etc.

•Are members of the communities they serve and understand the structural barriers.

•Generally Spanish-English bilingual.

•Are trusted by community members and able to engage them.

REACH Su Comunidad

•4 partners

•Expand CHW model to include leadership for policy, systems, and environmental strategies

•What is policy, systems, environmental change?

•10 communities, 5 states: Arizona, New Mexico, Oregon, Texas, Washington

•Specific focus on Hispanic/Latino communities

•Access to healthy food and physical activity opportunities

La Familia Medical Center REACH Program •Objectives – Policy, Systems, and Environmental Strategies

•Challenges in engaging historically marginalized community in Santa Fe

•Community Storytelling

What is Community Storytelling?

What is Community Storytelling?

Documentary Filmmaking about Food

Chris Sanchez Supports Yoga in Schools

http://www.youtube.com/watch?v=t-ErNuihtuk

Community Engagement

How do CHWs engage community

members and ensure community

participation on CLT?

TRAINING AND SUPPORTING Community Health Workers

Community Health Workers at La Familia Medical Center

REACH program: Engaging in population-wide strategies focused on increasing access to healthy foods and physical activity

CENA program: Direct service pediatric obesity intervention project, nutrition education, home visits, cooking classes, community garden

OB program: Lactation assistance, pre/postnatal health education classes, newborn care, gestational diabetes management, home visits throughout pregnancy and 8 weeks postpartum

Diabetes program: Diabetes management

Behavioral Health: Case Management

Health Care Guides: Assistance with ACA, medicaid expansion and health insurance exchange

Scope of Practice •Their role as a community health worker

• Specific hands on skills needed

• Specific training around disease management

•Boundaries; personal and professional • Living vs working in their community

• Peer-to peer learning

• Drawing from personal experiences

•HIPPA Confidentiality

CHWs in a primary care organization

•Understanding the organizational structure

•Getting to know co-workers not directly working with

•Working within a medical “team”

•Resources within the organization

CHWs with REACH: Communication Skills • Communicating to the community Method: Email, phone calls, text, flyers, social media, websites (English vs. Spanish)

Effectiveness, how to evaluate

• Communicating to our Community Leadership Team

• Communicating to leaders, board members, elected officials, media, and conference presentations

Community Engagement

• Organizing well-attended community meetings

• Imparting policy literacy to community members

• Using multi-media community storytelling

• Listening and coming up with solutions in partnership with community members

The Role of Primary Care Clinics and Community Health Programs

Primary Health Care Clinic and Community Health Programs

The Evidence:

Only 10-25 percent of the variance in health over time is due to medical care, the rest is shaped by

1. genetics (up to 30 percent) 2. health behaviors (30-40 percent) 3. social and economic factors (15-40 percent) 4. physical environmental factors (5-10 percent)

Franks P, Clancy C, Gold M. “Health Insurance and Mortality. Evidence from a National Cohort.” Journal of the American Medical Association, 27(6):737-741. 1993; County Health Rankings. University of Wisconsin Population Health Institute. 2011. http://www.countyhealthrankings.org/our-approach; and McGinnis JM, Williams-Russo P, Knickman JR. “The Case for More Active Policy Attention to Health Promotion.” Health Affairs. Vol. 21, No. 2. March/April 2002.

Case Study

The immigrant family where the mother has hypertension, the father has diabetes, and the children are struggling with obesity (which will eventually shorten their lives and afflict them with diabetes, hypertension, heart disease, liver disease and more) I (the medical provider) can treat their illnesses when they occur, I (the medical provider) can even recommend better diets and more exercise, but if the family is poor and living in a crime-ridden neighborhood in a food desert, accessing those ingredients necessary for a healthy lifestyle may be impossible for them.

Challenges: Areas outside of medical model

• Poverty

• Housing issues

• Safety

• Access to healthy foods

• Access to physical activity

• Immigration

Community Health Programs @ LFMC

1. REACH/CENA programs addresses the critical problems at the roots of obesity in our community

2. A medical case manager is on call all the time to help patients address their social issues and connect them with community resources.

3. Integrated behavioral health program employs counselors, case managers and community health workers to help patients deal with their mental health problems holistically.

4. OB education department includes a case manager/counselors, an RN Manager and 3 community health workers to help new families.

Caring for the Whole Person

Community Health Clinics can point the way forward for health care providers looking for ways to help care for the whole person by employing these innovative programs

In 2010 alone, Community Clinics in the U.S. served nearly 19.5 million patients through over 8,100 locations in every state in the nation.

The Community Clinic movement evolved out of a recognition that for these marginalized populations, just providing “medical” care isn’t enough and primary care must extend beyond the illness being treated to include the patient’s family dynamics and whatever community factors might be affecting the patient’s health

Funding Primary-Care Based Community Health

Medicaid/MCOs

Per member per month concept ◦Patient health status “level” ◦Cost for each service level

Thank You!

Contact Information La Familia Medical Center

Bonnie Lochner: blochner@lfmctr.org

Jasmine Meyer: jmeyer@lfmctr.org

Jackie Munro: jmunro@lfmctr.org

HMS Center for Health Innovation

Rachel Kutcher: rkutcher@hmsnm.org