COMMUNITY HEALTH WORKER NETWORK OF NYC Community Health Workers History, Identity, Financing...

COMMUNITY HEALTH WORKER NETWORK OF NYC

Community Health Workers History, Identity, Financing

Creating a Healthy CommunityP2 Collaborative of WNY Conference

September 25, 2009Buffalo, New York

Sergio Matos, CHWCommunity Health Worker Network of NYC - Executive Director

Columbia University - Director for CHW Development


We want freedom...

We want justice and peace...

We want completely free healthcare for all people...

We want decent housing for all people...

We want education that teaches us our history and our

role in present-day society...

We want land, housing, education, food and clothing...

We want the power to determine the destiny of our

communities...

We want opportunity and full employment...

We want an immediate end to all wars of aggression...


OverviewOverview

CHW historyCHW history CHWs in the USCHWs in the US The CHW identityThe CHW identity CHW effectiveness CHW effectiveness The future of CHWsThe future of CHWs


CHW – A tradition

Health Promoters in Latin America Village Health Workers in Mexico, Africa, Indonesia and

Europe Feldshers in Russia Barefoot Doctors in China Community Activists in NGOs, CBOs and FBOs Community Health Representatives in Native American

Nations Neighborhood Health Representatives in U.S.

Note: CHWs is not a medical model. It is a social concept that has always been a piece of society.


Background

World Health Organization, 1978 Primary health care approach adopted as most effective way to

achieve health for all - Prevent illness & promote health Names CHWs as integral member of healthcare teams Guiding Principles

Accessibility, public participation, health promotion, intersectoral cooperation

World Health Organization, 1987 Providing sophisticated hospitals and highly trained staff is not the

most efficient way to improve health

Guiding principle to utilize CHWs Support communities to identify their own capacities and health needs Help people solve their own health problems Extend health services to where people live and work


CHWs in the U.S.

1960s - Community Health Representatives - NACHR

1970s - Neighborhood Health Representatives in Unites States

1978 - Community Health Workers - WHO

1998 - Community Health Advisers – National Community Health

Advisor Study

2002 - American Public Health Association Supports CHWs

2004 - Institute of Medicine Supports CHW (Unequal Treatment)

2005 - WHO 3-by-5 Initiative demands tens of thousands of CHWs

2009 - Executive Office of President of the U.S. publishes 2010

Standard Occupational Classification to include unique CHW

classification (soc 21-1094)


Community realities CHWs find Mistrust of healthcare system Fear of government, police and authority Terror of Homeland Security Poverty & economic insecurity Experience that personal information is

shared – informed consent Past experience with healthcare system

Note: These social and psychosocial pressures have health consequences that then present in the medical setting – but have no medical solution.


What do CHWs do?

Respond to individuals, family & community Create change Promote liberation through education & organizing Promote development, freedom and independence Develop social networks and supports Organize communities Advocate for justice and equality Improve maturity of institutions


Too many titlesCase Worker, Community Follow-up Worker, Community Health Advocate, Community Health Adviser, Community Health Aide, Community Health Outreach Worker, Community Health Rep., Community Health Specialist, Community Health Worker, Counselor, Eligibility Worker, Family Health Promoter, Family Support Worker, Health Advisor, Health Facilitator, Health Information Specialist, Health Promoter, Health Liaison, Health Specialist, Outreach Worker, Outreach Specialist, Patient Navigator, Peer Counselor, Peer Educator, Peer Health Advisor, Peer Health Educator, Peer Worker, Promotor(a), Public Health Aide, Public Service Aide, Social Worker Assistant, Addiction Treatment Specialist, HIV/AIDS Educator, HIV Disclosure Counselor, Mental Health Aide, Nutrition Assistant, Pre-Perinatal Health Specialist, Volunteer, Women’s Health Specialist

Addiction Treatment Specialist, HIV/AIDS Educator, HIV/STD Prevention Counselor, HIV Risk Assessment/Disclosure Counselor, Mental Health Aide, Nutrition Assistant, Pre-Perinatal Health Specialist, Women’s Health Specialist


CHW organizing

Community Health Worker Network of NYC An independent professional association of

CHWs. Mission – To establish a CHW identity and

assume leadership of policy and practice issues relevant to our field.

Non-member organization CHW-led governance structure Evolved a policy and training focus


CHWs are…Community Health Workers are trustedmembers of the communities they serveand function as frontline health and socialservice providers and communityorganizers. Community Health Workers function within thecultural, linguistic, social, spiritual and economicvalue systems of the community.

*Endorsed by The Community Health Worker Network of NYC


National CHW definition

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 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.

- Endorsed by American Public Health Association, 2008- Submitted to US Dept of Labor, 2008- Adopted by Community Health Worker Network of NYC, 2008


How do CHWs function?

Trust & Respect Shared Life Experiences Understanding & Empathy Compassion Creativity/Resourcefulness Empowerment Approach vs. Service Delivery Self-reliance, Self-sufficiency


CHW roles — a continuum

Service Functions

Development Functions

2° and 3° Care

Mobilizing community members to seek services

Narrow Disease Focus

Extenders of health care system

1° Care

Mobilizing community members to create healthy community

Holistic, ecological approach

Community change agents


Challenge of priorities


CHW effectiveness

Reduce ER visits & preventable hospitalizations Increase primary care and well care visits Reduce cost of chronic disease care – asthma,

diabetes, CVD, HIV/AIDS Improve pre- and perinatal care & birth outcomes Reduce health disparities – immunizations in NYC Increase health insurance enrollment Positive effect in interventions – STDs, Smoking

cessation, Violence, Teen pregnancy


Evidence-base on CHWs

Davis et al 2007: CHWs can focus on the “how” of diabetes management, yet we do not document sufficiently exactly what CHW do with patients.

Norris et al. 2006: CHWs are effective as team members to promote improvements in participant knowledge and behavior, but many gaps in knowledge about the best setting/niche for their contributions to the care of persons with diabetes. Too few studies document health outcomes. Only 8 RCTs, and only 2 with strong designs.

Babamoto KS et al. 2009: Improving diabetes care and health measures among Hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav.

Gary TL et al. 2004: A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes.


Evidence-base on CHW effectiveness

Swider 2002: CHWs improve access to care, but few studies and inclusive results regarding health literacy, behavior change, and selected health outcomes. Need for clarity and documentation of role of CHWs.

Nemcek and Sabatier 2003: Quality of Care indicators key to assessing CHW effectiveness. Emphasis has been on health care utilization, risk reduction, and patient education, less on health outcomes.

Lewin 2005: Very few RCTs, but these show effectiveness of CHW to improve outcomes for selected problems (immunization, maternal/infant care). Need for more RCTs.

CDC Ongoing RCTs in NYC


CHWs improving health care

CHWs are trusted by the people they serve Access to truthful and accurate information – improve institutions Relationship guided by client priorities Improve access to and use of routine medical care services Improve client recruitment and retention Improve cultural and linguistic appropriateness of health care

systems and services Facilitate improved communication with providers – honest

accurate information Assistance navigating complicated Tx regimens Provide education about health promotion & disease

prevention/management Promote healthier lifestyle behaviors - diet, activity, monitoring Build social support and positive reinforcement among family and

friends


System challenges

Healthcare is a commodity – influenced by market forces Business case - investing entity realizes a financial return on its

investment in a reasonable timeframe. Social case - healthcare providers are mainly seeking to provide

good care for their patients Challenges

Data collected influenced by business values Benefits of your investment might be enjoyed by another entity

(externalitity) Payoffs on investment may occur far in the future – not

benefiting the innovator Investment may reduce need for future services – reduces your

revenues


The challenge of assessing CHW effectiveness

CHWs address social and psycho-social determinants of health Not valued in business modeling Focus on evidence base & clinical outcomes Externality ROI might not be timely enough

CHW contributions are both qualitative and quantitative Effect on utilization of healthcare services Effect on improving cultural and linguistic utility of healthcare

services

Albert Einstein - "Not everything that can be counted counts, and not everything that counts can be counted."


Establishing CHW in NYS


Establishing CHW in NYS

Build broad statewide coalition of CHWs and stakeholders with CHW leadership

Develop consensus identity and definition Establish scope of practice Develop appropriate credential process Reach consensus on potential training standards Build the CHW business case Conduct advocacy Develop stable sustainable financing models


Lessons Learned

1. Recognize, respect and value CHW unique roles in healthcare

2. Organize CHWs at local, regional and national levels

3. Support CHW leadership of policy and practice issues –

credentialing, training, scope of practice, financing

4. Embrace CHW self-determination – maintain identity & traditions

5. Provide appropriate training content and training pedagogy – core

skills plus specialty areas – NYC study

6. Involve CHWs in all aspects of program development- planning,

implementation, training, supervision, management and evaluation

7. Recognize, value and respect CHWs as members of a practice

8. Resist the urge to make CHWs like “Us”


Questions & Comments


We want freedom...

We want opportunity and full employment...

We want completely free healthcare for all people…

We want decent housing for all people...

We want education that teaches us our history and our role in present-day

society...

We want land, housing, education, food and clothing…

We want justice and peace…

We want the power to determine the destiny of our communities...

We want an immediate end to all wars of aggression...

Excerpts from the Ten Point Program, 1966

The Black Panther Party – a community-based, non-profit research, education, and advocacy center dedicated to fostering progressive social change.


Contact Information

Sergio Matos, CHWExecutive Director

Community Health Worker Network of [email protected]

917-653-9699

Director for CHW Training and DevelopmentColumbia University – Mailman School of Public HealthHeilbrunn Department for Population and Family Health

[email protected]

COMMUNITY HEALTH WORKER NETWORK OF NYC Community Health Workers History, Identity, Financing...

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