The Transcultural Community The Transcultural Community Health Initiative:Health Initiative:

Community Health WorkersCommunity Health Workers Bridging the Gap Bridging the Gap

RIH Community Service RIH Community Service Committee UpdateCommittee Update

03 November 200503 November 2005

Dannie Ritchie MD, MPHDannie Ritchie MD, MPHCenter for the Study of Race and Ethnicity in AmericaCenter for the Study of Race and Ethnicity in America

Brown UniversityBrown University

(Social Determinants of Health(Social Determinants of HealthHealth Disparities – not in this Health Disparities – not in this

excerpt)excerpt)Community Health WorkersCommunity Health Workers

Community Health Workers Community Health Workers AndAnd

Community Health Worker Community Health Worker SurveySurvey

Spring 2005Spring 2005

Community Health Worker Community Health Worker DefinitionDefinition

A frontline public health worker who serves as a link A frontline public health worker who serves as a link to resources which promote the health and well to resources which promote the health and well being of individuals and communities, and being of individuals and communities, and facilitates access to service providers by applying facilitates access to service providers by applying his or her unique understanding of the experiences, his or her unique understanding of the experiences, language and culture of the community he or she language and culture of the community he or she services, carrying out at least one of the seven core services, carrying out at least one of the seven core roles:roles: Bridging between communities and health and social service Bridging between communities and health and social service

systems (two-way cultural mediation);systems (two-way cultural mediation); Providing culturally appropriate health education and information;Providing culturally appropriate health education and information; Assuring people get services they need;Assuring people get services they need; Providing informal counseling and social support;Providing informal counseling and social support; Advocating for individual and community needs;Advocating for individual and community needs; Providing direct service, such as basic first aid and administering Providing direct service, such as basic first aid and administering

health screening tests; andhealth screening tests; and Building individual and community capacity.Building individual and community capacity.

Survey ResultsSurvey Results CHW Inclusion CriteriaCHW Inclusion Criteria Response RateResponse Rate Educational RequirementsEducational Requirements Training RequirementsTraining Requirements Formal CurriculumFormal Curriculum Qualities looked forQualities looked for Numbers Organization ServedNumbers Organization Served Volunteer or SalariedVolunteer or Salaried

CHW Inclusion CriteriaCHW Inclusion Criteria

Share common experience, language, or Share common experience, language, or culture with the communities they serveculture with the communities they serve

Promote healthy living through educationPromote healthy living through education Help community residents understand and Help community residents understand and

gain access to formal health and human gain access to formal health and human service systemsservice systems

Coordinate client interaction with services Coordinate client interaction with services

Response RateResponse Rate Of 62 agencies 52 responded - rate Of 62 agencies 52 responded - rate

83.8% 83.8% 42 completed the survey42 completed the survey 38 of the respondents qualified 38 of the respondents qualified 10 were responsive but did not 10 were responsive but did not

complete their surveycomplete their survey 10 either were non-responsive or had 10 either were non-responsive or had

missing contact information.missing contact information.

Educational RequirementsEducational Requirements

Educational Requirement

0

2

4

6

8

10

12

14

16

18

NoRequirements

Associates Bachelors Bachelors + No Response

Age

ncie

s' R

equi

rem

ent

Number Population ServedNumber Population ServedNumbers Population Served

0

2

4

6

8

10

12

14

16

> 3000 1,000-2,999 500-999 < 499 no answer

Volunteer or Salaried StaffVolunteer or Salaried StaffVolunteer or Salaried Staff

0

5

10

15

20

25

both volunteers andsalaried staff

only volunteer staff only salaried staff

TCHI DesignTCHI Design

Model Community Health Worker Model Community Health Worker Program to foster Community-Program to foster Community-

driven interventionsdriven interventions

LaborDepartment

HealthInstitutions

Academia

Legislature

Federal and State

Public Health

Agencies Communities

CHWs

CBOs

RI Institutional Infrastructure and Resources

Chain of Information to Action Chain of Information to Action -- CIA CIA CHW’s Enhancing CommunicationCHW’s Enhancing Communication

Process – ProgressProcess – ProgressCHW Core Competencies/SkillsCHW Core Competencies/Skills

communication skillscommunication skills interpersonal skillsinterpersonal skills knowledge baseknowledge base capacity-building skillscapacity-building skills advocacy skillsadvocacy skills teaching skillsteaching skills organizational skillsorganizational skills

Process – ProgressProcess – ProgressTCHI PROGRAM TRAINING OVERVIEWTCHI PROGRAM TRAINING OVERVIEW

Session 1: Intro to CHW Training Session 1: Intro to CHW Training Session 2: CommunicationSession 2: CommunicationSession 3: Teaching Others Session 3: Teaching Others

Session 4: Leadership & Facilitation Session 4: Leadership & Facilitation Session 5: Comm. Health Promotion & Capacity Building I Session 5: Comm. Health Promotion & Capacity Building I

Session 6 : “ “ “ “ “ II Session 6 : “ “ “ “ “ II Session 7: “ “ “ “ “ III Session 7: “ “ “ “ “ III Session 8: Self-care Skills Session 8: Self-care Skills Session 9: CPR & First Aid Session 9: CPR & First Aid Session 10:Working With Individuals & Families I Session 10:Working With Individuals & Families I Session 11: “ “ “ “ IISession 11: “ “ “ “ IISession 12: GraduationSession 12: Graduation

Social Value ContextSocial Value ContextDecrease Health Disparities thru effects Decrease Health Disparities thru effects

on Social Determinants of Health by:on Social Determinants of Health by: Building community capacityBuilding community capacity

– Building a diverse health workforceBuilding a diverse health workforce– Creating job training and employment for Creating job training and employment for

adult workforceadult workforce– Increasing literacy and Health literacyIncreasing literacy and Health literacy– Providing a link for Providing a link for

engagement/participationengagement/participation

CHWs: CHWs: RI and National contextRI and National context

The initiative works on many levels: The initiative works on many levels: – It improves existing networks for It improves existing networks for

educational options educational options – It creates opportunities in a new labor It creates opportunities in a new labor

forceforce– It promotes community organizations It promotes community organizations

advocacy, and health literacyadvocacy, and health literacy

Social Infrastructure ContextSocial Infrastructure ContextCHWs Bridging the GapCHWs Bridging the Gap

By applying his or her unique By applying his or her unique understanding of the experiences, understanding of the experiences, language and culture of the communities language and culture of the communities he or she serves, CHWs can: he or she serves, CHWs can: – Be a wraparound service that overcomes Be a wraparound service that overcomes

logistical and cultural barriers to carelogistical and cultural barriers to care– Contribute to Continuity of CareContribute to Continuity of Care– Be the voice of the community and part of the Be the voice of the community and part of the

community integration in the health care teamcommunity integration in the health care team

Direct services Direct services CHWs Bridging the GapCHWs Bridging the Gap

Create resource data bankCreate resource data bank Outreach services (i.e. health education, health Outreach services (i.e. health education, health

promotion, B.P. screening, motivate people to promotion, B.P. screening, motivate people to seek care, take people to services, make seek care, take people to services, make referrals)referrals)

Link to social service (i.e. assistance with social Link to social service (i.e. assistance with social service applications)service applications)

Informal counseling and social support (i.e. Informal counseling and social support (i.e. leading social support groups)leading social support groups)

Current PlanCurrent Plan

Current PlanCurrent Plan Refinement of CHW Core Curriculum Refinement of CHW Core Curriculum Training of the Trainer and Training of the Trainer and

preparation of the Participant manualpreparation of the Participant manual CHW’s Recruited CHW’s Recruited CHW Curriculum Program CHW Curriculum Program

Implemented Implemented