Community Health Workers 101

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MiCHWA is supported by a grant to the University of Michigan School of Social Work from the

Michigan Community Health Worker Alliance (MiCHWA)

The Michigan Community Health Worker Alliance’s mission is to promote and sustain the integration of community health workers into Michigan’s health and human service systems through coordinated changes in policy and workforce development.

MiCHWA’s Partners

CHW DefinitionA Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW 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.

A CHW also builds 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, Community Health Worker Section 2009

What are CHWs called in Michigan?• Camp Health Aide• Case Work Aide • Community Care Coordinator• Community Health Advocate• Community Health Promoter• Community Health Worker• Community Neighborhood Navigator• Community Outreach Worker• Family Health Advocate• HIV Peer Counselor • Lay Health Advisor

• Maternal Child Health Worker• Neighborhood Health Advisor• Outreach Specialist• Parent Support Partner• Patient Health Navigator• Patient Navigator• Peer Support Specialist• Promotor(a) de Salud • Public Health Aide• Recovery Coach• Weight Loss Counselor

Source: Rush CH. Promoting policy and systems change to expand employment of community health workers (CHWs). Centers for Disease Control Division for Heart Disease and Stroke Control. http://www.cdc.gov/DHDSP/pubs/chw_elearning/cdc_session_1_page_6_dhdsp.html. Updated November 14, 2011. Accessed July 8, 2013. Michigan Community Health Worker Alliance Employer Survey 2012.

CHWs in Michigan• How long have they been here?

– CHWs were first trained to provide services in Michigan in the 1960s

• Where do they provide services? – Homes, clinics, community centers,

schools, hospitals

• Who employs them? – Non-profits, health systems, Federally Qualified Health Centers, government

agencies, academic or research institutions – Programs including Healthy Start and the Maternal Infant Health Program at

some program sites

CHWs & supporters pose at the MDPH Advocate Conference in the early 1990s. Photo courtesy of Rebeca Guzman.

Source: Michigan Community Health Worker Alliance Employer Survey 2012.

What do CHWs do in Michigan?Health Areas in which CHWs work• Cancer Screening & Prevention• Diabetes• Enrollment• Heart Disease• Housing• Hypertension• Infant Mortality• Maternal/Child Health• Migrant Health• Nutrition• School-based health

Source: Michigan Community Health Worker Alliance Employer Survey 2012.

Photo courtesy of Rebeca Guzman and Anne Lee

Why Community Health Workers?• Directly address health disparities– Build trust in communities, work with patients and

providers, reach disadvantaged populations, provide culturally competent assistance, promote health

• Improve health outcomes– Asthma, hypertension, diabetes, cancer, infant mortality,

HIV/AIDS• Contain costs for health and social service systems– Reduce ED visits, increase number of kept appointments,

improve adherence

Cost Savings EvidenceReturn on Investment• $2.53 savings for every $1.00 (Spectrum Health in Grand Rapids)

• $350,000 in recovered costs (Health Project in Muskegon)

• $4.00 savings for every $1.00 of cost (Molina Healthcare of New Mexico)

• $2.28 saving for every $1.00 invested in the program (Denver Health)

National Policy: PPACA 2010The Patient Protection & Affordable Care Act cites CHWs: • §5101: CHWs listed as “health professionals” and as an important

part of the health care workforce; a comprehensive CHW definition is included

• §5313: CDC authorized to fund agencies who train and use CHWs to promote positive health behaviors and outcomes for populations in medically underserved communities; CHW functions include outreach, enrollment, and patient education

• §5403: mandates Area Health Education Centers to provide interdisciplinary training of health professionals, including CHWs

Source: Martinez J, Ro M, Villa NM, Powell W, Knickman JR. Transforming the delivery of care in the post-health reform era: what role will community health workers play? American Journal of Public Health. 2011;101(12):e1-e5.Rush CH. Professionalism and the Experience-Based Expert: CHWs Walking in Two Worlds: Part 2. 2012. Presentation: Spectrum Health Community Health Worker Conference, Grand Rapids, Michigan, August 22.PPACA 2010.

The Problem: CHW Sustainability

Existing policy and payment structures encourage CHW programs to depend on time-limited grants and other unsustainable mechanisms that limit the impact CHWs have in their communities to combat health disparities in Michigan.

CHW SustainabilityWhat are the barriers? How do we overcome them?

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Michigan Community Health Worker Alliance

Barriers to CHW SustainabilityTo the Programs• Lack of training programs• Unstable funding

– Grants, time-limited• Lack of recognition

– By providers, funders, policymakers

– Of CHW roles and CHW impact

To the Profession• Lack of training standards• Unstable funding

– Lack of job security, benefits• Lack of recognition

– As professionals– For the training they have and

the expertise they bring to their clients and employers

My Story:

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What does MiCHWA do?1. Strengthen and maintain the infrastructure

of MiCHWA2. Strengthen and support CHW workforce

development and education in Michigan3. Identify and develop sustainable policies and

financing mechanisms for CHWs in Michigan4. Develop and sustain effective communication

mechanisms for MiCHWA and CHWs in Michigan

5. Grow and strengthen a vibrant network of diverse CHWs and CHW supporters throughout Michigan

6. Develop and implement a process, context, and outcome evaluation of MiCHWA

Education & Workforce

The Education & Workforce Working Group seeks to strengthen and support CHW workforce development and education in Michigan

• Increase working group membership by 25%• Engage and collaborate with CHW employers in order to develop a workforce

development plan for the utilization and sustainability of CHWs in Michigan• Determine a recommendation for incumbent worker certification (grandfathering) of

CHWs in Michigan• Present a recommendation for governance of CHW professional recognition and/or

certification in Michigan to the Steering Committee

Education & Workforce Working Group 2014 Objectives

Policy & Finance

The MiCHWA Policy and Finance working group seeks to identify and develop sustainable policies and financing mechanisms for CHWs in Michigan

• Develop summary detailing return on investment evidence using data Identify processes, mechanisms, and outreach strategies needed to include CHWs as paid or reimbursed providers or health care team members

• Explore and advocate for state action supporting the creation of a Medicaid State Plan Amendment implementing the Federal Register July 15, 2013 ruling

• Monitor and seek opportunities to collaborate with partners and State-level projects • Create additional products to be used in communications with decision makers

Policy & Finance Working Group 2014 Objectives

Communications

The MiCHWA Communications working group seeks to develop and sustain effective communication mechanisms for MiCHWA and CHWs in Michigan

• Assist MiCHWA working groups with communications needs as detailed in their objectives and activities

• Launch and implement a statewide campaign to increase awareness of MiCHWA and CHWs in Michigan through the Web, social media, email, and product creation and dissemination

• Update existing MiCHWA communications mechanisms through stakeholder input, review, and collaboration

Communications Working Group 2014 Objectives

Michigan CHW NetworkThe CHW Network is a CHW-led working group that seeks to grow and strengthen a vibrant network of diverse CHWs and CHW supporters throughout Michigan

• Increase Network participation• Increase awareness of MiCHWA and the CHW Profession• Increase CHW awareness of MiCHWA’s activities and working groups• Plan, promote, and participate in CHW Month• Gather CHWs in person at the regional or state level for peer support• Have at least 2 CHW Network members involved with the APHA CHW Section• Collaborate with CHW networks nationwide

Michigan CHW Network Working Group 2014 Objectives

Evaluation Advisory BoardThe Program Evaluation Advisory Board seeks to develop and implement a process, context, and outcome evaluation of MiCHWA

• Identify and provide initial report of measures and results from return on investment studies of CHW programs

• Study, review, and finalize recommendation of standard common indicators • Design, launch, and analyze a statewide CHW Program Survey • Complete MiCHWA’s process, context, and outcome evaluation • Build capacity for and develop process to implement evaluation consultancies • Collaborate with the Curtis Center Program Evaluation Group (CC-PEG)

Program Evaluation Advisory Board 2014 Objectives

Getting Involved• Attend a CHW Network in-person

meeting (~3 times per year)• Participate in a working group via

conference call once per month• Become a working group co-leader• Join MiCHWA’s Steering Committee• Raise awareness about CHWs during

CHW Month and beyond• Attend MiCHWA events throughout

the year

CHW Octavia Smith helps report her group’s results at the MiCHWA Regional Meeting on certification in Detroit.

How do CHWs connect?• MiCHWA Meetings & Events• Social Gatherings• Training Opportunities Left: CHWs at WHLI training in

Oscoda; Below: CHWs at the Grand Rapids Regional Meeting;

Right: CHWs at the Detroit Regional Potluck in June

Connecting Online• Facebook: Michigan Community

Health Worker Alliance • Twitter: @Mi_CHWA• Website: www.michwa.org• YouTube: MichiganCHWAlliance

Final Thoughts: Call to ActionBe a part of promoting and sustaining community health workers in Michigan

1. Join MiCHWA2. Join a MiCHWA working group3. Spread the word about MiCHWA!

– Download toolkits on MiCHWA’s website– Send out the link to MiCHWA’s website– Connect with us on social media

Thank You

For more information about MiCHWAPlease visit our website, www.michwa.org

or email info@michwa.org

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MiCHWA is supported by a grant to the University of Michigan School of Social Work from the

Sonia, a Spectrum Health CHW, assists a client understand her baby carrier. Photo courtesy of James Graessle.