The Future of Community Health Workers in Connecticut

June 26, 2018Moderator: Quynh Tran, Grossman HeinzPresenter: Meredith C. Ferraro, MS, Executive Director, Southwestern AHEC

Objectives

At the end of this presentation, the participant will be able to:

• Describe who Community Health Workers (CHWs) are• Identify the importance of the qualities of CHWs• Explain three ways that CHWs can work to benefit your

patients with complex needs• Illustrate how CHWs can improve health equity

Who CHWs are, What CHWs do, and How CHWs can be used

Connecticut CHW DefinitionAs Approved by the SIM CHW Design Group on September 29, 2016

“A Community Health Worker (CHW) is a front line public health worker

who is a trusted member of, and/or has a unique understanding of the

experience, language, culture, and socioeconomic needs of the

community served. A CHW serves as a liaison/intermediary between

individuals, communities and health and social services to facilitate access

to care, improve the quality and cultural responsiveness of service

delivery, and address social determinants of health.

Connecticut CHW Definition con’t.As Approved by the SIM CHW Design Group on September 29, 2016

CHWs build individual and community capacity by increasing

health knowledge and self-sufficiency through a range of culturally

appropriate services such as: outreach and engagement;

education, coaching, and informal counseling; social support;

advocacy; care coordination; basic screenings and assessments;

and research and evaluation.”

Case manager

Promotor(a) de salud

Outreach Specialist

Community care coordinator Patient NavigatorLay Health Worker

Community Health Educator

Outreach worker

Parent Aide

Family Health Advocate

Home Visitor

Outreach Advocate

Youth Worker

Community Health Worker Umbrella

Certified Application Counselor

Making a Connection

http://w

ww.cachw

.org/abo

ut-us/

What Is Distinctive About CHWs?

• Do not provide clinical care• Generally do not hold another professional license• Expertise is based on shared life experience (and often culture) with people

served

Carl H. Rush, MRP

University of Texas

Institute for Health Policy

What Is Distinctive About CHWs? (Con’t.)

• Rely on relationships and trust more than on clinical expertise• Relate to community members as peers rather than purely as

clients• Can achieve certain results that other professionals can't (or

won't)

Carl H. Rush, MRPUniversity of Texas

Institute for Health Policy

Summary of theRole of Community Health Workers

in Health Reform

Social Determinants of Health (SDOH)

Compliments of Dr. Bruce Gould

Addressing Social Determinants of Health (SDOH) through Community Health Workers: A Call to Action

• 21 Recommendations to support the work of CHWs to address SDOH1. Payment for CHW Services2. CHW Caseloads3. CHW Recruitment4. CHW Training5. Reflective and Trauma-Informed

Mentoring and Supportive Supervision of CHWs

6. Integration of CHWs into Care Teams7. Documenting the Effects of CHW

Services on SDOH

http://hispanichealthcouncil.org/images/Brief2018.pdf

What CHW’s Do in CT Statewide Survey in 2012-13

• In 2012-13, Yale School of

Epidemiology and Public Health

students created, implemented and

analyzed a survey for CHWs and

Employers throughout Connecticut. • 43 CHWs and 97 Employers

responded. Areas of Focus:

• Community Health Worker

Characteristics

• Health Care Employer Characteristics

• Training

• Reimbursement

What CHW’s Do

Com m unity H ealth W orkers: Connecticut, Survey of CH W s and Em ployers. Southw estern AH EC, 2014.

ROLES

Cultural Mediation

Health Education

Care Coordination & Navigation

Coaching and

Social Support

Advocacy

Building Capacity

Provide Direct

Service

Assessments

Outreach

Research and

Evaluation

CHW Core Consensus Project (C3)

http://www.chrllc.net/id12.html

Qualities of CHWs CHW Core Consensus Project – C3

• Connected to the community• Strong and courageous• Friendly/outgoing/sociable• Patient• Open-minded/non-judgmental• Motivated and capable of self-

directed work• Caring• Empathetic• Committed/dedicated

• Respectful• Honest• Open/eager to grow/change/learn• Dependable/responsible/reliable• Compassionate• Flexible/adaptable• Desires to help the community• Persistent• Creative/resourceful

Are these items that are normally considered in hiring, or in a job interview?

How are CHWs Used?

Remember all of those names?

Examples of how CHWs are used

• Insurance enrollment• HIV case management• Community Action Agency staff• Peer Advisors for behavioral health

and substance abuse• Follow-up after hospital discharge

and ER visits• Asthma Home visiting• CEDP and WISEWOMAN – Cancer

and Cardiovascular screening and life style changes and support• Many others

CHW ROLES and Scope of Practice

Outreach/Community MobilizingPreparation and d issem ination of m aterials Case-find ing and recru itm entCom m unity Strengths/N eeds Assessm entH om e visitingProm oting health literacyCom m unity advocacy

Case Management/Care CoordinationFam ily engagem entIndividual strengths/needs assessm entAddressing basic needs – food, shelter, etc.Prom oting health literacyG oal setting, coaching and action p lanning Supportive counselingCoordination, referrals, and fo llow -upsFeedback to m edical providersTreatm ent adherence prom otion D ocum entation

Home-based SupportFam ily engagem entH om e visitingEnvironm ental assessm ent Prom oting health literacySupportive counselingCoaching on problem solving Action p lan im plem entationTreatm ent adherence prom otion D ocum entation

Health Promotion & CoachingTranslation and interpretation Teaching health prom otion and preventionTreatm ent adherence prom otion Coaching on problem solving M odeling behavior change Prom oting health literacyH arm Reduction

System NavigationTranslation and interpretation Preparation and d issem ination of m aterials Prom oting health literacyPatient navigation Addressing basic needs – food, shelter, etc.Coaching on problem solving Coordination, referrals, and fo llow -upsD ocum entation

Community/Cultural LiaisonCom m unity organizing Advocacy Translation and interpretation

Participatory ResearchPreparation and d issem ination of m aterialsEngaging participatory research partnersFacilitating translational researchInterview ingD ocum entation

Service Empowerment

Permission of Sergio Matos, CHWHealth Innovation AssociationsCHW Association of NYC

The Story Behind the Picture

CHW approach Service Empowerment

§ Improve access to health care and social service resources§ Improve the quality and cultural appropriateness of service systems§ Help people integrate and prioritize health promotion and disease

prevention/management regimens into their daily life § Organize communities to improve environmental, physical and social

wellbeing through community organizing and empowerment§ Negotiate and ameliorate cultural & linguistic barriers to wellness§ Help people become active participants in their health§ Combat social isolation, loneliness, stigma, discrimination and depression

“Warning! – If you do what you have always done, you will get what you have always gotten…” Sergio Matos, CHW

Permission of Sergio Matos, CHWHealth Innovation AssociationsCHW Network of NYC

CHW Outcomes§ Increased access and quality of services

§ Increased cultural and linguistic appropriateness of services§ Improved health outcomes

§ Chronic conditions§ Multiple chronic conditions§ Maternal and Child Health§ Aging populations§ Mental Health, Depression/Isolation

§ Improved service utilization§ Increase consumer satisfaction - retention§ Improve patient understanding, activation and self-management§ Increase primary care use/ lower missed appointments

§ Reduced/eliminated persistent inequities in health outcomes § immunizations, asthma, diabetes, substance abuse

§ Increased social capital & community connectedness§ Promote healthier communities and individuals

Connecticut State Innovation Model (SIM-CT)

• SIM-CT encourages expansion of CHWs’, as “non-traditional” providers, to achieve improvements in Population Health and help attain goals of the Triple Aim

• CCIP Standards• Complex Needs• Health Equity• Behavioral Health

Community Health Worker Advisory Committee 2016 - Present

• Completed CHW Definition• CHW Scope of Practice: Adopted Community Health Worker Core

Consensus Project (C3 Project) Core Competencies• Recommendations for sustainable Financing• CHW Advisory Committee White Paper:

https://files.acrobat.com/a/preview/b9e68e0f-1f16-43b1-afe2-2fa6968f64ef• Developed 5 Best Practice Manuals for CHW Integration into

Clinical Teams and 5 CHW Integration on-line Modules• Updated CHW Core Competency Curriculum with C3 Project and

current texts• Developing CHW Apprenticeship program

CHW Website

https://www.chwresourcesct.org

CHW Recognition & CertificationPublic Act No. 17-74: AN ACT CONCERNING COMMUNITY HEALTH WORKERSThe Director of the State Innovation Model Initiative program management office shall, within available resources and in consultation with the Community Health Worker Advisory Committee established by such office and the Commissioner of Public Health, study the feasibility of creating a certification program for community health workers. Such study shall examine the fiscal impact of implementing such a certification program and include recommendations for (1) requirements for certification and renewal of certification of community health workers, including any training, experience or continuing education requirements, (2) methods for administering a certification program, including a certification application, a standardized assessment of experience, knowledge and skills, and an electronic registry, and (3) requirements for recognizing training program curricula that are sufficient to satisfy the requirements of certification.

CHW Advisory Committee Current Work

Design Group 1

Certification Requirements

Certification Recommendations for CT

Design Group 2Methods & Administration of a Certification ProgramDesign Group 3

Training

CHW Advisory Committee Certification Report

SIM HISC to DPH/SIM toLegislatureOctober 1st

Public Information Sessions

July - August

Report completedJuly 10th

Community Health Workers Association of Connecticut

For more information contact:chwassociation@cpha.info

http://www.cpha.info/?page=CHWACT

About the Association

A Section of the CT Public Health Association

Meredith C. Ferraro, MS

SOUTHWESTERN AHEC, Inc.

5 Research Drive, 2nd Floor

Shelton, CT 06484

203 372-5503 x14

mferraro@swctahec.org

Opportunities to Partner with Access Health CT

What is a Community Partner?• Partners share information about access to health coverage

with communities all over Connecticut• AHCT provides resources and invites dialogue with our partners• Our community partners include:

Community Health CentersCommunity Organizations Department of Labor Educational institutionsElected OfficialsHealthcare Providers

Health Departments HospitalsLibrariesFaith Organizations and many others!

Community Partners

Partner EngagementWays that we can be helpful to you:

• AHCT staff can speak at events, informational, or training sessions

• The AHCT Outreach Team can table at your events or events in your community

• AHCT hosts educational webinars for our partners throughout the year

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• Providing materials to distribute to your community

Partner Engagement (continued)

Some ways that you can help us spread the word are:• Place an AHCT poster somewhere visible to your members

and the public• Display AHCT open enrollment brochures for your

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Engaging With Your Community• Speaking engagements (EN/SP)• Local/state events, fairs, festivals,

etc. • Educational webinars for partners• Informational materials• Research and surveys• Planning sessions

Want us in your community?Email Outreach@AccessHealthCT.com or fill out the form on our Community Partner website

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Contact Us

Learn.AccessHealthCT.com/Community

Save the Date!

2018COMMUNITYCONFERENCEFriday, October 19, 2018Red Lion Hotel - Cromwell, CT

Become a Community Partner!To reach the AHCT Outreach Team:

• Call 860-327-5517

• Email Outreach@AccessHealthCT.com

• Visit our website Learn.AccessHealthCT.com/Community

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