Integrating CHWs into Primary Care Practices Katherine Cauley, PhD, katherine.cauley@wright.edu Wright State University Ohio Community Health Worker Conference 2016

Context With support from the MEDTAPP HCA CHW funding program, CHWs are imbedded into primary care practices (PCPs). To prepare for utilization of CHWs, the PCP completes a training program prior to the arrival of the CHW. Prior to the beginning of the training program the PCP identifies specific clinical, cost and quality measures they hope to improve as a result of the integration of the CHW. Currently, CHWs are embedded in seven PCPs as follows: Colbert Family Health and Wellness Dayton Children’s Hospital Asthma Clinic Equitas Health Five Rivers Community Health Center Miami Valley Housing Opportunities PriMED Dunbar Wright State Physicians Family Medicine Practice Wright State Physicians Geriatric Practice

Context Primary Care Practice recruiting to work with CHWs began with members of the choir, and evolved through word of mouth, with more requests coming in on a regular basis. Two models emerged: embedded physically and embedded procedurally. CHW supervision provided jointly by the CHC CHW supervisor and the site based supervisor initially. The role of the CHC CHW supervisor has diminished as the sites have embraced the CHW, ad effort has shifted to outcome studies. Lessons Learned: Front load focus and attention with interprofessional team Track CHW attendance—this is often predictor of difficulties Monitor referral process Monitor physical space for CHW at practice When there is a social worker, engage them for success

Meetings The first meeting is with the physicians, the practice manager, the CHW and the Center for Healthy Communities (CHC) CHW supervisor. Review role and scope of practice of CHW Review literature demonstrating efficacy of CHWs in primary care Preliminary discussion re: clinical, cost and quality measures the PCP wants to improve The second meeting is with the full interprofessional team, the CHW and the CHC CHW supervisor. Introductions of everyone’s roles and responsibilities Discussion of Best Practices and typical interventions provided by CHWs Discussion of patients that would benefit most from CHW interventions

Meetings The third meeting is with the members of the interprofessional team most likely to be making referrals to the CHW, the CHW and the CHC CHW supervisor Discussion of referral protocol including specific patient population and referral process Discussion of on-site supervision of CHW and interfacing with CHC CHW supervisor Discussion of ongoing CHW continuing education and monthly seminars The fourth meeting is with the physicians, the practice manager the IT person from the PCP and the CHW and CHC CHW supervisor Finalize clinical, cost and quality measures to be addressed Determine process for CHW to chart interactions with patient, when to complete training on the EHR, and when to complete HIPAA training Determine process for accessing data in order to document clinical, cost and quality measures reporting

Meetings The fifth meeting is with the members of the interprofessional team, the CHW, the CHW and the CHC CHW supervisor Official introduction of the CHW to the team Discussion of patient population and protocols for referring patients to CHWs CHWs location in the PCP Schedule of ongoing interprofessional team meetings The sixth and subsequent meetings occur various subsets of the interprofessional team and the full interprofessional team on a quarterly basis to address ongoing issues associated with CHW and outcomes studies Evaluative and troubleshooting discussions re: integration of CHW into PCP Patient satisfaction feedback Clinician satisfaction feedback

Documents Best Practices and Services Provided by CHWs CHW Script CHW Patient Support Plan CHW Daily Log Sheets CHW Patient Report Memorandum of Understanding Business Associate Agreement Certificate of Liability