Introducing community health workers into primary care settings The “new” kid in town Introducing community health workers into primary care settings

A CHW by any other name… Application assistor Community health advocate Health navigator Health coach Community health aide Lay health advisor Health promoter (promotora de salud)

What is a CHW? A frontline public health worker who is a trusted member of the community who acts as a liaison between health and social services and the community to facilitate access and improve the quality and cultural competence of service delivery Grater understanding Share experiences Share language Share culture Source: American Public Health Association

What doES A CHW do? Provide direct services (i.e. informal counseling and health education, social support, care coordination, navigation of health systems) Bridge the gap between patients and the services they need by increasing knowledge and self-reliance (social determinants of health) Advocate for patients Fill the service gaps in the health care system that are particularly acute in underserved communities Source: American Public Health Association

Social Determinants of Health

CHW functions in clinic settings Assess symptoms/lifestyle to determine ability to manage chronic disease Address barriers to chronic disease management and connect to resources Coordinate with care team to develop clinical care plan Work with patient to develop goal plan Provide chronic disease self- management education Conduct home visits Conduct follow-up phone calls Strengthen linkages to community resources

What is Care Coordination? Case management and patient support activities Family focused Collaborative Identification of patient and family needs Advocacy Connection to services and resources Communication among care team members and patients/families References: Mechanic R. Will Care Management Improve the Value of U.S. Health Care? Background Paper for the 11th Annual Princeton Conference May 20 – 21, 2004 [Accessed: January 3, 2007]; Available from: http://council.brandeis.edu/pubs/Princeton%20XI/Rob%20Mechanic%20paper.pdf National Cancer Institute. NCI's Patient Navigator Research Program: Fact Sheet: What Exactly is a Patient Navigator? [Accessed: January 25, 2007]; Available from: http://www.cancer.gov/cancertopics/factsheet/PatientNavigator

Care Coordination Model Clinic Referrals Refer for Other Services Care Coordination Team Provider Nurse CHW Clinic Referrals Home Visits Risk Assessment & Enrollment Care Plan Weekly Assessment Patient Follow-up Clinic Referrals Involve Patient in Education and Community Events Reference: Crespo, R, Hatfield V, Hudson J, Justice M. Partnership with Community Health Workers Extends the Reach of Diabetes Educators. In Practice, The American Association of Diabetes Educators. 2015: 24-29

What difference does it make? Patients receive more preventive care Patients use primary care Fewer ED visits and hospitalizations Physicians have better access to medical records and patient history Patients have increased ability to manage chronic conditions Patients have greater continuity of care Health care costs decrease McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 7—Care Coordination. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; June 2007.

CHW training Kentucky Association of Community Health Workers June 15 -- Hazard Appalachian Kentucky Rural Health Access Network June 22 – Motivational Interviewing – Natural Bridge State Park UK Center of Excellence in Rural Health Kentucky Homeplace (40-hour classroom and 80-hour practicum) May 24 -- Appalachian Research Day – Hazard Community and Technical College Kentucky Department for Public Health Kentucky TRAIN May 16 – Kentucky Asthma Symposium – U of L Shelby Campus August 2 – Falls and Osteoporosis Summit -- Lexington August 21-24 CDSMP lay leader training – Lake Cumberland State Park National CHW Training Center Center for Sustainable Health Outreach – University of Southern Mississippi August 6-9 – Unity Conference – Dallas, Texas

Why are CHW’s effective? CHWs have access to the population they serve Trusting relationship lays the foundation for good diabetes self management CHWs have great flexibility to meet clients’ needs (i.e. amount of time spent, time of day services are provided, place of contact, range and extent of services) Reduce system costs Address barriers to care Cultural/spiritual beliefs and language issues Minimize stigma/reaction associated with disease Create an understanding of the disease Improve relationship with providers

Measuring Program success Patient Satisfaction Self-efficacy to manage disease Clinical measures Cost/burden

Do chw programs work? In Mingo County, WV, CHWs working 130 high-risk diabetes patients demonstrated an average reduction in hemoglobin HbA1c of 2.5 percentage points over a six-month period. The cohort’s average A1c after six months was 7.7% which was sustained over 18 months. In New Mexico, CHWs providing community-based support services to insurance enrollees who were high consumers of health care resources were able to generate a 4:1 return-on- investment for the payer. References: Crespo, R, Hatfield V, Hudson J, Justice M. Partnership with Community Health Workers Extends the Reach of Diabetes Educators. In Practice, The American Association of Diabetes Educators. 2015: 24-29 Johnson D., P. Saavedra, E. Sun, A Stageman, D. Grover, C. Alfero, C. Maynes, B. Skipper, W. Powell, and A. Kaufman. Community health workers and Medicaid managed care in New Mexico. Journal of Community Health, 2012, 37: 563-571.

Pam Spradling Big Sandy Health Care 606-886-8546 p.spradling@bshc.org