Cheryl Ulmer and Jason Patnosh APHA, November 7, 2007

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Presentation transcript:

Meeting the Promise of Racial and Ethnic Minorities’ Interest in Health Care Careers Cheryl Ulmer and Jason Patnosh APHA, November 7, 2007 www.nachc.com Community HealthCorps APHA Session 5184.0 Ethnic & Racial Disparities: Hospital System Level Solutions

Build a HealthCorps Enroll the uninsured in SCHIP and other programs. Act as nonmedical support staff (e.g., caseworkers, health educators) in underserved communities. Interest young people in nursing and medical careers. You may have seen a September 2007 issue of Time magazine making a case for universal national service. One of the ten parts of their plan was to build a HealthCorps.

HealthCorps Exists Now Enrollment of about 700 for program year 2007. Serving at over 100 delivery sites in urban and rural areas of 19 states, DC and Puerto Rico. Founded by National Association of Community Health Centers (NACHC) in 1995 with 117 enrollees placed in Community Health Centers (CHCs) in the first year. Part of AmeriCorps While such a HealthCorps exists now, it could be greatly expanded.

Accomplishments in first 10 Years Over 2500 volunteers provided more than: 411,000 outreach and case management encounters to assist underserved receive and better utilize primary and preventive care. 321,000 patient encounters for health education and chronic disease self-management. 170,500 encounters to link patients with other health and social services (e.g., housing, employment, child care).

Joining HealthCorps Eligibility: U.S. Citizen, U.S. National, or lawful permanent resident; 18 years and older, 17 year olds with guardian’s permission Terms of year long service: 1700 hour (full time), 900 hours (part-time), quarter time (450 hours) Benefits: Living allowance, health insurance, child care, training, educational award, student loan forebearance Educational Award: $4725 for full time, prorated for other service time Not all benefits are available for part and quarter time members.

Who Joins? Age range: 17-77 years, median age 24 years Minority race/ethnicity: 58% from 1995-2003; 71% in 2004-05 College graduate: 41-42% Home community: about half from local community; characterized by more nonwhite race, Hispanic ethnicity, unemployed young people, and poor people than U.S. Gender: 80-88% female Comparisons with the overall AmeriCorps program finds that there is a greater percentage of minorities and persons with a college degree in HealthCorps. Compared with the United States as a whole, the home communities of HealthCorps members have more nonwhite race (particularly black and Asian), Hispanic or Latino ethnicity, and poor people, as well as a greater portion of female heads of households, unemployed young people, and linguistically isolated households (Changing Lives). One in four HealthCorps members come from a community where 26% or more of individuals and 20% or more of families have incomes below the federal poverty level (Changing Lives).

What is the Impact on Volunteer? Increases interest in health care or social work as a career. Increases interest in Community Health Centers as a work environment. Increases knowledge of health issues. Offers educational opportunities not available to many of their parents. Expands job skills. Giving Back self-assessment of before and after service.

Interest in Health Care or Social Work as a Career Increases 66% interested at entry, but 83% at exit. 27% increase in interest among high school (HS) only grads and those with some college or an associate degree. Many college graduates join to gain health care experience as they apply to medical and public health programs (Giving Back).

Increase in Knowledge of Barriers and Health Disparities Before serving, more than half of all members say they had little or no knowledge of health barriers and disparities. After serving, more than 80% had a significant gain in knowledge. Even 75% of those who self-assessed themselves as having a great deal of knowledge beforehand had a significant gain. (Giving Back)

Members Gain in Knowledge of Specific Health Care Services Gain in knowledge of specific subjects may vary according to the content of members’ assignments, but all get training in 10 Core Competencies. (Giving Back)

Training in 10 Core Competencies Community Health Advocacy Patient Relations Professional Development Cultural Competency Civic Engagement Health Outreach Health Education Emergency/Disaster Preparedness Case Management Primary Care Environment Programs offer a minimum of 12-16 hours per month of training, team building events and/or service projects using the Ten CCs as the cornerstone. This training distinguishes HC from other AmeriCorps programs.

Most Members Gain “A Lot” of Experience Participating in a Work Environment 77% in being a reliable member of a working staff by coming to work on time 72% in solving unexpected problems 72% in learning how to gather and analyze data 69% Managing time when under pressure 76% in negotiating, compromising and getting along with co-workers 74% in taking guidance from others 53% in leading a team by taking charge and motivating co-workers The scale for gaining work experience skills is: “little or none,” “some” or “a lot” (Giving Back). Unemployment rates for young people (20-24 year olds) in the communities these HealthCorps members come from averages 9% (Changing Lives). Some come from communities where the unemployment rate is as high as 35% for young women and 43% for young men.

Service Activities Most Often Performed 48% Scheduling appointments, making reminders, and follow up 29% Providing outreach services 27% Teaching health education classes 27% Providing info about CHC services 24% Translating for patients 19% Enrolling patients in health insurance About 70% of those scheduling and 40% translating and enrolling in health insurance are high school graduates only; while more doing chronic disease management and health education are college graduates of have some college. (Giving Back)

Members’ Plans Immediately After HC Regardless of educational level equivalent percentages plan to work, go to school and/or continue in HC (Giving Back).

About 80% of Members at all Education Levels Plan to Go to School within Next Year 76% of HS grads, 82% of those with some college, and 87% of college grads. (Giving Back)

Most Frequently Planned School Choices 17% Nursing school (including 2% NP or CNM) 14% Four-year college 13% Medical school 12% Health-related trade school 9% Social work graduate program 7% Two-year college 6% Public health graduate program 6% Other health-related graduate programs (Giving Back)

Planned School Choices by Current Education High School Graduate only Some College/ Associate Degree College Graduate or More 23% Health-related trade school 35% Four-year college 24% Medical school 20% Nursing school 19% Nursing school 15% Public health 11% Non-health trade school 17% Two-year school 15% Other health-related graduate schools 9% Two-year college 13% Health-related trade school 12% Social work graduate program 9% Four-year college 9% Social work graduate program 7% Other graduate programs (Giving Back)

Education Award = Benefit to HealthCorps Members 76% of HealthCorps members serving in 1995-2003 earned an education award. Comparable to overall AmeriCorps average even though HC has a higher percentage of minority group members. In 1999 HC had 65% minority vs. 54% for AmeriCorps (Changing Lives).

Using Earned Education Award 63% of members from 1995 to 2003 used a portion of their earned award. Two-thirds of these members used their award for new educational opportunities rather than loan repayment. By August 2004, HealthCorps members had earned $4.7 million in education awards; members had used $2.6 million on loan repayment and school tuition. Awards are most often used within the first year after service, but they have7 years to utilize their awards. (Changing Lives)

Who’s at Risk of Not Going to College? U. S. Census data show the likelihood of going to college is decreased by: low family income, minority race, and having no family members who previously attended college. In HealthCorps, 74% of minority members earned an education award and 60% use their earned award. (Changing Lives)

HC Members with Less Education are Less Likely to Have Parents Who Have Graduated from College National Census Bureau statistics indicate that young people whose parents did not attend college are half as likely to attend college as those whose parents did go. Yet HC members appear to be going to school in greater numbers. (Graph from Giving Back)

Percent of 1995-2002 HC Members Earning and Utilizing Awards as of August 2004 Rates of earning and using awards is much lower for black members than other race and ethnic groups; however, it is somewhat impressive given the differential in college graduation rates before entering HC. Whites make up 42% (475 persons), blacks 29% (333), Hispanics 18.5 (211), Asian/PI 8.35 (94). College graduation rates are whites 65%, blacks 16%, Hispanics 25%, Asian/PI 69%. (Changing Lives)

Education Award Challenges Attrition (not completing and not earning an education award) is: among non-white members among young persons (ages 22-29) among the better educated (completed bachelor’s degree) African-American HealthCorps members are less likely to earn an award and even if an award is earned, less likely to spend it than other race/ethnicity groups. The lower rate of uptake of awards by black members may be more attributable to level of comparative educational attainment at enrollment than race (Changing Lives).

Program Solutions Additional mentoring for educational placement. Target at risk groups for follow-up. Majority of members who use their awards do so within the first year. Utilize performance measures on rates of earning and using awards. Earning rates varied from 50% to 94% by program site. Develop educational and job placement partnerships within communities (e.g., credit for volunteer experience, scholarships). Since a majority of members who use their awards do so within the first year after completing their service, groups that historically have been at risk for not using their earned award might be the primary target of follow-up in the year after exiting the program for further assistance in educational placement and accessing their award. (Changing Lives)

States with HC Programs California Colorado District of Columbia Florida Idaho Kansas Louisiana Maine Massachusetts Michigan Mississippi Missouri New York Puerto Rico Tennessee Texas Utah Washington Wisconsin Even at sites without HC specific programs, often the 1000 CHCs around the country also have other types of AmeriCorps volunteers. While some of their work day experiences may be similar, they may not have had as extensive training as HC volunteers.