Preparing Community Health Workers for Their Role as Agents of Social Change: Experience of the Community Capacitation Center Beth Poteet, Teresa Rios-Campos, and Noelle Wiggins

Objectives By the end of the session, participants will be able to: Describe the history, current status, and outcomes of the CCC model for training CHWs Discuss implications of the CCC model for other CHW training programs that wish to preserve CHWs’ role as agents of social change

Agenda Introduction Brainstorm: How does training influence CHW roles? Sociodrama Background on CHW training CHW Training at the CCC Best Practices in CHW Training Brainstorm: Applications

Brainstorm What do you imagine? How does training influence the roles that CHWs play?

History of CHW training programs Documented examples in the US date to the 1960s Until 1990s, most US CHWs were trained on-the-job Drawbacks of on-the-job training: no credential or academic credit not portable lack of standardization insufficient time to build skills and knowledge CHWs lacked opportunities to build peer networks Before focusing on our training program, I’d like to briefly discuss CHW training more generally. Documented examples of CHW training programs in the US date back to the 1960s, when the Indian Health Service developed its Community Health Representative Program, and CHWs were hired by the Office of Economic Opportunity during the War on Poverty. Until the 1990s, most CHWs were trained on the job. While on-the-job training did have some strengths, this training: offered no credential or academic credit was not portable when CHWs moved from job to job lacked standardization, so employers couldn’t count on a dependable set of skills often provided insufficient time for CHWs to build skills and knowledge, and most importantly, on-the-job training did not provide opportunities for CHWs to come together across various programs and communities to develop peer networks and support.

History of CHW training programs Early to mid-1990s: trend towards creation of training centers Examples of CHW training centers: Community Health Education Center, a project of the Boston City Health Dept. (1993); Community Health Works, a joint project of San Francisco State University and City College of San Francisco (1994); Community Capacitation Center, a project of the Multnomah County Health Dept., Portland (2000). In the mid-1990s, these drawbacks led to a trend towards the creation of training centers, where CHWs could come together to network and gain support. Early examples of CHW training centers included: Community Health Education Center, a project of the Boston City Health Dept. (1993); Community Health Works, a joint project of San Francisco State University and City College of San Francisco (1994); Community Capacitation Center, a project of the Multnomah County Health Dept., Portland (2000).

Best and Promising Practices in CHW Training Best or promising practice Reports referencing this practice Develop standard training curricula NCHA Study, 1998; Love et al., 2004; CHW-NEC, 2008 Use popular education and adult learning methods Love et al., 2004; CHW-NEC, 2008; NHLBI, 2011 Provide skills-focused as well as content-focused training NHLBI, 2011; NCHA Study, 1998; Love et al., 2004 Confer academic credit for training NCHA Study, 1998 Involve experienced CHWs in designing and conducting training CHW-NEC, 2008 Prepare CHWs to play a full range of roles Rosenthal et al., 2011; Farquhar et al., 2008 Provide training for CHW supervisors Reduce barriers to entry A variety of studies have identified best and promising practices in CHW training. These include: Developing standard training curricula Using popular education and adult learning methods Providing skills-focused as well as content-focused training Conferring academic credit for training Involving experienced CHWs in designing and conducting training Preparing CHWs to play a full range of roles Providing training for CHW supervisors Reducing barriers to entry

The Community Capacitation Center A program of the Multnomah County Health Dept. Has existed formally for 10+ years Mission: To support communities to identify and address their own most pressing health issues As well as providing CHW training, we also: Conduct participatory research Teach popular education Do culturally specific health promotion Lead the Health Promotion Change Process at MCHD Before I focus on CHW training, I’d like to provide a bit of context, by briefly introducing the CCC. As I said, we are a program of the Multnomah County Health Dept. We have existed formally since 2001, though our roots go back much further than that. Our mission is to support communities to identify and address their own most pressing health issues. In addition to providing training for CHWs, we also: Conduct community based participatory research projects Teach a variety of groups to use popular education methodology Conduct culturally specific health promotion in a variety of communities, and Lead an internal change management process at MCHD.

CHW Training at the CCC: Roots Noelle involved in training CHWs in El Salvador during the 1980s Both Tere and Noelle employed by La Familia Sana Program in the early 1990s. CHWs from LFS trained other CHWs around the state. Influenced by CHW training centers in other places, such as CHEC in Boston Now, finally, let me describe briefly the CHW training program we have developed at the CCC: The CCC’s standard CHW training curriculum is based on the findings of the Roles and Competencies Chapter of the Natl. Community Health Advisor Study (NCHAS, 1998).  The curriculum is divided into three components: health issues, orientation to the health and social service system, and core skills. The 80-hour version of the CCC curriculum was approved for academic credit by the Oregon State Board of Education in 2004. Through an arrangement with PSU’s Graduate School of Education, the CCC is able to confer 800-level academic credit for training. Popular education, also known as empowerment and Freirian education, is both the underlying philosophy of the CCC curriculum as well as the methodology used to build skills and knowledge. Because the CCC curriculum is based on the findings of the Roles and Competencies Chapter of the NCHA Study, it prepares CHWs to play a full range of roles, from connecting people to services and managing medical utilization, to advocating for community needs and building community capacity to address the social determinants of health.

CHW Training at the CCC: Curriculum Based on 8 skills clusters identified in the 1998 Natl. Comm. Health Advisor Study Skills- as well as content-focused Can confer academic credit Approved by Oregon Health Authority Prepares CHWs to play a full range of roles

CHW Training at the CCC: Popular Education A methodology and a philosophy for teaching and organizing Developed in response to conditions of inequity in Latin America, the US, and around the world Creates settings in which people most affected by inequity can: Bring out their own knowledge Build on their knowledge in community Use their knowledge to create a more just and equitable society

CHW Training at the Community Capacitation Center: Outcomes More than 95% of participants surveyed since 2007 state that participation in training enhanced their ability to promote health in their communities. Two CBPR studies suggest that combination of content and methodology equip CHWs to effectively promote health in their communities. Participants say training enabled them to: Be leaders and show others they are capable Do advocacy Realize how much they knew Teach using popular education

Best and Promising Practices in CHW Training Best or promising practice Present at the CCC? Develop standard training curricula Yes Use popular education and adult learning methods Provide skills-focused as well as content-focused training Confer academic credit for training Involve experienced CHWs in designing/conducting training Prepare CHWs to play a full range of roles Provide training for CHW supervisors Reduce barriers to entry Thus, you will see that of the best and promising practices mentioned earlier, the CHW training program at the CCC achieves 8 of the 8 practices.

CHW Training at the CCC Current Status Participating with OHA to create standards for certification of CHW and approval of training programs Licensing our curriculum to other groups around the state Creating, along with partners like the Urban League of Portland, culturally specific versions of our curriculum By March of 2014, we will have trained 150 of the 300 CHWs called for in Oregon’s Medicaid Waiver with our state-approved curriculum, titled, “We Are Health.”

Recommendations For creating and implementing CHW curricula Include both skill development and training on health issues Ground curricula in popular education Involve experienced CHWs in developing and facilitating the curriculum Prepare CHWs to play a wide range of roles

Applications How can you apply what you have learned in your work with CHWs or as a CHW?

For more information, visit our website at: Web.multco.us/ health/community-capacitation-center Thank you! If you have any questions, my colleagues and I would be happy to try to answer them.