Exploring New Job Opportunities as a CHW/CRS CHW/CRS Annual Conference May 9, 2014

Topics What is a CHW? What is a CRS? Where are CHW’s employed? What are the essential skills of CHW? What are the responsibilities of a CHW? What are employers paying for CHWs? Future job outlook for CHW?

Community Health Worker Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community they serve.  (American Public Health Association, 2008)

Community Health Worker This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.  CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. (American Public Health Association, 2008)

Federal Definition Community health workers provide a link between the community and health educators and other healthcare workers and develop and implement strategies to improve the health of individuals and communities. They collect data and discuss health concerns with members of specific populations or communities. Included in 2010 Standard Occupational Classifications. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

HISTORY In the early 1960's, community health workers played a significant role in the development of community health centers and in programs in many developing countries, promoting literacy, family planning, immunization, and other economic development activities. While formal participation of community health workers in health and human services programs in the United States has been documented since the 1950's, it was not until the 1960's that the federal government began supporting community health worker programs as vehicles for expanding access to health care for underserved communities Community Health Worker Network of NYC

HISTORY By the 1970's, the role of community-based assistance had gained increasing importance. Despite advancements in healthcare that improved the quality of care, not everyone was able to access the benefits of this care due to increasing costs, limited access, and reduced interpersonal communication between service providers and their patients. To address this lack of access, community health workers were increasingly employed to serve as sources of advice, information and support, and bridge the community to the health care service delivery system. Current estimates indicate that there are more than 120,000 community health workers serving communities throughout the United States. Community Health Worker Network of NYC

Employment of Community Health Workers by State, May 2013 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

CRS The CRS is a person in recovery from a mental health or addiction related disorder. The CRS provides peer support services, serves as a consumer advocate, provides consumer information and peer support for consumers in emergency, outpatient, or inpatient settings. Indiana's Integrated Care Community Health Worker and Certified Recovery Specialist Training and Certification Program

CHWs and CRSs Are Certified Recovery Specialists Community Health Workers? Are all Community Health Workers Certified Recovery Specialists? CRSs are a specific subset of CHWs.

Common Titles Community health workers go by many titles depending on: where they work, who they work for, and what they do. Ideas?

Common Titles Common titles include: Health Coach Community Health Advisor Family Advocate Health Educator Liaison Promoter Outreach Worker www.explorehealthcarears.org

Common Titles Common titles include: Peer Counselor Patient Navigator Health Interpreter Public Health Aide. In Spanish-speaking communities, community health workers are often referred to as health promoters or promotores(as) de salud. www.explorehealthcarears.org

CHW Titles in Indiana Indiana CHW Survey respondents (184) said: 12% Community Health Educator 6.5% Outreach Worker 5.4% Community Health Representative 3.8% Certified Recovery Specialist, Patient Navigator, or Peer Educator 42% Other (In title: 12% Coordinator , 8% Nurse) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

CHW Titles in Indiana CHW Employers (26) reported: 46% CHW 3.8% Community Health Educator, Certified Recovery Specialist, Patient Navigator, Promotor(a) 39% Other (Health Access Workers) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Where do CHW’s Work?

Where CHW’s work Community health workers (CHWs) often live in the community they serve. They spend much of their time traveling within the community, speaking to groups, visiting homes and health care facilities, distributing information and otherwise connecting with local people. Some community health workers work in health facilities, providing case management, client education, interpretation and follow-up care. Others are employed by government agencies and nonprofit groups to provide community organizing, health education, Medicaid enrollment and preventive care services in the field. www.exploreheathcarears.org

Top Industries Employing CHWs Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Organizational Settings in Indiana Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Rural – Urban Distribution of CHWs in Indiana Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Service Delivery Venues for CHW’s in Indiana Community Based Organization (44%) Clinics (43%) Community Center (40%) Homes (38%) Hospital (38%) Schools (34%) Worksites (33%) Churches (30%) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Service Delivery Format for CHW in Indiana One to one (87%) Telephone (68%) Community meetings or forums (52%) Group class (45%) Texting (17%) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

CHW Skills and Job Duties

Key Characteristics of CHWs Interpersonal warmth Trustworthiness Open-mindedness Objectivity Sensitivity Competence Commitment to social justice Good psychological health Self-awareness Understanding Milwaukee Area Healthcare Alliance

Essential Skills of CHW Communication skills Interpersonal skills Service coordination skills Capacity-building skills Advocacy skills Teaching skills Organizational skills Knowledge base about the community, health issues and available services Milwaukee Area Healthcare Alliance

CHW Core Skills by CHWs and Employers in Indiana Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

ROLES Substantial literature exists that examines the roles, responsibilities, and benefits of community health workers in health programs throughout the United States. From these evaluations, the majority of researchers conclude that community health workers have contributed positively in promoting health and increasing utilization of services. Significant recent studies have focused on articulating a distinct CHW scope of practice with associated roles, tasks and skills. Community Health Worker Network of NYC

Federally Defined Roles Community health workers do the following: Provide outreach and discuss health care concerns with community members Educate people about the importance and availability of healthcare services, such as cancer screenings Collect data Report findings to health educators and other healthcare providers Provide informal counseling and social support Conduct outreach programs Ensure that people have access to the healthcare services they need Advocate for individual and community needs Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Job Responsibilities Helping individuals, families, groups and communities develop their capacity and access to resources, including health insurance, food, housing, quality care and health information Facilitating communication and client empowerment in interactions with health care/social service systems Helping health care and social service systems become culturally relevant and responsive to their service population Helping people understand their health condition(s) and develop strategies to improve their health and well being Helping to build understanding and social capital to support healthier behaviors and lifestyle choices www.exploreheathcarears.org

Job Responsibilities Delivering health information using culturally appropriate terms and concepts Linking people to health care/social service resources Providing informal counseling, support and follow-up Advocating for local health needs Providing health services, such as monitoring blood pressure and providing first aid Making home visits to chronically ill patients, pregnant women and nursing mothers, individuals at high risk of health problems and the elderly Translating and interpreting for clients and health care/social service providers www.exploreheathcarears.org

CHW Roles by CHWs and Employers in Indiana

Health Issues Addressed by CHWs in Indiana 81% of CHWs reported that CHWS work on defined health issues. Top 5 Issues Reported by CHWs: Diabetes (44%) Nutrition (39%) Tobacco Control (37%) Mental Health (31%) High Blood Pressure (30%) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Most Pressing Needs of Those Served as Identified by CHWs in Indiana Health Information (77%) Disease Management (66%) Social Support (58%) Transportation (47%) Employment (54%) Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

Compensation Data

Annual Mean Wages of CHWs by State, May 2013 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Percentile Wage Estimates 10% 25% 50% (Median) 75% 90% Hourly Wage $9.96 $12.91 $16.64 $21.78 $28.31 Annual Wage $20,720 $26,860 $34,610 $45,310 $58,890 Industry Hourly Mean Wage Annual Mean Wage Individual and Family Services $15.25 $31,710 Local Government $19.14 $39,820 Outpatient Care Centers $16.50 $34,320 Hospitals $21.82 $45,390 Offices of Physicians $17.08 $35,530 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

CHW Wages Paid as Reported by Employers in Indiana Indiana Community Health Worker Workforce Assessment Surveys. October 15, 2012

CHW Workplace Benefits as Reported by CHWs in Indiana

CHW Job Outlook

Job Outlook Employment of CHWs is projected to grow 25% from 2012 to 2022, faster than the average for all occupations. Growth will be driven by efforts to improve health outcomes and to reduce healthcare costs by teaching people about healthy habits and behaviors and utilization of available health care services. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Job Outlook As healthcare costs continue to rise, insurance companies, employers, and governments are trying to find ways to both improve the quality of care and health outcomes, while curbing costs. One way is to employ CHWs, who teach people how to live healthy lives and how to avoid costly diseases and medical procedures. CHWs help people understand how to manage their condition and avoid unnecessary trips to the emergency room. CHWs help people understand how what they do affects their health. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Job Outlook For many illnesses, such as breast cancer and testicular cancer, finding the disease early greatly increases the likelihood that treatment will be successful. Therefore, it is important for people to know how to identify potential problems and when to seek medical help. The need to provide the public with this kind of information is expected to result in an increased demand for community health workers. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

Job Outlook Federal health reform will increase access to medical care, such as preventative screenings. Community Health Workers will be needed to direct patients in obtaining access to healthcare services. In addition, a number of state and local programs designed to manage conditions such as diabetes and obesity include community health workers as part of intervention teams. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition, Health Educators and Community Health Workers.

CRS Specific Job Outlook There is a strong need for workers specializing in the mental health field. Over the next six years, jobs in the mental health professions are projected to grow 37 percent. And those new jobs don't necessarily require advanced degrees. There are many entry-level jobs that require an undergraduate degree or GED. Entry-level jobs are in demand because of demographic and policy changes — such as patient navigators and community health workers. Psychiatric rehabilitation professionals are focused on working with people with various mental health conditions so they can really be in the community — to live, to work, to socialize, to move back into the community and have a regular life there. Health Care Industry Week highlights demand for jobs in mental health. April 9, 2014 NJBIZ

CHW/CRS: The Future’s So Bright…