Community Health Worker Model by Linda Stone, CEO

 New Mexico’s urban Indian health center  Located in Albuquerque, NM  Established in 1972  Mission: To provide a comprehensive and culturally appropriate health delivery system that addresses the social, emotional, spiritual and physical needs of urban Indians and other underserved populations in Albuquerque and the surrounding areas  Core services: Medical, Dental, Behavioral Health, Traditional Healing  Other services: HIV prevention education, Diabetes prevention education, social services, case management, patient navigation/community health worker, Medicaid enrollment/education, WIC, homeless outreach and case management, vocational development, housing assistance  10,000 urban Indians served in 2014

 The State of New Mexico is extremely rural and encompasses vast isolated regions of Native American Reservation land and some of the last frontier of the west.  Albuquerque is one of three metropolitan areas in the State  Albuquerque is bordered by the Pueblos on all sides  Large urban Indian community (est. 55,000)  Service area is southeast Albuquerque which is one of the most distressed areas of the City of Albuquerque  Area has the largest concentration of American Indians

 Albuquerque has the highest percent of Native Americans of any other city in the nation (10.5%), according to Indian Health Service  Massive migration away from Indian Country and Native Americans who left their tribal communities and are now living in urban areas ‘on or near’ their tribal land  Estimated 50,000 American Indians from more than 250 tribes living in Albuquerque  Significant income disparity exists with the American Indian community—median household income of $23,440 compared to $38,272 for non-Indians and a per capita income of $8,679 compared to $20,884 for non Indians—50% of American Indians live below 100% of the Federal Poverty Level  88-97% of children are enrolled in free/reduced lunches  American Indians experience multi-generational poverty that results in a low quality of life, high chronic disease rates (i.e., diabetes, cardiovascular disease, substance use, depression), poor oral health outcomes and reduced live expectancy

 The CHR/CHW model has been widely used by Indian Health Services since 1968 when 250 CHR/CHWs were trained in Alaska  Originally used to prevent the transmission of TB  By 1974, 1003 CHR/CHWs employed by Indian Health Services  Creation of CHR/CHWs: ◦ Need for more involvement of AIs in their own health programs and in identifying and addressing their own health problems ◦ Need for greater understanding between AIs and Indian Health Services ◦ Need to improve cross-cultural communication between Indian communities and health care providers ◦ Need to increase basic health care and instruction in Indian homes and communities

 Overall Goals:  To improve the health knowledge, attitudes and practices of American Indians by promoting, supporting, and assisting the Indian Health Services in delivering a holistic and integrated health care program  To address health care needs through the provision of community oriented primary care services including Traditional Native healing services using community based, well trained and medically guided health care workers

 Provide preventative services in areas of need that are not otherwise available to American Indians  Provide home visits and home based services  Provide transportation services  Acts as a liaison/advocate for communities  Provide language translations as needed  Facilitate communication between the community member and health care provider  Develop program plans that address specific community health care needs  Assess community health care resources  Provide or assist in demonstrations, training sessions and community meetings in the areas of safety, nutrition/diabetes, environmental needs, chronic disease and other health concerns  Provide health care education and facilitate understanding using the Native language and culturally appropriate materials  Provide health promotion/disease prevention information and instructions in self help services that address chronic health problems

 Provide outreach to community members  Serve as a community heath promoter/educator  Serve as a health advocate  Serve as a health paraprofessional  Conduct home visits  Conduct health assessments  Provide transportation services as needed  Role models in the communities they serve  Plan and organize community health promotion and disease prevention activities and facilitate learning (e.g., immunizations, well baby clinics, safety in the home, medication adherence counseling, dangers of substance use, etc.)  Create linkages to other needed services

 Need is significant among urban Indian community of Albuquerque  CHWs are in growing demand  Strong advocates who come from the same community  Health promotion/disease prevention activities by CHW have been helpful with lowering mortality rates

 Thank you!