1. Community Health Workers and State Government Collaborating to Promote Policies that Support and Sustain the CHW Workforce Gail Hirsch, MEd Office of Community Health Workers, MA Dept. of Public Health, and Board of Directors, Massachusetts Association of Community Health Workers Cindy Marti Martin, MPH Policy Director, Massachusetts Association of Community Health Workers American Public Health Association 138 th Annual Meeting November 9, 2010

2. 2 Presenter Disclosures We have no personal financial relationships with commercial interests relevant to this presentation to disclose.

3. 3 Learning Objectives Participants (you) will be able to: Identify at least 4 policy arenas essential to integrating the CHW workforce into public health Describe at least 3 collaborative strategies used in Massachusetts that could be adapted for use in your state.

4. 4 Background: Longstanding Collaboration MACHW – Massachusetts Association of Community Health Workers (founded in 2000). Mission:  Strengthen the professional identity of CHWs;  Foster leadership among CHWs; and  Promote the integration of CHWs into the healthcare, public health, and human services workforce. MDPH – Massachusetts Department of Public Health – long term commitment to CHWs as key to public health and to CHW workforce development

5. 5 Key Steps Along the Way  2000-2003: MDPH receives federal (HRSA) infrastructure grant for:  statewide CHW network  CHW and CHW supervisor survey  policy development 2000 - Statewide CHW network forms at at MDPH Prevention Conference 2002 forward – MACHW/MDPH partnership with Mass. Public Health Association 2003 - BCBS of MA Foundation funding for MACHW, as well as in-kind support from key partners

6. 6 Key Steps Along the Way 2005 – 1 st CHW association in U.S. to hire full-time CHW Executive Director 2005 MDPH report: “Community Health Workers: Essential to Improving Health in Massachusetts” (snapshot of the workforce and next steps) 2006 – MACHW successfully worked towards CHW inclusion in landmark health reform (Section 110) and seat on MDPH Public Health Council 2007 – MACHW hires full-time Policy Director

7. 7 Key Steps 2007-2009:  MDPH convenes legislatively mandated statewide CHW Advisory Council  MACHW plays leadership role in CHW workforce investigation and recommendations to the legislature 2010 - CHW Advisory Council Report released to legislature with 34 recommendations in 4 main areas:  CHW professional identity  CHW workforce development, inc. training and certification  Expanded public & private financing mechanisms  State CHW infrastructure

8. 8 Implementing Recommendations State Office of CHWs established at MDPH MACHW & MDPH collaboration to submit CHW certification legislation Sept. 2010:  MACHW successfully advocates for passage of certification bill (H4692)  MACHW celebrates 10 th anniversary

9. 9 National Markers & National Involvement Recognition & Recommendations to support CHWs: Institutes of Medicine, APHA, Nat’l Conference of State Legislatures, HRSA Bureaus and Office, CDC Formation of AACHW (American Assn. of CHWs) and Code of Ethics 2007 National HRSA CHW Workforce Study 9

10. 10 National Markers/National Involvement Bureau of Labor Statistics – 2009: distinct Standard Occupational Classification for CHWs CHWs in 2009 SCHIP reauthorization National Action Plan to Improve Health Literacy 2010 Inclusion of CHWs into 2010 national Health Care Reform (Patient Protection and Affordable Care Act -- H.R. 3590) 10

11. 11 Key policy areas for comprehensive systems changes Sustainable financing for community health worker services, especially in Medicaid, SCHIP and other major funding streams Workforce development resources, including training and career development Occupational regulation, such as standards for training and certification Guidelines for common metrics in research and evaluation related to CHWs. Rosenthal L, Brownstein JN, Hirsch GR, Willaert AM, Rush C, Holderby LR, Fox DJ, Scott JR, Community Health Workers, Part of the Solution: Promising State Policy Change Supporting the Integration of Community Health Workers into Systems of Care. Health Affairs. In Press July 2010. 11

12. 12 Collaboration for Systems Change POLICY ARENAState Public Health DepartmentMassachusetts Association of CHWs CHW Professional Identity Consistent contract language Educate other providers Professional ID campaign among the workforce, funders, other health professionals FinancingSupport effective use of public resources for CHW services to achieve DPH mission Promote stable funding Advocate for multiple funding streams and mechanisms with both public and private payers, i.e. state budget line items that support CHWs Workforce Development, Training Jointly id. core competencies Identify/convene state workforce development partners Advocate for CHW training programs Jointly identify core competencies, career ladders Advocate for funding for CHW training programs Occupational regulation/ Certification Joint development of certification board bill Board to be at MDPH with strong MACHW input Joint development of certification board bill Advocate for passage of bill Leadership in planning for Board Ongoing infrastructure Establishment of Office of CHWs in HC Workforce Center, Certification Board CHW Board of Certification

13. 13 Collaboration for Systems Change (1) POLICY ARENAState Public Health DepartmentMassachusetts Association of CHWs CHW Professional Identity Consistent contract language Educate other providers Professional ID campaign among the workforce, funders, other health professionals FinancingSupport effective use of public resources for CHW services to achieve DPH mission Promote stable funding Advocate for multiple funding streams and mechanisms with both public and private payers, i.e. state budget line items that support CHWs

14. 14 Collaboration for Systems Change (2) POLICY ARENAState Public Health DepartmentMassachusetts Association of CHWs Workforce Development, Training Jointly id. core competencies Identify/convene state workforce development partners Advocate for CHW training programs Jointly identify core competencies, career ladders Advocate for funding for CHW training programs Occupational regulation/ Certification Joint development of certification board bill Board to be at MDPH with strong MACHW input Joint development of certification board bill Advocate for passage of bill Leadership in planning for Board Ongoing infrastructure Establishment of Office of CHWs in HC Workforce Center, Certification Board CHW Board of Certification

15. 15 Strategies for Collaboration MDPH active TA and support to MACHW MACHW serves as consultant to state public health policy development Joint seeking of funding opportunities to promote workforce, professional identity Joint seeking of educational opportunities to promote workforce, build national efforts Joint refocus on priority recommendations in legislative report Joint planning & preparation for CHW Certification Board in January 2012

16. 16 All Hands on Deck  State APHA Affiliate – Mass. Public Health Association  State agencies (Medicaid, Dept. of Labor)  CHW training programs  Health plans (individual and association)  Health care and community-based organizations  CHW workforce  Healthcare providers  Hospitals  Employers of CHWs (CHCs, hospitals, others)  Foundations  Academic institutions  Primary care association  Health policy advocates

17. Questions to Consider in Your State Is there a CHW association in your state? Is your state public health department active in CHW workforce development? Do the state CHW association and health department collaborate? What other players in your state support CHW workforce development? Who are the leaders? Who is missing from the table? What next steps can you identify for your state? 17

18. 18 Opportunities & Lessons Learned CHWs – key role in health reform CHW leaders and other champions needed! Able to engage essential state partners & other stakeholders Diversity of stakeholders: public and private  Bring numerous perspectives to the table It’s a marathon, not a sprint  Change doesn’t happen overnight Sustainability depends on capacity-building and infrastructure 18

19. Thank you! Gail Hirsch, Director Office of Community Health Workers Massachusetts Dept. of Public Health Tel: (617) 624-6016 E-mail: gail.hirsch@state.ma.usgail.hirsch@state.ma.us www.mass.gov/dph/communityhealthworkers Cindy Marti Martin, Policy Director Massachusetts Association of Community Health Workers Tel: (617) 524-6696 ext. 108 Email: cmarti@mphaweb.orgcmarti@mphaweb.org www.machw.org 19