1. Introducing community health workers into primary care settings
The “new” kid in town
Introducing community health workers into primary care settings

2. A CHW by any other name… Application assistor
Community health advocate
Health navigator
Health coach
Community health aide
Lay health advisor
Health promoter (promotora de salud)

3. What is a CHW?
A frontline public health worker who is a trusted member of the community who acts as a liaison between health and social services and the community to facilitate access and improve the quality and cultural competence of service delivery
Grater understanding
Share experiences
Share language
Share culture
Source: American Public Health Association

4. What doES A CHW do?
Provide direct services (i.e. informal counseling and health education, social support, care coordination, navigation of health systems)
Bridge the gap between patients and the services they need by increasing knowledge and self-reliance (social determinants of health)
Advocate for patients
Fill the service gaps in the health care system that are particularly acute in underserved communities
Source: American Public Health Association

5. Social Determinants of Health

6. CHW functions in clinic settings
Assess symptoms/lifestyle to determine ability to manage chronic disease
Address barriers to chronic disease management and connect to resources
Coordinate with care team to develop clinical care plan
Work with patient to develop goal plan
Provide chronic disease self- management education
Conduct home visits
Conduct follow-up phone calls
Strengthen linkages to community resources

7. What is Care Coordination?
Case management and patient support activities
Family focused
Collaborative
Identification of patient and family needs
Advocacy
Connection to services and resources
Communication among care team members and patients/families
References:
Mechanic R. Will Care Management Improve the Value of U.S. Health Care? Background Paper for the 11th Annual Princeton Conference May 20 – 21, 2004 [Accessed: January 3, 2007]; Available from:
National Cancer Institute. NCI's Patient Navigator Research Program: Fact Sheet: What Exactly is a Patient Navigator? [Accessed: January 25, 2007]; Available from:

8. Care Coordination Model
Clinic Referrals
Refer for Other Services
Care Coordination Team
Provider
Nurse
CHW
Clinic Referrals
Home Visits
Risk Assessment & Enrollment
Care Plan
Weekly Assessment
Patient Follow-up
Clinic Referrals
Involve Patient in Education and Community Events
Reference: Crespo, R, Hatfield V, Hudson J, Justice M. Partnership with Community Health Workers Extends the Reach of Diabetes Educators. In Practice, The American Association of Diabetes Educators. 2015: 24-29

9. What difference does it make?
Patients receive more preventive care
Patients use primary care
Fewer ED visits and hospitalizations
Physicians have better access to medical records and patient history
Patients have increased ability to manage chronic conditions
Patients have greater continuity of care
Health care costs decrease
McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 7—Care
Coordination. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services; June 2007.

10. CHW training Kentucky Association of Community Health Workers
June Hazard
Appalachian Kentucky Rural Health Access Network
June 22 – Motivational Interviewing – Natural Bridge State Park
UK Center of Excellence in Rural Health
Kentucky Homeplace (40-hour classroom and 80-hour practicum)
May Appalachian Research Day – Hazard Community and Technical College
Kentucky Department for Public Health
Kentucky TRAIN
May 16 – Kentucky Asthma Symposium – U of L Shelby Campus
August 2 – Falls and Osteoporosis Summit -- Lexington
August CDSMP lay leader training – Lake Cumberland State Park
National CHW Training Center
Center for Sustainable Health Outreach – University of Southern Mississippi
August 6-9 – Unity Conference – Dallas, Texas

11. Why are CHW’s effective?
CHWs have access to the population they serve
Trusting relationship lays the foundation for good diabetes self management
CHWs have great flexibility to meet clients’ needs (i.e. amount of time spent, time of day services are provided, place of contact, range and extent of services)
Reduce system costs
Address barriers to care
Cultural/spiritual beliefs and language issues
Minimize stigma/reaction associated with disease
Create an understanding of the disease
Improve relationship with providers

12. Measuring Program success
Patient Satisfaction
Self-efficacy to manage disease
Clinical measures
Cost/burden

13. Do chw programs work?
In Mingo County, WV, CHWs working 130 high-risk diabetes patients demonstrated an average reduction in hemoglobin HbA1c of 2.5 percentage points over a six-month period. The cohort’s average A1c after six months was 7.7% which was sustained over 18 months.
In New Mexico, CHWs providing community-based support services to insurance enrollees who were high consumers of health care resources were able to generate a 4:1 return-on- investment for the payer.
References:
Crespo, R, Hatfield V, Hudson J, Justice M. Partnership with Community Health Workers Extends the Reach of Diabetes Educators. In Practice, The American Association of Diabetes Educators. 2015: 24-29
Johnson D., P. Saavedra, E. Sun, A Stageman, D. Grover, C. Alfero, C. Maynes, B. Skipper, W. Powell, and A. Kaufman. Community health workers and Medicaid managed care in New Mexico. Journal of Community Health, 2012, 37:

14. Pam Spradling Big Sandy Health Care 606-886-8546 p.spradling@bshc.org