1. PROMOTORAS AND COMMUNITY HEALTH WORKERS NETWORK How the Promotores Model Facilitates Access to Health Care in California Communities © 2009 Visión Y Compromiso

2. Promotoras and Community Health Workers Network Hacia una Vida Digna y Sana Established in 2001 by Visión y Compromiso, the Network is now active in 10 regions and includes over 3,000 P/CHWs. Established in 2001 by Visión y Compromiso, the Network is now active in 10 regions and includes over 3,000 P/CHWs. Network priorities are defined locally and may differ by region. Network priorities are defined locally and may differ by region. Regional Comités (RCs) are the vehicle for local leadership development. Regional Comités (RCs) are the vehicle for local leadership development. RCs organize quarterly forums, trainings, health fairs and family events. RCs organize quarterly forums, trainings, health fairs and family events.

3. International Origins of the Promotores Model Source: US/Mexico Border Health Association

4. Russia In 17 th century Russia, “Lay People” or outreach workers called feldshers took a one-year training to learn to care for civilians and people in the military. In 17 th century Russia, “Lay People” or outreach workers called feldshers took a one-year training to learn to care for civilians and people in the military. Source: US/Mexico Border Health Association

5. China In China in the 1960s, farm workers were trained as “barefoot doctors” to provide health care in rural communities. About 20% of these health workers later entered medical school. In China in the 1960s, farm workers were trained as “barefoot doctors” to provide health care in rural communities. About 20% of these health workers later entered medical school. Source: US-Mexico Border Health Association

6. Latin America Heightened political activism in the 1960s and 1970s increased the number of Promotores trained by popular organizations and church groups throughout Latin America. Heightened political activism in the 1960s and 1970s increased the number of Promotores trained by popular organizations and church groups throughout Latin America. Source: US-Mexico Border Health Association

7. United States The first formal community health worker programs in the United States were established in 1950-1960 as a strategy to deliver accessible and appropriate health resources to communities not being served by the traditional medical system. The first formal community health worker programs in the United States were established in 1950-1960 as a strategy to deliver accessible and appropriate health resources to communities not being served by the traditional medical system. Source: US-Mexico Border Health Association

8. The Health Promotores Model The Health Promotores Model The Alma Ata Declaration, signed at the World Health Organization (WHO) conference in 1978, called for: Local community participation in determining health care priorities. Local community participation in determining health care priorities. Increased emphasis on primary health care and preventative medicine. Increased emphasis on primary health care and preventative medicine. Linkages between medicine, trade, economics, industry, rural politics, and other political and social arenas. Linkages between medicine, trade, economics, industry, rural politics, and other political and social arenas.

9. Who are Promotores and Community Health Workers? Promotores are community members who act as natural helpers and liaisons to their neighbors and local neighborhoods; they may or may not be affiliated with community institutions.

10. Promotores are Natural “Boundary Spanners”… “ …sought after to provide advice, support, and tangible help.” They offer servicio de corazón (heartfelt service) and culturally relevant health prevention education and information to both native-born and immigrant communities. “ …sought after to provide advice, support, and tangible help.” They offer servicio de corazón (heartfelt service) and culturally relevant health prevention education and information to both native-born and immigrant communities. Source: US-Mexico Border Health Association

11. Promotores Programs  Promotor and Community Health Worker (P/CHW) programs flourish throughout California, particularly in metropolitan areas where community based organizations and health providers have nurtured P/CHW activities within their organizations.  While the content of these programs and the actual services provided vary according to the funding, health condition or behavior priority for that region, the core capabilities remain constant.  P/CHWs are involved in mental health, HIV/AIDS, diabetes and chronic disease prevention, cancer, nutrition, oral health, etc.

12. Promotores are… They may have diverse roles and functions. Promotora Outreach Worker CHW Advocate Health Educator Case Worker Block Parent

13. Community-based Informal Assistance Volunteer & Part-Time Little recognition Person-to-person interaction Live in community PromotoraCHW Institutional-based Formal Assistance Employed Part-/Full-Time Formal Recognition Authority interaction May reside outside community Source: Community-Workers: Who Are They and What Do They Do? 1996 and VyC focus group data Diverse Promotora and CHW Characteristics © 2002 Visión Y Compromiso

14. Integrated/ecological approach to health issues Integrated/ecological approach to health issues Learning through people’s experience and stories; people are active learners Learning through people’s experience and stories; people are active learners Curricula recognize and integrate cultural values Curricula recognize and integrate cultural values Transfer of information integrates diverse learning orientations Transfer of information integrates diverse learning orientations Community-driven curriculum Community-driven curriculum Community engagement to identify solutions Community engagement to identify solutions Popular Education ModelMedical Model Illness/individual/symptom/behavior focus of health “Teaching” and knowledge attainment; passive learning methods Standardized curricula, centered on white middle class values Transfer of information is centered on white, middle class learning orientations Agency-driven curriculum Experts define and drive solutions/programs Vision y Compromiso, 2003 Spectrum of Methodology

15. Research Supports the Work of P/CHWs Role of P/CHWs: Facilitate access to services Strengthen social support networks Programs that Integrate Promotores Show: Improved health care access Increased prenatal care access Improved pregnancy and birth outcomes Improved client health status Increased health and screening behaviors Reduced health care costs (Brownstein and Rosenthal, 1998)

16. Promotores Reduce Disparities Community Promotores Health Care System As Liaisons, they help: Keep appointments Remove cultural and linguistic barriers Encourage participation in maintaining health Increase access to prevention, services and follow up care Provide a wide range of services & integrate prevention Naturally connects with and maximizes existing social networks Increase trustworthiness Local workforce development Provide cost-effective services Reinforce cultural values & norms Reduce access barriers to agencies, hospitals & pharmacies Healthy Families and Communities © 2002 Visión Y Compromiso, 2009

17. Educate the community about how to navigate health care and other systems. Educate the community about how to navigate health care and other systems. Inform the community about their right to interpreter services, how to file a complaint, and access health education. Inform the community about their right to interpreter services, how to file a complaint, and access health education. Provide linkages to health care providers and community-based resources. Provide linkages to health care providers and community-based resources. Vision Y Compromiso, 2003 Promotores Meet the Cultural and Linguistic Needs of Limited English Speakers

18. VyC Statewide Survey of P/CHWs In 2004, VyC implemented a survey in 22 cities to gather data about the P/CHW workforce in California: In 2004, VyC implemented a survey in 22 cities to gather data about the P/CHW workforce in California: 85% of respondents were women 85% of respondents were women 71% were married with children 71% were married with children 75% were high school graduates 75% were high school graduates 32% had at least some college education 32% had at least some college education 80% believed they were underpaid 80% believed they were underpaid

19. Promotores Need Institutional Support The 2004 Survey found Promotores more likely to be integrated as independent contractors or volunteers than employed as agency personnel. The 2004 Survey found Promotores more likely to be integrated as independent contractors or volunteers than employed as agency personnel. About 50% of Promotores were paid $7-$14/hr. On average, they earned $10.60/hr. Over 50% received some form of a stipend. About 50% of Promotores were paid $7-$14/hr. On average, they earned $10.60/hr. Over 50% received some form of a stipend. The average monthly household income of survey respondents was $2,200. The average monthly household income of survey respondents was $2,200. 70% of unpaid Promotores received no health insurance. 70% of unpaid Promotores received no health insurance.

20. Next Steps for VyC Identified by P/CHWs at the 2008 Workforce Summit VyC to develop standards and core competencies associated with uniform curricula and training. VyC to develop standards and core competencies associated with uniform curricula and training. VyC to create a Promotora Training Institute to certify Promotores in CA and implement innovative strategies to deliver training, support and technical assistance. VyC to create a Promotora Training Institute to certify Promotores in CA and implement innovative strategies to deliver training, support and technical assistance. Incorporate literacy, ESL, computer training, childcare, and scholarships into the certification process. Incorporate literacy, ESL, computer training, childcare, and scholarships into the certification process. Create mechanism to convert life experiences and years served into academic credits. Create mechanism to convert life experiences and years served into academic credits.

21. Core Activities of the Promotoras and CHWs Network Promotoras and Community Health Workers Network Technical Assistance Workforce and Career Development Leadership Development Capacity Building Research and Evaluation Policy Advocacy Linkage/Build Social Capital © 2002 Visión Y Compromiso, 2009

22. © 2008 Visión y Compromiso Network Regions in California Northern California Central Coast Inland Empire San Diego Los Angeles and San Fernando Valley SF Bay Area Orange County Central Valley

23. LA RED DE PROMOTORAS Y TRABAJADORES COMUNITARIOS For additional Information: Maria Lemus Melinda Cordero Executive Director Associate Director mholl67174@aol.commholl67174@aol.com promotorasinCA@aol.compromotorasinCA@aol.com 510.303.3444 626.864.6117

24. What do Promotores Need from You…? Get to know the Promotores in your District. Get to know the Promotores in your District. Who are they? Who are they? What role do they play in their neighborhoods? What role do they play in their neighborhoods? Which communities do they represent? Which communities do they represent? What agencies, if any, are they affiliated with? What agencies, if any, are they affiliated with? What are their workforce concerns? What are their workforce concerns? What are their successes? What are their successes?

25. What do Promotores Need from You…? Understand the community. Understand the community. What are the community-identified priorities? What are the community-identified priorities? What are the local assets? What are the local assets? Are there community-identified solutions to some of these priority issues? Are there community-identified solutions to some of these priority issues? How can you/your office become more involved in these priority issues? How can you/your office become more involved in these priority issues?

26. What do Promotores Need from You…? Support P/CHWs regionally and statewide. Support P/CHWs regionally and statewide. Send District staff to participate at community events, forums, convenings and activities. Send District staff to participate at community events, forums, convenings and activities. VyC Annual P/CHW Conference in Burbank, December 4-5, 2009. VyC Annual P/CHW Conference in Burbank, December 4-5, 2009. Fund P/CHWs as frontline health care workforce. Fund P/CHWs as frontline health care workforce. Help launch the Promotora Training Institute in California. Help launch the Promotora Training Institute in California. Support ACR 75 (Authored by V. Manuel Perez). Support ACR 75 (Authored by V. Manuel Perez).