1. Diabetes Community Health Workers: A Piece of the Health Care Puzzle Diabetes Partners In Action Coalition (DPAC) Diabetes Partners In Action Coalition (DPAC) Training & Education Program Workgroup

2. Purpose  To provide awareness of and information about the role of the Diabetes Community Health Worker (DCHW) in addressing prevention or self-management of diabetes, particularly with underserved populations.

3. Learning Objectives  1. Describe four skills that are demonstrated by an effective DCHW.  2. Identify training components required to become a DCHW.  3. Explain the unique role of the DCHW as part of an integrated diabetes management

4. Who are Diabetes Community Health Workers? Diabetes Community Health Workers (DCHWs) are community members who work as bridges between their ethnic, cultural, or geographic communities and healthcare providers to help their neighbors prevent diabetes and its complications through self-care management and social support, including community engagement. AADE Position Statement. “Diabetes Community Health Workers. The Diabetes Educator. 2003; 29(5):818-24.

5. Workforce Size & Characteristics Michigan-Specific Data  2,724 total CHW workers: 1,807 paid CHWs (66%); 917 volunteer CHWs (34%)  Occupations: counseling, substance abuse, educational-vocational counseling, health education, and other health/community services  In Michigan: Federally Qualified Health Centers, Detroit Department of Health & Wellness Promotion, University of Michigan, Diabetes Outreach Networks, Access, Indian Health Services, Spectrum and St. Mary’s Hospital, Henry Ford Health System, etc.

6. National Pay Rates National Pay Rates New Hires  64% paid below $13 per hour  3.4% paid at or near minimum wage  21% paid $15 or more per hour Experienced CHWs  70% paid $13 or more per hour  50% paid $15 or more per hour Michigan Public Health Training Center October 9, 2007

7. DCHWs: Promoters of Healthy Lifestyles  Members of target communities  Share cultural beliefs and values  Share social and ethnic characteristics  Eliminate communication barriers  Act as role models for change  Disseminate information and educate families

8. Recommended Competencies of Diabetes Community Health Workers  The Final Report Of The National Community Health Advisor Study; CHW Chapter Three: Core Roles and Competencies of Community Health Advisors  Competencies include personal characteristics, qualities, and skills that DCHWs need to be effective

9. Personal Characteristics of DCHWs  Relationship with the community being served  Personal strength and courage (healthy self-esteem and able to remain calm)  Friendly/outgoing/sociable  Patient and compassionate  Open-minded/not-judgmental  Motivated and capable of self-directed work  Caring and empathetic

10. Personal Characteristics of DCHWs (cont.)  Committed/dedicated  Respectful and honest  Open/eager to grow/change/learn  Dependable/responsible/reliable  Flexible/adaptable  Desire to help the community  Persistent  Creative/resourceful

11. Skills of Diabetes Community Health Workers CommunicationInterpersonalTeaching Knowledge Base

12. Skills of Diabetes Community Health Workers (cont.) Service Coordination AdvocacyCapacity-BuildingOrganizational

13. DCHW Training-Options  Community Outreach Worker (WSU – 160 hrs.)  “Empowerment” education (developed at U of M Diabetes Research and Training Center (DRTC)  Attend a Diabetes Self-Management Training (DSMT) program provided by Certified Diabetes Educators (10 hours)  DSMT programs: www.michigan.gov/diabetes

14. DCHW Training-Topics  Human Subjects” (IRB) training  Human enhancement skills  Mental health (signs of depression, stress)  Case management skills  Cultural diversity/ competence training  Conducting assessments and collecting health data

15. DCHW Training-Topics  Computer skills and use of the Internet  Group facilitation/delivery of diabetes curriculum  Behavior modification techniques – goal setting skills  Understanding health disparities  Other training needs

16. National and State CHW Organizations/Trainings  American Association of Community Health Workers (part of APHA, American Public Health Association) pam.chapman@spectrumhealth.org pam.chapman@spectrumhealth.org  Michigan Community Advocate Association (MICAA) Grand Rapids, MI Grand Rapids, MI Lisa Marie Fisher @ 616-356-6205) Lisa Marie Fisher @ 616-356-6205)  Wayne State University: “Empowerment Skills for Family Workers” Training Series Joan Blount @ 313-827-7113 Joan Blount @ 313-827-7113

17. Diversity Training

18. Ongoing Competency Component to DCHW Training  Ensures that the DCHW maintains current knowledge about the treatment and self- management of diabetes  Provide frequent and regular diabetes education opportunities  Suggestions for training

19. DCHW Personal Successes  Survey showed a significant increase in knowledge of diabetes and self- management  Learning about diabetes prevention and complications and how to educate others  Perceive selves as making a difference, influencing change, small steps, “help get over the wall”

20. DCHW Personal Successes (cont.)  Increasing ability to relate to clients and gain their trust  Learning about computers  Helping each other with resources and other DCHW tasks  Learning to work with people across cultures  Developing their own healthier eating and exercise habits

21. DCHW Evaluation  DCHW focus groups and survey administered to assess previous and current knowledge of diabetes and self-management, attitudes, expectations, and assessment of the intervention  DCHW client file audits, include quarterly review of all files with follow up procedures, including a specific timeline for completion, second review, and follow up action  DCHW effectiveness phone survey

22. How DCHWs Helped REACH Participants Meet Their Goals

23. Responses To Rating Questions E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable, SC/NC=Somewhat Comfortable/Not Comfortable  96% of respondents reported feeling either very comfortable or comfortable contacting their DCHW for needs or services.  93% of respondents rated their DCHW understanding of their experiences as an African American or Hispanic as excellent or good.  In terms of doing what they said they would do, 87% of respondents rated their DCHW as excellent or good.

24.  94% of respondents reported either E/G: relationship with DCHW relationship with DCHW satisfaction with DCHW satisfaction with DCHW  Respondents rated DCHWs on their ability to: get them services to improve their health (E/G=85% and F/P=15%) get them services to improve their health (E/G=85% and F/P=15%) help them with relationship with their doctor (87% and 12%) and communication with doctor (E/G=76% and F/P=16%). help them with relationship with their doctor (87% and 12%) and communication with doctor (E/G=76% and F/P=16%).

25. Funding  Private foundations  Federal (CDC, NIH, USDA)  State and local agencies and health departments

26. The DCHW and the Diabetes Care Team  Team care is a necessary component of effective chronic illness management per DCCT* and UKPDS** (NDEP*** Team Care booklet)  Skills and roles of different health care providers should be integrated and coordinated  The DCHW is an important member of this team, particularly for high risk populations. *The Diabetes Control and Complications Research Trial Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329 (14): 977-986. **UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in subjects with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853. ***http://ndep.nih.gov/diabetes/pubs/TeamCare.pdf

27. The DCHW and the Diabetes Care Team DCHWs augment the role of the diabetes educator and other diabetes care team members  Promote trust to promote access to DSMT and other health care services  Provide diabetes self-management support after Diabetes Self-Management Training  Help diabetes educator provide culturally sensitive care/education

28. DCHW: An Important Piece of the Health Care Puzzle  Important role of the diabetes health care team, esp. for vulnerable populations  Provide access to and act as liaison with diverse populations  Serve as resources to their communities and to the advocacy and policy worlds* *Perez LM and Martinez J. Community Health Workers: Social justice and policy advocates for community health and well-being. Am J Public Health. 2008; 98:11- 14.

29. Thank you! For more information, contact: Dawn Crane (517) 335-9504 craned@michigan.govor REACH Detroit Partnership www.reachdetroit.org