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10/11/16 1
Inform. Involve. Inspire.
October 13, 2016
Abby Charles, Ins3tute for Public Health Innova3on Denise Wise, Ins3tute for Public Health Innova3on Shikita Taylor, Ins3tute for Public Health Innova3on Stephanie Toney, Richmond City Health District Shanteny Calvin, Richmond City Health District
The Role of Community Health Workers in Collabora7on with Public Health Nurses
Who We Are
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v An independent non-‐profit resource that builds partnerships across sectors and cul:vates innova:ve solu:ons to improve health and well-‐being for all people and communi:es throughout VA, DC and MD. • Facilitate Cross Sector
Partnerships • Training, Technical Assistance, and Capacity Support
• Support Effec3ve Public Policy • Design, Implement, and Evaluate Innova3ve Public Health Strategies
IPHI’s Role Crea:ng Sustainable CHW Models
Developing Adap:ng Implemen:ng Evalua:ng
CHW program models across the region to create best prac3ces for the region.
• Facilitate state-‐level CHW policy development
• CHW workforce and integrated care team training
• Crea3ng partnerships with CBOs, medical providers, and Medicaid MCOs to test CHWs as a business strategy
v 400+ CHWs trained v 30+ CHW employees v 40+ CHW jobs created v Thousands enrolled in CHW
services across our region
Virginia CHW Defini:on
“A Community Health Worker applies his or her unique understanding of the experience, language and culture of the popula7ons he or she serves to promote healthy living and to help people take greater control over their health and their lives. CHWs are trained to work in a variety of community se=ngs, partnering in the delivery of health and human services to carry out one or more of the following roles:-‐ Providing culturally appropriate health educa7on and informaBon-‐ Linking people to the services they need-‐ Providing direct services, including informal counseling & social support-‐ Advoca7ng for individual and community needs, including idenBficaBon of gaps and exisBng strengths and acBvely building individual and community capacity.”
(Interim Report: The Status, Impact, and U3liza3on of Community Health Workers, James Madison University, 2005)
What is Dis:nc:ve About Community Health Workers?
ü Do not provide clinical care ü Generally do not hold a professional license ü Exper3se is based on shared life experience (and o^en
culture and community) with people served ü Rely on rela3onships and trust more than on clinical
exper3se ü Relate to community members as peers rather than purely as clients or pa3ents ü Can achieve certain results that other professionals cannot Acknowledgement: Carl Rush, Community Resources LLC
VA CHW Scope of Prac:ce Role 1: Community Mobiliza3on and Outreach
Role 2: Health Promo3on and Coaching
Role 3: Service System Access and Naviga3on
Role 4: Care Coordina3on/Management
Role 5: Community-‐Based Support
Role 6: Par3cipatory Research
VA CHW Core Competencies
#1: Communica3on Skills
#2: Cultural Humility and Responsiveness
#3: Knowledge Based Skills
#4: Service Coordina3on and System Naviga3on Skills
#5: Health Promo3on and Disease Preven3on
#6: Advocacy and Outreach Skills
# 7: Professionalism
Why Community Health Workers? Why Now?
ü Increased recogni3on of the evidence base related to improved health outcomes ü Emerging evidence base demonstra3ng significant Return on Investment (ROI) – average of about 3:1 ü Recogni3on of CHWs as an official job classifica:on by the Department of Labor in 2010 ü Medicaid rule change opens door for Medicaid financing of CHWs ü Federal government and many states, incl. VA, involved in work to
promote CHW workforce development and u3liza3on ü Trends toward Pa:ent-‐Centered Medical Homes, Accountable
Care Organiza:ons, and value-‐based financing
Inform. Involve. Inspire.
The Resource Centers: Community Health Partnership in
Richmond Public Housing Communi7es
The Resource Centers -‐ Who We Are:
A team of staff: Nurse Prac33oners, Nurses, Resource Center Specialists, Community Advocates, and Housing Advocates
The Resource Centers – What We Do:
ü Satellite health clinics located in renovated low-‐income housing communi3es that aim to:
o REMOVE BARRIERS to health care services including:
§ Lack of knowledge, transporta3on and trust o PROVIDE SERVICES that focus on health promo3on &
preven3on o CONNECT individuals to local medical homes o INVEST in indigenous leaders who provide support to the community
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Resource Center Space
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The Community & Housing Advocate Model
v Strategy: Each Resource Center has a Community Advocate and Housing Advocate who focus on:
ü Community outreach ü Health and housing educaBon ü NavigaBng individuals to medical, housing, educaBon, and
employment resources ü Improving community quality of life by addressing social
determinants of health
Who are our Advocates?
Trained community leaders who understand the barriers of their own neighborhood and educate, mo3vate, and inspire other community members to make posi3ve lifestyle choices
Shikita Taylor, Community Advocate
“I do what the community needs me to do. I make sure that residents have healthcare and insurance so that they can have access to their own physician. I call and make appointments for residents who are unable to do so for themselves. If they need jobs, I will find one on the bus line that would interest them. Whatever they need I try to make sure I get informaBon for them.”
Community Partnerships
Financial Support ü City of Richmond ü The Community Founda3on & Jenkins
Founda3on ü Bon Secours ü VCUHS ü RCHD
In-‐kind Support ü RRHA
Referring Medical Homes ü Daily Planet ü Crossover ü Bon Secours ü VCU Health Systems ü Center for High Blood Pressure ü CAHN
Community Partners ü Family Life Line ü YMCA ü HOME ü CARITAS ü Full Circle Grief Center ü RBHA ü Shalom Farms ü Challenge Discovery ü Senior Connec3ons ü 7th District Wellness Ini3a3ve ü Richmond Promise Neighborhoods
On-‐Site Service Providers ü Fan Free ü Minority Health Consor3um
Impact: Cost Savings
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0
200
400
600
800
1000
1200
1400
Emergency Room Primary Care Health Center
Cost per visit (in
$)
Type of Visit
Average Cost per Pa:ent Visit
$1265
$199 $108
“Access Granted: The Primary Care Payoff.” hmp://3nyurl.com/cpe2yfs
CA and PHN rela:onship
1. Coordina3on and naviga3on to medical homes and resources that address social determinants of health
2. Improved professional development and overall self-‐sufficiency of CAs
3. Rela3onal and physical connec3on for city resources into public housing developments
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CAs, PHNs and Diabetes Preven:on
ü PHNs and CAs partner to engage in diabetes preven3on in communi3es ü Nurses provide screening as well as more in-‐depth clinical support on treatment needs for pa3ents, while CHWs support pa3ents with their self management.
ü CAs are trained to do blood pressure screening and glucose tes3ng
ü CAs also provide chronic disease self management training to residents through health educa3on and cooking classes
ü CAs provide linkage to educa3on and support services to prevent diabetes.
ü CAs to be trained to conduct CDC Pre-‐diabetes screening in the community
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Resource Center
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Linkage to Care
ü Medical home referrals and u3liza3on ü Iden3fy par3cipa3ng medical homes ü MOUs ü Designated Agency Personnel ü Staff Training ü Referral Tracking
ü 2015 Service Profile
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Resource Center
THANK YOU!
Any ques3ons?
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