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Community Health Worker Strategy Meeting
March 20, 2019 Herrin Hospital
Heritage Building
A Value Driven Solution for Population Health
Funding for this Project is Provided by IDPH 1815 Grant; Prevention and Management of Diabetes, Heart Disease, and Stroke
What is a CHW- APHA? “A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of
and/or has an unusually close understanding of the community served. This trusting relationship enables
the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality
and cultural competence of service delivery.
A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency
through a range of activities such as outreach, community education, informal counseling, social
support and advocacy.”
Other Names Promotores de Salud
Community Health Representatives
Community Health Advisors
Peer Navigator
Other
Recommendations Roles and Responsibilities
Training and Certification
Financing & Reimbursement
Workforce Development
Raising Awareness
A National Lens: National Association of Community
Health Workers (NACHW)
Wandy D. Hernandez
NACHW Board Co-Chairs Wandy Hernandez & Sergio Matos
Founding Board of Directors
• 20 Directors • Bi-weekly phone calls since 2016
• In-person meetings across country
• Local/regional representation of USA
• Majority CHW
• Majority women
• Includes both allies and practitioners
• 1 part-time support staff
NACHW Board Members
• Mae-Gilene Begay, [email protected]
• Naomi Cottoms, [email protected]
• Ramona Dillard, [email protected]
• Durrell Fox, [email protected]
• Catherine Haywood, [email protected]
• Gail Hirsch, [email protected]
• Lisa Renee Holderby-Fox, [email protected]
• Maria Lemus, [email protected]
• Susan Mayfield-Johnson, [email protected]
• Anita McDonnell, [email protected]
• Floribella Redondo, [email protected]
• Alise Sanchez, [email protected]
• Julie Smithwick, [email protected]
• Napualani Spock, [email protected]
• Ashley Wennerstrom, [email protected]
• Geoff Wilkinson, [email protected]
• Katie Sutkowi, [email protected], ex-oficio/consultant
Wandy Hernandez, Co-Chair [email protected] Carl Rush, Treasurer [email protected]
Sergio Matos, Co-chair [email protected] Joelisa Castillo, Secretary [email protected]
Why Now?
• Increased interest in CHWs • ACA • DOL • CMMI • Health Reform Innovations – goals and financing
• Value-based payment, shared risk, bundled payments
• Large body of evidence – effectiveness of CHWs • Business Case
• Value-added, cost-savings, return-on-investment • Outreach, engagement, activation, adherence, retention • CMMI report
• Scholarly texts
• Preserve integrity of CHW work
Honoring Our Past, Building Our Future
NACHW AACHW,
2007 - 2009 APHA
• CHW SPIG, 2000
• CHW Section, 2009
• Resolutions
Unity conferences,
1999 - present
NACHW Mission, Vision, Values
Vision: Community Health Workers united nationally to support communities in achieving health, equity and social justice
Mission: To unify the voices of Community Health Workers and strengthen the profession’s capacity to promote healthy communities
Values: • Self-empowerment of CHWs and their communities • Social justice and Equity • Integrity of CHW work • Dignity and Respect • Unity • Informed Self-determination
Work in Progress
• Non-profit incorporation- Completed Feb. 2019
• Member recruitment & engagement
• Fundraising
• Launch Planning
NACHW’s Value for the CHW Workforce
• Build a unified professional identity
• Preserve workforce integrity
• CHW policy development and advocacy
• Technical assistance to state CHW associations
• National information clearinghouse
• Convene conferences and foster professional collaboration
• Training, networking, and other member services and benefits
• Conduct and disseminate research
Washington, DC, 2018
Membership • Four categories of membership:
• Individual CHW
• Individual Ally (Non-CHW)
• CHW Network Organization
• Other Organization
• Sponsor and Champion memberships core to financial sustainability
• Multiple membership benefits
Make NACHW Your Organization!
Participate in a NACHW Launch Committee
Engage with your local or state CHW organization • Strong local efforts are essential for sustaining a national effort
Make plans to join as a founding member
Attend the Launch at Unity 2019 in April (Las Vegas)
Share information about NACHW with your CHW colleagues
Sign up for NACHW’s mailing list
Join Us for the Official Launch!
Unity Conference, 2019
April 14-17, 2019
Las Vegas, Nevada
All CHWs and allies interested in celebrating
the launch of NACHW are invited and encouraged to attend this historic event!
Thank You
Email: [email protected] Website: www.nachw.org
Wandy Hernandez
Co-Chair NACHW/Vice President
ILCHWA
Illinois Department of Public Health Community Health Worker (CHW) Update
Paula Jimenez, RN
Mona Van Kanegan, DDS, MS, MPH
Centers for Disease Control Grant Period (October 1, 2018 – June 30, 2023)
DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention
Long Term Outcomes
• Decreased proportion of people with diabetes with an
AIC>9
• Increased number of people with prediabetes enrolled
in a CDC-recognized lifestyle change
program who have achieved 5-7% weight loss
• Increased control among adults with known high
blood pressure and high blood cholesterol
DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention
2 Out of 10 Strategies involve CHWs
• Develop a statewide infrastructure to
promote long-term
sustainability/reimbursement for
CHWs as a means to establish or
expand their use in
– a) CDC-recognized lifestyle
change programs for type 2
diabetes prevention and/or
– b) ADA-recognized/AADE-
accredited DSMES programs
for diabetes management.
Strategy A7
• Develop a statewide
infrastructure to promote
sustainability for CHWs to
promote management of
hypertension and high
blood cholesterol.
Strategy B5
ADA – American Diabetes Association
AADE – American Association of Diabetes Educators
DSMES – Diabetes Self-Management Education and Support
DP18-1815 Improving the Health of Illinoisans Through Chronic Disease Prevention
Asthma Education and
Environmental Management
• Asthma education/environmental management are evidence-based
strategies that reduce asthma-related emergency room visits and
hospitalizations and reduce health care costs.
– reimbursement tends to be lower
• GOAL: To expand access to evidence-based, home-based asthma
education and environmental interventions through sustainable financing
mechanisms.
– Expand reimbursement for asthma educators, CHWs.
– Amend contracts between state Medicaid and Medicaid
Managed Care Organizations to enable and provide guidance for
the use of CHWs.
EH-14-1404 Comprehensive Asthma Control Through Evidence-Based Strategies and Public Health – Health Care Collaboration
Health Resource and Services Administration (September 1, 2018 – August 31, 2022)
HRSA-18-014 Grants to States to Support Oral Health Workforce Activities
Project Approach
Improve understanding of oral health workforce, workforce
shortages and capacities in Illinois to better focus on improving
oral health status of Illinoisans,
Implement workforce strategies in selected areas of state (see
next few slides)
Use project outcomes and evaluation of IOHWA to re-align key
tasks, if needed.
HRSA-18-014 Illinois Oral Health Workforce Activities
IOHWA - Illinois Oral Health Workforce Activities
County/are
a
Population
Characteristics
% of
childre
n
FRLP**
ED visit
rates*
Workforc
e Focus
Area
Cook/Will Large urban area with
pockets of rural,
population: 6M
40-
68%
16.2-
56.3
CHW,
CDHC
LaSalle/Put
nam/Burea
u
Rural, Population: 150K,
40% of population
without dental insurance
35-
53%
56.4-
169.8
CDHC,
PHDH
Knox/Warr
en/Fulton
Rural, Population: 104K,
45% of population
without dental insurance
55-
66%
56.4-
169.8
CHW,
PHDH
Champaign Rural area with pockets of
urban, Population: 31%
of population without
dental insurance 208K
54%
110.3-
169.8
CHW,
PHDH
Christian Rural area with pockets of
urban, Population: 33K,
38% of population
without dental insurance
56%
169.9-
228.9
CHW,
PHDH
Jackson Rural area with pockets of
urban, Population: 59K,
35% of population
without dental insurance
66%
110.3-
169.8
CDHC,
PHDH
HRSA-18-014 Illinois Oral Health Workforce Activities
Long Term Workforce
Objectives Utilize a layered approach that increases the number of skilled
providers of oral health care in Dental HPSAs and improve the health
status of community members living in targeted Dental HPSAs by
expanding roles and numbers of the three community health-related
professionals, CHW, CDHC and PHDH
1) Expand the role of CHW by including oral disease, oral health and
pain management in their training curriculum,
2) Utilize CDHC curriculum component (i.e., internship) to provide
education and prevention services to underserved children, and
3) Leverage the newly legislated PHDH to increase the accessibility to
clinical services in public health settings (schools, FQHCs, and LHDs)
HRSA-18-014 Illinois Oral Health Workforce Activities
CHW - Community Health Worker
CDHC - Community Dental Health Coordinator
PHDH - Public Health Dental Hygienist
HPSA - Health Provider Shortage Areas
Strategies that Involve CHWs
Discussion with Illinois stakeholders demonstrate a willingness to review and expand CHW Curriculum.
(oral health and disease concepts including navigation and dental pain management)
• Systemic, sustainable solutions led by CHW leaders
• Close the gap in oral health knowledge and begin to re-integrate oral health as a mainstream health issue
• Focus on individual behavior change, prevention, navigation to treatment and their impact on chronic health conditions
HRSA-18-014 Illinois Oral Health Workforce Activities
Measureable CHW
Objectives
1) Include oral health training in state-certified CHW curriculum
2) By August 31, 2022, implement newly certified CHW curriculum in
at least 3 college/universities in the state
3) By August 31, 2022, complete training of at least 50 CHW students
that can work in HPSAs.
HRSA-18-014 Illinois Oral Health Workforce Activities
CHW - Community Health Worker
HPSA - Health Provider Shortage Area
Illinois Department of
Public Health
Paula Jimenez, RN
Assistant Chief, Division of Chronic Disease
Nikki Woolverton, MPH
Asthma Program Manager, Division of
Chronic Disease
Mona Van Kanegan, DDS, MS, MPH
Chief, Division of Oral Health
Thank You! Questions?
Implementing and Integrating CHWs in Central and Southern Illinois
Tracey Smith, DNP, PHCNS-BC, MS
March 20, 2019
Community Health Worker Strategy Meeting
Herrin, Il
From the Farm I learned the three “L”s of life
What are the three “L” s of life?
• Listening • taking notice of and acting on what someone says
• Loving • feeling or showing love or great care- accept me as I am
• Looking • regarding in a specified way
Show Up Don’t Give UP!
Equality vs. Equity
Basic Approach: Philosophies for SIU
Community Health Worker Models
Harm reduction Motivational interviewing
Trauma informed care
Accompaniment
Trust
SIU Community Health Worker Models
• Lay Health Worker Model
• Member of Care Delivery Team Model
• Care Coordinator/Manager Model
• Health Educator Model
• Outreach and Engagement Model
• Community Organizer and Capacity Builder Model
Rural Health Information HUB: https://www.ruralhealthinfo.org/toolkits/community-health-workers
Diabetes
Hypertension
Mental Health
Pediatric Asthma
Enos Park Neighborhood: A Community Organizer and Capacity Builder Model
43
Even Disadvantaged Neighborhoods Are
Not the Same
“There are places and cities around the country that are very
poor, but still benefit from community gardens, and active
religious organizations, nice parks – and the people who live in
those places are likely to be healthier, live longer life
expectancy, and better capacity to survive crises like
hurricanes or heat waves than are people who live in
comparably poor neighborhoods but who don’t have that
social infrastructure to support them.”
Klinenberg, E. (Guest) & Ben-Achour, S. (Host). (2018, September 11). How "social infrastructure" can save us all [Radio Broadcast Episode]. https://www.marketplace.org/2018/09/11/sustainability/social-infrastructure-helps-keeps-us-safe
Outcomes of Enos Park PRogram
● Increased:
○ Employment by 50%
○ Income by 200%
○ Food and nutrition by 50%
○ Health care coverage by 50%
○ Life skills by 40%
○ Mobility by 100%
○ Community Involvement by 66.7%
○ Physical Health by 25% *
○ Increased Asthma action plans and high blood pressure control
● Decreased:
○ Police Calls by 44%
○ No Shows to Medical Appointment by over 60%
○ Unnecessary Emergency Room Visits by over 25%
○ Evictions from housing by 80%
○ Recidivism rate by 54%
○ HgA1Cs
○ Decreased Asthma ED Visits, Smoking Rates
Engagement of Patients Working With a CHW in Enos
A Medical Home was created for 100% of
our clients
Engagement with primary care providers
was high
96% of our patients saw a primary care
provider at least once in the past year
No children in program excluded from
school
Our patients had an 83% show rate up
from a 17% show rate!
Expansion of CHW Concept….
• Brandon Court
• East Springfield Program
• Access to Health Program: Enos and Pillsbury
• Healthy Jacksonville
• Quincy Public School Health Collaborative
• Helping Hands Shelter
• Mercy Communities
• Sangamon Court System
Total CHWs trained: 20 CHWs, 5 CHW Supervisors, 15 CHWs special training in diabetes, asthma, complex care, ED overuse with an emphasis on the life spectrum
Financial Outcomes – An Example
Month
Inpatient/ Emergency
Visits Total Charges Actual
Payment True Cost
30 days between
Visits?
Preintervention
January 1 $ 48,422.84 $ 9,921.38
$ 16,337.24
February 0 $ - $ - $ -
March 1 $ 51,061.70 $ 11,211.06
$ 24,955.46 Yes
April 3 $ 84,998.58 $ 20,025.92
$ 28,877.56 No
May 1 $ 37,736.30 $ 6,993.62
$ 19,805.53 No
June 1 $ 28,266.40 $ 2,743.28
$ 14,195.98 No
July 1 $ 98,259.54 $ 6,450.29
$ 42,451.44 Yes
Totals Preintervention
8
$ 348,745.36
$ 57,345.55
$ 146,623.21
Average Preintervention
1.14 /Month
$ 49,820.77
$ 8,192.22
$ 20,946.17
Intervention
August 2
37,376.29 2,747.72 $ 17,517.15 No
September - December 0 $ - $ - $ - N/A
Totals Post-intervention
37,376.29 2,747.72 17,517.15
Avg. Post-intervention
7,475.26 549.54 3,503.43
Average 30 Days Post $ - $ - $ -
2
0.4 /Month
0 /Month
Program has exceeded our expectations.
American Hospital Association 2018 NOVA Award for collaboration on looking beyond physical ailments to address economic and social barriers to care.
SIU CHW Training Program ETC…(Evolving Training for Community Health Workers)
• Combination of trainings for the continuum of CHW provision including:
• Consulting Model for implementation, administration, and evaluation of CHW programs
• Specific training programs for CHWs to function in the different CHW models and directions including disease specific, complex care, chronic care, substance use, and super utilization of resources
• Mixture of learning modalities utilized including in person, technical assistant calls, and ECHO • ECHO (Extending Community Health Outcomes) is a training model
created at the University of New Mexico which utilizes Zoom technology to connect the ETC… training team at SIU SOM and CHW teams at distant sites through an audio/video platform.
• The model utilizes an all-teach, all-learn model that includes a short
didactic session, a case presentation, discussion, and the development of recommendations.
• *** Broad band issues can be addressed practically.
• Training content aligns with the core skills prioritized by the Illinois CHW Advisory Board
• An SIU Certificate in CHW will be provided to those who complete programming
The ETC…Training Team is an interdisciplinary team made up of:
• Nurse • Masters in Communication, CHES • LCSW/LCPC • CHW • Pharm D
Tracey Smith 217-825-9181 [email protected]
Community Healthy Worker Strategy
Where Do WE Go From Here?
BIG Questions we need to address prior to submission of recommendations
• Who/ What entity will be the Certifying body for CHW in Ill?
• What will be the status of institutions of higher learning who are already implementing a State Certification (approved by Ill State Board of Ed) for CHW (Malcolm X and South Suburban College)?
• Will there be a re-certification process for agencies and CHW’s?
• How do we address reimbursement for CHW given the various level of CHW throughout the State? How do we “guarantee employers” the competency of a CHW?
Next Steps Review and Summarize input from
Today’s Session
CHW Strategic Planning Committee meet to discuss next steps
Based on recommendations from all 3 sessions (Chicago and 2 downstate) the Strategic Planning Committee will develop an addendum to the original CHW 2016 Recommendation Report
Convene one more meeting to discuss certification process etc
Circulate addendum for comments to CHWs and CHW Stakeholders throughout the state.
Convene a final strategy meeting to review final recommendations/addendum
Submit to Final Recommendations to Governor, Fall 2019
Any Burning Questions or
Suggestions that was not listed ?
Questions or Suggestions Please contact
Angela Ellison
Thank You for Your Time Today!!!
Thank You
• Illinois Department Of Health
• Illinois Public Healthcare Association
• Illinois Community Health Worker Network
• Malcolm X College
• Sinai Urban Health Institute
• University of Illinois – Chicago
• Southern Illinois University
• South Suburban College
• Chicago Department of Health
