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10/12/16 MWCOG Health Officials Commi8ee 1
Inform. Involve. Inspire.
October 13, 2016
Abby Charles, Ins@tute for Public Health Innova@on Denise Wise, Ins@tute for Public Health Innova@on Shikita Taylor, Ins@tute for Public Health Innova@on 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 Effec@ve Public Policy • Design, Implement, and Evaluate Innova@ve Public Health Strategies
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IPHI’s Role Crea:ng Sustainable CHW Models
Developing Adap:ng Implemen:ng Evalua:ng
CHW program models across the region to create best prac@ces for the region.
• Facilitate state-‐level CHW policy development
• CHW workforce and integrated care team training
• Crea@ng 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 U@liza@on 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 Exper@se is based on shared life experience (and o`en
culture and community) with people served ü Rely on rela@onships and trust more than on clinical
exper@se ü Relate to community members as peers rather than purely as clients or pa@ents ü Can achieve certain results that other professionals cannot Acknowledgement: Carl Rush, Community Resources LLC
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VA CHW Scope of Prac:ce Role 1: Community Mobiliza@on and Outreach
Role 2: Health Promo@on and Coaching
Role 3: Service System Access and Naviga@on
Role 4: Care Coordina@on/Management
Role 5: Community-‐Based Support
Role 6: Par@cipatory Research
VA CHW Core Competencies
#1: Communica@on Skills
#2: Cultural Humility and Responsiveness
#3: Knowledge Based Skills
#4: Service Coordina@on and System Naviga@on Skills
#5: Health Promo@on and Disease Preven@on
#6: Advocacy and Outreach Skills
# 7: Professionalism
Why Community Health Workers? Why Now?
ü Increased recogni@on of the evidence base related to improved health outcomes ü Emerging evidence base demonstra@ng significant Return on Investment (ROI) – average of about 3:1 ü Recogni@on 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 u@liza@on ü Trends toward Pa:ent-‐Centered Medical Homes, Accountable
Care Organiza:ons, and value-‐based financing
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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 Prac@@oners, 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 communi@es that aim to:
o REMOVE BARRIERS to health care services including:
§ Lack of knowledge, transporta@on and trust o PROVIDE SERVICES that focus on health promo@on &
preven@on 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, mo@vate, and inspire other community members to make posi@ve lifestyle choices
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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 Founda@on & Jenkins
Founda@on 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 Connec@ons ü 7th District Wellness Ini@a@ve ü Richmond Promise Neighborhoods
On-‐Site Service Providers ü Fan Free ü Minority Health Consor@um
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.” h8p://@nyurl.com/cpe2yfs
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CA and PHN rela:onship
1. Coordina@on and naviga@on to medical homes and resources that address social determinants of health
2. Improved professional development and overall self-‐sufficiency of CAs
3. Rela@onal and physical connec@on 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 preven@on in communi@es ü Nurses provide screening as well as more in-‐depth clinical support on treatment needs for pa@ents, while CHWs support pa@ents with their self management.
ü CAs are trained to do blood pressure screening and glucose tes@ng
ü CAs also provide chronic disease self management training to residents through health educa@on and cooking classes
ü CAs provide linkage to educa@on 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 u@liza@on ü Iden@fy par@cipa@ng 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 ques@ons?
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