Community Health Workers Finding Answers: Disparities Research for Change Key Components of Successful
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Finding Answers: Disparities Research for Change Community Health Workers Key Components of Successful Community Health Worker Programs Annual Grantee Conference October 12, 2007 A National Program of the Robert Wood Johnson Foundation at the University of Chicago 1 Finding Answers: Disparities Research for Change Recruitment and Retention Quyen Ngo-Metzger, MD, MPH Dara H. Sorkin, PhD University of California, Irvine A National Program of the Robert Wood Johnson Foundation at the University of Chicago 2 Finding Answers: Disparities Research for Change Community Health Workers “Community members who serve as connectors between health care consumers and providers to promote health among groups that have traditionally lacked access to health care.” Witmer et al, AJPH 1995 A National Program of the Robert Wood Johnson Foundation at the University of Chicago 3 Finding Answers: Disparities Research for Change Key Distinctive Characteristics Individuals from target community (culturally/ ethnically/ linguistically) Carry out functions related to health care Trained in the context of an intervention Have no formal or paraprofessional health care degree A National Program of the Robert Wood Johnson Foundation at the University of Chicago 4 Finding Answers: Disparities Research for Change Roles of CHWs Improve access-promote programs/services Provide culturally appropriate education/ information Improve behavioral outcomes Act as advocate/mediator between providers and client Provide social support A National Program of the Robert Wood Johnson Foundation at the University of Chicago 5 Finding Answers: Disparities Research for Change Recruitment How to find CHW? – Community-based organizations – Local health care clinics/providers – Local support groups/education classes – Newsletters of social/community organizations – Key informants in community A National Program of the Robert Wood Johnson Foundation at the University of Chicago 6 Finding Answers: Disparities Research for Change Characteristics of Successful CHW Motivation--desire to help others/self High self-esteem resulting in credibility Trustworthiness/confidentiality Maturity/responsibility Good interpersonal skills Literacy (not necessarily bilingual) Experience with disease/condition A National Program of the Robert Wood Johnson Foundation at the University of Chicago 7 Finding Answers: Disparities Research for Change Retention of CHW Availability to do the work (full vs. part time) Commitment to the duration of program Documentation situation Transportation Family’s attitude toward role of CHW Cohesiveness of “team” membership A National Program of the Robert Wood Johnson Foundation at the University of Chicago 8 Finding Answers: Disparities Research for Change Training/Curriculum/Supervision Massachusetts League of Community Health Centers University of Massachusetts Medical School A National Program of the Robert Wood Johnson Foundation at the University of Chicago 9 Finding Answers: Disparities Research for Change How do we match the curriculum to the CHW role? Partnered with the Outreach Worker Training Institute – Five years of experience – Taught by professional instructors and experienced CHWs – CHW generalist curriculum modified to diabetic specialist A National Program of the Robert Wood Johnson Foundation at the University of Chicago 10 Finding Answers: Disparities Research for Change Designing the Job Description Self management goal setting Review of existing CHW roles Performance expectations Guidance in hiring process A National Program of the Robert Wood Johnson Foundation at the University of Chicago 11 Finding Answers: Disparities Research for Change Training 45-hour Community Health Worker certificate course modified to include diabetes self management • 15 sessions (three hours per session) • 8 core competency sessions • 7 diabetes components A National Program of the Robert Wood Johnson Foundation at the University of Chicago 12 Finding Answers: Disparities Research for Change Eight Core Competencies Service coordination Interpersonal Communication and interviewing Organizational Presentation and facilitation Individual and community assessment Advocacy and leadership Cultural awareness and sensitivity A National Program of the Robert Wood Johnson Foundation at the University of Chicago 13 Finding Answers: Disparities Research for Change Self Management Goal Setting Theme woven throughout curriculum Patient directed Stages of Change Motivational Interviewing Realistic goal setting Role playing exercises Documentation (encounter form) A National Program of the Robert Wood Johnson Foundation at the University of Chicago 14 Finding Answers: Disparities Research for Change Supervision Why is it important? – Burnout – Boundaries Who should be involved? – Clinical versus Social Service What should it include? A National Program of the Robert Wood Johnson Foundation at the University of Chicago 15 Finding Answers: Disparities Research for Change Training of Supervisors 6 hour supervisor training – Role of CHW – Boundaries Dual relationships Self-disclosure – Role creep Previous/current position at CHC – Deployment Integration strategies Communication A National Program of the Robert Wood Johnson Foundation at the University of Chicago 16 Finding Answers: Disparities Research for Change Ongoing training CHWs – Scheduled conference calls – Workshops- Developed based upon continuous needs assessment Supervisors – Scheduled conference calls – Workshops- Developed based upon continuous needs assessment A National Program of the Robert Wood Johnson Foundation at the University of Chicago 17 Finding Answers: Disparities Research for Change What do supervisors need? Pre-implementation support Ongoing support and technical assistance Peer-to-Peer contact (networking opportunities A National Program of the Robert Wood Johnson Foundation at the University of Chicago 18 Finding Answers: Disparities Research for Change “THANKS FOR THIS GREAT OPPORTUNITY TO LEARN MORE ABOUT DIABETES IN GENERAL AND ALSO THE OPPORTUNITY TO SHARE WITH COLLEAGUES WORKING ON THE SAME FIELD. HEALTHY PEOPLE MAKE A STRONG COMMUNITY.” A National Program of the Robert Wood Johnson Foundation at the University of Chicago 19 Finding Answers: Disparities Research for Change Quality and Financing Scott Cook, Ph.D. University of Chicago A National Program of the Robert Wood Johnson Foundation at the University of Chicago 20 Finding Answers: Disparities Research for Change Performance Evaluation Supervisor – Observation – Task / procedure documentation – Supervision meetings Patient/client Medical/Behavioral Health Other CHW A National Program of the Robert Wood Johnson Foundation at the University of Chicago 21 Finding Answers: Disparities Research for Change Documentation Standardized policies and procedures – Supervisor review – Supervision notes Keeping up Separate records Outcome data – Health – Behavior A National Program of the Robert Wood Johnson Foundation at the University of Chicago 22 Finding Answers: Disparities Research for Change Program Funding Dower, Knox, Lindler & O’Neil 2006 A National Program of the Robert Wood Johnson Foundation at the University of Chicago 23 Finding Answers: Disparities Research for Change Vulnerable to Exploitation Mostly women without college or professional education Often foreign-born and/or living in underserved communities Not represented by unions or subject to regulation or oversight by regulatory boards No national association or network / only a few state associations A National Program of the Robert Wood Johnson Foundation at the University of Chicago 24
