FROM THE CLINIC TO THE COMMUNITY:
THE ROLE OF PUBLIC HEALTH INSTITUTES IN
MODELING THE EXPANSION OF THE
COMMUNITY HEALTH WORKFORCE
21-1094 Community Health Workers
• Assist individuals and communities to adopt healthy
behaviors. Conduct outreach for medical personnel or
health organizations to implement programs in the
community that promote, maintain, and improve
individual and community health. May provide
information on available resources, provide social
support and informal counseling, advocate for
individuals and community health needs, and provide
services such as first aid and blood pressure
screening. May collect data to help identify community
health needs. Excludes "Health Educators" (21-1091)
United States Department of Labor
CHWs in the Health System
• Increase the reach of the health system
• Allow clients to receive more in-depth services
• Increase the diversity of providers
• Allow for the rapid expansion of the health workforce
• Increase access to the health system for clients
• Improve the cultural competence/cultural humility of
providers (clinicians, nurses etc)
• Train clients to better understand the health system and
become self advocates
The Environment – The Opportunity
• Washington, DC: An estimated 89- 94% of persons were insured
• Yet 46% of people living with HIV had not received medical care in the last 12
months
• CHWs worked in silos
• No standardized training
• Limited coordination across agencies
• Disconnect between CBOs and Medical providers
• Low health literacy
• Clinicians and case managers have high caseloads and limited time
• Lack of comfort and understanding about the role of the CHW and the
Affordable Care Act
Formative Research & Community
Assessment
• At the beginning of this process we engaged in necessary
conversations with providers, clinicians and stakeholders
across the community
• This engagement is continuous throughout the
implementation of these CHW programs.
Overview & Timeline of IPHi’s Funded
CHW Initiatives
• March 2011: Positive Pathways (Washington, DC)- HIV
•
•
•
•
Linkage to Care
Summer 2011: Co-Convened the Community Health
Worker Professional Network of DC
January 2012: Northern Virginia Early Intervention
Services Project
May 2012: Virginia Department of Health Prevention For
Positives
September 2012: Community Transformation Grant
Overview & Timeline of IPHi’s Funded
CHW Initiatives
• January 2013: Kaiser Permanente Testing & Linkage to
•
•
•
•
Care Initiative (Prince George’s County)
February 2013: AIDS United Retention in Care Initiative
(Prince George’s County)
May 2013: George Washington University Heart Failure
Initiative
June 2013: DC Community Transformation Grant –
addressing chronic disease self management through
CHWs
June 2013: VDH CAPUS CHW Training
The Approach
• FT and PT Community Health Workers placed across
clinical and community settings
• Consistent training across sites
• Systematized use of peers across the DC, MD,
and VA region
• Multi-cultural team of CHWs working across populations
• Strategic placement of peers to reduce gaps in coverage
Building Knowledge and Awareness about
CHWs
• Creating a brand/standard for CHWs in the region
Doctor
Doctor
Nurses
Mental
Health
Nurses
Client
Social Worker
Mental Health
CHW
CHW
Social
Worker
Convening
• Ongoing training of partner sites
• Discuss challenges and successes
• Share best practices for
• CHW supervision
• Linkage to medical care
• Retention of clients in medical care
• Solicit advice on ongoing training of CHWs
• Present monthly project data
• Quality management
Training & Capacity Building
• Trained nearly 100 CHWs since March 2011
• Developed our own CHW training program which consists of
over 200 training hours over a one-year period, beginning with
an initial 80-hour intensive course
• Implemented ongoing training series for CHW supervisors as
well as training for clinical and community based care team
members on effective integration of CHWs
• Designing tailored trainings for FQHCs and Hospitals on the
role of CHWs in Patient Centered Medical Homes
• Provide ongoing capacity building and technical assistance for
partners
Recruitment & Retention
• Provide support to organizations with recruitment of
CHWs.
• Design of standard job descriptions
• Guidance on recruitment pools
• Standardized interview tools/ guides
• Along with providing advice and opportunity for CHW
personal and professional development, Sites require
ongoing support on supervision and retention of CHWs.
Model Development &Implementation
• Selection or design of relevant effective CHW Program
models and implementing the models for diverse sites
• Managed Care organizations
• Hospitals
• FQHCs with multiple clinical sites
• Community Based Organizations
• Health Departments
• Designing policies and procedures
• Sharing best practices
Building Models for Data Collection and
Assessment
• Using new technology and innovation to support data collection
in the field
• Using program models to design effective data collection
systems
• Designing program evaluation to capture essential elements of
CHW programs including CHW skills, site knowledge and skills,
client and community level health outcomes
• Working across sites to facilitate data sharing. Data system and
information sharing barriers (e.g., verifying whether clients are
truly out of care)
Attracting Funding to the Region
• Since the beginning of our work in 2011 funding for
programming has grown three fold and opportunities for
funding continue to be presented.
Sustainability
• Critical role of IPHi is to work with all partners to ensure
sustainability of this role in the health and public health
workforce
• Supporting the culture at agencies, FQHCs, Hospitals, health
departments, to value this role and integrate the role into their
policies and procedures
• Convening and engaging in regional dialogues to move
certification and sustainable financing for this job class.
• Co-convening CHW networks to foster networking, professional
development, collaboration and engagement in the advocacy
process
Workforce Development
• Creating a pipeline for
training and employment
for peers across the
region
• Working with trainers in
the community and
across academic
institutions to facilitate
continuing education and
other academic
opportunities
Dissemination
• Documentation of process and outcomes
• Supporting organizations with research and quality
evaluation
• Dissemination of lessons learned across the network and
nationally
• Serving as a clearinghouse for best practices for
organizations across the region.
New Opportunities for PHIs
• Health Enterprise Zones
• Patient Centered Medical Homes
• Community Transformation
• CMS Innovations
• Knowledge of and engagement in these opportunities is
essential to ensure an equitable health system.
Contact Information
Contact information:
Abby Charles, Program Manager
Institute for Public Health Innovation
tel. 202-407-7088, ext. 1016
acharles@institutephi.org
Courtney Coffey, Program Associate
Institute for Public Health Innovation
Tel. 202-407-7088, ext 1030
ccoffey@institutephi.org
www.institutephi.org