Diabetes Community
Health Workers:
A Piece of the Health
Care Puzzle
Diabetes Partners In Action Coalition (DPAC)
Training & Education Program Workgroup
Purpose
 To provide awareness of and information
about the role of the Diabetes Community
Health Worker (DCHW) in addressing
prevention or self-management of
diabetes, particularly with underserved
populations.
Learning Objectives
 1. Describe four skills that are
demonstrated by an effective DCHW.
 2. Identify training components required to
become a DCHW.
 3. Explain the unique role of the DCHW as
part of an integrated diabetes
management
Who are Diabetes Community
Health Workers?
Diabetes Community Health Workers (DCHWs)
are community members who work as bridges
between their ethnic, cultural, or geographic
communities and healthcare providers to help
their neighbors prevent diabetes and its
complications through self-care management
and social support, including community
engagement.
AADE Position Statement. “Diabetes Community Health
Workers. The Diabetes Educator. 2003; 29(5):818-24.
Workforce Size & Characteristics
Michigan-Specific Data
 2,724 total CHW workers: 1,807 paid CHWs
(66%); 917 volunteer CHWs (34%)
 Occupations: counseling, substance abuse,
educational-vocational counseling, health
education, and other health/community services
 In Michigan: Federally Qualified Health Centers,
Detroit Department of Health & Wellness
Promotion, University of Michigan, Diabetes
Outreach Networks, Access, Indian Health
Services, Spectrum and St. Mary’s Hospital,
Henry Ford Health System, etc.
National Pay Rates
New Hires
 64% paid below $13 per hour
 3.4% paid at or near minimum wage
 21% paid $15 or more per hour
Experienced CHWs
 70% paid $13 or more per hour
 50% paid $15 or more per hour
Michigan Public Health Training Center October 9, 2007
DCHWs:
Promoters of Healthy Lifestyles
 Members of target
communities
 Share cultural beliefs
and values
 Share social and ethnic
characteristics
 Eliminate
communication barriers
 Act as role models for
change
 Disseminate information
and educate families
Recommended Competencies of
Diabetes Community Health Workers
 The Final Report Of The National
Community Health Advisor Study; CHW
Chapter Three: Core Roles and
Competencies of Community Health
Advisors
 Competencies include personal
characteristics, qualities, and skills that
DCHWs need to be effective
Personal Characteristics of
DCHWs
Relationship with the community being
served
Personal strength and courage (healthy
self-esteem and able to remain calm)
Friendly/outgoing/sociable
Patient and compassionate
Open-minded/not-judgmental
Motivated and capable of self-directed work
Caring and empathetic
Personal Characteristics of
DCHWs (cont.)
 Committed/dedicated
 Respectful and honest
 Open/eager to grow/change/learn
 Dependable/responsible/reliable
 Flexible/adaptable
 Desire to help the community
 Persistent
 Creative/resourceful
Skills of Diabetes Community
Health Workers
Communication
Interpersonal
Teaching
Knowledge Base
Skills of Diabetes Community
Health Workers (cont.)
Service Coordination
Advocacy
Capacity-Building
Organizational
DCHW Training-Options
 Community Outreach Worker (WSU – 160 hrs.)
 “Empowerment” education (developed at U of M
Diabetes Research and Training Center (DRTC)
 Attend a Diabetes Self-Management Training
(DSMT) program provided by Certified Diabetes
Educators (10 hours)
 DSMT programs: www.michigan.gov/diabetes
DCHW Training-Topics
Human Subjects” (IRB) training
Human enhancement skills
Mental health (signs of depression, stress)
Case management skills
Cultural diversity/ competence training
Conducting assessments and collecting
health data
DCHW Training-Topics
Computer skills and use of the Internet
Group facilitation/delivery of diabetes
curriculum
Behavior modification techniques – goal
setting skills
Understanding health disparities
Other training needs
National and State CHW
Organizations/Trainings
 American Association of Community Health
Workers (part of APHA, American Public Health
Association)
pam.chapman@spectrumhealth.org
 Michigan Community Advocate Association
(MICAA)
Grand Rapids, MI
Lisa Marie Fisher @ 616-356-6205)
 Wayne State University: “Empowerment Skills
for Family Workers” Training Series
Joan Blount @ 313-827-7113
Diversity Training
Ongoing Competency
Component to DCHW Training
 Ensures that the DCHW maintains current
knowledge about the treatment and selfmanagement of diabetes
 Provide frequent and regular diabetes
education opportunities
 Suggestions for training
DCHW Personal Successes
 Survey showed a significant increase
in knowledge of diabetes and selfmanagement
 Learning about diabetes prevention
and complications and how to educate
others
 Perceive selves as making a
difference, influencing change, small
steps, “help get over the wall”
DCHW Personal Successes
(cont.)
Increasing ability to relate to clients
and gain their trust
Learning about computers
Helping each other with resources and
other DCHW tasks
Learning to work with people across
cultures
Developing their own healthier eating
and exercise habits
DCHW Evaluation
 DCHW focus groups and survey administered to
assess previous and current knowledge of
diabetes and self-management, attitudes,
expectations, and assessment of the
intervention
 DCHW client file audits, include quarterly review
of all files with follow up procedures, including a
specific timeline for completion, second review,
and follow up action
 DCHW effectiveness phone survey
How DCHWs Helped REACH
Participants Meet Their Goals
How FHA Helped Participants Meet Goals
Menu Ideas
Exercise Information
16
Exercise Encouragement
Event Information
Number of Respondents
14
Regular Contact
12
Attends Meetings
Attends Doctor Visits
10
Diabetes Education
8
Motivation/Support
Reminders
6
Glucose Monitoring Education
4
Journey to Health Classes
2
Health Eating Education
Information about Medications
0
Type of Help
Recommendations/Referals
Other
Responses To Rating Questions
E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable,
SC/NC=Somewhat Comfortable/Not Comfortable
 96% of respondents reported feeling either very
comfortable or comfortable contacting their
DCHW for needs or services.
 93% of respondents rated their DCHW
understanding of their experiences as an African
American or Hispanic as excellent or good.
 In terms of doing what they said they would do,
87% of respondents rated their DCHW as
excellent or good.
 94% of respondents
reported either E/G:
 relationship with DCHW
 satisfaction with DCHW

Respondents rated DCHWs
on their ability to:
 get them services to
improve their health
(E/G=85% and F/P=15%)
 help them with
relationship with their
doctor (87% and 12%)
and communication with
doctor (E/G=76% and
F/P=16%).
Funding
 Private foundations
 Federal (CDC, NIH, USDA)
 State and local agencies and
health departments
The DCHW and the
Diabetes Care Team
 Team care is a necessary component of
effective chronic illness management per DCCT*
and UKPDS** (NDEP*** Team Care booklet)
 Skills and roles of different health care providers
should be integrated and coordinated
 The DCHW is an important member of this team,
particularly for high risk populations.
*The Diabetes Control and Complications Research Trial Group. The effect of intensive treatment of diabetes on the
development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329
(14): 977-986.
**UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin
compared with conventional treatment and risk of complications in subjects with Type 2 diabetes (UKPDS 33). Lancet
1998; 352:837-853.
***http://ndep.nih.gov/diabetes/pubs/TeamCare.pdf
The DCHW and the
Diabetes Care Team
DCHWs augment
the role of the diabetes educator
and other diabetes care team members
Promote trust to promote access to DSMT
and other health care services
Provide diabetes self-management support
after Diabetes Self-Management Training
Help diabetes educator provide culturally
sensitive care/education
DCHW: An
Important Piece of
the Health Care Puzzle
Important role of the diabetes health care
team, esp. for vulnerable populations
Provide access to and act as liaison with
diverse populations
Serve as resources to their communities
and to the advocacy and policy worlds*
*Perez LM and Martinez J. Community Health Workers: Social justice and policy
advocates for community health and well-being. Am J Public Health. 2008; 98:1114.
For more information, contact:
Dawn Crane
(517) 335-9504
craned@michigan.gov
or
REACH Detroit Partnership
www.reachdetroit.org
Thank you!