21-1094 Community Health Workers

1. From the Clinic to the Community: the role of Public Health Institutes in modeling the expansion of the Community Health Workforce

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. Building Knowledge and Awareness about CHWs • Creating a brand/standard for CHWs in the region Doctor Nurses Social Worker Mental Health CHW

10. 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

12. 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

13. 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.

14. 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

15. 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)

16. 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.

17. 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

18. 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

19. 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.

20. 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.

21. 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