Community Health Workers
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Community health workers (CHWs) act as liaisons between communities and health/social services, improving access and quality of care while building individual and community capacity. Their history dates back to the 17th century, with a resurgence in the U.S. during the 1960s and a recognized role in modern healthcare systems, particularly following the Affordable Care Act. CHWs offer various services including advocacy, education, and support to enhance health outcomes in at-risk populations.
Community Health Workers
- 1. Using Community Health Workers As Health NaHveailgtha Ctaorer sDelivered Where People Live, Learn, Work and Play Dennis Dunmyer, JD, LCSW
- 2. American Public Health Association • APHA Definition of a CHW: • A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. • A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. Community Health Workers: Patient Engagement
- 3. Kansas City Definition: • “Community Health Workers bridge the gap between healthcare providers and populations in need of care. CHW’s are a trusted member or have a close understanding of the community they serve. They are a link between the patient and the health or social services agencies, striving to improve health outcomes. Ultimately, a CHW improves access to services and quality of care for patients.” – Established by MARC Regional CHW Stakeholder Committee. – Currently under review Community Health Workers: Patient Engagement
- 4. Community Health Workers: Patient Engagement Dula Peer Counselor Health Promoter Prevention Outreach worker Promotora de salud Navigator Health Coach
- 5. History of CHWs • The history of the CHW can be traced back to the early 17th century. During a shortage of doctors in Russia, laypeople known as “feldshers” received training in the field to provide basic medical care to military personnel. • In the 1950’s, CHW’s thrived in Latin America. Their role was to remedy the unequal distribution of health resources and bring health care to the poor. Community Health Workers: Patient Engagement
- 6. History of CHWs cont. • In the 1960’s, CHW’s started emerging in the United States as part of the Great Society domestic programs. The Federal Migrant act of 1962 and the Economic Opportunity Act of 1964 brought formal government support to community health programs. These legislations also mandated outreach efforts to low-income neighborhoods and migrant worker camps. • The use of CHW’s began to wane in the 1970’s and early 1980’s. In the late 1980’s and early 1990’s programs began to pop up again in migrant and seasonal farm working communities. Community Health Workers: Patient Engagement
- 7. CHWs today • In the 2000’s, CHWs continue to grow: – CMS recognizes CHWs as reimbursable provider and between 2001 and 2007 the following states began using CHW’s: Texas, Ohio, New Mexico, Massachusetts, and Minnesota. – In 2010 the Affordable Care Act included language that encourages the use of CHWs – Currently HHS, CDC, OASH and state and local Public Health departments are exploring increasing the use of CHWs Community Health Workers: Patient Engagement
- 8. Scope of Practice* 1. Bridge the gap between communities and the health and social service systems 2. Navigate the health and human service systems 3. Advocate for individual and community needs 4. Provide Direct Services 5. Build individual and community capacity *Minnesota CHW Alliance Community Health Workers: Patient Engagement
- 9. Bridge the Gap • Enhance the quality and safety of health care by aiding communication between provider and patient • Educate community members about how to use the health care and social service systems • Educate the health and social service systems about the community needs and perspectives Community Health Workers: Patient Engagement
- 10. Navigate • Increase access to Primary Care – Often will attend medical visit with the client • Make referrals and coordinate services • Teach self management skills and tools • Facilitate continuity of care by providing follow-up • Enroll clients in health coverage programs – Ie Medicaid, Medicare, Marketplace • And educate them on how to use their new coverage • Link clients to community resources Community Health Workers: Patient Engagement
- 11. Advocate • Be a spokesperson for clients when they are unable to speak for themselves • Involve participants in self and community advocacy Community Health Workers: Patient Engagement
- 12. Direct Services • Provide culturally appropriate health information • Educate clients about disease prevention • Assist clients in self-management of chronic disease • Assist clients with medication adherence • Conduct health screenings • Provide individual and social and health care support • Organize and facilitate support groups Community Health Workers: Patient Engagement
- 13. Build capacity • Build individual capacity to achieve wellness • Build community capacity by addressing social determinants of health • Identify individual and community needs • Mentor other CHWs Community Health Workers: Patient Engagement
- 14. Bob • ED high utilizer (8 times for alcohol abuse) • Homeless with no phone • CHW worked with ED staff so that ED staff contacted CHW the 9th time Bob came in. CHW worked with Artist’s Helping the Homeless and together enrolled Bob in rehab at Salvation Army. Then the CHW created care plan and worked with Bob to connect him to Medicaid and housing. Community Health Workers: Patient Engagement
- 15. Bob 2 years later • Has Medicaid • Stable housing • Sober • Has not been to the ED in over a year • Attends medical appointments at his new Primary Care medical home Community Health Workers: Patient Engagement
- 16. Settings for CHWs • Hospitals • Physician Clinics • Health Departments • Faith Communities • Community Based Organizations Community Health Workers: Patient Engagement
- 17. Why a CHW? • Hired from within at-risk communities, CHWs reflect the values and culture of the community they work within. • Peer-to-peer relationship of trust with patients, rather than provider-patient relationships. • It is this relationships that allows CHWs to communicate openly with patients on issues related to health and ultimately to improve health care access and outcomes. Community Health Workers: Patient Engagement
- 18. KC CARE CHW program • Our goal is to improve health of patients as evidenced by: 1) increased access to medication 2) improved patient self-management 3) high percentage of patients achieving personal healthcare goals 4) increased engagement with a medical home 5) reduction in ED use 6) a high level of patient satisfaction Community Health Workers: Patient Engagement
- 19. CHWs at the KC CARE Clinic • Started in 2010 with two CHWs working with “afterhours” safety net clinics • Today intervene in a continuum with 8 CHWs – Hospital EDs – Safety Net Clinics – Wellness Center Community Health Workers: Patient Engagement
- 20. Strategies for Patient engagement • CHWs function as a medical tour guide for patients, walking side-by-side they teach patients to navigate the health care system – Attendance at appointments – Home/Community visits • Individualized assessment and treatment plan • Motivational interviewing techniques • Self management capacity building – Ask me three – Pre-appointment planning – Post-appointment review Community Health Workers: Patient Engagement
- 21. Self Management Strategies cont • Note book – Pre-appointment planning – Post appointment review • “Ask me three” (questions to ask provider) – What is my main problem? – What do I need to do? – Why is it important for me to do this? • Operationalizing care plan – Home visit or trip to grocery store Community Health Workers: Patient Engagement
- 22. Mary • Diabetes, Hypertension, COPD • $200,000 hospital bill because of frequent ED use • Agoraphobia • Using ED because leaving the house terrifies her and so a trip to the doctor was frightening • CHW met her at her house to travel with her by cab to the first doctor’s appointment Community Health Workers: Patient Engagement
- 23. Mary after CHW • Approved for Medicaid and disability • Attends appointments with primary care doctor • Diabetes is now controlled • Attended specialty physician visits • Currently in MH services for her agoraphobia • Will now leave the house with her husband occasionally • Overall health improvement Community Health Workers: Patient Engagement
- 24. Sustainability/ROI • Cost savings due to lower ER utilization and hospital admissions, and access to preventive medicine – Denver Health found an ROI of $2.38 for every $1 invested – Arkansas Community Connector realized 23.8 percent reduction in Medicaid spending for long term care with use of CHWs – In Baltimore, MD, CHWs work with diabetes patients on Medicaid. They realized 38% reduction in ER visits and 27% drop in Medicaid spending for these patients. Each CHW is estimated to save $80-90,000 Community Health Workers: Patient Engagement
- 25. Questions??? Community Health Workers: Patient Engagement • Dennis Dunmyer – dennisd@kccareclinic.org