Arizona CHW

Workforce Study

Arizona CHW Workforce Coalition Meeting

May 23, 2013

Samantha Sabo DrPH, MPH

Zuckerman College of Public Health

Discussion Overview

RationaleMethods

ResultsFacilitated Discussion by Lee and Carl

Rationale and Goals

Rationale

No known counts of Az CHWs HRSA Workforce Study

2007

Lack of consensus among CHWs, CHW Employers and between CHWs and Employers on: CHW definition CHW Scope of Practice

Goals

Paint a picture of Arizona’s CHW workforce

Results to serve as a catalyst from which to build consensus on the definition of CHWs from the perspective of CHWs and their employers

Facilitate discussion of results with AzCHOW membership during Annual Conference

Methods

Survey : Anonymous, on-line survey of CHWs and Employers/Orgs

Development: UA researchers and AzCHOW board members developed the survey.

Dissemination : CHW, Promotora and CHR networks, list serves, and personal contacts of members of the CHW Workforce Coalition (April 1, 2013 through May 18, 2013)

1.CHW Count and Description Paid versus volunteer Agency name and type CHW Job Titles

2.Definition of CHWs APHA CHW definition

3.Perspectives of CHW Scope of Practice New York State CHW Initiative

Results

159 total participants

47 (30%) CHW Employer, Supervisor or Organization

111 (70%) Community Health Workers

98% paid for work

All counties represented

Agency Type

FQCHC

Health

Dep

artm

ent

NGO/C

BO

Oth

er/U

nkow

n

Hospi

tal

Trib

e

Unive

rsity

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

28%25% 25%

7% 6% 5% 4%

Job Titles

Community Health Worker CHW I, II, III, Senior Promotora Community Health

Representative Community Lay Worker Care Coordinator Case Manager Community Health

Advisor Health Educator , I, II Instructional Specialist Human Rights Advocate Lay Leaders Peer Leaders Health Systems Navigator

Lay Health Worker Outreach Program Manager Outreach Promotora Patient Navigator Peer Support Specialist Public Health Specialist Educadora de Salud Public Health Aide Public Health Specialist Teen Health Educator Trainer Tribal Laison Well being Promoter Home Visitor Office Assistant

CHW Definition

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.

American Public Health Association – CHW Section

CHW Definition Consensus

Strongly Agree Agree Disagree Strongly Disagree0%

10%

20%

30%

40%

50%

60%

70%

80%74%

25%

0% 1%

68%

21%

6% 4%

CHW Employers

CHW Thoughts on Definition

Cultural expert and cultural educator to organizations in their community

A CHW is also the person that adds love and empathy to hes or her work.

Me parece que esta muy completa …hay veces que el paciente se abre tanto al CHW que tambien nos confian sus problemas personales y se le ayuda en lo que se pueda al paciente claro dandole animo positivo. Tal vez seria consejeria informal como se refiere en la parte de arriba.

La Promotora tambien aboga o intercede por los clientes pacientes

Llevar a cabo la Medicina Preventiva, por medio de Platicas con temas de: Las enfermedades cronicas como, Diabetes, Presion arterial, obesidad entre otras a grupos de la Comunidad. Darle seguimiento a casos especificos de preferencia preventivos, que estan en riesgo de padecer una enfermedad cronica. Enfocarnos mas en Salud mental para apoyar a personas victimas del rechazo social, tanto por su estatus migratorio, economico y cultural.

Employer Thoughts on Definition

They help to create change in communities that is culturally, linguistically and community relevant and community driven. Not just a close understanding but an in depth understanding of the issues, barriers and assets of that community that impact health addressing the social determinants of health.

I feel that the definition should cut across racial/ethnic cultural lines and also be applicable in rural and urban settings.

I believe the definition hits it right on.

…Promotoras contribute to the cultural relevancy of the intervention and the cultural equivalence of instruments and educational materials.

…should describe specifically the notion of community empowerment …even though is related to increasing community capacity, it is still a different outcome that Promotoras can bring to the table.

Interpersonal and Communication Skills

Ability to Establish Trust

Listening

Advocacy ( Individual or community)

Outreach and Enrollment

Provide social support for clients

Information Sharing

Setting goals and making plans with clients

Multi-cultural competency

Case management and referrals including insurance

Community Organizing

Ability to lead group discussion or support groups

Facilitating workshops or group activity

Bilingual

0 10 20 30 40 50 60 70 80 90 100

Very Important CHW Very Important Employer

Teaching and Organizational Skills

Electronic Medical Records

Participation in Research Projects

Computer skills (office email web)

Home assessment and advice on daily routines

Mentoring other CHWs

Role-playing and modeling health behaviors

Adult learning techniques

Chronic disease knowledge and management

Time management

Health education skills

Documentation and data collection

0 10 20 30 40 50 60 70 80 90 100

CHW Employer

Top 5CHW SOP Considered NOT Important

TOP 5CHW SOP Considered VERY Important

Significant Differences – Clinical SOP

010203040506070

22 19 2334

6455

4758

Very Important Employer Very Important CHW

Significant Differences : Non Clinical SOP

Prov

ide

socia

l sup

port

for c

lient

s

Facil

itatin

g wor

ksho

ps o

r gro

up a

ctivity

Parti

cipat

ion

in R

esea

rch

Proj

ects

0

20

40

60

80 6251

30

8169 60

Very Important Employer Very Important CHW

Clinical SOP Variations

Cas

e m

anag

emen

t and

refe

rrals i

ncluding

insu

ranc

e

Inte

ract

ing

with p

hysic

ians

/hea

lth car

e sy

stem

Elig

ibilit

y an

d en

rollm

ent (

AHCCS,

hea

lth p

lans

etc

.)

Scre

ening

( blood

gluco

se, b

lood

pre

ssur

e et

c. )

Med

ical in

terp

reta

tions

and

fillin

g ou

t med

ical f

orm

s0

1020304050607080 59

22

57

3419

7164 61 58 55

Very Important Employer Very Important CHW

Summary of Difference Between CHWs and Employer

1. Medical interpretations and filling out medical forms

2. Participation in Research Projects

3. Screening ( blood glucose, blood pressure etc. )

4. Electronic Medical Records

5. Interacting with physicians/health care system

6. Provide social support for clients

FINAL Employer Thoughts on SOP

I'd like to see more on future professional development. As much as I don't want to lose my Promoters I want them to move up in their careers. They are so much more talented than their 'resume skills' show. I'd like to see avenues for them to attend some of Pima Community College's medical programs.

I think it is important to clarify that CHW's are not medical professionals and cannot diagnose or treat. Informal "counseling" is a concern because they are not licensed counselors. What protects them or the client from working outside of their scope of practice?

Proficient in counseling sensitive issues like domestic violence

CHW's are expected to know something about almost everything from medical to social, or mental. A lot is being required for a limited amount of education. The expectations of the public or families using the program may be exceeding what the CHW is actually trained for.

FINAL CHW Thoughts on SOP

They need trainings about safety and how to protect from risk situations like when they attending domestic violence clients, drugs dealer partners etc.

Community organizations need to understand that the CHW's scope of work varies on a daily basis. Because working with the community is so important, organizations need to know that a CHW can one day work in her office and the next she could be out in the community. Organizations that are new to this model have different expectations for the CHW so it has to be communicated from the beginning that this position can change a million times and that the most important thing is the relationship building and being out in the community.

Es muy importante que tambien las/los promotoras/es esten siendo constantemente capacitados para estar mas al dia con las necesidades de los clientes y organizaciones.