COMMUNITY HEALTH WORKERS - MSP-scdhhs.gov · Johnson D, Saavedra, P, Sun E, et al. Community health...

2/18/2015 1

COMMUNITY HEALTH WORKERS

Julie Smithwick, LMSWExecutive Director, PASOs Programs

Arnold School of Public Health, USC

Brief intro to PASOs

Definition, skills, roles, profile

Why CHWs now?

State of the Evidence

The CHW movement in the US and in SC

Key challenges and lessons learned

2/18/2015 2

AGENDA

WHAT IS PASOS?

• PASOs is a community-based organization whose mission is to help the Latino community and service providers work together for strong and healthy families.

• We respond to the particular needs of the Latino communities and build bridges to the health system

Healthy Children. Knowledgeable Families. Strong Communities.

PASOS IN SC

Healthy Children. Knowledgeable Families. Strong

Communities.

PASOS IN SC


JENNY AND SANDRA: A CHW AND

A MOTHER WHO NEEDED HER

Who do you turn to for advice?

The 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.

The CHW also builds individual and community

capacity by increasing health knowledge and self -

sufficiency 7

Community Health Worker Definition American Publ ic Health Associat ion

Cultural mediation between communities and health and human services system

Providing culturally appropriate health education and information

Finding people that are hard to reach

Assuring people get the services they need

Source: Nat ional Community Heal th Advisor Study, Univ. of Ar izona, 1998

8

A WIDE RANGE OF CORE ROLES

Informal counseling and social support

Advocating for individual and community

needs

Providing [some] direct services and meeting

basic needs

Teaching skills

Source: National Community Health Advisor Study, Univ. of Arizona,

1998

2/18/2015 9

A WIDE RANGE OF CORE ROLES

Do not provide clinical care

Generally do not hold another

professional license

Expertise is based on shared life

experience and (usually) culture with the

population served

2/18/2015 10

CHWS ARE UNLIKE OTHER

HEALTH-RELATED PROFESSIONS

Rely on relationships and trust more than on

clinical expertise

Relate to community members as peers

rather than purely as client

Can achieve certain results more effectively

than other professionals

2/18/2015 11

CHWS ARE UNLIKE OTHER

HEALTH-RELATED PROFESSIONS

PASOS’ CHW PROFILE

Recommendation from community leader

Can connect with a particular community (place based, ethnic/racial)

Natural guide or “go -to person”; willing to learn

Dedicated to work, able to work on a team


TRAINING CURRICULUM

Understanding of role

Ethics

Empowerment

Popular education

techniques

Resources

Social determinants of

health

Health systems

Communication skills

Evaluation, data

collection

Advocacy skills

Technology, basic

computer skills

Mentoring from

current CHW


Member of primary care team

Patient navigator

Provider: services, screening, education

Outreach/enroll/inform concerning specific programs or services

Organizer/advocate

S o u r c e : H R S A C H W N a t i o n a l W o r k f o r c e S t u d y , 2 0 0 7

2/18/2015

14

CHWS ARE EMPLOYED IN MANY

DIFFERENT MODELS OF CARE

Hybrid (Community HUB, Accountable

Care Community, Health Neighborhood)

Outsourcing to CBOs

Social entrepreneurial (Canadian co-op)

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CHWS ARE INCREASINGLY EMPLOYED IN

INNOVATIVE SETTINGS COMBINING CLINICAL

CARE AND POPULATION HEALTH

2/18/2015 16

SARA’S STORY

2/18/2015 17

Why CHWs Now?

Growing diversity of U.S. population

Growing prevalence of chronic diseases

Growing complexity of health care

Cost pressures on health care system

Shortages of clinical personnel

Commitment to reducing health inequities

Recognition of social/behavioral

determinants of health

Growing experience/evidence base with

CHWs

2/18/2015 18

WHY ARE WE DISCUSSING CHWS?

The “Triple Aim”

Improving the patient experience of care (including quality and

satisfaction);

Improving the health of populations; and

Reducing the per capita cost of health care

Health care reform: changing accountability for outcomes:

CHW as members of health care teams

Accountable care organizations (ACOs)

Patient-centered medical homes (PCMHs)

Incentives to reduce costs, improve care

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WHY ARE WE DISCUSSING

CHWS?

20

CHWS CAN BE THE INTEGRATORS!

Health Care Individual Level

Disease Research & Intervention

Public Health

SDOH research & intervention

IOM. 2013. U.S. Health in International Perspective: Shorter Lives, poorer health. Washington DC: The National

Academies Press.

Social determinants

have not been

integrated in clinic

practice or health

care systems

Leads

to lower value, substandard care

2/18/2015 21

The State of the Evidence

Birth outcomes: clearest evidence of

preventive impact

Diabetes: A1c, BMI, HTN, health behaviors

Asthma: symptom control, missed days

Cancer screening rates > early detection

Immunization rates

Hospital readmissions (care transitions)

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EVIDENCE OF CHW IMPACT ON

HEALTH OUTCOMES IS

CLEAR IN MANY AREAS

PASOS: SAMPLE OF RESULTS

Before breastfeeding education/support:

42% of mothers indicated that they wanted to exclusively

breastfeed their babies

29% planned to breastfeed and give formula

21% were undecided

After breastfeeding education/support:

71% planned to exclusively breastfeed

14% planned to mix breastfeeding and formula

Only 14% planned to exclusively formula feed


Communities.

PASOS AS A TRUSTED ACCESS POINT

11

12

12

13

14

16

17

17

18

19

19

21

25

26

31

31

31

32

36

39

39

42

58

92

94

0 20 40 60 80 100

Support - Health Insurance

Child Needs - Dentist

Child Needs - School Issue

Support - Housing

Support - WIC

Child Needs - Pediatrician

Support - Medicaid

Support - SNAP

Support - Domestic Violence

Health - Health care options (ER, Urgent, Medical home, DHEC)

Health - Urgent Medical Issue

Child Needs - Medicaid/CHIP

Health - Women's Health

Child Needs - Special Needs

Health - Family Planning

Health - Medical Specialist

Support - Material Resources

Support - Adult Education/ESL

Support - Legal Documentation

Child Needs - Early childhood resources

Health - Mental Health

Health - Dentist

Health - Prenatal Care

Support - Legal Situation

Health - Medical Home (Doctor)

Number of Referrals

Re

ferr

al N

ee

ds

Referrals for services 2013-2014, N=765

PASOS: CONNECTION TO

A MEDICAL HOME


Communities.

Yes

75%

No

12%

Still Active

13%

Connection to primary care, all PASOs sites

N=280 participants

Recent studies all showing about 3:1 net return or better:

Molina Health Care: Medicaid HMO reducing cost of high utilizers

Arkansas “Community Connectors” keeping elderly and disabled out of long-term care facilities

Community Health Access Program (Ohio) “Pathways” reducing low birth weight and premature deliveries

Texas hospitals: redirecting uninsured from Emergency Depts. to primary care

Langdale Industries: self-insured industrial company working with employees who cost benefits program the most

DIALBEST: Latinos with diabetes assisted by CHWs had improved HbA1c levels

2/18/2015 26

FINANCIAL ROI CAN BE

DRAMATIC

2/18/2015 27

What’s happening IN THE

STATES - AND AT the

federal level?

Legislative: Texas, Ohio, Massachusetts,

New Mexico, Illinois, Maryland

Medicaid rules: Minnesota, Wisconsin, DC

Policy driven by specific health reform

initiatives: New York, Oregon, South

Carolina + SIM states

Broad-based coalition process: Arizona,

Florida. Michigan

2/18/2015 29

STATES ARE PURSUING VARIOUS

MODELS IN CHW POLICY INNOVATION

CDC priority on support for policy and

systems change

CDC and HRSA support for TA at state

request

HHS CHW Interagency Work Group

Office of Women’s Health:

Women’s Health Leadership Institute

CMMI Grantee CHW Learning Collaborative

National Health Care Workforce Commission

2/18/2015 30

FEDERAL AGENCIES ARE INCREASING

SUPPORT FOR CHW STRATEGIES

SOUTH CAROLINA’S JOURNEY

Most CHWs grant funded

Health Access at the Right Time - statewide collaborative to identify alternative providers (policy makers and CBOs, AHEC, others)

In order to reach the hardest-to-reach, needed Community Health Workers


Communities.

Currently 14 CHWs embedded in clinics -

working on expansion

Developing state plan document - for DHHS

and CHWs throughout state

CHW Association to represent needs of

CHWs and provide continuing education


Communities.

SOUTH CAROLINA’S JOURNEY

1. Occupational definition (agreement on

scope of practice and skill requirements)

2. Sustainable financing models

3. Documentation, research and data

standards

(records, evidence of effectiveness and

“ROI”)

4. Workforce development (training

capacity/resources)

2/18/2015 33

4 KEY POLICY AREAS REQUIRE

ATTENTION

Need to hire the right person for the job- you can’t “make” someone a CHW

Provision of education that mirrors CHWs work crucial yet challenging

Critical to connect health systems and communities

Need to educate stakeholders involved when implementing (supervisors, clinics, policymakers, funders)

Crucial to have expertise at the table

2/18/2015 34

LESSONS LEARNED ALONG THE WAY

Johnson D, Saavedra, P, Sun E, et al . Community health workers and Medicaid managed care in New Mexico. J Community Health; 2011; DOI 10.1007/s10900-011-0484-1

Felix HC, Mays GP, Stewart MK, et al . The care span: Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs. 2011;30(7):1366-74.

Redding S, Conrey E, Porter K, Paulson J, Hughes K, Redding M. Pathways Community Care Coordination in Low Bir th Weight Prevention. Matern Child Health J; Aug 2014; DOI 10.1007/s10995-014-1554-4

Dols J. Return on investment from CHRISTUS Health CHW program. PowerPoint presentation, Houston TX, 2010.

Miller A. Georgia firm’s blueprint for taming health costs. Georgia Health News; July 27, 2011.

Pérez-Escamilla R, et al . Diabetes Care . 2015;doi:10.2337/dc14-0327. Community health workers fi l l treatment gaps for Latino diabetes population 35

CITATIONS FOR ROI

2/18/2015 36

THANK YOU!

Julie Smithwick, LMSWExecutive Director, PASOs Programs

Arnold School of Public Health, USC

[email protected]

Special thanks to the following for parts of this

presentation:

• Ashley Wennerstrom, PhD, MPH

• Carl H. Rush, MRP

• Samantha Sabo, DrPH, MPH

COMMUNITY HEALTH WORKERS - MSP-scdhhs.gov · Johnson D, Saavedra, P, Sun E, et al. Community health...

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