Transcript Arizona CHW Workforce Study

Arizona CHW
Workforce Study
Arizona CHW Workforce
Coalition Meeting
May 23, 2013
Samantha Sabo DrPH, MPH
Zuckerman College of Public
Health
Discussion
Overview
Rationale
Methods
Results
Facilitated Discussion by Lee and Carl
Rationale and Goals
Rationale
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No known counts of Az CHWs
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Paint a picture of Arizona’s CHW
workforce
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Results to serve as a catalyst
from which to build consensus
on the definition of CHWs from
the perspective of CHWs and
their employers
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Facilitate discussion of results
with AzCHOW membership
during Annual Conference
HRSA Workforce Study 2007
Lack of consensus among
CHWs, CHW Employers and
between CHWs and Employers
on:
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Goals
CHW definition
CHW Scope of Practice
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
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159 total participants
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47 (30%) CHW Employer, Supervisor or Organization
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111 (70%) Community Health Workers
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98% paid for work
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All counties represented
Agency Type
50%
45%
40%
35%
30%
28%
25%
25%
25%
20%
15%
10%
7%
6%
5%
5%
4%
0%
FQCHC
Health
Department
NGO/CBO
Other/Unkown
Hospital
Tribe
University
Job Titles
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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
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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
American Public Health Association – CHW Section
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.
CHW Definition Consensus
80%
74%
70%
68%
60%
50%
40%
30%
25%
21%
20%
10%
6%
0%
1%
4%
0%
Strongly Agree
Agree
CHW
Disagree
Employers
Strongly Disagree
CHW Thoughts on Definition
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Cultural expert and cultural educator to organizations in their community
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A CHW is also the person that adds love and empathy to hes or her work.
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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.
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La Promotora tambien aboga o intercede por los clientes pacientes
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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
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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.
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I feel that the definition should cut across racial/ethnic cultural lines and also
be applicable in rural and urban settings.
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I believe the definition hits it right on.
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…Promotoras contribute to the cultural relevancy of the intervention and the
cultural equivalence of instruments and educational materials.
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…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
Bilingual
Facilitating workshops or group activity
Ability to lead group discussion or support groups
Community Organizing
Case management and referrals including insurance
Multi-cultural competency
Setting goals and making plans with clients
Information Sharing
Provide social support for clients
Outreach and Enrollment
Advocacy ( Individual or community)
Listening
Ability to Establish Trust
0
Very Important CHW
10
20
30
40
50
60
Very Important Employer
70
80
90
100
Teaching and Organizational
Skills
Documentation and data collection
Health education skills
Time management
Chronic disease knowledge and management
Adult learning techniques
Role-playing and modeling health behaviors
Mentoring other CHWs
Home assessment and advice on daily routines
Computer skills (office email web)
Participation in Research Projects
Electronic Medical Records
0
CHW
10
20
30
Employer
40
50
60
70
80
90
100
Top 5
CHW SOP Considered NOT Important
TOP 5
CHW SOP Considered VERY Important
Significant Differences –
Clinical SOP
64
70
58
55
60
47
50
34
40
30
23
22
19
20
10
0
Interacting with
physicians/health
care system
Medial
interpretations and
filling out medical
forms
Electronic Medical
Records
Very Important Employer
Screening ( blood
glucose, blood
pressure etc. )
Very Important CHW
Significant Differences : Non
Clinical SOP
81
90
80
70
69
62
60
51
60
50
40
30
30
20
10
0
Provide social support for
clients
Facilitating workshops or
group activity
Very Important Employer
Participation in Research
Projects
Very Important CHW
Clinical SOP Variations
80
71
64
70
59
57
60
61
58
55
50
34
40
30
22
19
20
10
0
Case
management and
referrals including
insurance
Interacting with
physicians/health
care system
Eligibility and
enrollment (
AHCCS, health
plans etc.)
Very Important Employer
Screening ( blood
glucose, blood
pressure etc. )
Medical
interpretations and
filling out medical
forms
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
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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.
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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?
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Proficient in counseling sensitive issues like domestic violence
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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
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They need trainings about safety and how to protect from risk situations
like when they attending domestic violence clients, drugs dealer partners
etc.
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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.
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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.