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CURRICULUM, INSTRUCTION, AND PEDAGOGY article
Front. Public Health, 08 June 2021 | https://doi.org/10.3389/fpubh.2021.673208
Background: Recent reports have recognized that only 20 percent of health outcomes are attributed to clinical care. Environmental conditions, behaviors, and social determinants of health account for 80 percent of overall health outcomes. With shortages of clinical providers stressing an already burdened healthcare system, Community Health Workers (CHWs) can bridge healthcare gaps by addressing these nonmedical factors influencing health. This paper details how a comprehensive training model equips CHWs for workforce readiness so they can perform at the top of their practice and profession and deliver well-coordinated client/patient-centered care.
Community health workers (CHWs) and promotores de salud are playing an increasingly important role in the delivery of high quality and equitable health related services, particularly to vulnerable populations. Using a Theory of Change framework, this report connects intervention and support opportunities across the spectrum of policy, care delivery and workforce development to drive collective action toward integrating this complex and critically important role into health care teams in California.
Integrating CHWs and promotores into more traditional clinical care models is proving to have direct impact on addressing social determinants of health, enhancing patient care, and improving access to health care and social services. Creating a sustainable community health workforce will require institutional and cultural change in health care systems as well as direct investment into community health and the existing models of care that have been actively working on-the-ground for decades to enhance the health and well-being of marginalized communities.
Here are some quotes from study participants:
“We want people to grow as CHWs in all levels, whether at the field level, program design/evaluation, supervisor, etc.”
“I feel blessed at the moment. I am a trailblazer, and I like that. I would like to have the ability to train others as well.”
—Community Health Worker
“We are like the thread in the material. You don’t always see it, but it’s important. You are always winding and tying things together from the community to the medical field.”
—Community Health Worker
“It would be nice if all of us could work together and skill share. The promotora model has more knowledge about the community, interpersonal, and family matters that [clinicians] may not be tapping into. There is room to work together...”
—Social Work Lead/CHW Supervisor
Utilization of Community Health Workers in Emerging Care Coordination Models in California
Date: January 24, 2017
Source: Healthforce Center at UCSF
Community health workers (CHWs) and promotores de salud are playing an increasingly important role in community-based and clinical care settings. This research, supported by the Blue Shield of California Foundation, represents the culmination of the first phase of a two-part project aimed at enhancing California's readiness to integrate CHWs and promotores in the health care delivery system.
This brief includes:
A Community Health Worker is a trusted member of the community who empowers their peers through education and connections to health and social resources. Building on 35 years of experience in designing, implementing and improving Community Health Worker programs, we have taken our innovative, outcomes-driven Community Health Worker programming to offer you the tools to make it work in your system, with your providers, and for your population.
Phone : 956-968-3600
The interactive PDF format allows easy navigation among sections of the toolkit. The toolkit performs best when the PDF is downloaded to your device and opened in Adobe.
To download the PCCI Peer Support Toolkit (275 pages)
To learn more about the Peer Support Toolkit, be sure to take advantage of a quick tutorial in this YouTube video.
The Pathways Community HUB Institute (PCHI) was founded by Drs. Sarah and Mark Redding and a team of individuals working together over many years to support communities and community health workers (CHWs) in improving health and social equity.
Through their practice, they saw that individually modifiable risk factors (spanning medical, social and behavioral health needs), can be effectively identified and addressed by capitalizing on the strong, trusting relationships CHWs develop over time with the individuals and families they serve. Many individually modifiable risk factors hinge on changes in client behavior related to things like nutrition, education, parenting, or compliance with medical care. CHWs, who regularly visit clients in their homes, are in a unique role to be able not only to support coordination of care, but to also coach and support individuals to learn new skills, get access to needed services, and make vital behavioral changes to improve their health and social outcomes.
As outlined in the recent Association for Maternal and Infant Health Program (AMCHP) announcement for “Best Practice” designation - Each PCH represents a network of at least two
and up to 30 community care coordination agencies (CCAs). The CCAs are most often developed from existing community based organizations that have the current staff with the
knowledge and trust of the community to be served. The CCAs deploy and or hire and support CHWs who reach out to those most at risk, assess medical, social and behavioral health risk
factors, and confirm that risks are addressed using standardized Pathways. The CCAs contract with their local HUB for outcome payments achieved by their CHW workforce.
The HUB establishes financial agreements with available funding including managed care organizations (MCOs), public health, and others. The HUB provides payment to the network of CCA agencies based on confirmed and comprehensive risk mitigation outcomes as documented in Pathways. The HUB also provides training, technology support, data management, quality improvement, supervision, training and related services.
Buckeye Health Insurance calculated their ROI 286% ( > 1:5)
Mark Redding, Research and Quality Director, Pathways Community Hub Institute; Risk Reduction Research Director, Akron Children’s Hospital and
Rick Wilk, MPH, MBA, Director of Operations and Development, Pathways Community Hub Institute
Phone: (567) 307 3465
This webpage contains resources for state health agencies on the use of non-licensed providers such as Community Health Workers (CHWs), including resources related to financing, certification and licensure, and examples of work in states to support CHWs.
Community Health Workers: Evidence of Their Effectiveness
This two-pager document contains a summary of research studies demonstrating the effectiveness of community health workers across multiple settings and health issues. (March 2020)
Making the Case: State of Evidence Documenting the Value of CHWs
ASTHO delivered a presentation summarizing the literature and evidence base documenting how CHWs can deliver health improvements and healthcare cost reductions across a variety of settings and populations. The presentation highlighted an evaluation from CMMI’s Health Care Innovation Awards that showed that only innovations involving CHWs were found to lower total costs ($138 per beneficiary per quarter). (September 9, 2019)
Penn Center for CHWs and the IMPaCT Model
This presentation provides an overview of the IMPaCT Model and lessons learned from implementing the model across various settings. IMPaCT has been tested in three randomized controlled trials and improves chronic disease control, mental health and quality of care while reducing total hospital days by 65%. IMPaCT has a $2:1 annual return on investment to payers and has been delivered to over 10,000 high-risk patients in the Philadelphia region. (February 11, 2019)
CHW Successes and Opportunities for States Issue Brief
ASTHO published an issue brief on how state health departments can work with CHWs to improve healthy outcomes and generate reduced healthcare spending. Highlights include how states are successfully implementing best practices and evidence-based policies to identify, control, and improve blood pressure, and how CHWs are advancing the Triple Aim for health. (2017)
Achieving a Strong Evidence-base for Sustainable CHW Programs
This interactive panel discussion highlighted issues related to evaluating CHW programs. This webinar provided an overview of CHW evaluation, described the CHW Common Indicators Project, and highlighted action steps that participants can take to capture the contributions of CHWs in their individual settings. Presenter slides and a list of CHW evaluation resources are also available. (August 31, 2016)
Map: State Approaches to CHW Certification
This map shows the current status of community health worker certification across states. (February 2020)
Overview of Financing Strategies to Support CHWs
These presentation slides provide an overview of different financing mechanisms to support CHW workforce, such as through Medicaid state plan amendments, 1115 demonstration waivers, managed care contracts, alternative payment models, and grant and provider funding. Each financing strategy includes state examples and a discussion of the pros/cons associated with each. (November 2019)
Developing and Defining the CHW Workforce: Findings From a Multi-State Learning Community
This presentation provides an overview of the learning community from 2017-2019 with a focus on financing mechanisms available to support the CHW workforce. (November 2019)
CHW Certification: Overview and Paths Taken in Different States
These presentation slides provide an overview of what certification is and is not, explains processes and pathways explored across different states, and highlights how states have incorporated CHW perspectives and leadership in all decision-making processes. (June 26, 2019)
A Patchwork Quilt of State Approaches to CHW Training
This blog post explains how states select and adopt CHW training models that best fit the unique needs of their population and workforce. The state-specific examples described within this resource reflect the diversity of state approaches to training and certification. (May 30, 2019)
CHW Training and Core Competencies: ASTHOStat Chart
ASTHO compiled a chart, per a technical assistance request from a state department of health, comparing states’ CHW training and education standards. This included detail on whether the CHW Core Consensus Project (C3) provided a framework and documentation on how the standards were developed. (November 2018)
Opportunities for State Public Health Agencies to Support and Integrate the CHW Workforce
This presentation provides an overview of the lessons learned and outcomes of the 2017 learning community, including state considerations for advancing a CHW certification program and promising practices for including a range of stakeholders. (November 2017)
Variation in State Approaches to CHW Certification
This state-by-state comparison chart offers an overview of approaches to certifying CHWs, both with and without legislation. (August 2017)
Statewide Training and Certification Program Strengthens the Community Health Worker/Promotor(a) Workforce in Texas
This ASTHO state story illustrates how Texas is expanding the capacity of its CHW workforce by building partnerships, identifying workforce champions, and integrating CHWs in quality improvement and public health initiatives. (2017)
CHW Certification and Financing Issue Brief
ASTHO, with support from CDC, has published an issue brief that provides an overview of the unique capabilities of CHWs and possibilities for CHW certification and financing. The brief also offers recommendations for state and territorial health agencies to cooperate effectively with other stakeholders in planning, policy development, program design, strategy implementation, and evaluation to promote health workforce innovation involving CHWs. (2016)
Certification and Licensure Panel Discussion
This interactive call provided an overview of state legislative activity related to certification and training of CHWs, described the Community Health Worker Core Consensus (C3) Project, and discussed the pros and cons to certification through a facilitated panel discussion with three CHW experts. Presenter slides and Q&A Responses are available. (March 3, 2016)
Leveraging Managed Care to Support CHWs and Promote Population Health
Trust for America’s Health and ASTHO hosted a webinar that discussed how managed care organizations (MCOs) can integrate CHWs into the healthcare workforce and impact population health. Participants learned the importance of effective Medicaid partnerships, how states can use MCO contracts as a policy and financing lever, and effective models incorporating MCOs. Presenter slides are available. (September 9, 2015)
Expanding Access for Preventive Services: Key Issues for State Public Health Agencies
This ASTHO issue brief gives a broad overview of financing strategies to expand preventive services, and opportunities for state public health departments to influence and lead such efforts in their states. (2015)
CDC’s 1815 Cooperative Agreement Funding: Efforts to Support CHW Infrastructure
Speakers from CDC’s Division of Diabetes explained how the 1815 grant program can be used by states to support CHW infrastructure, such as by: conducting surveys to understand the landscape of CHWs, developing partnerships with and investing in CHW coalitions and associations, and developing materials to explain the role and value of CHWs to be used in outreach to healthcare providers and policymakers. The speakers also highlighted the various studies that demonstrate the effectiveness of CHWs. (May 31, 2019)
Stakeholder Engagement in CHW Workforce Development
This ASTHO webinar for the 2018-2020 learning community addressed potential stakeholder categories to be included in CHW policy development, the role of the state health agency in convening and engaging stakeholders, and results of successful collaborations. (July 12, 2018)
Supporting and Integrating Community Health Workers: Leadership Opportunities for State Public Health Agencies
This ASTHO blog post provides detail on the strategies that emerged across the learning community members, which can be considered in other states working across sectors to develop the CHW workforce. (January 26, 2018)
CHW Workforce Development and Engagement
These presentation slides provide information on the general areas of state health department support for CHW workforce development, including leadership, resources, policies and programming, research, and partnership building. (August 2017)
CHW Integration: Issues and Options for State Health Departments
These presentation slides provide a framework for talking about CHW integration; offer practical guidance for health department officials, payers, and providers to collaborate; and provide examples of integrated CHW programs. (August 2017)
CHW Integration: Issues and Options for State Health Departments
With support from HRSA, ASTHO hosted this webinar to offer practical guidance to state health department officials working with internal and external colleagues to advance CHW integration into care teams. (August 2017)
CHW Orientation for State Health Departments
These presentation slides were developed as part of ASTHO’s technical assistance work for state health departments. This presentation gives an overview of the history of CHWs, their scope of work, and the distinctive skills and capabilities that provide value to the healthcare and public health systems. (2016)
How State Health Agencies Can Support Patient Navigators and Community Health Workers Address Cancer Prevention and Control
This ASTHO issue brief highlights the growing importance of patient navigators and community health workers in the healthcare workforce and showcases successful developments to establish the role of these vocations in various states, territories and regions. (2012)
National Association of Community Health Workers
The National Association of Community Health Workers (NACHW) represents individual CHWs and allies and can be a liaison to facilitate connections to state and regional CHW associations and coalitions.
NACHW CHW Document Resource Center
NACHW offers a searchable database for stakeholders working on developing or advocating for policies affecting CHWs. This effort has been informed by the CDC and NACDD. The Resource Center initially contains over 800 documents from most of the 50 states on the process of considering and developing policies such as CHW certification, and workforce development initiatives for CHWs. The collection reflects the experience of state and local-level groups in process-oriented documents as well as reports resulting from those processes.
CDC Toolkit: Statewide Community Health Worker Certification
The CDC published this technical assistance resource, which includes background information on CHW certification, considerations for putting statewide CHW certification into action, and a list of potential decisions and case examples for stakeholders who are considering statewide CHW certification.
CDC Division for Heart Disease and Stroke Prevention Community Health Worker Toolkit
This informational toolkit compiled of evidence-based research that supports the effectiveness of community health workers.
Community Guide: Interventions Engaging Community Health Workers
This informational handout summarizes The Community Guide review on interventions that engage community health workers to prevent cardiovascular disease.
NASHP State Community Health Worker Models
This map from the National Academy for State Health Policy highlights state activity to integrate CHWs into evolving health care systems in key areas such as financing, education and training, certification, and state definitions, roles and scope of practice. The map includes enacted state CHW legislation and provides links to state CHW associations and other leading organizations working on CHW issues in states.
Return on Investment (ROI) Toolkit for Community Health Worker Programs
This toolkit from MHP Salud provides a step-by-step guide to conducting a return on investment analysis for Community Health Worker programs. It is designed to help organizations learn and understand the key steps and factors involved in calculating ROI.
Rural Health Information Hub Community Health Worker Toolkit
This toolkit from the Rural Health Information Hub includes eight modules focused on the following topics: an introduction to CHWs, different CHW program models, training approaches, program implementation, planning for sustainability, disseminating best practices, and examples of and contacts for successful CHW programs.
DATE: Tuesday, May 16, 2017
TIME: 1:00 p.m. to 2:30 p.m. (PST)
NEW! Community Health Worker & Promotora Trainings!
CPCA is offering this multi-part training program to introduce health centers and regional associations to a new workforce; community health workers (CHWs) and Promotoras who can be integrated into a clinic to help provide a more holistic approach when caring for patients.
Training providers know that whole-person care is important, but an additional step many providers are taking is expanding their team to include CHWs. CHWs (also known as Promotoras, health coaches, and a number of other titles) have demonstrated their ability to improve health behaviors and outcomes, particularly for racial and ethnic minority communities. CHWs provide culturally responsive services to educate patients, identify resources, provide case management, support care coordination activities, and become part of an individual's support network. Because many of these allied health professionals come from the community, many have a heightened understanding of the needs of the people in their communities, including cultural barriers to care.
According to a survey conducted by the California Primary Care Association, more than 45 community health clinics have incorporated CHWs into their care team. You can be next!
Click the following links to view descriptions, and register for parts 2 & 3 of this new series!
May 23 - How to Fund CHWs/Promotoras in Your Health Center
May 30 - Data Collection and Evaluation for CHW/Promotora Programs
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