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Hispanic Health Council
POLICY BRIEF
Addressing Social Determinants of Health through Community Health Workers: A Call to Action
https://hispanichealthcouncil.org/images/Brief2018.pdf
Date: 2018
Pages: 22
Authors: Hispanic Health Council
PROJECT DIRECTOR
Grace Damio Director of Research and Training Hispanic Health Council
COLLABORATORS
PROJECT ADVISORS
- Meredith Ferraro Executive Director Southwestern AHEC COMMUNITY HEALTH
WORKER POLICY RESEARCH EXPERT PANEL
- Katharine London, Principal, Center for Health Law and Economics University of Massachusetts Medical School
- Dr. Rafael Pérez-Escamilla, Director, Office of Public Health Practice Professor of Epidemiology and Public Health Yale School of Public Health
- Dr. Noelle Wiggins, Director of Capacity Building and Collaboration Whole Person Care-LA Community Health & Integrated Programs Los Angeles County Department of Health Services
The Hispanic Health Council and its expert policy research panel developed a total of 20 recommendations in seven broad CHW policy categories, as listed below:
Payment of Community Health Worker Services Recommendations:
- No. 1 Healthcare payment methods should reward improved outcomes, rather than volume, and should address the underlying health risks of the population, including SDOH.
- No. 2 Payments for CHW services should cover the full range of services needed to be effective in improving health outcomes for high-risk populations, including addressing SDOH. Funding should be adjusted to meet the health and SDOH needs of the population of focus for each specific intervention (see Community Health Worker Caseloads section, page 10-11).
Community Health Worker Caseloads Recommendations:
- No. 3 CHW services should support full performance of CHW roles, including addressing SDOH. Therefore, employers should structure CHW job duties to provide sufficient time for:
- 1) significant, extended face-time with clients, and often, families;
- 2) individual visits in the home and/or clinic; and
- 3) active engagement with clients to plan for future care.
Community Health Worker Training Recommendations:
- No. 5 Curricula should include education on health issues, SDOH, and health inequities, as well as training to develop specific skills, such as communication and service coordination.
- No. 6 Training programs should use the principles and techniques of popular education (also known as empowerment or Freirian education, in honor of the Brazilian popular educator Paulo Freire).
- No. 7 Training programs should involve experienced CHWs in designing and conducting CHW training.
- No. 8 Training programs should prepare and support CHWs to perform the full range of CHW roles.
- No. 9 CHWs should be trained in data collection and documentation in electronic health records.
Reflective and Trauma-Informed Mentoring and Supportive Supervision of Community Health Workers Recommendations:
- No. 10 The supervisor to CHW ratio should facilitate high quality administrative and clinical supervision.
- No. 11 Training for CHW supervisors is crucial, and should include training in popular education and the unique roles and needs of CHWs.
Integration of Community Health Workers into Care Teams Recommendations:
- No. 12 A CHW champion should be designated within the organization to help ensure that the role of CHWs is valued, understood and supported.
- No. 13 Training for all members of the healthcare team should be conducted to establish a thorough understanding of the history and current status of the CHW profession before bringing a CHW onto the team.
- No. 14 Adequate time should be allocated to provide an intensive orientation for the CHW to the organization.
- No. 15 CHWs should be included in care team meetings and empowered to provide insights about their participants/the community during and between meetings.
- No. 16 CHW services should be documented as part of the electronic health record, to facilitate sharing of their work with other team members, and tailoring their support to individual needs.
Documenting the Effects of Community Health Worker Services on Social Determinants of Health Recommendations:
- No. 17 CHWs should be trained to collect data while completing participant services.
- No. 18 Indicators of CHW work should be systematically documented, including process, health outcomes and social outcomes measures related to the SDOH, in alignment with the Connecticut adaptation of the CHW Common Indicators Project.
- No. 19 Regular process and impact evaluations of CHW services should be conducted for continuous quality improvement and continued program support and sustainability of the CHW services.
- No. 20 CHWs should be involved in developing evaluation methods and outcomes in order to contribute to their professional growth and to build more valid and reliable measurements.
Evaluating chw programs
CHW Common Indicators Project
CHW Common Indicators Project
Goal: In partnership with and building on work begun by Dr. Edith Kieffer and Gloria Palmisano of the Michigan CHW Alliance (MiCHWA), the CHW Common Indicator Project, are attempting to identify common process and outcome indicators for CHW practice.
Jan 11 2017: Over 90 people joined CHW Common Indicators Project for a pre-conference workshop at the Annual Meeting of the American Public Health Association in Denver, Colorado. We gathered additional input on the proposed list of indicators as well as suggestions for tools and scales to measure the indicators.
Executive-Summary_Community-Health-Worker-Common-Indicator-Summit_Final.pdf
Prepared by: Edith Kieffer, Gloria Palmisano, Pei-ru Wang, Leticia Rodriguez Garcia, Kenneth Maes, Caitlin Allen and Noelle Wiggins
Funders: Cambia Health Foundation and Social Venture Partners of Portland, OR.
Pages: 10
Noelle Wiggins, MS, EdD, co-principal investigator for the CHW Common Indicators Project, was the lead author on the Roles and Competencies chapter of the 1998 National Community Health Advisor (NCHA) Study. She came to the CHW/P community as a researcher and an advocate.
Why CHW indicators are needed
- Indicators are needed to measure the processes by which CHW programs achieve their outcomes.
- How specifically do CHW address the social determinants of health or other non-clinical indicators.
- Metrics for long term CHW programs: often developed using community-based participatory research (CBPR) approaches, take time to develop, fully implement and evaluate over a long enough time to measure sustained individual or community outcomes
- One of the reasons CHWs are so effective is that they respond in unique ways to the unique needs of diverse individuals and communities. They address a wide array of health issues and social concerns in a range of contexts from clinic to community.19 This strength can become a weakness when evaluating CHW programs, since it is challenging to measure program processes and outcomes in such a way that data can be aggregated to create a more comprehensive picture of CHW programs’ processes and effects.
The summit, which was held in Portland, OR, on October 2-3, 2015, brought together 16 CHWs, researchers and evaluators, and program staff from five states.
Proposed Process Indicators:
1. Workforce capacitation/support (level of CHW)
a. Involvement of CHWs in decision making process
b. Level of social support the organization provides for the CHW
c. Value of CHW to the organization and acceptance of CHW
2. Frequency of enactment of 10 core roles (level of community member/participant/client)
3. Trust/satisfaction with CHW relationship (level of community member/participant/client)
4. Referrals made (level of community member/participant/client) a. CHW facilitated connections at all levels b. Connections to resources, organizations, and policy makers (level of systems)
5. The extent to which CHWs are part of the policy-making process
a. CHWs teaming with systems, organizations and policy making bodies
b. Degree are CHWs are integrated into health care teams
Proposed Outcome Indicators
1. CHW satisfaction with their job
2. Participant food, water, transportation, and security
3. Participant access to health and social services
4. Participant knowledge, attitudes and behaviors
5. Participant social support
Community Health Workers and the Power of Measurement
By Keara Rodela on May 12, 2020
Health Systems Global- SHAPES
Community Health Workers and the Power of Measurement
Table 1. Evaluation constructs co-identified by CHWs and other evaluation experts
(See above)
How should community health worker (CHW) programs be evaluated? A collaborative team recently published an important article advancing an answer to this pressing question, focused on CHW programs in low- and middle-income countries. Here, we provide a complementary answer to this question, advanced by the CHW Common Indicators Project (CI Project), which aims to identify and recommend a set of evaluation indicators to systematically assess the work and impacts of CHWs in the USA. The CI Project’s long-term objective is nationwide adoption of these indicators and development of infrastructure to collect data and report results, with the ultimate goal of optimizing CHW contributions through standardized monitoring and quality improvement, while centering CHWs as experts and leaders.
NACHW
NACHW National Policy Platform
Author: NACHW
Pages: 6
Date: March 1, 2021
Sections:
- The National Association of Community Health Workers Calls on Public and Private Institutions to Respect, Protect, and Partner with Community Health Workers to Ensure Equity During the Pandemic and Beyond
- Community Health Workers are Needed More than ever to strengthen COVID-19 response
- Why aren't more Community Health Workers integrated into COVID 19 response?
- Who are Community Health Workers?
- Respect Community Health Workers
- Protect Community Health Workers
- Partner with Community Health Workers
- About the National Association of Community Health Workers
- Resources to advance CHW leadership and integration into the COVID 19 response
*********************************************************************************
It is with great excitement that we share with you all the NACHW National Policy Platform. This document is an important tool to promote national professional identity, leadership and capacity of CHWs and our Associations.
This document was created over the past year of town hall calls with over 30 CHW Associations, 3 national CHW polls, numerous partner meetings, member input on the Biden administration's national plan to Build Back Better and in consultation with many of you. It centers many of the policies and best practices that are already nationally endorsed within our field and can be applied to COVID-19 response efforts as well as long term policy development.
Likely there are things we will add to this document as we learn! However, now is the time for us to come together as CHWs and allies to articulate to public and private institutions our values and strategies to Respect, Protect and Partner with us.
Over the next few weeks, NACHW will begin to share this document widely, in presentations, on social media, through our newsletter, etc. if you have an upcoming presentation, we would be happy to provide you with slides to share these policy recommendations and more about NACHW.
Thank you again for your expertise, contributions and partnership. I honor your voices and look forward to continued advancement of CHWs through our unity.
Many thanks!
Denise Octavia Smith, MBA, CHW, PN
Executive Director
American public Health Association (APHA)
Public Health INstitute
CALIFORNIA HEALTH WORKFORCE ALLIANCE
Date August 2013
Pages 24
Contact: For more information, please contact: Kevin Barnett, Dr.P.H., M.C.P., Senior Investigator, Public Health Institute, and Co-Director, California Health Workforce Alliance (www.calhealthworkforce.org), at kevinpb@pacbell.net
PROJECT LEADERSHIP TEAM (pg 22)
Steve Barrow CEO and President AHEAD
Juan Carlos Belliard, Ph.D. Assistant Vice President for Community Partnerships and Diversity Loma Linda University
America Bracho, MD Executive Director Latino Health Access
Xochitl Castaneda Director Health Initiative of the Americas,
UC Berkeley, School of Public Health
Cecilia Echeverría, MPP, MPH Director of Safety Net Partnerships Kaiser Permanente
Catherine Dower, JD Associate Director Center for the Health Professions, University of California, San Francisco
Pamela Ford-Keach, MS California Department of Public Health
Nancy Halpern Ibrahim, MPH Executive Director Esperanza Community Housing Corporation
Maria Lemus Executive Director Vision y Compromiso
Laura Long, MBA Director of National Workforce Planning and Development, Kaiser Permanente
Jean Nudelman, MPH, Director of Community Benefit Programs, Kaiser Permanente
David Quackenbush, Vice President of Member Services, California Primary Care Association
Rea Pañares, MHS ;Senior Advisor, Prevention Institute
Beatriz Solis, Ph.D., MPH, Director of Healthy Communities, Strategies South Region, The California Endowment
Perfecto Munoz, Senior Policy Advisor on Consumer Health and the Workforce, UC Berkeley, School of Public Health
Tivo Rojas-Cheatham, MPH, Chief of the Community Participation and Education Section, CDPH
Public Health Institute
CALIFORNIA HEALTH WORKFORCE ALLIANCE
COMMUNITY HEALTH WORKERS IN CALIFORNIA: Sharpening Our Focus on Strategies to Expand Engagement
Date: January 2015
Pages: 33
http://www.phi.org/uploads/application/files/2rapr38zarzdgvycgqnizf7o8ftv03ie3mdnioede1ou6s1cv3.pdf
CONTENTS Acknowledgements..............................................................................................................................2
Executive Summary..............................................................................................................................3 Introduction ..........................................................................................................................................6 Background ...........................................................................................................................................8 Discussion Themes Design Considerations in Team-Based Care..................................................17
Skills, Recruitment, and Training of CHWs.......................................................................................20
Organizational Capacity for Engagement .......................................................................................23
Building Analytic Capacity .................................................................................................................25
Taking the Engagement of CHWs to Scale: Recommendations....................................................30
Appendix A..........................................................................................................................................33
R1: Establish a statewide clearinghouse to facilitate the rapid sharing of innovations, tools, best practice delivery models, and research support resources.
R2: Develop a landscape analysis that outlines a scope of practice for CHWs that accommodates alternative team-based models and other team members and the full range of services and activities in clinical and community-based settings.
R3: Conduct an independent assessment of employer-based, independent, and academic institution-based training programs that describes content scope and intensity, time frame, prerequisites, pedagogical models, geographic focus, and competencies.
R4: Develop competency-based certification standards for new and existing training programs and for individuals who complete the appropriate training.
R5: Identify regional sites to pilot the establishment of centralized data repositories that facilitate the integration of community-level data collection efforts and support the expanded use of collaborative data sharing tools for patient care management.
R6: Provide targeted technical assistance to community health clinics to develop or adapt existing evaluation tools to monitor and disseminate program outcomes.
R7: Partner with mobile health technology organizations to support mobile data collection, point of care decision support, and case management by CHWs and pilot those interventions with selected communities and organizations.
R8: Develop standard metrics that effectively capture outcomes associated with services and activities undertaken by CHWs to address the social determinants of health.