Montana Community Health Worker Project Montana Healthcare Foundation Kristin Juliar, Director MT Office of Rural Health/AHEC July 13, 2017

Transcription

1 Montana Community Health Worker Project Montana Healthcare Foundation Kristin Juliar, Director MT Office of Rural Health/AHEC July 13, 2017

2 History Began exploring interest in CHWs in 2010 Periodic workforce assessments Community Health Integration Project Care Coordination Pilot Project Funded by Federal Office of Rural Health Policy and CMS Placed CHWs in 11 critical access hospital communities Regional supervision by ADRN at MT Hospital Association Heavily evaluated and found to be cost effective, improve patient outcomes Convening of stakeholder groups beginning in 2015

3 Policy and Reimbursement Committee Purpose Examine the role of CHWs in the models under consideration by the Governor s Council on the Montana State Innovation Model Design and other Montana initiatives Evaluate the use of CHWs with Medicaid populations and care coordination models including PCMH, CMS funded care coordination projects and ACOs Identify policies and reimbursement models that support the use of CHWs through Medicaid and private payers

4 Policy & Reimbursement Membership Organizations and agencies that have a role in implementing CHW policies and reimbursement models that will aide in the sustainability of the use of CHWs in Montana area asked to participate on the Committee and may include: Agencies: DPHHS, Governor s Innovation Council, MT Department of Labor Payers: BCBS, Pacific Source, Medicaid, New West Systems and delivery models: PCMH (CSI, Providence), ACO (National Rural ACO), Billings Clinic, CHCs, Mountain Pacific Quality Health Foundation and other grant funded programs (e.g. PCORI, community paramedicine), Indian and Tribal Health, AHECs, MUS system

5 Current Status Funding from MT HC Foundation, HealthCARE MT (Dept. of Labor project), MT Geriatric Education Center, and AHEC Stakeholder group, curriculum committee, policy and reimbursement committee Staffed by MT AHEC/Office of Rural Health Creating curriculum and pilot with Mountain Pacific Quality Health Foundation project (RWJF and CMS funding) Apprenticeships and distance training models in the works Policy and Reimbursement Committee met in June

6 CHW Driving Definition APHA 2009 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.

7 CHW Fundamentals Learning Outcomes At the end of CHW Fundamentals, participants will: 1. Display positive behaviors and attitudes needed to effectively succeed in the role and fulfill the responsibilities of a CHW. 2. Incorporate legal requirements and ethical guidelines into all responsibilities particularly when observing, reporting, and documenting. 3. Exhibit effective communication, coaching, and counseling skills and the ability to collaborate with a multi-disciplinary healthcare team. 4. Identify how healthcare and public/community health structure, design, issues, and technology influence the coordination and management of care and services, and effect quality and safety. 5. Use critical thinking, appropriate decision making, and organization and coordination skills to ensure appropriate and timely delivery of resources, services, and care.

8 CHW Fundamentals Learning Outcomes, Cont. 6. Integrate into the provision of resources and services, the values and needs of the cultures and practices of the populations and communities represented. 7. Provide outreach, advocacy, and social support to promote health needs. 8. Perform community/individual education programs to build capacity, promote health, and bring about change. 9. Engage in self-care and personal safety. 10. Demonstrate required CHW skill competencies.

9 CHW Fundamentals 8 Core Competencies Communication Interpersonal Relationships Organization Service Coordination Capacity Building Advocacy Teaching Self Care

10 CHW Fundamentals Modules There are 4-15 hour Modules in CHW Fundamentals with each Module divided into 3-5 hour Units 1. Community Health Worker: Roles and Responsibilities 2. Communicating and Collaborating with Individuals, Groups, and Communities 3. Quality Healthcare Systems: Organizing and Coordinating Resources, Services, and Care 4. Providing Outreach, Advocacy, and Promoting Healthy Communities

11 CHW Fundamentals Module Instructional Design Module Title and Description Module Objectives and Units Module Requirements and Expectations Module Content and Application Activities Required Reading Instructional and Supplementary Resources Relevant Terminology and Glossary Module Assignments Module Summary CHW Practice Journal Module Evaluation

12 Are CHWs employed in Montana? 2017 Environmental Scan 11 or 42% Assorted non-profit 10 or 38% CAH 2 or 8% State agency 2 or 8% Tribal Health 1 or 4% Long term care

13 Do you currently employ a Community Health Worker? % - Yes 68% - No % - Yes 73% - No A variety of job titles Varies from < 1 FTE to 7 FTE Employed from < 1 year to 10 years +

14 Likelihood for employing CHWs in the future % Highly likely 7% Somewhat likely 7% Likely 12% 7% Somewhat unlikely 7% Highly unlikely 36% 32% Don t know 28% 29% Not applicable

15 Qualifications-in rank order 9 Background check 6 HIPAA training 5 High school diploma or GED 4 Auto insurance 4 Currant vehicle registration 3 CPR training 3 Medical background 3 Awareness of community resources 2 Drug test

16 Services provided- in rank order 9 Underserved population 8 Promote preventive care 8 Help clients with paperwork 7 Transportation 7 Conduit for health care services 7 Education to clients on how to navigate and access health care 6 Nutrition education 6 Health promotion 6 Chronic disease management 5 Link uninsured to health care coverage 4 Conduit to health screenings

17 Populations served- in rank order Elderly residents Rural residents Low socio-economic households American Indians New mothers Non-English speakers Elderly residents Rural residents Low socio-economic households American Indians Non-English speakers New mothers

18 Some details: 60% of those that utilize CHWs provide CHW training $ $13.07 to $ $36.00/hour in 2017; $12 - $14/hour in 2015 Federal $$$ provided the bulk of the funding in both 2015 and or 70% said YES for standardized CHW training (77% in 2015)

19 Behavioral Health Fundamentals Certificate In development through Highlands College, as part of HealthCARE Montana Using same curriculum consultant as CHW and aligned with work related to Peer support Expected to be completed by fall 2017

20 Components of BH Fundamentals How to deal with emotionally Disturbed and Mentally ill Patients (Basic Clinical Competencies of the Mental Health Apprentice) How to de-escalate and Resolve Conflict(Maintain client and personal safety for the Behavioral Health Technician) How to Communicate Effectively(Documentation and Patient Confidentiality; Organization debriefing and employee self-care management) Ethics and Boundaries Electives for the Behavioral Health Technician Suicide Prevention Self-Help Groups and Other Recovery Support Services Naloxone Use About 60 hours of training plus a supervised experience

21 Questions? Kristin Juliar