HEALTH LITERACY PROJECT

Transcription

1 HEALTH LITERACY PROJECT Joining Forces of Criminal Justice and Medicine September 2014 July 2015

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4 2 If we want health equity, we need to make health literacy a priority...to give [the people] the tools to make healthier decisions. -Sylvia Matthews Burwell, AB, BA, Secretary of Health and Human Services (HHS)

5 TABLE OF C O N T E N T S 01 1 Page 4-5: Introduction 02 Page 6: Background: Community-Based Participatory Approach Page 7: Background: Health Literacy Page Page 8-11: Project Timelines 04 Page 12-15: Module 1: Understanding Health Insurance 05 Page 16-19: Module 2: Preventive Services 06 Page 20-23: Outcomes 07 Page 24: Lessons Learned 3

6 01 INTRODUCTION TO THE PROJECT A ccording to the former U.S. Surgeon General, Richard Carmona, more than 90 million Americans cannot understand basic health information, and low health literacy costs the health care industry $73 billion annually in misunderstood or misdirected health care services 1. Having difficulty obtaining, processing and understanding basic health information influences an individual s need to make appropriate health decisions, including the process of obtaining health insurance coverage that best suits their unique lifestyle. With the onset of the health care reform, The Affordable Care Act (ACA), and the expansion of Medicaid, health literacy has become a pressing issue. The ACA aims to provide affordable and quality health coverage to all Americans, which means that many uninsured individuals may be enrolling in health coverage for the first time and may not understand the language of coverage or how to use their health insurance. In addition, the health care law has expanded health care services such as those regarding behavioral health issues which can be important for vulnerable populations like the adult probation population. Many adult probationers are additionally burdened by higher rates of substance abuse and mental illness. In general, probationers have lower education levels than the overall population, are predominantly uninsured, and burdened by higher rates of substance abuse, mental health issues and trauma. Previously, most indigent probationers did not qualify for publicly funded health services. Thus, collaboration began with Maricopa Integrated Health System (MIHS), Maricopa County Adult Probation (APD), Enroll America, and AmeriCorps VISTA to improve health literacy and to provide enrollment support to the adult probation population. A primary objective of this collaboration was to educate low-literate and at-risk probationers about health insurance and using preventive services in a classroom setting that emphasizes interactive components and a relaxed learning environment. Two health literacy modules were created that focus on basic health insurance knowledge and access to preventive services. The parties decided on the learning goals and priorities, the outreach methods, and class content modifications. 90 million Americans cannot adequately understand basic health information -17th U.S. Surgeon General, Richard Carmona, MD, MPD, FACS 4

7 A collaborative effort to create a place where the adult probation population in Maricopa County can: Improve their ability to understand basic health information Become empowered in their own care Be influenced to adopt healthy living behaviors Improve individual and community health outcomes The class curriculum is based on the Centers for Medicare & Medicaid Services (CMS) Roadmap to Better Care and A Healthier You. CMS ROADMAP 5

8 02 BACKGROUND Community-Based Participatory Approach M aricopa Integrated Health System (MIHS), the only public teaching hospital and healthcare system in Arizona has partnered with Maricopa County Adult Probation (APD), Enroll America, and HandsOn Greater Phoenix AmeriCorps VISTA to provide literacy activities, insurance screenings and enrollment support for low-income and at risk 6 adult probationers in Maricopa County, Arizona. In order to connect these individuals to health care in a different way, and to enhance their literacy and access to health care, we used a community-based participatory approach. This approach is recognized as a critical strategy in addressing health inequities among socially disadvantaged and marginalized communities. All collaboration partners were engaged and supportive within this initiative which fueled our successes. Together we have: 1) identified and assisted low-income, minority, and adult probation populations; 2) provided awareness of health coverage and care; 3) conducted classes designed for low-literacy probationers pertaining to health insurance enrollment and preventives services; and even 4) assisted them with completing applications and enrollment in Medicaid/Marketplace plans. Maricopa County Adult Probation The APD identified the need to address health care coverage needs of both the existing probation population and those new to probation. They have positioned themselves into the community as a department committed to client health care, and worked to create new partnerships with community-based organizations focused on health care. A large number of probationers are Medicaid eligible and may be unaware of the Arizona Medicaid expansion. Thus, as probationers continue to utilize the APD system, it is necessary for APD to enhance their ability to provide health coverage support and assistance. Maricopa Integrated Health System With the onset of the ACA, MIHS embraced the philosophy that our community needs health coverage and assistance to understand the changes in the health care law. To do so, MIHS assembled strong leaders and collaborated with key partners, building a team to transform the health care coverage experience. MIHS has focused on promoting access and navigation to healthcare and on promoting preventive and wellness services. MIHS, along with APD, serve a high number of minorities, especially those who are Hispanic, who are low-income or struggle with low levels of literacy. Enroll America Enroll America is a non-profit, non-partisan organization that focuses on one goal: to maximize the number of Americans who are enrolled and are retained in health coverage. For this collaboration, they were crucial to enhancing our outreach efforts, enrollment support, and coalition building. They also provided the APD offices with Get Covered Commitment Cards which were passed to the probationers to collect contact information. Enroll America could then contact the probationers, offer enrollment support and resources, and foster the motivation to enroll. HandsOn Greater Phoenix AmeriCorps VISTA MIHS has collaborated with HandsOn Greater Phoenix s AmeriCorps program in FY14 to place workers at the public hospital. The VISTAs have enabled MIHS to build capacity with their ACA activities, such as this health literacy initiative. The VISTAs have created and piloted the curriculum. They have designed tip-sheets and how-to information to provide to the participants, and have presented the health education classes at the APD locations and the MIHS Family Learning Centers. They have been instrumental in the expansion of the APD teaching sites.

9 Health Insurance Literacy Healthy Literacy is defined as the ability to obtain, process, and understand health information needed to make informed decisions. 2 Low health literacy is more prevalent among these groups: older adults, minority populations, individuals with low socioeconomic status, and the medically underserved population. Individuals who have low health literacy may find it difficult to find health services and health care providers, to complete health forms, to share their medical history, to understand the connection between risky behaviors and their health, to manage chronic illnesses, to understand medical directions, and to pursue preventive care. Preventive care is especially crucial to our nation as it improves individual health and helps to keep health care costs down. The ability to address low health literacy in our nation requires a collaborative effort which is highlighted within this national action plan and is seen within this health literacy initiative. With the effective and suitable delivery of health care information and education, we can encourage a culture of improved health literacy to enhance individual and community health. We at MIHS will continue to strive to minimize the health disparities that result from low health literacy, and we ll continue to do so by collaborating with internal and external partners to help empower our community. After Open Enrollment Year 1, studies have shown that many individuals needed and desired to have more information to help them select a health coverage plan and to understand their health coverage. With the healthcare changes and with the ability to obtain quality and affordable health coverage, many individuals are enrolling in coverage for the first time, this may affect their ability to select a health plan that s suitable for them and how to properly use their health coverage. With these changes and the anticipated confusion, The U.S. Department of Health and Human Services have worked with over 700 public and private sector partners to create a national action plan that aims to improve the health literacy of our population 2. The plan is based on the values that: Everyone has the right to health care information that assists them to make better decisions about their health 2. Health services should be delivered in a way that is easy to understand and is beneficial to our population s health, longevity, and quality of life Source for above data: Enroll America 7

10 03 PROJECT TIMELINE T he health literacy initiative targeting the adult probation population started in September This section of the report will display and explain the timeline and process of implementation that occurred respectively for each of the each of the 3 different classes created and used during this project. 1 Module 1: Understanding Health Insurance 90 min 2 Module 2: Preventive Services 90 min 3 Combined: Module 1 & min Process of Development and Implementation A structured plan was in place to keep the project team on track on each stage of the project starting with the creation of the class and the materials to the implementation of the classes. The first stage of the project was to create the class presentations and supplemental materials. Once the curriculum and materials were created we piloted the class. During our pilot phase, we presented the class as we would a real-live class to various health professionals and partners that interact with the adult probationers and to the residents at the Garfield Probation Service Center. During this pilot phase, attendees were asked to discuss and provide feedback on what needed to be changed in the class to best serve their clients and the target population. Feedback was collected, and the next step in the project plan was to refine the curriculum until a final product was agreed upon. This stage is one of the more important stages of the project, as it allowed us to create curriculum and materials that would effectively communicate with the target population to ensure we were providing the best classes and materials possible to encourage healthy behavior changes. Once the final product was ready, we could then implement the classes to the target sites. During the implementation stage, the project was expanded to a wider audience by connecting with other probation sites and by targeting other meeting spaces that the adult probationers visit frequently. Process of Development The first site targeted was the Garfield Probation Service Center as it provides living quarters for individuals and holds Community Service project days on Saturdays. We were able to pilot and initiate the curriculum to the residents on Sunday evenings when they had their required resident meetings. We then expanded to holding classes during their Community Service Project days in which individuals arriving to receive hours would finish up their service days by participating in the class. The targeted sites for Community Service hours expanded to the Black Canyon Probation Department and the Mesa Probation Department. Following that expansion, we implemented classes at locations in which individuals were coming for court mandated drug and DUI support groups. The final expansion of the project was to target the adult probationers in 8

11 Intensive Probation Supervision (IPS). After meeting and presenting the health literacy curriculum to the IPS Supervisors, we agreed upon selecting one IPS location to educate each IPS officer s clients. Each site has about six IPS officers who have about probationers each. The first IPS Department to target during this project was the IPS Department at the Adult Probation Durango site. For the month of June, classes were held four days out of the week in the morning and evening to capture all adult probationers assigned to each of the probation officers. During the first two weeks of June, Module 1 was taught to all participants. The next two weeks in June focused on Module 2, thus, those individuals who sat in Module 1 were asked to return in two weeks to take Module 2. This allowed our health educator to make a second connection to the target population which enhanced our ability to provide enrollment support and preventive service information to empower the adult probationers. To capture the individuals who were unable to attend either module or needed to partake in the two, we schedule a Module 1 course and a Module 2 course back-to-back on the last day of June for those individuals. The next IPS site that was targeted for the month of July was the Glendale Western Regional Center. This site and class structure reflected that of our efforts at the Durango Adult Probation site. Timeline of Attendance The timeline on the following page represents the attendance rates for each month of this project s lifespan. In looking at class numbers and attendance rates, the timeline shows that September through November consisted mainly of creation of materials, piloting, and refining the curriculum and class materials. December highlights when the classes began to be implemented. February shows our team s efforts in opening up the course to the community, spreading word of the class to the community via and online sites like CoverMeAz.org and Facebook. However, only one individual showed up to the class. In addition, February marked our expansion to a new site to deliver the course for Community Service. April indicates our involvement with the Drug and DUI Support Groups. Lastly, June and July represent our busiest teaching months as we targeted the IPS units, and teaching to a captive audience proved to be very beneficial and effective during the summer months of this project. Site Expansion Timeline Sage Counseling (Tempe)

12 03 PROJECT TIMELINE SEPT OCT NOV DEC JAN FEB MAR APR 10 -Two pilot classes were conducted at MIHS for MIHS staff, Maricopa County staff, and Adult Probation Department staff. Total: 2 classes, 29 attended -Month focused on modifying curriculum and finding an adult probation population to target next pilots. -Module 1 Pilot Classes to Garfield Residents Total: 2 classes, 23 attended -1 Community Service Class at Garfield -Module 2 Pilot Classes at Garfield Total: 3 classes, 28 attended -1 Community Service Class at Garfield Total: 1 classes, 7 attended -1 Open Class at Garfield -1 Combined Class for Community Service at Black Canyon Site Total: 2 classes, 8 attended -1 Community Service Class at Garfield Total: 1 classes, 6 attended -1 Community Service Class at Garfield - 1 Drug Court Support Group Class at Black Canyon Total: 2 classes, 38 attended

13 Total Attendees 526 Total Classes MAY JUNE JULY 0-1 Community Service Class at PSC -2 Drug Court Support Group Classes at Mesa -2 Classes for Garfield Residents Targeting 1st IPS Unit Durango Adult Probation Site Targeting 2nd IPS Unit Glendale Adult Probation Site Total: 5 classes, 73 attended Total: 21 classes, 203 attended Total: 15 classes, 100 attended 11

14 MODULE 1 About half (51%) of Americans do not understand the basic health insurance terms premium, deductible, and copay. -Alliance for Health Reform, 2015 MODULE 1: Understanding Health Insurance Health insurance is a confusing topic, and the Affordable Care Act has further complicated the topic. We anticipated that individuals who are uninsured or newly insured may have a difficult time understanding the health insurance process. In addition, we also anticipated that those with health coverage may not be utilizing it correctly. We wanted to empower these individuals with information so they can make thoughtful decisions about their health. This module highlights and explains both AHCCCS and Marketplace, the importance of health coverage, cost-sharing terms, and the enrollment process. The class is encouraged to ask questions and is asked to participate in the class activity to enjoy their time learning the information. 12

15 THE CLASS Module 1 is a 90 minute long class. The class covers the following elements, in this order: 04 1 WHAT IS THE AFFORDABLE CARE ACT? WHAT INSURANCE PROGRAMS ARE THERE? In Section 1, the class is introduced to the Affordable Care Act and reviews terms used to describe the healthcare law. The class is then asked via a TurningPoint Response tool pre-test questions regarding the definitions of the following: AHCCCS (Medicaid), Medicare, and the Marketplace. These responses will be recorded and will be asked again at the end of the class to assess an increase in knowledge. WHY IS HEATLH COVERAGE IMPORTANT? 2 In Section 2, four themes are discussed as to why health coverage is important to have: 1) protection, 2) prevention, 3) peace of mind, and 4) it is federally mandated. Within these discussions there are real-life examples to showcase how much a 3-day hospital stay would cost to illustrate the importance of having health coverage to protect your finances. The class also reviews how the penalty fee increases each year for those individuals who do not have health coverage. WORDS TO KNOW! 3 4 During Section 3, the class then goes through the following cost-sharing terms: premium, copayment, deductible, coinsurance, and out-of-pocket maximum. Prior to the information is shown, the class is asked pre-test questions to assess what they already know and are then asked again at the end of class. This section allows us to demystify the language of health insurance for our clients as the terms are defined with real-life examples. To conclude this section, the class participates in an activity to simulate these terms: a volunteer is given a health situation and fake money and role plays the scenario with the class to put the cost-sharing terms in a fun and engaging way. HOW AND WHEN CAN I GET IT? CAN I AFFORD HEALTH COVERAGE? In Section 4, the class reviews the open enrollment dates for the Marketplace and is then presented with ways to get help when applying for health coverage. This includes MIHS locations, MIHS phone numbers, and websites to visit if participants desire more information or plan on enrolling on their own. The discussion then links to the two types of financial assistance in the Marketplace: Advanced Premium Tax Credit (APTC) and Cost Sharing Reduction Plans. HOW DO I FIND THE BEST PLAN FOR ME? AND WHEN I DO, WHAT DO I DO NEXT? 5 The class concludes with Section 5. By now the class has reviewed why health coverage is important, how they use it via cost-sharing, and how/ where they can get it, and now they hear about how they can find the best plan for them. Through plan comparisons they see why it s important to look at the difference in out-of-pocket costs and what benefits each plan covers. The class then discusses what happens after they get health coverage: 1) receiving a health insurance card, 2) reviewing their Summary of Benefits and Coverage, and 3) understanding an Explanation of Benefits is. The class ends on covering how to go about making a doctor s appointment follower by the post-test questions via the TurningPoint Response. 13

16 KEY MESSAGING: The health literacy project implemented key messages within the curriculum to ensure that the information being taught resonated with the participants. The key messages used for Module 1 were based on the messaging recommended for health insurance outreach as stated by the Center for Medicare and Medicaid Services. M odule 1 implemented two sets of key messages throughout the class presentation. The first set of key messages aimed to engage and inform consumers to think about how health insurance is important for protecting themselves, their community, and their finances; preventing future health complications; providing peace of mind in case of emergencies; and to avoid paying the penalty fee as health coverage is now the federally mandated. T he second set of key messages aims to ease consumers minds about the cost of coverage by explaining the forms of financial assistance and enrollment support that may be available to them. HEALTH INSURANCE TERMS The following health insurance terms are presented and defined in Module 1: AHCCCS Medicare Marketplace Premium Copayment Deductible Coinsurance Out-of-Pocket Maximum 14

17 INTERACTIVE COMPONENTS: Module 1 includes interactive components within the curriculum to help keep the audience engaged and active in their learning. These interactive components included: facilitated discussion, TurningPoint Response Clicker System, educational videos, and a role-playing activity. TurningPoint Response Clicker System: This system was utilized in order to collect data on demographic information, knowledge retention, and class satisfaction with all individuals participating in the classes. The participants are encouraged to respond honestly to the questions as the answers they provide are anonymous. The questions in the class that require use of this system are placed sporadically within the course which helps to retain the engagement of the participants. This system has also been helpful for our team to assess the satisfaction with the course to make any curriculum modifications necessary. Role-Playing Activity: After the class participants go over the cost-sharing terms, there is time for the class to participate in a fun activity that will help them to review the information they just received, and to see the terms used in real-time. The participants are asked to volunteer to play the role of the Doctor and the Patient. The Patient is given play money and an insurance card, and then a scenario is presented for the Patient in which the class is encouraged to participate and assist with creating the scenario and with the Patient s next steps. The scenario is a health-related scenario that forces the Patient to use terms such as premium and copayment. The goal of this activity is to help the participants have a better understanding of the health insurance terms. CLASS MATERIALS: We developed and integrated paper handouts into the presentation. Before the clients arrive, we place a Notes Page at each seat. This page had a place for note taking, an outline of the class content, and contact information for resources mentioned within the class presentation. During the class, we speak briefly about the Special Enrollment Periods and pass out a handout that reviews this specific topic in more detail for them to take with them. After we quiz the participants on the health coverage terms, we pass out a handout with the terms and their definitions to the class for them to also take home. Providing handouts helped the participants to focus on the class content and allows them to take the salient points home with them to discuss with their family and friends and to refer to when needed. 15

18 MODULE 2 Among adults, there is a direct association between low health literacy and a poor understanding of preventive care information and access to preventive care services. -Surgeon General, Regina M. Benjamin, MD, MBA, VADM, USPHS, 2010 MODULE 2: Preventive Services The Affordable Care Act mandates that insurance companies cover various preventive services at no cost to the consumer. This is a shift into prioritizing prevention and wellness within our community and our nation, and is a crucial aspect of the health care law that should be discussed with our communities. To educate clients about the services provided to them, we profile services that are available, the importance of the preventive service, and who it is appropriate for (Men, Women, or Children). We emphasize that preventive services are invaluable for maintaining health, catching health problems before they worsen, and for managing chronic conditions. 16

19 THE CLASS Module 2 is a 90 minute long class. The class covers the following elements, in this order: 05 WHAT ARE PREVENTIVE SERVICES AND WHY ARE THEY IMPORTANT? In Section 1, preventive care and services are defined. To stress their importance we provide statistical evidence and give reasons as to why it s important to see a doctor regularly, even if healthy: find problems early, help to establish a relationship of trust with a provider, and can help create healthy lifestyle habits. The audience then participates in an activity where two individuals play out these scenarios to compare the time and money spent: 1) generally healthy person with health insurance receiving preventive care and 2) generally heathy person with no health insurance receiving no preventive care. This further implies the importance of preventive care as it can save a person time and money. ADULT PREVENTIVE SERVICES In Section 2, we highlight many services that are available to adults, starting off with vaccines. The mechanisms of vaccination are explained in simple language. The services that follow are related to mental health concerns, risky behaviors, and cardio and nutrition concerns. The last services mentioned fall under an other category that include services such as a colorectal cancer screening. The importance of the services is emphasized by statistical evidence and with a few videos. In addition, the class is always encouraged to share their personal connection to any health concern, e.g. My grandma has Type 2 diabetes. WOMEN PREVENTIVE SERVICES During Section 3, the class reviews preventive services that are geared specifically towards women. Vaccines and conditions that are exclusive for women, such as pregnancy, are discussed and resources are also provided. Some crucial services that are highlighted in this section include: breast cancer screenings, gestational diabetes screening, and well-woman visits. The women in the class are encouraged to ask questions and to share concerns they may have. CHILDREN PREVENTIVE SERVICES 4 In Section 4, the class receives information on preventive services for children that relate to their developing minds and bodies. We stress the importance of well-child check-ups and vaccines the children should be receiving during their first years. Developmental issues, such as mental health and childhood obesity, are presented and discussed. Information about teen alcohol and drug abuse, and pregnancy are also highlighted. Prior to this section, the class is encouraged to share if they have children and what concerns they have about their children s health to help them to personally see the importance in the information. HOW TO MAKE AN APPOINTMENT FOR PREVENTIVE SERVICES 5 The class concludes with Section 5, and by now they hopefully have seen the importance of making regular visits to their doctor. We review how to make a check-up and what steps they should take if they have a Primary Doctor or if they are in the need of a Primary Doctor. They are then encouraged to make an appointment by calling or walking into a clinic that is nearest them so they can take advantage of their free preventive services. In addition, the class is presented with the CoverMeAZ phone number, NEW-HEALTH and webpage for individuals in the class who would like to receive these preventive services but are currently uninsured. 17

20 ADULT WOMEN CHILDREN THE SERVICES: The chart below displays the list of preventive services that are covered by all Marketplace and most other health coverage plans. This list is derived from the Healthcare.gov website which also provides a small description of the services. The services in RED are those that are gone over in detail in Module 2. Source: healthcare.gov 18

21 INFOGRAPHICS INTERACTIVE COMPONENTS: Module 2 includes interactive components within the curriculum to help keep the audience engaged and active in their learning. These interactive components included: facilitated discussion, TurningPoint Response Clicker System, educational videos, infographics and a role-playing activity. TurningPoint Response Clicker System: This system was utilized in order to collect data on demographic information, knowledge retention, and class satisfaction with all individuals participating in the classes. The participants are encouraged to respond honestly to the questions as the answers they provide are anonymous. The questions in the class that require use of this system are placed sporadically within the course which helps to retain the engagement of the participants. This system has also been helpful for our team to assess the satisfaction with the course to make any curriculum modifications necessary. Role-Playing Activity: The role-playing activity within Module 1 is a titled Chose Your Health Adventure. The activity requires two volunteers to walk through a specific scenario in which they are both healthy and young adults. One participant chooses to forego purchasing health coverage. This patient then develops the flu and is then asked during the stages of developing their illness what they decide to do that may include: choosing to still attend work and purchase over the counter medication, calling in sick to work and resting, or going to the doctor/ urgent care/emergency room. If the patient chooses not to see the doctor, the flu eventually turns into pneumonia. During the activity, we keep track of the money and time spent required by each choice on butcher paper. When the patient develops pneumonia, the time and money for their hospital stay far exceeds what they saved in the beginning by not having health coverage or visiting the doctor. The second volunteer chooses to purchase health coverage, which is more money and time spent up front. However, the second volunteer visits the doctor for a free check-up, and receives a free flu-shot. This prevents the second volunteer from suffering from the flu and allows them to avoid a length, and expensive, hospital stay. This activity emphasizes to the class that preventive services and care can save them time and money. 19

22 06 OUTCOMES Attendance The following figure shows the total attendance per class type: open to the community class, Drug Court Support Group Class, IPS targeted class, pilots, Community Service class, and Garfield resident classes. Total Attendees by Target Population 526 Total Attendees Total Classes Module 1 Classes Module 2 Classes 20 Pilot Classes Open Community IPS Target Classes Garfield Resident Drug Group Classes Community Service Attendance Class Attendance Attendance Classes Attendance Attendance Classes Attendance

23 Total Classes and Attendees by Site The table below displays the number of classes and attendees per each site. Each site was critical to our strategies to reach as many adult probations as possible. Total Modules Taught The graph below displays the number of classes taught per each module: pilot classes, Module 1 and Module 2 classes, and combined module classes. SITE TOTAL CLASSES TOTAL ATTENDEES 35 Garfield Black Canyon 2 29 Mesa (PSC) 3 50 Glendale (WRC) Durango Sage 2 37 MIHS 2 29 TOTAL classes classes classes class PILOT MODULE 1 MODULE 2 COMBINED CLASS The relationship between literacy and health is complex. Literacy impacts health knowledge, health status, and access to health services -National Institutes of Health,

24 06 OUTCOMES Overall Demographic Information What is your age? % % % What is your gender? Male 73.53% Female 24.47% What is your household size? % % % % What is your ethnicity? Hispanic 30.30% Non-Hispanic 66.67% Don t know 3.03% What is your race? White/ Caucasian Black/African American Native Hawaiian/ Pacific Islander 34.04% 14.89% 6.38% Asian 4.26% American Indian/Alaska Native 19.15% Other 21.28% What is your primary language? English 91.18% Spanish 5.88% Other 2.94% What is your employment status? Full Time 40% Part Time 20% Self-Employed 3% Unemployed 29.41% Retired 3% Other 5.71% What city do you live in? Chandler 11.25% Gilbert 3.75% Glendale 23.75% Mesa 7.50% Peoria 3.75% Phoenix 37.50% Scottsdale 1.25% Surprise 7.50% Tempe 2.50% Other 1.25% 75.86% Are between the ages % English is their primary language 73.53% Are males 47.06% Have a household size of % Are Non-Hispanic 40% Are employed full-time HIGHLIGHTS 37.50% Live in Phoenix 22

25 Increase in Knowledge The charts below display the total increase in correct answers from pre-test to post-test questions for each Module. MODULE 1 At the end of the class, an average of 88.91% of all participants found that it was either Very Important or Important to them to have health coverage. In addition, 96.45% reported that they now know where to go for help when signing up for health coverage. A 24.66% increase from the start of the class. MODULE 2 At the start of class, an average of 68.97% believe it was important to have a doctor. At the end of the class, that increased to an average of 98.9%. At the end of class, an average of 37.43% said it was likely they would sign-up for a doctor s appointment in the next 30 days. A 19.32% increase. Class Evaluation The diagrams below display the total participant satisfaction with both modules % Very Satisfied/Satisfied Would Recommend Class to Others Length of Class Too short 7% What They Liked Best About the Class of all participants reported to be uninsured 95.25% 80.72% Too long 30% About right 63% 54.52% of all participants reported to have AHCCCS coverage 23

26 Health literacy can help us prevent health problems and protect our health, as well as better manage those problems and unexpected situations that happen. -Centers for Disease Control and Prevention 24

27 07 LESSONS LEARNED We have learned many lessons during the first year of implementing this project. These key lessons relate to investment in infrastructure, recruitment, site involvement, and goals and measurements. We discovered that the developmental phases prior to implementing the curriculum were crucial, but took longer than anticipated. Once we were able to implement the curriculum, it was critical to have the site locations involved in the class schedules and the set-up for the classes for the initiative to function properly. It was easiest to schedule and secure classes at sites that were flexible and eager to participate with the project. In addition, to secure participants in the class it was beneficial to our project to schedule classes where individuals would have to opt-out instead of opt-in. This meant that we had a captive audience when teaching during Garfield Sunday resident meetings, to Community Service scheduled days and at Drug and DUI Court Support groups, as opposed to teaching and offering classes to the community hosted at the probation sites. Thus, it became heavily important throughout the project that the health literacy classes were to be integrated within the business practice. To capture the effectiveness and overall satisfaction with the courses, it was imperative to collect information from our class participants. Our TurningPoint Response Clicker System was an essential component of this initiative as it allowed us to assess the class and guided us to make any necessary changes to evaluate and improve the curriculum. With reviewing these lessons, we will be able to improve this initiative in the future to help empower and educate our community to make better decisions about their health. Investment in Infrastructure Recruitment Site Involvement Goals and Measurements 25

28 07 LESSONS LEARNED LESSONS LEARNED Investment in Infrastructure We anticipated that we would be teaching the classes at the probation sites at an earlier date than we actually did due to the extra time we needed to complete the development, pilot, and refining phases. We needed to be more realistic in our ability to schedule the right pilot classes that had the proper audience to provide the feedback we needed. Refining the material based on the feedback we were given from our pilots took much longer that we predicted, but this stage was crucial to our class successes as we needed to ensure that the curriculum was constructed to effectively communicate to our target population. Piloting the classes to MIHS staff, APD staff, and the residents at Garfield were essential to the classes ability to connect to the adult probation population and we were grateful for the suggestions given. Without the pilot and refining stages our curriculum would not have been as effective. In order to successfully target the adult probationers, the APD locations needed to be flexible and needed to see that the classes would only be a supplementation to already existing programs. We successfully implemented classes at locations where the sites understood the goals of this project, and saw how it was fitting into their business practice by hosting these classes during existing meeting groups. The sites were also critical to inform our team of how we could effectively engage our target population that visits their sites. For Garfield Probation Center, we were able to conduct community service classes and classes to the residents. For the Black Canyon and Western Regional Probation Center, individuals arriving for community service hours could take the course and then head out to a project off-site to get all the hours necessary. When targeting the IPS individuals, the IPS officers at Western Regional and Adult Probation on Durango were helpful in our expansion to the IPS individuals as they properly orientated the health educator to their staff and their site. Thus, it was crucial to have the health educator and all APD staff involved to meet in-person to discuss the best ways schedule classes at their site. Site Involvement 26

29 We wanted to reach as many adult probationers in Maricopa County as possible, and to do so we experimented with different avenues to outreach and recruit the participants. Throughout our initiative we saw great success when the recruitment efforts were carried heavily by the APD staff and sites. It was crucial for them to decide on the best days, times, and locations to implement the classes during Community Service days. They were also needed to drive the participation within the DUI and Drug Court Support groups, as those groups already convene we needed them to see the value in having a guest speaker come to the group to present the health classes. Recruitment In addition, the recruitment efforts were of utmost importance when targeting the IPS units as the IPS officers needed to specifically tell their clients to come to a class, making it a schedule requirement or an opportunity for community service hours. The IPS efforts would not have been as successful if the recruitment efforts of the specific departments were not strong and if they were not eager about implementing the project within their APD site/location. It was critical to have a data-driven process to this project as it allowed us to see how effective our classes were to the participants and if there were changes that we needed to make in order to suite their needs better. Goals and Measurements As we gathered data on attendance we were able to highlight which APD sites and which APD outreach were drawing in more participants. This allowed us to discuss what reasons could lead to high attendance and what could lead to low attendance. We realized that hosting these classes for community service hours was an effective way to reach many individuals, and when targeting IPS we were able to teach many adult probationers as each IPS officer instilled the need to come to the two health classes as they could get community service hours or would be a schedule violation if they did not attend. Collecting data via the TurningPoint Response Clicker System showcased areas where they were increasing knowledge, which is critical to see if they were gaining anything from the course. The clickers also assisted the engagement with the participants and generated reports per class immediately after the session was done. In addition, we could collect satisfaction questions which helped us to make class modifications as necessary to make the curriculum more exciting and engaging. 27

30 FOR MORE INFORMATION MIHS Cheri Tomlinson Vice President Grants & Research Phone: Websites: grants.mihs.org and CoverMeAZ.org APD Jennifer M. Hawkins Health Care Services Integration Administrator Phone: Enroll America Montserrat Caballero Arizona State Director Phone: HandsOn Greater Phoenix AmeriCorps VISTA Mallory Debus Community Programs Supervisor Phone:

31 RESOURCES 1. Vice Admiral Richard H. Carmona. Health Literacy in America: The Role of Health Care Professionals. American Association House of Delegates Meeting Almader-Douglas, Diana. National Institutes of Health. Health Literacy. National Network of Libraries of Medicine U.S. Department of Health and Human Services. National Action Plan to Improve Health Literacy Stern, Stephanie. A Framework on Health Insurance Literacy for the Outreach and enrollment Community. Enroll America Funded in whole or in part by the United States Department of Health and Human Services, Health Resources and Services Administration, the Ryan White HIV/AIDS Treatment Extension Act of 2011, Maricopa County Employee Benefits and Health, and the Maricopa Integrated Health System.