NAVIGATION STRATEGIES AND LINKAGE TO CARE FOR HEPATITIS B

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1 NAVIGATION STRATEGIES AND LINKAGE TO CARE FOR HEPATITIS B 1 Karen Jiobu, DLM (ASCP) Health Care Consultant Asian American Community Services July 29, 2016, HBU Summit

2 ABOUT ASIAN AMERICAN COMMUNITY SERVICES Asian American Community Services (AACS) is the premier non-profit community-based organization serving needs of all Asian Americans in Central Ohio. Since 1976, AACS. Located in Columbus, Ohio November 11, year anniversary gala Serving the community in Family support (after school program, domestic violence, human trafficking), Health Care (Asian Free Clinic, Hepatitis B free clinic, and Navigator program), Education (ESL, Computer, and Voter ed/ engagement), Interpretation/translation. Part of the Ohio Asian American Health Coalition since inception. (OAAHC became a 501 C 3 organization in 2008) 2

3 PATIENT NAVIGATION STRATEGIES Use of the Community Health worker Increasing provider awareness/education Overcoming language and insurance status barriers Program Development 3

4 AACS HISTORY WITH CHWS 2006: Started Hep B testing at Asian Festival. CHWs were called liaisons and they were already interacting with their ethnic communities for other testing (glucose, cholesterol, etc.) : Worked with OSU APAMSA medical students to train the trainer (CHWs). 2011: Heard of the Promotora and made presentation to AACS interpreters (60 + interpreters) 2014 & 2015: AACS Asian Health Fair and Somali Health Fair used the train the trainer method to develop CHW volunteers. Especially needed in the Somali community : Advocated for use of CHW as a member of the Ohio Statewide Disparities Collaborative. Brought attention to the CHW and the HUB model. This was a OCMH funded project that was identified nationally as a best practice. The OCMH has expanded this practice to 4 more sites in Ohio. 4

PROVIDER EDUCATION: FUTURE PHYSICIANS Johnathan Zhang UC Irvine, IM residency, 2011-2012 Jimmy Feng Li IM,

5 PROVIDER EDUCATION: FUTURE PHYSICIANS Johnathan Zhang UC Irvine, IM residency, Jimmy Feng Li IM, Gastroenterology residency, OSU Joanna Liu Family Practice, Ohio Health Jason Ho Gen Surg, Baylor University 5

6 WHAT WE LEARNED? For some CHWs, there was some difficulty in language comprehension. Need to have CHW repeat back to you what was said Procedures needed for screening and education. Must speak in very simple terms Medical students had to be reminded to use 6 th to 8 th grade language when speaking to the lay CHWs Need to show the connection to liver cancer to have people take notice and go to screenings 6

causes damage 肝刺激受损 Frequently NO SYMPTOMS until advanced

7 CHRONIC (LONG-TERM) HEPATITIS B 慢性肝 Body is unable to fight off the virus 无法抵抗病毒 Continual irritation of liver causes damage 肝刺激受损 Frequently NO SYMPTOMS until advanced disease 无表癥 1 in 4 will die from liver complications!!!! ¼ 死亡率 7

8 CHW: INCENTIVES ARE KEY! At the Asian Festival, the liaisons are paid per person they educate and ask to the screening (Memorial Day weekend). At the Asian Health Fair, the medical students did it voluntarily, but the CHWs were paid or given gift certificates. During past two years, we have been giving gift cards to those being screened Example: Somali Health Fair. In the HUB model of Community Health Workers, these are paid positions. 8

9 WHAT WE LEARNED AT THE SOMALI HEALTH FAIR SCREENING Flyers were taken to mosques by our Somali chair person (CPH). Communication was word of mouth. Used TV screen showing a Somali physician being interviewed about Hepatitis B (ECHO) Local Somali TV announcer was on committee and agreed to interview and these were used the following year to advertise about the upcoming Somali Health Fair Somali Health Fair committee key in providing teamwork for a successful fair and screening 9

10 BUILDING AWARENESS TO ENCOURAGE TESTING ( ) Needed to determine who are the targets in Columbus: 1. Infant Mortality hotspots are where the South East Asians and recent refugees live. 2. The Northwest quadrant includes most Asian Indians, Chinese, Korean, Filipino, and Japanese 3. Children of immigrants were targeted through the high schools and afterschool programs 10

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12 TARGET FOR AWARENESS CAMPAIGN Korean in Northwest sector Chinese in Northwest sector 12

13 PROGRAM DEVELOPMENT: AWARENESS CAMPAIGN BASED ON VARIOUS FACTORS Language fluency Location of residency Sophistication of media ethnic newspapers, internet: website, , Facebook Transportation needs Awareness through children Availability of campaign tools: University of Washington video, CDC, Jade program 13

14 AWARENESS CAMPAIGNS 2014 HEPATITIS TESTING DAY 14

15 AWARENESS CAMPAIGN 2015 KNOW HEPATITIS MATERIALS In Korean (church website) In Chinese (ethnic website) 15

16 AWARENESS CAMPAIGN 2016 KNOW HEPATITIS : A 30 SEC PSA ON HEPATITIS TESTING DAY 16

17 PRESENTATION BY DR. SON DO DECEMBER, 2015 Exec Dir, Kathy Chen, works with Gilead to bring Dr. Son Do Event held in restaurant at Easton. 17

med student. Attendees : Included Columbus Health Commissioner, Dr.

18 CANCER DISPARITIES WORKSHOP, MOON CHEN, MPH, PHD, & DARRELL GRAY, MD Moon Chen, MPH, PHD, Darrell Gray, MD & Christopher Zhang, OSU med student. Attendees : Included Columbus Health Commissioner, Dr. Teresa Long, past exec dir, OCMH, Cheryl Boyce, community leaders. 18

19 FUTURE PROGRAM DEVELOPMENT Action Plan developed for next two years Medicare decision: Medicare National Coverage Determination letter comment period by August 6. Will make a difference in physician ordering patterns. Provider articles published in a journal (2015) Looking toward pathologist journal, emergency medicine, as a possible avenue for provider education Hep B alerts EPIC at OSU, Ohio Health, Primary One. Work with National Reference labs for follow-up testing groups and reflex testing; and education. 19

20 AACS HEPATITIS B ACTION PLAN 2016 AND

21 EXPAND PROVIDER JOURNAL ARTICLES Jan, 2015 The Ohio Pediatric Newsmagazine of Ohio Chapter AAP Dec, 2015 The Ohio Family Physician Journal 21

22 HEPATITIS B SCREENING AT THE ASIAN FREE CLINIC 22

23 NEW PATIENT UPON REGISTRATION Physician Standing Order Risk Factor: Country of birth 23

24 CHRONIC HEPATITIS B INFECTION HEPATITIS B RESEARCH NETWORK 24

25 HEPATITIS B ALERTS Hospitals in Columbus Primary One Health OSU Wexner Medical Center EPIC Grant-Riverside Hospital, Ohio health EPIC Mount Carmel Medical Center - CERNER 10 FQHCs; has EPIC 25

26 PATIENT NAVIGATION STRATEGIES Use of the CHW SUMMARY Work with OSU APAMSA and OSU med student program Realization that some target ethnic groups publicity needs to be more graphic Incentives are key Value of Word of Mouth In language videos Use of Maps to target populations of need Development of Awareness Campaign: Action Plan, use of in-language videos/youtube, Provider Education: Physician State-wide journals, Use of Hep B alerts manually and by EMR. 26

27 ANY QUESTIONS, COMMENTS 27

Minnesota CHW Curriculum

Minnesota CHW Curriculum The Minnesota Community Health Worker curriculum is based on the core competencies that are identified in Minnesota s CHW "Scope of Practice." The curriculum also incorporates