Community Health Workers: Providing Essential Services in Rural America 7th Annual Rural Public Health Institute March 16, 2011
330A Grant Evaluation Partners Walsh Center for Rural Health Analysis Michael Meit, MA, MPH Alana Knudson, PhD University of Minnesota Ira Moscovice, PhD Michelle Casey, MS Walt Gregg, MPH National Rural Health Association National Organization of State Offices of Rural Health Rural Health Resource Center
Overview of 330A Grant Outreach Authority Grant Programs ORHP 330A Outreach Authority Grant Programs Created as part of the Public Health Service Act of 1991 Under the authority of section 301 More than $460 million awarded since program inception Nearly 900 consortia projects have participated and sought to: Expand rural health care access Coordinate resources Improve rural health care service quality Six grant programs operate under the authority of section 330A Rural Health Care Services Outreach (Outreach) Network Development Planning (Network Planning) Rural Health Network Development (Network Development) Small Health Care Provider Quality Improvement (Quality) Delta States Rural Development Network (Delta) Rural Health Workforce Development (newly established)
Focus on Community Health Workers CHW is the focus of the first toolkit Why is HRSA and ORHP interested in CHWs? Health care reform Context from the literature No definition of CHWs Little information is available Models Best practices Resources
CHW Project Project Team: Alycia Infante, Alana Knudson, and Alexa Brown Project Goals: 1. Identify evidence-based models that may benefit the 330A Outreach Authority Program grantees 2. Document the scope of their use in the field 3. Build an Evidence-Based Model Toolkit around topic areas specific to rural health
Project Activities Reviewed Outreach Grantee applications and literature on CHW evidence-based models Sought potential CHW models being utilized in the field, within and outside of the 330A grant program Conducted semi-structured phone interviews with Outreach grantees that have implemented CHW programs Developed a Promising Practice toolkit for rural communities that contains CHW program resources Located on the Rural Assistance Center (RAC)
Operational Definition of CHW Lay members of communities, paid or volunteer, who work in association with the local health care system; Usually share ethnicity, language, socioeconomic status, and life experiences with the community members served; May provide: interpretation & translation; health education & information; assistance in receiving needed care; informal counseling & guidance; advocating for health needs; and direct services, i.e., first aid, BP screening. Community Health Workers National Workforce Study. March 2007. bhpr.hrsa.gov/healthworkforce/chw/3.htm
Other Titles Used for CHWs Community health advisors Lay health advocates Promotores(as) de Salud Outreach educators Community health representatives Peer health promoters Peer health educators
Models of Care Using CHWs Member of care delivery team Provides case management with lead provider Responsible for coordination of care Navigator Assists individual in navigating health care system, services, & providers Screening and Health Education Provider Works with individuals with specific health conditions, i.e., asthma and diabetes Accesses hard-to-reach populations & provides screenings, care methods
Models of Care cont d Outreach/enrolling/informing agent Outreach worker Reaches individuals eligible for benefits and enrolls them or brings them to a health care provider Organizer Promote community action around a specific topic/issue More commonly volunteers than paid workers
Building the CHW Toolkit CHW Toolkit Objectives: Organize available resources on RAC Use Q&A format to seed thinking Be useful to grantees and other rural communities at different levels of knowledge/stages of implementation of CHW programs Provide resources that can help grantees, future applicants, and rural communities, more generally, to identify and apply relevant CHW evidence-based models to their projects
How will the CHW toolbox be used? Learning: Who are CHWs and what are their roles? Disseminating: How do we disseminate our approaches to other communities? Modeling: Are there model CHW programs that offer promising practices? Evaluating: What benefits are we seeing, and what s the next step? Adapting: How do we create a program that meets the needs of our community? Measuring: How do we measure the value of our CHW program? Training: What types of training materials and approaches are available? Sustaining: How do we plan for sustainability of our CHW program? Hiring: What do we need to think about when hiring CHWs? Implementing: What resources will we need to implement a CHW program? Funding: What resources are available for implementing CHW programs?
Organization of Modules Module 1: Introduction to Community Health Workers Module 2: CHW Program Models Module 3: Training Approaches for CHWs Module 4: Implementation of CHW Programs Module 5: Sustainability of CHW Programs Module 6: Measuring and Evaluating the Impact of CHW Programs Module 7: Dissemination of CHW Resources and Promising Practices Module 8: Rural CHW Program Clearinghouse
Module 1 - Introduction to CHWs Objective: To introduce grantees, future applicants, and rural communities to CHWs and their roles. Questions Who are CHWs? What are the roles of CHWs? How are CHWs used in communities? What are the advantages of including CHWs in our intervention? Key Resources Resources on role of CHWs Research on CHW interventions Links to websites that focus on CHWs Links to federal websites Glossary of definitions/terms Leadership speeches/ testimony Press releases
Module 2: Models Using CHWs Promotora/Lay Health Worker Model Member of Care Delivery Team Model Care Coordinator/ Manager Model Health Educator Model Outreach and Enrollment Agent Model Community Organizer and Capacity Builder Model
Module 3: Training Approaches for CHWs State CHW certification programs Texas, Indiana, Ohio, and Alaska State-level standards for CHW training programs Arizona, Southern California, Massachusetts, and Virginia Non-state mandated programs or exploring certification for CHW programs Kentucky, New Mexico, Minnesota, and Hawaii
Module 8: Rural CHW Program Clearinghouse Provides a list of past ORHP grantees with CHW programs New Mexico Puerto Rico Texas Mississippi South Carolina Washington Alaska
CHW Program Opportunities Extends access Expands networks Supports partnerships Enhances credibility of community organizations Increases educational opportunities for participants Provides applicable skills
CHW Program Challenges CHW Payment Evaluation Impact data Limited resources Sustainability Funding Reimbursement
Summary The 330A Outreach Authority grantees offer promising CHW program practices There are liability issues to consider for CHWs Transporting clients in their own vehicles Conducting outreach activities in remote areas The most effective CHW program evaluation strategy involves CHWs Designing the evaluation and learning about the results CHW programs are the most sustainable if a consortium of community partners is created Lend resources and time Investigate the feasibility of different fiscal sustainability models such as third party reimbursement for CHW services Community buy-in
Contact Information Alana Knudson, PhD Co-Director, Walsh Center for Rural Health Analysis 301-634-9326 knudson-alana@norc.org Michael Meit, MA, MPH Co-Director, Walsh Center for Rural Health Analysis 301-634-9324 meit-michael@norc.org Ira Moscovice, PhD Mayo Professor and Division Head of the Division of Health Policy and Management at the University of Minnesota 612-624-8618 mosco001@umn.edu