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CHWs: Suddenly Popular - but Not Understood

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Carl Rush

on 5 November 2016

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Transcript of CHWs: Suddenly Popular - but Not Understood

Early support for growth
Roots in War on Poverty
First CHWs in US funded thru Office of Economic Opportunity
Federal Migrant Act
Community Health Representatives in tribal health programs
Early days of Community Health Centers
Columbia Point HC in Mass.
Delta Health Center in Miss.
Alviso HC in California
Folklore: feldshers and barefoot doctors
Providers, payers recognizing CHW value
Demonstration project funding
Early academic research
Pioneers in CHW education
Early CHW networks
Interest from HRSA
National Community Health Advisor Study (1998)
HRSA National Outreach Conference (1998)
APHA New Professions SPIG (1999)
APHA CHW Section (2009)
HRSA CHW National Workforce Study (2007)
Labor Dept. Occupational Classification (2009)
APHA Policy Statements 2001-2009-2014
CHWs recognized in team-based care
Advantages for CHWs in new health care settings
Accountable Care Organizations, Medical Homes need new ways to relate to patients
CHWs: Suddenly Popular - but Not Understood

How did we get here???
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
- Dr. Martin Luther King, Jr.
People confuse other kinds of workers with CHWs
Patient Navigators
ACA Exchange "Navigators"
Alaska Community Health Aides
Peer Support Specialists
Dental Health Coordinators
Conflicting definitions
Potential challenges
Medical culture favors clinical training
Health care may push to make definition, training more medical/clinical
Grassroots CHWs/Promotores have own identity
Other professions worry about encroachment
States, other payers worry about increased costs
Perceived competition
Institutional volunteers: Americorps, "Health Leads"
Community paramedics
Patient Navigators
Peer educators
Clinically-driven home visiting (Nurse-Family Partnership)

Community Paramedics
Able to divert away from hospital
May do follow-up to manage conditions
Not necessarily employed by EMS
Trusted reputation
They are familiar, in "comfort zone" for decision-makers
Keeping Your Identity in the
New World of Health Care

Health Resources and Services Administration
Bureau of Health Workforce
Bureau of Primary Health Care
Maternal-Child Health Bureau
CHWs have special capabilities these systems need:
Social Determinants of Health
CHWs can help clinicians understand patient's LIFE
...can help directly to address non-medical needs
...can help community address bigger issues
Increasing evidence that CHWs can improve outcomes and reduce cost in many situations:
Evidence of CHW impact in:
Managing and preventing chronic conditions
Improving birth outcomes
Maintaining older/disabled people in home care
Reducing total cost of care for high utilizers
Increasing cancer screening & early detection
Increasing immunization rates
House of Delegates report Nov. 2015 recognizes CHWs as a "profession"
Forthcoming "white paper" calls for CHWs to be included on care teams
Why doesn't everybody understand CHWs?
Affordable Care Act
Department of Labor/OMB
Individual state governments
Health Resources & Services Administration
What can you do about it?
Grow your Association
Promote your definition of CHW
Become a resource to your members
Be inclusive of all types of CHWs in all settings - not just health care
Find stakeholders who can "champion" CHWs and get them involved
Get involved in public health and healthcare policy
Do your homework, especially Medicaid
Create your "elevator speech"
Get "champions" to mentor you
Find organizations who are natural allies
Insist on being at the table for decisions that affect CHWs
Get involved nationally
Participate in APHA (committee calls are open)
Get involved in newly forming national CHW association
Use the C3 Project as a resource
Follow national organizations in your areas of interest (diabetes, mental health, child development etc.)
Create an awareness/education campaign
Get invitations to speak at meetings of state and local associations
Place articles in association newsletters
Get a proclamation from Governor or Legislature
Get providers to display posters or "rack cards"
Carl H. Rush, MRP
Project on CHW Policy & Practice
University of Texas-Houston, Institute for Health Policy

(210) 775-2709
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