Judul : Community Health Solutions Of America
link : Community Health Solutions Of America
Community Health Solutions Of America
ladies and gentlemen, thank you for standingby and welcome to community health workers - part of the solution for advancing healthequity, perspectives and initiatives from region nine. during the presentation, allparticipants will be in a listen-only mode. afterwards, we will conduct a question andanswer session. at that time, if you are dialed in by phone, you may register for a questionby pressing 14 on your telephone keypad. as
Community Health Solutions Of America, well you may submit questions using the chatfeature located in the lower left corner of your screens. if you need to reach an operatorat any time, please press star zero. as a reminder, this conference is being recordedtoday, wednesday, september 3, 2014. i would now like to turn the conference over to shene'bowie-onye. please go ahead.
good afternoon, everyone. my name is shene'bowie-onye and i'm the execute director of the healthy kids and after school resourcecenters in alameda county with the office of education. i transitioned to acoe in octoberor 2011 from the county of san joaquin, the public health services department, where iwas the program manager of health promotion and chronic disease prevention. i have morethan 13 years of experience in public health and program development, implementation, evaluation,research and health ministries. i'm a member of the region nine health equity council forthe office of minority health, and i have a doctorate of public health in health education.this webinar we will describe strategies, resources and tools used to promote equitythrough the community health worker initiatives
throughout region nine. so just as kind of an overview, a communityhealth worker, or chw, is a front line public health worker who is a trusted member of and/orhas an unusually close understanding of the community that they serve in. this trustingrelationship enables the chw to serve as a liaison between health and social servicesand the community to facilitate access to services and improve the quality and culturalcompetence service delivery. a community health worker's unique role facilitates addressingand ultimately reducing health disparities. now for some key housekeeping points. if youhave a question during the webinar, you are welcome to post it in the chat box at thelower left-hand corner of your screen at any
time during the actual webinar. these questionswill be answered during the q&a session at the end of today's presentation and the conclusionof the webinar. at that time, you'll be directed to an evaluation survey, and if you wouldplease take a few minutes to complete the survey as we will appreciate any feedbackyou have to help inform future acoe webinars. we're also going to include three pollingquestions during this webinar to encourage active participation from all of our participants.i'll do the first polling question now. what would assist most in establishing, sustaining- establishing or sustaining community health worker work in your community or workplace.please check all that apply. state department support, funding, federal guidelines for coretraining, a repository of best or promising
practices or a regional depository of communityhealth worker organizations and associations. giving you a few seconds more to respond.okay, so it looks like the results are pretty spread across the five areas, the top areabeing funding, and looks like most of the poll responses have come in, i've stoppedseeing things change. so just showing the results, the top one, of course, was spending,and then pretty close but second was state health agency support and then followed bya repository of promising practices, and then the last two were guidelines for trainingand a repository of agencies or associations. so thank you very much for that. i am pleased to introduce our panel of esteemedspeakers. first is ms. anna alonzo, who serves
as the office chief for chronic disease forthe arizona department of health services. anna oversees the state and federal programsthat address diabetes, heart disease, stroke, pulmonary disease and asthma. her office alsohouses the arizona healthy aging program and the community health workers program. shehas more than 25 years of experience in public health and has held management positions atthe state of arizona's governor's office, arizona health care cost containment system,the city of phoenix city manager's office, mountain park community health center andthe arizona academy of pediatrics. she has developed many strong partnerships withinhealth care, academics, public health, social services and community-based organizationsacross the region, state and nation. anna
is a native of arizona and is passionate aboutserving those in need, so i'm happy to have her with us today. our other presenter is emma torres. emma torres,who's a msw, is the founder and execute director of campesinos sin fronteras, a grassroots501-c-3 community-based organization serving farm workers and their families in yuma county,arizona. ms. torres has been working as a community representative and farm worker advocatesince 1987. a former migrant farm worker herself, ms. torres now has over 24 years of publichealth experience and recently earned her master's degree in social work. she is a pioneerand proponent of the promotora model as one of the most effective strategies to servethe low income hispanic population. she has
served numerous local, state, and - she hasreceived, i'm sorry, numerous local, state and national awards for her work on behalfof the farm worker population, including the ohlt award, which is the highest recognitionaward by the mexican government to people who live outside of the country. i also wanted to point out that acoe has acommunity health worker page, and you'll find resources available for federal and - forfederal medicare and medicare rulings, legislative tracking and state community health workerprograms, and you can see that there on your screen. so now before we start with our speaker presentations,i wanted to actually go through the webinar
objectives and also give a little bit of backgroundon the national partnership for action and the regional health equity councils. so interms of the objectives, we basically want to highlight the focus on community healthworkers and the role that they play in helping to address the social determinants of health.we want to talk about a little bit about the history and landscape of the work that's actuallyhappened throughout this region and in our state's territories of region nine. we wantto also discuss recommendations on actually how to build and sustain a regional basessystem of support for supporting this work, and then of course identify national resourcesto support the work that's going on in your communities.
so just to give a little bit of backgroundon the national partnership for action to end health disparity, it's a national movementthat has a purpose of increasing the effectiveness of programs and mobilizing partners and leadersand other stakeholders, with of course the ultimate goal of eliminating health disparities.there are ten regional health councils throughout the nation that have been established to dothe following: mobilize regional action around common issues across the nation, leveragefederal, regional, state and local resources, infuse goals and strategies into policy sothat things actually can take place in a policy sense at a national level, and then to ofcourse support what's going on at the local level, both state levels and the communitylevel, and then to share success stories around
the country, which is one of the reasons forthe webinar on today. as you can see, the health equity councilsare spread across the nation, and this kind of gives you an idea of where they are andwhat territories they cover. just to give you a little bit specifically about regionnine, you have here both the mission for the rhec in region nine, which is basically tobe effective agents of change to eliminate health disparities, and we want to do thatby working with leaders, partners and policymakers that are specifically within region nine,and then particularly the sub-committee goals. so within region nine's rhec, we actuallyhave a community health worker sub-committee, and the sub-committee goal was to identifysolutions that demonstrate that value and
impact of community health workers on healthdisparities and then to use the documented value to educate, inform and inform policymakers,payers and other critical audiences about this value. so with that, i would like to present ournext polling question, and if you will, what title is most often used in your communityto describe community health worker work? and we'll give you a few minutes to completethe poll, or a few seconds, rather. looks like we have pretty steady results comingin, and with the top result right now being community health worker, and following nextin line seemed to be community health educator, promotoras and patient navigator. we'll giveyou a few more seconds, looks like we have
most responses, and yes, there are your results.well, thank you for participating in that poll, as well. so with that, we will beginwith our first presenter, and i will now turn the webinar over to ms. anna alonzo. anna? yes, thank you so much. hi, this is anna alonzo,as mentioned, i'm the office chief for chronic disease for the state of arizona departmentof health services, and i'm truly happy to be speaking to you today about the utilizationof community health workers. it's - in utilizing them as a strategy to address health equityand promote health, prevent diseases and assist in navigating the health care system. andreally before i get much further into our slides, i really want to acknowledge all ofthe partners within arizona who work so closely
with the state in implementing community healthworker strategies, and there's so many, and emma you'll be hearing from in just a fewminutes, but one in particular is the university of arizona prevention research center, whowe contract with to help support our initiatives across the state, and so we're very strongwith our collaborators and partners in utilizing community health workers, so i'm here andi'm hoping to represent them well in today's conversation. so just to give you a quick overview of ourvision within adhs, specifically our chronic disease office, it's to positively impactthe health and wellbeing of arizonans by reducing health burdens and cost burdens of chronicdisease. and just very quickly, the major
goals of our office are to advance policiesthat address risk factors of chronic disease, identify and eliminate disparities in specificpopulation groups, and the word disparities is very important in our talk today, and we'rein the process of implementing our very large cdc, what we call the 1305 or public healthin action grant, and that's the grant that helps fund my office, my staff, and also providesfunds for us to be able to implement strategies such as the use of community health workersto lessen diabetes, hypertension, school health and obesity in arizona. and we also have withinour office what we call prop. 303 dollars, and that's state fund and tobacco tax, andwith those funds, we're able to address the 4 leading causes of health, which within arizonaat this point are cancer, heart disease, stroke
and pulmonary disease, with alzheimer's creepingup very closely and we assume within the next year or so it will overtake stroke. so withthose funds and with our 1305 public health in action funds, those are the funds thatwe currently have to implement community health worker strategies, and one important factwithin the public health in action grant is that we are able to hire our community healthworker program manager, ms. yanita soto, who's been with us for about almost three monthsnow, and we're very pleased to have her and it shows our commitment to the strategiesof utilizing community health workers within the state. so when we're talking about social determinantsof health and the use of community health
workers, as you can see, the issues surroundingsocial determinants of health are health disparities are not decreasing, social and economic, environmentaland cultural barriers continue to impede access to equitable care. rising health care costsfor minority and low income populations still exist, and more people are experiencing chronicdisease and more specifically are disparate populations, and of course there's the changein the landscape within the us population. so ensuring that underserved populations receiveneeded health care, it's a challenge for state and local health departments, health systemsand also policymakers. so we're looking for ways to extend the already strained healthcare system and more effectively reach underserved populations, and this is specifically especiallytrue in health disparities. as mentioned,
they're not decreasing. crucial to addressingsocial determinants of health is the ability to reach and community to underserved andhard reached populations and improve the quality of information between patient and provider,increase health literacy and patient capacity to adhere to treatment and improvements inhealth-related behaviors, and also we're looking to reach communities with upstream to preventchronic disease, which is our focus. and what we find and what we have found in arizonafor many years is that community health workers are extremely effective in health outcomes,health care cost savings and overall health care access and health promotion, and theyact as liaisons between health systems and communities, they facilitate access to andimprove the quality and cultural competence
of medical care, with an emphasis on preventiveand primary care. but however, many states' community health worker programs lack thesustained financial support, and we'll chat about that in just a few minutes. so the community health worker model, they'rerecognized in the affordable care act as important members of the health care workforce, andthe utilization of community health workers is one approach to improve the social determinanceof health, which is the focus of our talk today. they're extremely effective in healthoutcomes, improving health outcomes, reducing health care cost savings, overall access tohealth and promoting prevention and chronic disease management programs. we utilize themquite a bit in arizona to refer patients to
programs such as chronic disease self management,diabetes self management, education, so in that capacity, they're extremely important.they�ve demonstrated evidence-based impact in both health outcomes, access to care, costsavings to the health care system, including patients with diabetes who attend communityhealth worker education classes and receive ongoing social support. they improve theirself management behaviors significantly, lower their blood pressure and glucose levels. andwhat we find is there's almost a three dollar cost savings for every dollar spent for managedcare health care coordination, and a little over six dollar cost savings for every dollarspent in providing self management education and coordination for diabetes. so as you cansee, the use of community health workers is
extremely important. so they're - community health workers, asyou took the poll earlier, are known by many different names. in our community, you'llyear often the word promotora, but what we're finding is we have to start utilizing theword promotores, because there's an increase in men actually participating as communityhealth workers in the community, and that's a good thing. so we can't use the word justpromotora, which is gender specific for women, we have to use the word promotores, but youcan see the other words - other terms, community health advisor, home visitor, community organizer,health coach, public health aide, community health representative and so on, and whatwe find is where you're working often will
depend on what term you use. for example,within health systems here in arizona, some of the large hospitals, they have been usingthe word navigator. well, a navigator may often have a different type of responsibilitythan, say, a promotora, an individual who is directly from the community, and what we'refinding within arizona, especially with the affordable care act in place, is that systemsthat are not used to using community health workers or promotores are using terms thata lot of our communities are not used to hearing, such as navigators. for us, navigators oftenmeans navigating people into our medicaid programs or navigating them into applyingfor affordable care act. so just keep in mind, in your community, there could be differentterms and you just kind of have to take it
with a grain of salt as to who's utilizingthe term and what they mean. so within arizona, we have a wonderful coalitionthat's already in place, it's been in place, oh, for almost a couple years now. it's thearizona community health worker outreach coalition, and within arizona, this is a definition thatwe've adopted, and i'm not going to read through it completely for you today, but basicallywe determined we really need to come up with a definition, because depending on who you'reworking ah, as i just mentioned earlier, it could have a difference in what terms youuse and oftentimes when you're dealing with policymakers, et cetera, they want to seea definition. so we determined that we would use the definition that the american publichealth association adopted in 2009, so that's
the current definition that we're utilizing. so community health worker modeling in ourarea, oftentimes the majority of them do not provide clinical care. they complement servicesdelivered through the more formal health care network to provide more comprehensive andsupportive care. in the area of policy, community health workers engage community members increating ideas to improve their community, and in the political arena, they can developrelationships and advance a community's policy agenda with entities such as school districts,health care systems, et cetera. whoops, excuse me, i think i went forward here a little bittoo quickly. so in this instance - my goodness, i apologize. it oftentimes depends on what- where they're working depends on what type
of model you will be utilizing. what we findwithin arizona is we try to include community health workers' input into everything thatwe look to do in developing strategies, policies, et cetera. so the community health worker role in thehealth workforce includes trust, rapport, understanding in a cultural manner, they functionas a bridge to communicate with the individual and families on their health issues. theyimprove the individual experience of care, improving the health of their own communities.oftentimes they�ll reside in the communities where they work or often volunteer, and reducinghealth disparities of - and per capita cost of care for population, and once again workingwithin health systems, and what we're finding
is that health - they're being utilized - they'restarting to be utilized more frequently within health systems, and so we're - within arizona,we're working very closely with those health systems, whether it's a large hospital, whetherit's federally qualified community health centers or non-fqacs, community clinics. sowe find it's very important to work hand in hand with these health systems so that theycan better learn how to utilize community health workers. so i wanted to present this slide, and thisis a slide that yanita, our health program manager, community health program manager,found, and i really like this slide, because it shows the community health worker as beinga bridge, and one of the most important features
of programs that engage community health workersis that these women and men strengthen already-existing ties with community networks, and this isn'tsurprising as chws are qualified as connecters to their community and they generally live,as i mentioned, in the communities where they serve and understand the social context ofthe community members' lives that they're touching. in addition, they educate healthcare providers and administrators about the community health needs and cultural relevancyof interventions by helping providers and managers of health care systems to build theircultural competence and strengthen communicate skills. now, we know this often means thatthe provider has to be open to learning, and so we're hoping with the use of communityhealth workers that there'll be that openness
from our providers to learn how to use communityhealth workers and understand how crucial they could be to improving health. so just to give you a short overview of theuse of community health workers within arizona, it actually started way back in the '60s withour tribal communities, and within our tribal communities, they're called community healthrepresentatives. then, in the 1980s, university of arizona begun a program in yuma, whichis in the southwestern part of the state called un comienzo sano, or healthy start promotoraprogram, and this is really the start of a widespread use of chws across the state. andthen in 1998, there's the first national study of community health workers by the u of arural health office. 1999, the arizona prevention
- u of a prevention research center conducteda study on the effectiveness of the chw model. and within the 2000s, we began the healthstart program here within the adhs, which utilizes community health workers, and in2011, we began actually funding clinics across the state, and we'll touch about this in justa few moments. so we did provide some hypertension system of care grants utilizing chws withsome of our local health departments, and in 2012, we extended that funding to westsidecommunity health center, which is located here in maricopa county, in implementing acommunity health worker model. and also, as mentioned earlier, we have state health funding,tobacco tax dollars that we utilize to assist and pay our local health departments to implementcommunity health worker models, as well.
so as mentioned earlier, in 2011, we had ahypertension system of care grant, and this is really the first. dave heat, who is ourcardiovascular program manager here, actually implemented this in yuma county, with theassistance of the university of arizona. and i just felt it was important to share modelswith you all so you could see how chws can be utilized and how effective they can be.so the regional center for border health participated in this, as well as the sunset community healthcenter. and just to show you where it's located, if you take a look where it says baja, californianorte, and you got up just a little bit you can see the community of yuma, arizona, that'swhere this project was initiated. very rural, most of arizona is very rural. and the primaryobjectives were to detail training of community
health workers on topics surrounding hypertensionand integrate hypertension patient identification, education and a navigation program at thecommunity health worker level. and what we found is that - i'm just going to move alongto the next slide so we don�t run out of time. this is the model that we utilized.as you can see, the - in this case, we used the term patient navigator, but it's a circle.as with most health systems, it is circular and you can see there's a medical home inthe middle, with community - the patient navigator, the promotora, circling and touching everypiece of this model, whether it be case management, health education, patient care, and of courseshowing the evidence-based continuity of care with the use of a primary pcp.
and what we found with this particular grantwas that it worked, it worked extremely well, that the - there was visibility of chws withinthe clinic setting and the providers were - most of them were aware of the patient outreachand education role that the chws provided. and most of the concept of a patient navigatorat that time was really new to veteran community health workers, so we took them from the communitysetting and we put them in a clinical setting, and this was one of the first opportunitiesfor us to promote this strategy within the state of arizona. oops, looks like there's an extra slide. sorryabout that. looks like there's some extra slides here. okay, so the arizona communityhealth worker movement currently, we're establishing
an advisory board within our office, we'relooking at certification and training, and we're continuing to advocate for communityhealth worker workforce within arizona, and we're providing constant communication betweencommunity health worker leadership and our office, so we're including community healthworker coalition members as well as members of our 50-plus coalition - ascha coalitionmembers in actually assisting us in how we move forward with what we're - how we're goingto further increase the use of community health workers within the state. and we're also modelingother states who have been successful in supporting community health worker workforce, and we'reconducting an annual assessment, we will be conducting an annual assessment to measurehow and where community health workers are
employed in arizona. i know the universityof arizona has previously conducted such an assessment, so we'll just keep moving forwardwith that. and as you can see, we have 40-plus membersin our coalition. we've identified the definition, as we discussed earlier. we've identifieda scope or practice for community health workers, as well as core competencies, and then wehave work groups within our coalition, we are looking at workforce development, definitionand awareness, data credibility and sustainable financing. so i wanted to share with you whatthe scope of practice - what we've identified as the scope of practice. as you can see,there's outreach, community mobilization, home-based support, system navigation, casemanagement and care coordination, health promotion
and health coaching, community cultural liaisonand participatory research. so as a coalition, we've already voted on these areas. then wehave our core competencies, which are - we're looking at communication, and which can includelistening, use of language confidently and appropriately in written communication, capacitybuilding, which could be looking at empowerment and the ability to identify problems, resourcesto help clients solve problems themselves and leadership, interpersonal skills, so we'relooking for informal counseling, relationship building, advocacy, ability to speak up forindividuals or communities and withstand intimidation, and for many of our chws, that can be a littleoverwhelming. knowledge base. we're looking to broaden knowledge about the community,a specific health issues, a knowledge of health
and social service systems, so they can correctlyrefer individuals to where they need - can receive care, teaching, the ability to shareinformation one-on-one, service coordination, ability to identify and access resources,and organizational skills. ability to set goals and plan, juggle priorities and managetime, so these are the core competencies that we're looking at currently. what we're hoping to do, with the assistanceof our partners, is to look at a certification process. adhs will be the facilitator, arizonadepartment of health services, excuse me, will be the facilitator of the certificationprocess, so we're in - currently in conversations with our partners to see what would a certificationprocess look like, and that's something yanita,
our community health worker program managerwill be taking the lead on. so i just wanted to touch a little bit onthis - the grant, the cdc grant that we currently have, because it's been crucial to us to providefunding for our health care - community health worker strategies. and so it's basically acombined - our separate, individual grants that we have for diabetes, obesity and heartdisease and school health, and it's a combined integration grant. and as a result of thisgrant, we're able to focus on things such as community health workers, which is a goodthing for us, because prior to this, we really didn�t have any funds to do so. so one ofour goals was to hire a community health worker program manager, so we're really extremelyglad to have yanita on board with us. we're
looking at team-based care within health systems,so actually contracting with local health departments to then subcontract with clinicsto hire community health workers. we're looking at health care extenders to support in selfmanagement, engage community health workers to support that community clinical linkages,and we also included strategies in our grant and some additional dollars that we receivedin another grant that we're applying for, which is a 1422 grant. anywhere that we can,we're trying to support the use of community health workers, wherever possible. we're reallytrying to leverage. so this is just a couple of examples of whatwe're doing with our federal dollars. within the health care domains, within domain three,which is health systems intervention, we're
implementing a community health worker modelin one clinic for the management of diabetes and hypertension and to increase referrals.we're now in year two of this public health in action grant, and so we are replicatingthis model into year two. and then within the community clinical linkages, or domainfour, we're implementing a community pharmacist medication adherence program, which is workingwith clinics, community pharmacies across the state to assist them in learning how tobetter speak to their - to the individuals who purchase prescriptions at their pharmacyon how to better use - to adhere to pharmacy - to their prescription, and then we'll betaking this training on to our community health workers, as well, because that's - prescriptionadherence is a huge focus for us right now
in arizona. and then we're continued to collaboratewith the university of arizona to support the infrastructure and development and trainingfor our community health workers. so this is just a little chart to show youthat the money comes from cdc and from other funding sources to us, department of healthservices, and then we're pushing that money out to our community partners, not only inthe community health worker area, but also in other strategies that focuses on diabetesand hypertension. but some of the organizations we're currently contracting with, as mentionedearlier, is the university of arizona, federally qualified health centers, non-federally qualifiedhealth centers, local health departments, and a new strategy that we're getting involvedwith, which is working with fire departments
across the state, and a new movement that'scalled paramedicine, where they're actually implementing public health strategies outin their areas, and the use of community health workers will be an area that we're lookingto assist them. other states are utilizing these dollars,as well. there's 18 states are doing 1 or more community health worker interventionswith the cdc funds. these three are implementing community health worker interventions, there'sarizona, michigan and nebraska. five are doing two of the community health worker interventionsthat are listed within the grant, and the remaining ten states are doing one or moreof the other interventions in domain three and four. and what this is basically tellingyou is that more and more states are getting
on board with chws, and it's here to stay.as we mentioned earlier, there's a big return on investment, and we're seeing how communityhealth workers can greatly improve individuals, assist individuals in improving chronic diseasein our case, but making a difference within their communities. so we just wanted to sharea little bit what's happening around the nation and i just mentioned a few of the things thatare happening within the state, across the united states with the use of community healthworkers. i know the state of nevada, my colleague there, monica morales, is looking to embedcommunity health workers within the fqacs in nevada. california is right on board there,as well, with the use of community health workers, and so is the state of hawaii. theyare - the university of hawaii miami - maui
college has a community health worker program,it's non - using non-state mandated certification programs and/or - let's see, they're alsoin the process of exploring certification in utilization of chws, as well. so as youcan see, from across the country there's a huge movement, and as mentioned earlier, withhealth disparities not decreasing but increasing, we're just continuing to support the use ofchws. i'm going to leave my information for youand i don't want to take more of emma's time. emma, i think you have a question before youactually get into your part of the conversation, is that correct? yes, that's correct. thank you, anna. goodafternoon. as mentioned, my name is emma torres
and i'm in yuma, arizona. before i continuewith our presentation, i'm going to move pretty fast because our time is running pretty fast,as well. i have the last polling question and that is that what role does chws playin your community or workplace, and it says check all that apply. and it's either outreach,health care service education, information, data collection, informal counseling or socialsupport, connection to community services, health insurance enrolment or education, communityadvocacy, a liaison between community members and providers. so i'm going to give you acouple seconds so we can get the answers. and i think it looks pretty divided, pretty- and i can - i might take that this is probably something that we all see in our communitythat promotores or community health workers
take or have different roles within theirsame occupation, within their same job. so i'm going to go ahead and since anna didan excellent job in providing an overview of arizona's community health worker movementsince 1980 and even after the community health worker, the ch representatives, and then inthe 1980s with un comienzo sano in yuma, i was very fortunate to be one of the pioneersof that model, and i have seen and it's pretty exciting to see now anna presenting an overviewof what has happened since that 30-some years ago. i didn�t want to even mention thatit's been 30-some years ago, but i've been working with this model and seeing it's effectiveness,and that's why i'm one of the proponents of this model throughout the country. i've beenalso fortunate to help different individuals
implement their programs and again, seeingover and over the impact and the evidence, and now that this has gotten us to where we'reat. so i'm going to move on with my presentation, and in particular i'm speaking about the modelthat campesinos uses, and as you see, i decided to use shayla, one of our cancer preventionpromotoras that is probably one of the best on what she does and to present the modelthat we have in campesinos sin fronteras. and to put the who are promotores, it's our______ community health workers, because this is what we were told at the very beginningwhen we started, and now it's a little bit if, and the american public health associationdefinition pretty much fits what we were - we started doing. however, this - what we startedwhen we started the first promotora program
was that we were called promotores becausethe model was brought from south - latin - from latin america, and dr. meister brought thatmodel looking into a similar replication here in our farm worker community in yuma. andafter that we saw that different people were calling their programs even comadres or chroutreach workers and so forth, but we continue calling them promotores, and we were - andi still do, in order to recruit a promotora, i look for someone that represents the populationthey serve culturally, linguistically, educationally and economically, because they know firsthandand understand the needs of their community they serve. they have that developing trustand relationship with our clients, they serve as liaisons, intermediaries, an advocate betweenthe health system and their clients, and they
go to where their target group works, lives,worships and plays, and that's the model that we use, and they serve as advocate in accessinghealth care, as we have seen with the aca. again, as mentioned, they have to be culturallyand linguistically competent to serve those they represent. they build capacity and selfsufficiency among those they serve, they're multitask, multifaceted, they educate, provideinformal counseling and social support and advocacy. promotores facilitate access toculture and linguistic appropriate health care, and they improve the service qualityin communities and clinics, as anna was talking. i'm also a part of the health and human servicepromotora ________ community health workers initiative, and the goal of this initiativehas been to recognize the important contributions
of promotoras in reaching vulnerable, lowincome and underserved members of the latino, hispanic and other minority populations, andpromote the increased engagement of promotores to support health education and preventionefforts and access to health insurance. there are 15 members that have been selected throughoutthe country to represent in this initiative, and most definitely we always talk about thepromotora or community health worker model, it's expanding throughout the country, theneed to - for better representation or more representation from other states that arenot represented in our advisory groups. and as anna was mentioning and you all probablyknow, the promotora/chw now is an evidence-based model that has been endorsed by the healthresources and service administration, the
us mexico border health commission, the arizonapublic health association, centers for disease control and prevention, the national associationof community health centers, national diabetes association, robert wood johnson foundation,the us health and human services, the white house, among many, many others. last year,we got a recognition from president obama and declaring i believe october 13 as theday of the community health worker. so we even now have a day, a national day to celebrate,and as mentioned before, as _______, the us department of labor included the promotoramodel as an allied health care occupation. that was a big win for our efforts in promotingthis model, because as good as our efforts have always been, we had always had difficultyin being recognized as really an effective
part of the health care system, and in 2010,it was identified as a key part of affordable care act implementation, and then that reallygot it to where everybody wanted to know a little bit more about who are these promotoras,who are these community health workers, and again, that's one of the reasons why we'rehere. the promotora model that i use, i implementedin many community in clinical settings. we had started that promotora - that navigation,clinical navigator with community - with ______ community health center in 19 - 2005, somethinglike that, and we had also established pilot projects that demonstrated it's effectivenessin management of diabetes care, working with doctors and clinics and other - and with thecommunity, developing support, care in the
community. so the promotoras work in thesediverse settings and they're funded by chronic disease prevention funding. they also werefunded, many of them, as - through aca navigators funding. their functions are multiple, fromzumba instructors to outreach workers to lay educators, as you can see here, one of ourpromotoras, christina, goes to the field when the farm workers are having their lunch. shegoes, and that's the time that she goes in and starts educating them in whatever areaof focus that she's working on, and we work with the whole family. we - our promotoraswork in the churches and take information there at the schools. wherever they can finda group that will receive them, they go there. and working with the farm worker populationhas been - it's not challenging, it's - what
has been challenging is the fact that manypeople do not understand the lifestyles of farm workers, and we go - as the promotoras- our promotoras work non-traditional hours. when i say non-traditional, when i recruitthem and hire them, i always say we don�t work an 8:00 to 5:00 job. this is not mondayto friday, this is whenever, and people - whenever our community needs are serviced. so theygo to the pickup site where the farm workers are taken to the fields at 4:00 am in thewinter, and they provide them the education while they're waiting there. so that's whati mean non-traditional. here are our promotoras talking, presenting to the farm workers thatare waiting to be taken to the fields. they work, as was mentioned, we do healthfairs and we work with the clinics and the
hospital, and our promotoras are trained andcertified to also assist with doing health screening, so they also participate in that.whenever - in the field, sometimes before they - when there's frost in the lettuce,they may wait for four hours, just waiting to be able to start working in - by theirfields, so our promotoras go in and take that opportunity to teach them and provide informationas much as they can at that moment. as i mentioned, we've been working in addressing diabeteswith our children and childhood obesity prevention, and organizing activities with the whole communityto motivate them to get active as they - as well as eat healthier. you know - those ofyou that work with promotoras, you know how creative they are. they are creative. theymake everything look nice and engage people,
they - one of our promotoras at campesinossin fronteras have a reputation of they can bring any group of anything from 50 to 200people for their classes if they put themselves to it. so whenever people want to gather othergroups from outside the state, they want to come and meet with our community, our promotorasare the ones that are pretty much the ones that are able to recruit them to participate. and i'm going to hurry up because i know thatour time is really running out. we use - promotoras use a population learning strategy, we usetheater. this is one of our promotoras, you would never tell, and she's good. this isabout domestic violence and this is about teen pregnancy prevention. they developedthe plays, they practice, they do everything,
and these programs also receive funding fromthe state maternal and child health to provide education for i think pregnancy prevention.we work with the youth a lot. as with any latino community, there's so many young kidsthat are always willing to participate. we do community service learning projects, butwe can engage them at the same time that they participate in improving their community.the support that is key to implement effective promotoras chw programs is understanding andvaluing the work that they do. a lot of people think about them and they value them, butthey don�t want to invest or pay for their services. they - so you have to have a strongadministrative buy in. if your administrator don�t understand and don�t value the workthat promotoras do, it's going to be difficult
that you establish a strong community program,community health program. you have to be willing to work non-traditional hours with them, aswell, provide ongoing cross training opportunities for the promotoras. i don�t believe in puttingpromotoras under just one curriculum, because when they're out there in the community, theyget asked - they get questions of diverse - questions that they're sometimes not trainedon answering, so i cross train them. i include them in organization planning of any communityefforts, have ongoing volunteer recruiting _____ to grow strong promotoras for futurehiring opportunities. reimbursement, working with - through clinical settings, it's beena lot easier to get the reimbursement, but most important, we need to pay them.
sources of funding for promotoras, as annawas mentioning, the state has been very supportive of our efforts and not just funding some ofour projects, but also promoting recognition and also inviting us to partake in decisionmaking about the public health strategies that are going to be implemented in our communities.and i think i'm given two minutes for questions [laughter]. thank you both for your very informative presentations.so as this time, we'll start the question and answer period. i'm going to turn it overto the operator, who'll give instructions on how to ask a question. thank you. ladies and gentlemen, if you'redialed in by phone and would like to ask a
question over the phone line, please press14 on your telephone keypad. you'll hear a three-tone prompter acknowledge your request.as well if your question has been answered and you would like to withdraw your registration,please press 13. as well you may submit a question using the chat feature, located inthe lower left corner of your screens, and we can wait a few moments for the first questionsto come in. and just another reminder for everyone, if you do have a question you'dlike to ask by phone, please press 14 on your telephone keypad, and you may submit questionsusing the chat feature on the lower left corner of your screens. and our first question comesfrom the line of lonell james, please proceed with your question.
hello, this is lonell james, i'm with theregion five rec, and in the discussion, you talked about community health workers andthe affordable care act. could you maybe elaborate kind of your perspective on how it fits inthe community care act and accountable care organizations. thank you very much. and would this be for emma, for emma torres,would this question be? [crosstalk] i did mention about the participation in the affordablecare act because campesinos sin fronteras did receive the navigator grant. it was asmall navigator grant that allow us to train 20 of our promotoras and certify them as navigators,and primarily with this is because we are usually the first responders in any situationin our community that people trust to come
and ask information on, and there was so muchconfusion about what aca was that we took it upon ourselves to become the trainers andthe leaders on our - at the community-based level, which that's where i work, and havethe promotoras, again, being sensitive culturally, linguistically and understanding the needsof their - of our population, particularly being in the border community, we have tobe very sensitive about the population that we serve, and for us, they were the perfectmessengers to be able to send this in appropriate manner and culturally sensitive. this is lonell, there's another part of theaffordable care act that actually includes a role for the recognized community healthworkers to help accountable care organization
in their community outreach to engage communitymembers to be part of an accountable care organization and get the benefit of the careprograms unique to an affordable care organization, and it includes an impact on the per member,per month charge, to the extent that they can demonstrate a community health workerhas engaged the community to become part of an aco. the challenge, as i understand, isthat part of the affordable care act involves the states having a formal way to recognizecommunity health workers. and so didn�t know if arizona, since you folks are so farahead, whether you had a state recognition for community health workers so that theycould benefit in the per member, per month payments to an accountable care organization.thanks.
anna, you want to take that? let me tell youfrom my end, i know that there has been discussions about that, but as - i don't know, it hasbeen my experience, i don't know if everybody else have had this experience, but there isthis division between community and clinical. people think that somehow the community healthworkers, i don't know if they're not as prepared or don�t have the links with the medicalcommunity, that they're not able to be reimbursed, that's why i mentioned that usually in clinicalsettings, and they - through these accountable care organizations, that's how they're gettingsome reimbursement. but for the community health workers at community based level, ithas been very difficult and it is - been hard to be recognized for the impact of their work.
yes, this is anna, can you hear me okay? yes. okay, sorry, i thought i was on mute. i knowwithin arizona, and i know we're just not at that point yet. but we have been lookingto work very closely with our medicaid program here, because at this point they're not recognizingthe cms, the expansion to actually reimburse for a community health worker participationin providing health care. within arizona, we contract with health plans for our medicaidprogram, so there is that per member, per month piece that actually, having worked foraccess before, i understand, but it can be very overwhelming, and to go in and to makea change to our medicaid program is - can
be very difficult. but we are in conversationswith them currently. i can tell you, within adhs, we are looking to work with an aco inutilizing community health workers, but it would be through federal dollars, throughour cdc grant, to possibly do a pilot with them. since we've worked with clinics, we'rereally interested in working with our behavioral health organizations and also with acos. thank you very much. you're welcome. and we currently have no further questionsfrom the phone lines, we can turn it over for any chat question.
so we have a few questions. being that weare over time, i mean, how much time should we - is there another way to answer the questionsthat are in the chat box, like through e-mail to those who participated, can we post? ido want to be cognizant of time. yes, we can answer the questions through andsend answers and post them up on astho's website, we can do that since we're out of time. right, okay. so we will definitely work withour meeting co-hosts to answer the rest of the questions that are in the chat box, andthen provide information to those who participated in the webinar today, as well. so i just wantedto say thank you again for joining us. as was mentioned earlier, you'll be directedto an evaluation, so please take a few minutes
to complete that, because it's helpful forfuture projects, and thank you so much also to the office of minority health for sponsoringthe webinar, and also to our speakers for their very interesting presentation. and today'swebinar is - has been recorded and will be available on astho's website within the nextfew weeks at www.astho.org. so we hope that you find the information useful and the webinaras a useful resource, and please share the link with others once it's available. thankyou so much and enjoy the rest of your day. [end of audio]
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