DOCSLIB.ORG

Promising Practices for Rural Community Health Worker

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Promising Practices for Rural Community Health Worker Promising Practices for Rural Rural Evaluation Brief Community Health Worker Programs March 2011 RuralRural EvaluationEvaluation and data collection methods are developed with—and information on best practices for recording information, dedicated program coordinator to supervise, train, and Identifying promising practices for rural CHW BriefBrief discussed, modified, and accepted by—the CHWs.”5 documenting the effectiveness of their activities, and mentor the CHWs. Given the time that it takes to train a programs will be important as CHWs continue to play Grantees also highlighted the importance of including analyzing data. CHW coordinator, staff retention is a key sustainability an expanding role in rural health initiatives. This project CHWs in the evaluation process and discussing the issue. The grantee noted: “Living in a small town, our and toolkit help to build knowledge on CHW strategies March 2011 • Y Series - No. 1 results with CHWs. candidate pool for positions it not huge; it’s [about] that work well in rural communities and disseminate WALSH CENTER FOR Sustainability Strategies RURAL HEALTH ANALYSIS finding the right people.” promising approaches. Identifying promising practices NORC “I think the promotora community health worker model is Rural CHW programs are developing sustainability for rural CHW programs is particularly important in http://walshcenter.norc.org www.sph.umn.edu/hpm/rhrc/ Health reform may offer new opportunities for absolutely key to long-term health and decreases in health strategies to continue their work post-grant. The grantees’ light of recent policy activity at the national level. sustaining rural CHW programs. The ACA recognizes disparities. We just need to find a way to fund it long enough most common sustainability strategy is to develop a The ACA’s recognition of the role of CHWs and the CHWs as members of the health care work force and to allow those outcomes to be clear.” consortium of community partners that advocate for U.S. Department of Labor’s creation of a Standard allows Congress to allocate funding to establish a the program. The majority of the grantees developed Occupational Classification for CHWs may change – 330A Outreach Authority Grantee federal grant program to support the use of CHWs in a consortium, network, or steering committee to guide the landscape in the future—with CHWs playing an medically underserved areas. Future grants could be the program and its sustainability and share promising expanded role in the improvement of health in rural Promising Practices for Rural Rural CHW programs have used a variety of program made available to health departments, clinics, hospitals, practices and new ideas. Creating a sense of ownership communities. evaluation strategies to demonstrate the effectiveness for the CHW program among the public and private federally qualified health centers, and other private of their activities. Some hired an external evaluator stakeholders in the community has helped grantees to organizations for promising programs using CHWs. References Community Health Worker Programs while others assigned an internal staff member to serve identify new opportunities to sustain their activities. For 1. Community Health Worker National Workforce Alycia Infante, MPA, Alana Knudson, PhD, Alexa Brown, BS as an evaluator or quality coordinator. Grantees are example, community organizations provided facilities Rural Implications collecting qualitative and quantitative data from their for CHW trainings, transportation services, and other Study. March 2007. U.S. Department of Health and The 330A Outreach Authority grantees commented CHW programs using individual encounter forms, group in-kind resources. Additionally, another grantee Human Services, Health Resources and Services that there are some unique benefits to implementing Community health workers (CHWs) have made important contributions education session documents, clinic reports, and case commented that they are trying to expand their network. Administration, Bureau of Health Professions: 2. a CHW program in a rural area. Grantees commented to improving the health of underserved populations in rural communities. management reports. Common outcome measures for While this grantee belongs to numerous coalitions of 2. Rural Community Health Workers Toolkit. 2010. Key Findings that, in rural areas, “people are used to being self- While there are many ways to characterize the scope of their activities, grantee evaluations of CHW services are patients’ blood social services organizations and medical agencies, Rural Assistance Center Online. www.raconline.org sufficient because there are not a plethora of services the Health Resources and Services Administration’s (HRSA) Community glucose levels and blood pressure. Process measures they are striving to partner with organizations that focus 3. The Community Health Worker Toolkit. 1998. • This project identified six rural CHW available;” “people know how to make things work Health Workers National Workforce Study defined CHWs as “lay include the number of clients receiving education, the on the social determinants of health, such as housing University of Arizona. Office of Rural Health and models in the literature and in practice: without electric or roads” and “the mentality is ‘let’s members of communities who work either for pay or as volunteers in number of community education programs facilitated by projects and legal aid groups. College of Public Health. Accessed January 7, 2011 promotora, member of the care delivery association with the local health care system in both urban and rural CHWs, and the number and types of topics presented by do this for ourselves.’” Also, “people are connected in https://apps.publichealth.arizona.edu/CHWToolkit/ team, care coordinator, health educator, CHW programs are also investigating viable fiscal a rural community.” Grantees reported that there is a 4. Evaluation Toolkit. 2009. Migrant Health Promotion. environments and usually share ethnicity, language, socioeconomic outreach and enrollment agent, and CHWs at community presentations. In addition, some 1 of the grantees solicited feedback from their consortia sustainability models. One potential model is to seek deep sense of community; people know one another and Accessed January 7, 2011 status, and life experiences with the community members they serve.” community organizer and capacity builder. or boards of directors to identify program strengths and third-party reimbursement for services provided organizations from the public and private sectors have www.migranthealth.org CHWs expand access to health services in areas where transportation by CHWs. For example, one of the 330A Outreach a history of collaborating to create solutions that will 5. “A Handbook for Enhancing Community Health barriers, provider shortages, stigmas, and other challenges prevent • The 330A Outreach Authority grantees weaknesses. offer promising strategies in the areas of Authority grantees is a community health center (CHC) benefit their communities. For these reasons, another Worker Programs: Guidance from the National people from receiving basic care. They play a number of roles in the A few grantees noted that they are trying to develop a that contracts their CHWs out to other clinics in the rural grantee expressed that “it might be easier [to implement community—from outreach worker to resource coordinator to health program implementation, evaluation, and Breast and Cervical Cancer Early Detection sustainability. business case for CHW activities, but are a few years away community. This financial model has helped the CHC a CHW program] in a rural community.” Finally, a few Program” (Part I), 29. Accessed January 7, 2011 educator—depending on the needs of the target population. from having adequate data to demonstrate outcomes. collect revenue for their CHW services. Another grantee grantees commented that rural CHW programs are more www.cdc.gov/cancer/nbccedp/training/community. • Liabilities for CHWs include transporting Recognizing the value of CHW programs in rural communities, the No other business case analyses were identified in the is developing a similar relationship with their local likely to be successful in the long term because “rural htm clients in their own vehicles and conducting HRSA Federal Office of Rural Health Policy funded rural communities literature. One grantee is conducting a cost effectiveness fisherman’s association, given that migrant workers in populations are much more stable; they come to rural outreach activities in remote areas. analysis of their program by comparing the cost of the the community need translation, health care, and social areas and they stay.” to implement CHW programs as part of the 330A Outreach Authority infrastructure needed to conduct CHW activities to the support services. In other rural programs, Medicaid has program. The 330A Outreach Authority program focuses on reducing • An empowerment approach to evaluation, where CHWs are involved in the value of the program. Another grantee is evaluating reimbursed CHWs’ health education services. health care disparities and expanding health care services in rural areas. the differences in productivity and outcomes between One of the lessons learned from the experiences of the 330A Outreach evaluation design and learn the results, is most effective. voluntary part-time and paid full-time CHWs. Authority grantees—and the literature on rural CHW programs, more “If people on the ground don’t
Load more

Recommended publications
  • A Randomized Controlled Trial of a Community Health Worker Intervention in a Population of Patients with Multiple Chronic Diseases: Study Design and Protocol
    Contemporary Clinical Trials 53 (2017) 115–121 Contents lists available at ScienceDirect Contemporary Clinical Trials journal homepage: www.elsevier.com/locate/conclintrial A randomized controlled trial of a community health worker intervention in a population of patients with multiple chronic diseases: Study design and protocol Shreya Kangovi a,b,⁎, Nandita Mitra c, Lindsey Turr a, Hairong Huo a,DavidGrandea, Judith A. Long a,d a Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia 19104, PA, United States b Penn Center for Community Health Workers, Penn Medicine, Philadelphia 19104, PA, United States c Perelman School of Medicine, University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia 19104, PA, United States d Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA, Philadelphia 19104, PA, United States article info abstract Article history: Upstream interventions – e.g. housing programs and community health worker interventions– address socioeco- Received 14 September 2016 nomic and behavioral factors that influence health outcomes across diseases. Studying these types of interven- Received in revised form 2 December 2016 tions in clinical trials raises a methodological challenge: how should researchers measure the effect of an Accepted 3 December 2016 upstream intervention in a sample of patients with different diseases? This paper addresses this question using Available online 10 December 2016 an illustrative protocol of a randomized controlled trial of collaborative-goal setting versus goal-setting plus com- munity health worker support among patients multiple chronic diseases: diabetes, obesity, hypertension and to- Keywords: Randomized controlled trial bacco dependence. Upstream medicine At study enrollment, patients met with their primary care providers to select one of their chronic diseases to focus Socioeconomic determinants on during the study, and to collaboratively set a goal for that disease.
    [Show full text]
  • Arsenic, Air Pollution, and Threats to Traditional Values of the Hopi Tribe
    Journal of Community Health (2019) 44:896–902 https://doi.org/10.1007/s10900-019-00627-8 ORIGINAL PAPER Environmental Risk Perceptions and Community Health: Arsenic, Air Pollution, and Threats to Traditional Values of the Hopi Tribe Brian Mayer1 · Lorencita Joshweseoma2 · Gregory Sehongva2 Published online: 21 February 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract American Indian and Alaska Native populations experience chronic disparities in a wide range of health outcomes, many of which are associated with disproportionate exposures to environmental health hazards. In the American Southwest, many indigenous tribes experience challenges in securing access to sustainable and safe sources of drinking water, limiting air pol- lution emissions on and off tribal lands, and cleaning up hazardous contaminants left over from a legacy of natural resource extraction. To better understand how households perceive the risk of exposure to potential environmental health risks, we conducted six focus groups organized by age and geographic location on the Hopi reservation. Focus group participants (n = 41) were asked to reflect on changes in their natural and manmade environment and how their health might be influ- enced by any potential changes. By investigating these environmental risk perceptions, we were able to identify arsenic in drinking water and indoor air quality as significant exposures of concern. These risk perceptions were frequently anchored in personal and familial experiences with health problems such as cancer and asthma. Older focus group participants iden- tified ongoing shifts away from tradition and cultural practices as increasing environmental health risks. Similar to other communities economically dependent on the extraction of natural resources, focus group participants described the need for behavioral modifications regarding environmental health risks rather than eliminating the sources of potential health risks entirely.
    [Show full text]
  • Guide to Community Engagement in Wash
    OXFAM GUIDE NOVEMBER 2016 GUIDE TO COMMUNITY ENGAGEMENT IN WASH A practitioner’s guide, based on lessons from Ebola Community Health Volunteers receiving training in Clara Town, Monrovia, Liberia. Photo: Pablo Tosco/Oxfam By Eva Niederberger, Suzanne Ferron and Marion O’Reilly www.oxfam.org ABOUT THIS GUIDE This guide is a compilation of best practices and key lessons learned through Oxfam’s experience of community engagement during the 2014–15 Ebola response in Sierra Leone and Liberia. It aims to inform public health practitioners and programme teams about the design and implementation of community-centred approaches. 2 CONTENTS Acronyms .............................................................................................................................4 1. Introduction ......................................................................................................................5 1.1 About this note ............................................................................................ 5 1.2 Ten key lessons .......................................................................................... 6 2. Assessing contexts .........................................................................................................7 2.1 Pre-epidemic healthcare systems .............................................................. 8 2.2 Community history and leadership dynamics ............................................. 8 2.3 Community capacity ..................................................................................
    [Show full text]
  • The Importance of Community Health Workers for CVD Prevention And
    The Importance of Community Health Workers for CVD Prevention and Treatment Guidance to AHA Staff July 2018 Summary AHA position The American Heart Association (AHA) supports the appropriate use of Community Health Workers (CHWs) as part of a team approach to preventing and treating cardiovascular disease. With an unparalleled ability to reach and support individuals in their homes and communities, CHWs play a vital role in supporting patient care, particularly in many underserved communities. Additionally, with the critical need to create seamless clinic to community linkages, CHWs will continue to serve an increasingly important role in the healthcare workforce. Background Cardiovascular disease (CVD) remains the number one killer of American men and women.1 With an aging population, the prevalence and cost of care associated with CVD and conditions like heart failure and stroke will increase markedly over the next several decades.2,3 By the year 2035, nearly half of the U.S. population is projected to have CVD, generating $1.2 trillion annually in direct and indirect medical costs.4,5 Because of the growing national burden and persistent disparities in the rates of CVD, AHA is committed to improving the cardiovascular health of all Americans while simultaneously reducing deaths from CVD.6 This is especially true for children and adolescents who are increasingly exhibiting pre-diabetes, hypertension, and other risk factors for CVD and stroke at an earlier age.7,8 In addition to the growing burden of CVD, too few health care providers exist where they are needed to prevent and treat chronic diseases. Significant numbers of medical students are subspecializing, rather than pursuing primary care, and decades-long nursing shortages show no indication of correcting.9 Under likely scenarios, the U.S.
    [Show full text]
  • Optimising Community Health Worker Programmes
    Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews Developed for the WHO Prepared by: Aron Shlonsky; Patrick Condron; Bianca Albers; Loyal Pattuwage; April 2017 Centre for Evidence and Implementation Level 6, 250 Victoria Parade, East Melbourne VIC 3002 Web: cei.org.au Twitter: @CEI_org Optimising Community Health Worker Programmes A Search Strategy for 15 Systematic Reviews i Contents 1. Overarching Research Aims .............................................................................. 3 2. Defining Community Health Workers................................................................... 4 3. Search Strategy and Brief Description of Synthesis Methods ...................................... 5 3.1. The search ........................................................................................... 5 3.2. Databases ............................................................................................ 6 3.3. PICOS specific searches ............................................................................ 7 3.4. Inclusion and exclusion criteria ................................................................ 11 3.5. Screening .......................................................................................... 14 3.6. Data extraction ................................................................................... 15 3.7. Data synthesis ..................................................................................... 17 4. References ................................................................................................
    [Show full text]
  • Challenges and Innovations in a Community-Based Participatory
    HEBXXX10.1177/1090198116639243Health Education & BehaviorGoodkind et al. 639243research-article2016 Original Article Health Education & Behavior 2017, Vol. 44(1) 123 –130 Challenges and Innovations in a © 2016 Society for Public Health Education Reprints and permissions: Community-Based Participatory sagepub.com/journalsPermissions.nav DOI: 10.1177/1090198116639243 Randomized Controlled Trial journals.sagepub.com/home/heb Jessica R. Goodkind, PhD1, Suha Amer, MA1, Charlisa Christian, MBA1, Julia Meredith Hess, PhD1, Deborah Bybee, PhD2, Brian L. Isakson, PhD1, Brandon Baca, BS1, Martin Ndayisenga, ASW1, R. Neil Greene, MA1, and Cece Shantzek, BA1 Abstract Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants’ intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused
    [Show full text]
  • Community Health Worker Frequently Asked Questions
    Community Health Worker Frequently Asked Questions I. Role of a CHW Q. What is a Community Health Worker? A. Community Health Workers (CHWs) are trained health workers who come from the communities they serve which aids in building trust and vital relationships with the residents of the community. This peer-to-peer relationship enables the CHWs to be effective links between their own communities and systems of care. The goal of the CHW initiative is to significantly lower health disparities in South Carolina by providing access to services, improving the quality and cultural competence of care, creating an effective system of chronic disease management, and increasing the health knowledge and self-sufficiency for Medicaid recipients. Q. What are the goals of the CHW initiative? A. 1. To increase value of the partnership between the Medicaid patient and the physician/medical homes. 2. To decrease emergency room visits and hospitalizations by improving utilization of the medical home. 3. To improve Medicaid recipients’ chronic disease management skills and engagement with primary health care. 4. To reduce costs and improve health outcomes. Q. What are the job duties of the CHW? A. As members of care delivery teams, CHWs will assist individuals within their Medicaid patient community in managing their own health including promoting compliance with appointments, screenings, treatment and medications. A CHW will assist patients in navigating the health care system, improve patients’ health knowledge and self-sufficiency by helping them understand their health condition(s) and develop strategies to improve their health and well being. CHWs are particularly adept at promoting health and extending primary care compliance since they are a member of the community for which they serve and do in-home peer-to-peer education.
    [Show full text]
  • 15 Practices to Improve Vaccination Program Effectiveness by Reaching the People Most at Risk
    15 Practices to Improve Vaccination Program Effectiveness by Reaching the People Most at Risk Introduction The percent of the U.S. population vaccinated for COVID-19 has increased steadily over the past few weeks alongside of expansion of eligibility. As of June 2, 2021, nearly 63% of U.S. adults 18 years of age and older have received at least one dose of COVID-19 vaccine, nearly 52% are fully vaccinated and everyone 12 years of age and older is now eligible for the vaccine. But this does not tell us the whole story. There are large disparities in vaccine uptake; racial and ethnic minorities, particularly the Black and Latinx communities, are being vaccinated at much lower rates than their white counterparts. These population groups also experience a higher burden of disease and higher COVID-19 hospitalization and death rates than whites. Vaccine uptake rates are also lower among rural populations and people About Us Vital Strategies is a global public with certain political perspectives. Vaccine equity needs to be prioritized in all health organization working in counties throughout the United States, not only as a matter of justice and to save 70+ countries to strengthen public health systems. Resolve lives, but also to reduce the risk of having more dangerous variants emerge. to Save Lives, an initiative of Vital Strategies, aims to prevent at least 100 million deaths from cardiovascular disease and epidemics. Through its Prevent Epidemics program, Resolve to Save Lives has rapidly leveraged existing networks to establish a multi-disciplinary, multi-pronged effort to support countries throughout Africa and beyond.
    [Show full text]
  • Community Health Workers: What Do We Know About Them?
    Community health workers: What do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers Evidence and Information for Policy, Department of Human Resources for Health Geneva, January 2007 Content Background........................................................................................................................1 Who are community health workers? ............................................................................1 What do community health workers do?........................................................................1 What do we know about performance of CHW programmes?.......................................2 What factors act as incentives and disincentives for CHWs?........................................3 What makes for successful CHW programmes? ...........................................................4 Conclusions ...................................................................................................................5 Background The use of community members to render certain basic health services to their communities is a concept that has existed for at least 50 years. There have been innumerable experiences throughout the world with programmes ranging from large-scale, national programmes to small-scale, community-based initiatives. We now know that CHWs can play a crucial role in broadening access and coverage of health services in remote areas and can undertake actions that lead to improved health outcomes,
    [Show full text]
  • Community Health Worker Certification Requirements by State
    FEBRUARY 2016 Community Health Worker Certification Requirements by State Prepared by: Katharine London, Margaret Carey and Kate Russell, UMass Medical School Center for Health Law and Economics Community Health Workers (CHW) are increasingly recognized for their powerful potential role in improving today’s health care system. Recent studies have demonstrated that CHWs can help to reduce costs and improve care – key goals of most state’s health care priorities.1 For this reason, many states are currently working to promote and formalize Community Health Workers’ role within the state health care system. Though there are some common themes in approaches states are choosing to develop CHW models, there is great variability in models and levers they are using to develop CHW models. The wide breadth of CHW models provides many options for states considering developing a CHW certification process. The chart on the following pages includes 15 states that Community Health Worker Certification are moving toward or have established training and/or a certification process for CHWs as of December 2015. States’ In many states private nonprofit organizations that focus processes may have evolved after that date. Information in on the promotion of the CHWs have a key role in training the chart below were gathered from both national resources and certifying CHWs. Certification typically includes such as The National Academy for State Health Policy classroom training on core competencies, a practicum or (NASHP) and its State Refor(u)m, as well as state agency and internship experience and an evaluation of skills and/or regional CHW organization websites. knowledge.
    [Show full text]
  • The Role of Community Health Workers in COVID-19 Vaccination
    The role of community health workers in COVID-19 vaccination implementation support guide 26 April 2021 WHO and UNICEF continue to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO and UNICEF will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. © World Health Organization and the United Nations Children’s Fund (UNICEF), 2021. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO reference number: WHO/2019-nCoV/NDVP/CHWs_role/2021.1 The role of community health workers in COVID-19 vaccination implementation support guide 26 April 2021 Contents Acknowledgements ................................................................................................................. 1 Abbreviations .......................................................................................................................... 2 Executive summary ................................................................................................................. 3 1. Introduction. 4 1.2 Background resources. 4 1.3 Document updates and constraints. 4 1.4 Target audience ............................................................................................................. 5 2. Key community health worker roles in the COVID-19 vaccines rollout. 6 2.1 Planning and coordination ............................................................................................. 6 2.2 Identification
    [Show full text]
  • Capacity Building
    COMMUNITIES CARE: TRANSFORMING LIVES AND PREVENTING VIOLENCE PART 3 STRENGTHENING COMMUNITY-BASED CARE SECTION 2 CAPACITY TRAININGBUILDING SESSIONS AND MATERIALS COMMUNITY HEALTH WORKERS TRAINING PARTICIPANT PACKET all survivors need good quality care and support to help them heal and recover b CAPACITY BUILDING Community health workers training MODULE 2: What is sexual violence and what are its consequences? STRENGTHENING COMMUNITY-BASED CARE CAPACITY BUILDING 10 DAYS • 8 MODULES MODULE PARTICIPANT PACKET Community-based management of survivors of sexual violence This training is for community health workers (CHWs) to help survivors of sexual violence in the community. Through the training, CHWs will be able to: • Understand sexual violence and what can happen WHAT to survivors MODULE • Provide key messages about sexual violence WILL YOU to community members as part of the CHWs’ daily activities LEARN? • Communicate with survivors of sexual violence • Refer survivors to health care and other services, respecting their safety, privacy and dignity • Directly provide health care to survivors when care at a health facility is too far 1 PART 3 Strengthening Community-Based Care CONTENTS Overview . 3 Module 2: What is sexual violence and what are its consequences? . .. 5 Module 3: Principles of working with survivors of sexual violence . 29 Module 4: Recognizing survivors and facilitating referrals for sexual violence . 39 Module 5: Providing community-based care for survivors of sexual violence . 47 Module 6: Self-care for community health
    [Show full text]