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BEHAVIORAL HEALTH LEADERSHIP INSTITUTE Community Health Worker Toolkit Featuring a special focus on mental and substance use disorders within 2 3

TABLE OF CONTENTS

01 Introduction to Community Health...... 7 People, Community, Place, and Health: What Can You do?...... 8 Welcome! Social Determinants...... 9 This Community Health Worker toolkit is to carry with you while you are out in What is a team?...... 10 the community to provide information and support as you work or as a reference at your desk. It will remind you of what you learned in your trainings. There is also 02 What do I do after I knock on the door?...... 11 extra information for topics related to and substance use disorders. Treatment Plan and Keeping Appointments...... 12 When you are out in the community or preparing for your day, you can use this Communication Skills...... 13 Toolkit to answer specific questions that might come up in your work. Motivating the Client...... 14 Working with Older Patients...... 15 The Toolkit includes general information sections related to being a community Home Visits...... 16 health worker {CHW}. The reason there is a lot of information about mental 03 Stigma and Community...... 17 health and substance use disorders is because many of your clients might need help in these areas even though you are seeing them because of other health What Is Stigma?...... 18 Respecting Differences: Sensitivity to All Cultures...... 19 problems. Also, there might be times when the information will provide helpful hints to use when working with your clients, even if they don’t have a specific 04 Recovery...... 21 mental health or substance use diagnosis. Recovery: Motivating Change...... 22 Stages of Change...... 23 This Toolkit will not work as a substitute for training. This Toolkit can serve as an Harm Reduction...... 25 aid or a guide but the best source for help and information is your team. Always Harm Reduction Case Study...... 26 ask for help or information if you are not sure of something.

05 Mental Health & Substance Abuse Basics...... 27 Behavioral Health Leadership Institute wishes you the very best in your work and hopes that this Toolkit is helpful. If you have any suggestions about making 06 Diseases Commonly Seen in the Community...... 31 the Toolkit better or any concerns about the Toolkit, please write directly to: 07 Physical Health Basics...... 51 [email protected].

08 Crisis and Urgent or Emergency Situations...... 55 NOTE: In this Toolkit, the word “patient” will be used to refer to the people with How Do I Recognize a Crisis?...... 56 whom you are working.

09 Conclusion...... 57 The words “you” or “your” will be used to refer to YOU as the Community Health Worker. Self Care: Tips for Preventing Burnout...... 58 Glossary...... 59 Thank you.

4 5 02 Understanding the Healthcare System

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All specific tasks and duties will be described and directed by your employer. It o is most important to remember that you are a “promoter” of health. You are not trained to give treatment. You are expected to ask questions when you are not A health care system is made up of many parts all of which together affect the sure of your role. If the patient asks you something that should be answered by health of each individual and of the population as a whole. The diagram above is a health care professional, then tell him or her that you need to ask the doctor meant to illustrate some of the most common pieces of a health care system. The or nurse. Your role is incredibly important and it is equally important that you circle is important to show that each of these pieces is part of a whole and that do ONLY what you are trained to do as a CHW. For everything else – consult only when the parts are working together is health improved. Each of these parts your team or employer. has an effect on all the others. As shown, the CHW helps to pull all of these parts together and is essentail in working with the client to make it work. 6 7

Notes

01 Introduction to Community Health

8 People, Community, Places and Health: What Can You Do? 9 Social Determinants 10 What Is a Health Care Team? 8 9

Social Determinants This is a term used by professionals who work in the fields of health, theenvironment, social services and policy. It means that what is happening around you affects your life, your health, your moods and your ability to move forward. DETERMINANTS INCLUDE SUCH THINGS AS:

Your job Your health Whether and your and your you live $ income family’s health with others

Health = Power YOUR NEIGHBORHOOD Is there an active, supportive community or is it isolated? Is there a lot of crime around you or your family? Are you People, Community, Places worried daily about crime? Are you worried about violence? IMPORTANT QUESTIONS • Is the area you live or work safe? and Health: What Can You Do? • Is the air you live or work in clean or is it smoky or uncomfortable? Lots of things people do affects their health. Eating lots of fruits andvegetables, not • Can you go somewhere easily for recreation or exercise? smoking cigarettes and drinking fewer than two alcoholic drinks a day is good for • Is it easy to shop for healthy, nutrient-rich food near where you live? health. But where people live, who they live with, their neighbors, whether they are It is important to know about these types of facts to understand what impact rich or poor, and how they fit within the larger community also make a difference. they have on your clients (or yourself). Living in a neighborhood without sidewalks or in a neighborhood with lots of crime means that people will walk less and get less exercise. They might not feel safe walking While moving might not be possible, it is important to be aware of these isues and around. A healthy diet including lots of fruits and vegetables, getting exercise and help your client improve the things they can. Also, it is important to understand reducing or eliminating harmful behaviors such as smoking are all important to staying that they cause a great deal of stress and help them to use tools to reduce stress. healthy. Discrimination and racism are stressful and can cause many mental health and other health problems. Therefore, to improve the health of the population living in these conditions (the population health), there need to be changes to improve income and environment as well. As a community health worker, you can’t change this alone. However, you can help teach your clients about these ideas and invite them to participate in groups to help improve their situation. In the meantime, it is most important to help your clients be in charge of trying to change what they can control on their own. Encourage them to walk someplace instead of driving or taking the bus or to use stairs instead of elevators. Drink water instead of soda or sweetened drinks and save money too. Eat fruit instead of a fruit drink. Take a group to the farmer’s market where good produce is often cheaper than at the store and it is much fresher. 10 1111

MEDICAL CASE ONE STAFF + MANAGER + = TEAM

What Is a Health Care Team? WHAT IS A TEAM? 02 In most instances, a CHW will be a member of a health care team. Each team will have different members depending on the location where you work and the purpose of the team. In most cases, a health care team will include at least one medical professional What do I do such as a , nurse, nurse practitioner, licensed clinical social worker and substance use counselor. Many teams include someone from each of these fields and also have a case manager who is trained to coordinate services and also work directly with clients. When you are hired, you will learn who is on your team and how your after I knock team operates. YOUR ROLE ON A TEAM on the door? Each person on the team will have a specific role related to their particular job. This role should be clearly defined by the team. If you are not sure, you should ask. 12 Treatment Plan and Keeping Appointments HOW A TEAM WORKS 13 Communication Skills In addition to the specific roles, the team itself has a job. That is to provide a safe place 14 Motivating the Client to operate as a unit with the goal of providing the best services for the client. Every 15 Working with Older Patients member of the team must be able to communicate in the meeting and share comments and concerns and questions. The team meeting is a place to work together to create 16 Home Visits the best solutions and to provide support for each member. You have a role to play as a team member and the team will not perform at its best unless you are an active participant: to share ideas about your clients and any issues, to provide feedback, to provide suggestions for improvements, to ask questions so that you can do your work better or to ask questions about concerns related to your clients or your work. Team discussions are private and confidential unless a decision is made by the whole team to share information. Discussions in the team are good but once a decision is made by the team, it is important to support it and make it work. REMEMBER Your team is your support and a team that functions well will provide the best services. 12 13

TREATMENT PLAN

Communication Skills Treatment Plan and Keeping How to listen so that you build a strong relationship, Appointments provide support, provide motivation and build trust. 1. Listen actively: See explanations below. One of the most important jobs you have is helping the patient understand 2. Slow down: when explaining something complicated, don’t rush, repeat in and follow the treatment plan given to them by the medical team. It might tell them what medications to take and when, and also when to schedule return different ways, stop to make sure the client is understanding. appointments. As you learned in your training, you should go over the plan with 3. Be clear and concise. the medical team so that you understand it. Then you will be better prepared 4. Assure client that you are aware of the need for privacy and show that to help your patient understand and follow the plan. If there are parts that the you care about the client’s privacy and safety. patient is not comfortable with, you can help them explain that to the medical 5. Do not judge. team and help communicate so that a plan is developed that works. 6. Be aware of verbal and non-verbal body language, gestures and facial Scheduling and keeping doctors’ appointments is very important to continued expressions are key. health. This is a skill that the patient might not have. You can help them in this 7. Be aware of tone and voice. Self –check once in a while. skill so that they are organized with date, time and transportation. If they have 8. Use open-ended questions when trying to understand or get information. children at home, you might want to remind them to arrange for childcare if possible. HOW TO BE AN ACTIVE LISTENER AND OBSERVER You might want to talk to your team about ways to help your patient learn to pay 1. Give your undivided attention: nod, say yes or nod to show understanding. attention to and follow the treatment plan. 2. Reflect back: listen and then paraphrase to make sure you understand. Reflect back facts and feelings. 3. Listen and look for emotions behind the statements and whether words agree with emotions. 4. Emphasize positive statements you hear and emphasize strengths. 14 15

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at a Working With Older Patients time When you are working with a patient who is elderly and/or frail, there are special needs to consider. How is their mood? You are a very important link for them to the team and to the community outside. This is especially true if they are unable to leave their home easily. Be patient and kind. Getting older is not for the faint of heart – having a companion by your side is a great help. Falls: For people who are frail, there is always a danger of falls. It is good to check their living situation for loose rugs, clutter or other items that might cause a fall. Motivating the Client Make sure there are lights at night in case they need to get up to go to the bathroom. Help motivate the client towards positive changes. Dizziness: When talking to them, remember that some of the medications they 1. Have client identify behavior that is not in their best interest. take might make them dizzy. Always discuss this and check on side effects so that you 2. Identify what can be changed. can tell the team. 3. Listen for emotions behind the statements and question whether words Swelling: Check for swelling especially around the ankles. This could be a agree with those statements. symptom of some serious health problem. 4. Emphasize positive statements you hear and emphasize strengths. Be encouraging. Emotions and Depression: Always discuss how they are feeling. Depression 5. Develop a plan. is common among older adults and can be hard to identify. People may be 6. Decide first step and help make it happen if client is ready. depressed and not know it. Instead, they might just stop eating, not want to 7. Continue to use these positive strategies: progress might be slow and will get dressed, lose energy and be easily irritable. If someone is depressed then slide back. Be patient and start over. they might get more confused. Their eating habits may change and they may not sleep well. This can be serious. If concerned, ask your team about having a list of questions to ask to help identify whether someone is depressed. Memory: It will also help to try little mental checks to make sure that they are not confused or having new memory problems. There are questions that are helpful and your team might give you a little checklist to use in conversation. Medicines: Elderly patients often have many different medicines to remember. Check on whether they are taking their medicines correctly. When we get older, the medicines have different effects and it is very important to make sure that they take what they should, when they should. Always ask how the medicine makes them feel. Help organize the medicine so they remember to take it. The team can help provide a kit to help organize the medicines. 16 17 02

03 Stigma and Community

18 What Is Stigma? 19 Respecting Differences: Sensitivity to All Cultures Home Visits A productive and respectful home visit builds trust with clients and aids in creating healthier communities.

If you are going to someone’s home Your Their you need to be aware of and respect: ! safety privacy

Always knock on the door, request permission to come in and wait to be let in. If you have any concerns at all, do not enter. Call your team. In all visits with your client, you must continue to establish a relationship. Remember the purpose of the visit that day and prepare in advance for what you want to do/see/learn while there. Most importantly, you will always be most successful if you have good communication skills so that you can learn how your client is doing and help them move towards recovery and positive change. 18 19

D U N C E

What Is Stigma? People with mental illness often experience rejection, fear, avoidance or discrimination from the people around them. These negative beliefs and thoughts are called Stigma. Stigma makes it harder for people experiencing a mental illness to get a job or make friends. Stigma can also affect the family members of people experiencing a mental illness causing family problems. When people experiencing a mental illness come to believe these negative attitudes and beliefs they can feel embarrassed or ashamed about themselves, the result is Self-Stigma. Self-Stigma can cause people to hide symptoms from loved ones or treatment providers and cause people to avoid seeking treatment for their mental illness. Both Stigma and Self-stigma make the lives of people suffering from mental illness more difficult and make it harder for them to get necessary mental health treatment. Tools for Reducing Stigma Respecting Differences: There are several ways we can help reduce the stigma associated with mental illness. Sensitivity to All Cultures People are not a disease. When talking about someone experiencing mental health symptoms be careful to talk about them as people first, not as a disease. Many of us belong to different groups. Usually these groups include people who For example don’t call someone a “schizophrenic,” say “person diagnosed with are similar to us. We either share interests, or ethnic or racial background and/ schizophrenia.” or religion. Sometimes we define ourselves by our groups or by our backgrounds. Some are groups we choose to join and some are groups that are based on Talk about person’s strengths not just their symptoms. We often focus on mental health symptoms that people are experiencing such as sadness, anxiety or outside factors such as our race, income or where we were born. Either way, we hearing voices and forget the strengths people have. Talk with clients about their develop a culture or way of behaving that is related to our group. We might share goals, hopes and dreams, not just the mental health symptoms that they customs, or beliefs or certain language that we understand but others might not. are experiencing. For example, in Native-American tribes it is not polite to walk up to someone’s Help educate our community. As a community health worker other people house and knock. Instead, you are supposed to wait a little distance from the will seek out your advice and counsel. You can use these opportunities to help house and stay until you are noticed and invited to approach.