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