Dialogue About the Workforce for Population Health Improvement Proceedings of a Workshop (2021) / Chapter Skim
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4 The Community Health Workforce
4 The Community Health Workforce
Pages 33-46
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From page 33... ...
1 This section summarizes information presented by the following CHWs on the CHW panel: Shanteny Jackson, Richmond City Health District and VACHWA; Kevin Jordan, Damien Ministries and Maryland Community Health Worker Advisory Committee; Orson Brown, Penn Center for Community Health Workers; and Adriana Rodriguez Palacios, ORCHWA. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 34... ...
Brown noted that his organization, the Penn Center for Community Health Workers, has seen success from CHWs helping people first to understand the barriers preventing them from attending doctors' appointments, and then to develop a plan for addressing them. Murphy next asked the panelists what they see as key elements of success for a CHW.
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From page 35... ...
STANDARDIZED, SCALABLE, AND EFFECTIVE COMMUNITY HEALTH WORKER PROGRAMS TO IMPROVE POPULATION HEALTH Shreya Kangovi from the Division of General Internal Medicine, the Perelman School of Medicine, and the Penn Center for Community Health Workers at the University of Pennsylvania began her presentation by sharing a story of a patient2 who had suffered childhood trauma and spent time incarcerated as an adult. When he was released, he struggled with estrangement from his family and difficulty finding housing.
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From page 36... ...
The final reason is the lack of scientific evidence regarding the field of social determinants broadly and CHW programs specifically. Kangovi noted that most studies on the impact of CHWs have been pre– post studies with limitations that overestimate the effect of CHW programs and create a hype that she sees as damaging in the long term.
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From page 37... ...
COMMUNITY HEALTH WORKER WORKFORCE DEVELOPMENT AND THE OREGON COMMUNITY HEALTH WORKERS ASSOCIATION The next presentation by Noelle Wiggins from ORCHWA provided participants with background on the association and how it operates.3,4 3 This section summarizes information presented by Noelle Wiggins from ORCHWA. The statements made are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 38... ...
As background on ORCHWA's history, Wiggins explained that Oregon has had a history of successful CHW and promotor/promotora programs since the 1960s. Foundational CHW programs in the state have included the community health representative program founded at the Confederated Tribes of the Umatilla Indian Reservation in 1967, outreach worker programs that began in county health departments during the HIV/AIDS crisis in the 1980s, and the El Niño Sano ("The Healthy Child")
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From page 39... ...
These served as the jumping off point for ORCHWA, with the mission to "serve as a unified voice to empower and advocate for CHWs and our communities."6 ORCHWA held its first meeting in November 2011. Initially, ORCHWA did not have any funding and was supported by in-kind donations from the Oregon Latino Health Coalition and Community Capacitation Center at the Multnomah County health department.
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From page 40... ...
spoke about where and how CHWs fit into the health sector, CHW training needs, the ROI of employing CHWs, the state of CHWs and CHW associations, and changes to the role with changes in the health care system and an increased focus on population health. Rhein explained that as the public health institute serving the District of Columbia, Maryland, and Virginia for the past decade, IPHI has the mission of leading innovative solutions to public health issues in the region and working at a systems level to address workforce development, advocacy, capacity building, convening, and leading the development of effective interventions.8 As Rhein described, the community health workforce is not a panacea, but it is an integral component of a strategy to address health equity.
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From page 41... ...
IPHI also promotes health equity through a 2-day perspective transformation training for CHWs that addresses prejudice, race, and the CHW role. Monroe noted that IPHI also supports team integration, and she added that there is interest among organizations employing CHWs in providing initial training for CHWs but less interest in team-based trainings that include the CHW, supervisor, and other team members and provide an opportunity to discuss issues related to triage and workflow.
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From page 42... ...
POPULATION HEALTH WORKFORCE SUPPORT FOR DISADVANTAGED AREAS PROGRAM9 Katie Wunderlich from the Maryland Health Services Cost Review Commission presented on the challenges of integrating payment for CHWs into the business model of delivering health care across the care spectrum. She also described how Maryland has promoted the use of CHWs through regulatory processes and health care system initiatives, including financing mechanisms for hospitals and other communitybased organizations.
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From page 43... ...
Other key program partners included the Baltimore Alliance for Careers in Healthcare, which served as a training coordinator and intermediary with the hospital systems; Turnaround Tuesday, which provided support with recruiting, essential skills training, and wraparound services for workers; and CHW, nursing assistant, and peer recovery specialist organizations, which provided technical training for workers in these professions. Wunderlich presented data on program outcomes.
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From page 44... ...
With this arrangement, ORCHWA is the broker between community-based organizations and the large health care institutions, providing the contracting capacity, relationships, training for CHWs and supervisors, support for creating job descriptions and recruitment, and evaluations of program impact. Kangovi pointed out that there could be tension between the goals of workforce development and of improving population health.
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From page 45... ...
, which is similar to ORCHWA's model of engaging CHWs through a nonprofit organization that partners with all of the payers and providers in an area. Barnett noted that this model allows CHWs to retain their agency and move beyond individual patient care management to broader population health improvement.
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From page 46... ...
Potential reasons for lack of success include poor hiring practices, lack of standardized infrastructure, lack of balance between clinical integration and retaining grassroots identity, and lack of scientific evi dence regarding the field of social determinants broadly and CHW programs specifically. (Kangovi)
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