Community Health Worker - Archived Newsletters
Section Newsletter
Annual Meeting 2005

Message from the Chair

November 2005

Dear Colleagues:

Greetings to all and welcome to the Community Health Worker (CHW) Special Primary Interest Group (SPIG) Fall 2005 Newsletter. Please read, print out, copy and share this newsletter with many, especially public health professionals like other CHWs!

“Is this the calm before the next storm?”

I write this letter with a heavy heart as I pass the gavel to the incoming chair at a time when many of us are becoming more active as “drum majors” for social justice and public health in the aftermath of the storm. We have added our voice, and indeed our hearts and resources, to the rebuilding efforts in the Gulf as we tried to make sense of an emergency response that lacks “common sense” (a reference to Erin Brockovich’s keynote address during last year’s APHA Annual Meeting).

Many of the people we saw waving signs that read “Help Us!” were abandoned and left to the elements long before Hurricane Katrina. The health, human and social service systems have abandoned many people across this country; many of the abandoned lived in and around New Orleans' Ninth Ward. We pay homage to all of those impacted and affected by the many storms and to those who long for the calm.

I want to give a heartfelt thanks to all of the CHWs and their allies and partners who responded quickly to the needs and challenges faced by our CHW brothers and sisters who were in the path of the storm. During this year’s Annual Meeting, some of those CHWs will tell their story, and the CHW SPIG is working hard to secure support and assistance for those CHWs to attend the conference.

As I prepare to pass the gavel to our next chair, I wanted to reflect on the progress the CHW SPIG has made during my tenure. Up until 2000, the CHW SPIG was known as the New Professionals SPIG. We have always had a focus on CHWs and served as the primary place for CHWs to further develop their knowledge and skills as well as to network and organize.

During my tenure as chair-elect and chair, the CHW SPIG has grown by leaps and bounds, particularly in our efforts to advocate for and support CHW leadership at every level within the SPIG. I applaud the efforts of Lee Rosenthal, Tere Rios and Yvonne Lacey as the past leadership upon whose shoulders I stand today! The milestones during my tenure include:

  • The election of two CHW governing counselors to represent the SPIG in APHA’s Governing Council. Lisa Renee Siciliano and I are the 2006-2007 Governing Counselors, and this is our first time having two CHWs who are active on local, regional and national CHW initiatives as counselors!
  • The development of active subcommittees (Policy, Executive, Newsletter, Program Planning and Liaison to Other SPIGs, Sections and Caucuses). This has given us a vehicle to organize ourselves and stay connected all year!
  • Active involvement of SPIG leadership in providing feedback and recommendations to APHA as it assesses and evaluates its policies and procedures. APHA is participating in an intensive evaluation of the organization as a whole, including its structure and involvement of SPIGs, sections and caucuses. Recommendations will be presented during this Annual Meeting as a result of this assessment/evaluation that will guide strategic planning for the future!
  • CHW integration into other SPIGs, sections and caucuses as members and presenters. This effort has been in the works for years, and with our new Liaison Committee we have made significant strides during this past year!
  • Development of support and funding for CHWs to present at the Annual Meeting. The support comes in many forms, including mentoring and guiding CHWs through the abstract writing and submission process as well as fostering an atmosphere of support for CHWs to get involved in APHA and other public health organizations. Also, thanks to the kind, generous support from the Harold and Grace Sewell Trust Fund, we have been able to create a CHW presenter scholarship program that gives modest financial support to accepted CHW presenters to attend the Annual Meeting.
I have been blessed to have been supported to attend the APHA Annual Meeting every year since 1994, and have presented at each meeting since 1995 (San Diego, ’95; NYC, ’96; Indianapolis, ’97; D.C., ’98; Chicago, ‘99; Boston, ’00; Atlanta, ‘01; Philadelphia, ‘02; San Francisco, ’03; D.C., ’04). I’ve co-presented with CHWs and youth peer educators from across the country, including my oldest son Darnell (1997).

As I pass the gavel and torch, I will stay active as a CHW SPIG Executive Committee member, Governing Counselor and CHW advocate/presenter/facilitator/moderator! I encourage all of you to join APHA and our SPIG, and get or stay active with us. I also want to encourage all CHWs and those who support them to be active in local, state, regional and national CHW led networks and associations. This is as critical to the development, sustainability and, in many cases, survival of CHWs. We need you, and we need your support.

I look forward to seeing you during this year’s Annual Meeting in Philadelphia and am excited that next year the Annual Meeting will return to Boston (Nov. 4-8, 2006), so, together with other Massachusetts CHWs, I can play host and offer a tour of some of our community-based organizations (as I did in 2000)!

Durrell J. Fox
Chair, 2003-2005
Governing Counselor, 2006-2007

CHW SPIG Program at APHA 2005

CHW SPIG Program at APHA 2005

The highlight of the CHW SPIG's program at the 133rd APHA Annual Meeting (Dec. 10-14, 2005) will be the participation of community health workers from the Gulf region in a special session: “CHWs in the Eye of the Storm: Responding to Katrina.” CHW representatives of the “Walkers and Talkers” program from Kingsley House in New Orleans will be joined by CHWs from Mississippi and Alabama to share their experiences and reflections on the vital role of CHWs in disaster response at this timely session. Kingsley House was to have hosted our CHW SPIG social event before the devastating aftermath of Katrina forced its CHW staff to relocate across the country.

This year’s program also continues our commitment to community health worker presenters as we welcome more than 30 CHW presenters (many of them first-time APHA presenters and attendees) from international health outreach programs in Nigeria and Guatemala, to community wellness programs in rural Alaska, to the border and immigrant communities of Florida and South Texas, to the urban streets of Philadelphia, Detroit and Los Angeles. CHWs will explore their new roles as researchers and policy advocates, and share their participation in program evaluation and their invaluable experience as a bridge to underserved communities in diabetes management, cancer prevention, and HIV and sexuality education. Issues in capacity building and training of CHWs will be the topic of a roundtable discussion. And, as always, our social event will be a chance to come together, network and celebrate the growing strength of community health workers.

The CHW SPIG has worked hard this year to expand our visibility and recognition within APHA, and many of our sessions are being co-sponsored by other sections and caucuses, including the Public Health Education and Health Promotion Section, the HIV/AIDS Section, the Maternal Child Health Section and others. We welcome this growing collaboration and encourage our members to check out the sessions we have co-sponsored in this year’s program.

Events will be held at the Philadelphia Marriott Hotel. For more details, search for the CHW SPIG program at:

Join us in Philadelphia as we continue to build a national community health worker movement and share our successes and challenges with the public health community!

Out of the Eye of the Storm

An Interview with Tammi Fleming, Public-Private Ventures (PPV)

Tammi, a CHW with more than 10 years of experience, worked with the “Walkers and Talkers” of the Plain Talk program at Kingsley House in New Orleans, and with their Health Care for All program. Tammi recently moved from New Orleans to Philadelphia. In this interview she shares her insights on the CHW field and the experience of Hurricane Katrina. She was interviewed at her office on Nov. 1 by Carl Rush of the New Jersey Community Health Worker Institute.

Carl (CR): How did you end up here?
Tammi (TF): I had been at Kingsley House in New Orleans for about five years, and part of that time I had been acting as a consultant to the [Annie E.] Casey Foundation and PPV. For the past 10 years I’ve been doing Plain Talk, and when they developed a replication strategy they offered me a position.

CR: What is Plain Talk?
TF: PT is a teen pregnancy prevention strategy, but it’s focused on adults -- parents rather than teens -- in a small, identified community. We believe parents are primary educators for their adolescents on reproductive heath issues. If we can help develop the parents’ communications skills, they can impart their own values and beliefs, and the adolescents will then make wiser decisions when they decide to be sexually active.

CR: You were in the process of moving to Philadelphia when Katrina hit?
TF: We had just sold our house, and we were on a house-hunting trip in Philadelphia right before the hurricane hit. For the first few days I totally forgot about my [household] things, because I was so worried about family members. I had a rolling list of people who were missing… if I had been in New Orleans, would I have left? I’m not sure I would have. We had disasters in the past, and the City said they were going to fix the whole evacuation strategy, but it was a mess. I have smaller kids now, and I was thinking about what would happen if the storm hit while we were in the car. For a lot of people, the decision not to leave was economic, because the employer doesn’t have to pay you if you leave.

CR: We heard early on that some of your colleagues at Kingsley House had not been located.
TF: At this point everyone’s been located. My Mom was missing for several weeks; she was in an assisted living apartment for the elderly, and the managers didn’t have to stay. I called everybody: the Red Cross, the Coast Guard, my state representative, my city councilman, trying to figure out – what do you do? You can post something on the Internet, but you’re talking about elderly, poor people without resources, they won’t necessarily go to a computer to look for help. I had 13 relatives I could not find.

CR: Did you have any disaster plans at Kingsley House?
TF: They had a good plan as far as securing the property, getting information to the participants, but there was no long-term strategy –- what happens if it really hits? Do we pay staff? Decisions had to be made on the spot; on some of them the executive director had to get a telephone poll of the Board. And if they did want to [pay them], how would they do it? One older staff member came in and manually wrote checks for the staff. That actually put Kingsley House in the hole -- they tried to do the humane thing, and kept paying staff for a month.

CR: Have they reopened?
TF: Yes, but unfortunately for the CHWs, about three weeks ago, they were all told they had to be at work the following week or they would be laid off. Of the 12 CHWs working with me, only one of them returned, so all of them have been laid off. They had nowhere to go! There’s no low-income housing left in New Orleans at all. CHWs are mostly an entry-level position, although Kingsley House paid their staff quite well, with health insurance and everything. My family members are struggling, trying to get the smallest house they can find. People are only a paycheck or two away from being in extreme poverty.

CR: Were some of the CHWs evacuated?
TF: They were all evacuated, most of them ended up in Texas. One was in Atlanta. They’ve found temporary housing, through FEMA and mostly local churches, but no one has found employment yet. They are out on a daily basis looking for work. Some of them are making a decision to stay, but some are not thinking it through. I’m concerned because if you don’t have that safety net –- family, friends –- that’s my first concern. If you relocate without a plan, with no one you really know, you have to learn a whole new system. If you don’t find employment within a couple of weeks you are in trouble. Disasters can bring out the good in people, but unfortunately that’s a short-term commitment –- “How long are you going to be here?” One of the older workers at Kingsley, a really great CHW -– she had the pulse of the community, could talk to anyone -– she could get anyone to let us in their house. She was hired without a high school diploma, although she writes so well. What chance does she have of getting another job?

CR: Where is she now?
TF: Her family was scattered. She was in the Superdome, because she didn’t have a car. It was her and her husband, her daughter and her grandbaby. She said it wasn’t as bad as they depicted it on the news –- it was uncomfortable, and they were running out of resources, but she didn’t see any of the things they describe. At one point it started to smell, and it was hot, but she said the evacuation itself was the worst part. She was separated from her husband, who was really sick. She was in Houston, he was in Austin, and they had no resources. They have a few dollars stashed, but not enough for the long term, or to pay to get him where she was. Finally I posted her on the Web, and when she was in line at the Astrodome they found her posting and called me. We finally found her daughter in Gulfport [Mississippi], which was really bad, no water, they were just walking around. We had to get them together in a kind of safety net for each other. “You’re in Austin, she’s in Austin, you need to meet up to figure out where you can find housing.” That was also my strategy with the Walkers and Talkers. Each person had at least one other that they had worked with, so at least they know another person.

CR: What is going to happen to Plain Talk in New Orleans?
TF: From what I understand it’s not going to be implemented right now. They’ve asked for a reprieve from the [Casey] Foundation. But Health Care for All, which was my department, will continue, and they are looking at expanding into other social benefits. They’re enrolling people in Medicaid, they are talking with the state about doing Food Stamps, and with other departments so they can do all of it at once when they work with a family.

CR: What are you doing now at Public Private Ventures?
TF: I’ve been hired to work on the national replication -– all the training for the Walkers and Talkers, to get them ready to address the issue of adolescent reproductive health. There are three basic components to the program: “community mapping,” where the community does its own assessment and names their priority issues around adolescent reproductive health; the “Walkers and Talkers” (CHWs); and the “home health parties,” which are the main intervention to educate the community. So I train the mapping volunteers –- on how to be social researchers: how to get into a home, all the questions, rephrasing, probing, not drawing people toward a certain answer. We help them to identify resources within the community that already address these issues. They do a community inventory, as small as checking the corner store to see if they carry condoms and whether they are in front or behind the counter. What kind of services are available? Does the adolescent have to have permission to get an appointment? And then they go out and get the community’s perception on these issues. Are there issues in communication between adolescents and adults? We get parents’ views and adolescents’ views and compare the data to find out if there are any oddities: for example, in every community, the adults say they talk to adolescents about these issues –- but it’s never perceived the same way by the adolescents. Then I go in and do the Walkers and Talkers training –- they learn birth control methods, teen pregnancy prevention, anatomy, communication -– why it’s important for adults and teens to communicate. Then we train them to organize the home health parties; they go out and recruit hosts. I’m more involved with the sites than most of the staff here –- training and technical assistance, like if they are having trouble getting positions filled. It’s a lot of traveling.

CR: How many communities are you working with?
TF: Plain Talk has 12 communities. One of the great things is to see how this plays out in different types of communities. Brawley [CA] is predominately Spanish-speaking, so I had to have a translator. They are mainly factory and farm workers, so you have to devise a strategy, because you can’t get to people during the day when they are harvesting. In New Orleans we did it in a housing development; there are people working in the hospitality industry, so you can get to them in the daylight hours, at any time of year.

CR: What’s the most exciting part of this job for you?
TF: Seeing how the different community groups realize how important it is. The data part is [also] really important to me. I’ve been doing this work for many years in New Orleans, and when I went back to school and started learning some of the theory behind what I already knew, I saw how people in the community didn’t realize how important the data part is. They should know what kind of money is coming into the community, where they get these numbers from. Not everybody is going to be into it, but for folks who are engaged -- CHWs -– it can be fun, it doesn’t have to be boring. The more they understand it, the more likely they will be to do a better job. They will understand why it’s important to get these questionnaires filled out correctly. They need to understand it from the beginning and how it affects the program at the end, in the evaluation. That’s been exciting, to see folks have that “aha, I get it now.”

CR: That’s something we may want to talk more about, because there’s a lot of interest in “participatory research” in evaluation, where people can have a say in what data gets collected. The way things have typically been done, the CHWs aren’t really interested in collecting data, because they can’t relate to it.
TF: We deal with that in every site. It’s difficult, because the program has been evaluated [nationally], and we have to be able to compare apples to apples. What we’ve tried to do is let each community add their own questions, and if they feel it just doesn’t make sense to ask a particular question, we eliminate it; they just can’t compare the site on that point.

CR: There’s a lot more attention being focused on the CHW field. That’s not necessarily good news for everybody -– there are some CHWs who just want to be left alone to do what they love. There are three states now with credentialing, more thinking about it. There are differences of opinion, including the definition of CHW. There are so many CHWs out there who don’t know that’s what they are, and the employers don't know either.
TF: We didn’t know either until we came to APHA. It was so logical -– “Oh, we fit right here, this is what we do,” but we had never been defined in those terms. In one sense, credentialing can help a lot of CHWs in terms of salaries, getting paid what I believe they’re worth. Their worth is connected to the broader strategy of the agencies they work for -– they are the link that makes everything happen. A lot of [CHWs] have a vested interest in their community and start volunteering. If the employer is thinking they need to hire people who meet a certain standard, you’re going to miss out on a lot of great folks. The training is definitely needed, but I think there need to be different levels of training.

CR: There is a concern that some people who have the desire and the commitment will be shut out, that credentialing will create barriers. How can we keep it open?
TF: I don’t know, but let me talk about my experience at Kingsley House. It’s a nonprofit, a CBO, but they did have barriers to hiring community residents. With all my experience, I couldn’t be hired as a manager because I didn’t have a Master’s degree. I was hired at a lower level, doing the same work as a manager, but I couldn’t be paid the same. I was one of the few community residents who was hired at a higher level, not as custodial staff. We applied for a grant and said we were going to hire residents, knowing their literacy level was not high, and that was a fight in itself. These were great people -– they know the community, they have access to social networks, they have leadership skills. Part of the agreement was we could hire people without a high school diploma, on the condition they would work toward their diploma. We had to do a lot of training: they had innate abilities, but they didn’t have the theory behind it. That’s why credentialing is important -– people are working on a gut feeling. They know what’s wrong in their community, they know how to fix it, [but] you need to have something behind it. You can’t just tell a few stories about individuals and think it’s going to make a difference. I think there’s a lot more to think out about credentialing. We can’t say, “You have to go to school first and then you can become a CHW.” [Maybe -level position and then go through training.

CR: CHWs are something different, not a nurse or a social worker, but something distinctive -- not a “paraprofessional” relative to either one.
TF: They want to be considered professionals: well, I want to be a professional, too –- I don’t want to be a “para-” anything. After people go through this training, I don’t think they should be “paraprofessionals.” But a CHW could serve as a support to those other professionals –- just as they could be a support to CHWs.

CR: Was there any talk about this in New Orleans?
TF: When we went to Unity, some of us were part of these discussions. I think the CHWs like the idea of getting credentialed. One of our workers wanted to go to college, and she asked, “What should I get, a social work degree?” They want to continue to be CHWs, and they like the idea of getting trained on the job.

CR: What are your thoughts about forming a national network or association of CHWs, so you can have more of a voice in policy?
TF: I think the best way to do it is through APHA. As I said, I hadn’t heard the term “CHW” until I had been involved in APHA for several years. I was in a different Section all that time, until I found the SPIG table at the Expo. I got the Casey Foundation to agree that all the CHWs in each site will be enrolled as members of APHA, but they have to choose the CHW SPIG. The network, the whole conversation on training, it’s all happening there.

CR: How can we get more CHWs involved in the leadership of this field?
TF: I have read a lot of the information on definitions. A lot of the definitions are very similar. It needs to be broad enough to include a lot of different jobs. They each have a different focus, so how do we approach them with this new name? The term “CHW” just sounds so right, but getting people to embrace it -– they’ve given people so many titles!

CR: Anything else you want to add about where the field is going?
TF: Just what we were exposed to in the CHAN training -– a lot of us don’t realize we’re involved in advocacy.

CR: Back to Katrina - as we think about the roles that CHWs could play, both in how the community is prepared, and in the actual response when a disaster hits, what do you think about that?
TF: There’s a group working on rebuilding New Orleans, and they are trying to involve low-income residents. I think CHWs could be the best voices at the table, because they know the community, its deficits, they have better knowledge about who’s going to move and who isn’t. In my community, I knew who was going to evacuate, which families needed help, the elderly who would have to be moved. Older people just don’t want to leave. There was no plan –- they just didn’t think about the poor people. This is not the first time. I don’t think it’s just race or economics, I think it’s best to just plan for everybody. The people who are affected have to be at the table, maybe a plan a rationale for working with employers.

CR: If you were at the table yourself, what would you need so the community was better prepared? What could CHWs actually be doing on a regular basis?
TF: If we were planning for the Kingsley House neighborhood, we would be looking at specific needs, like supplies for diabetics. What happens if people can’t get out? Food, water, medical supplies. [CHWs can be involved in] passing on information –- like the boy who cried wolf, people have gotten too relaxed -– information on how people can prepare. They can weave it into the CHWs’ regular jobs; they are like a walking resource directory already, just add it to their routine. Every so often FEMA could pay the agency for training or special activities.

CR: What does the community itself need to do, or be thinking about, that would make them better prepared?
TF: There are a lot of small things. But the residents don’t have the resources to put things aside. A lot of poor people don’t think they have choices. They hear Katrina is coming, they think, “I don’t have any money, no transportation, I’m just going to have to stay here.” In areas that get tornados or snow storms, they have guidelines. We never had public service announcements about hurricanes -– they should be saying what you should have, like how much water you will need. Most of what I know about this is from the older generations. My grandmother would always say when a storm was coming, we needed to clean the bathtub with bleach, fill it with water and add a capful of bleach to keep it drinkable. Younger people never heard of this. If you can afford to put aside money for a few days in a hotel, do that –- find out who you can ride with if you need to evacuate.

CR: What could CHWs actually do in response to a disaster?
TF: There was a woman who owned a multi-story building; most of the houses in the area are one-story. We told her we would watch out for her property if she would give us keys to this building, so we could get people above the flooding. She gave us the keys. Or like Wal-Mart –- they could be a distribution point for water, bread, meat, which is going to go bad anyway, just give it away –- then people wouldn’t be looting TVs. Also, people shouldn’t have to stand in long lines –- like with the Census, CHWs can get access to homes, and they could run “sub-stations” in the neighborhoods so people don’t have to go to a few central locations like the Superdome. Train the CHWs on computer software, so they can process applications; if people feel they have at least applied, it gives them some hope. I can tell people about how to pick insurance -- renter’s insurance is not expensive –- if you only have $5,000 worth of stuff, and the premium is only maybe $70 a year, that’s better than getting $1,500 from FEMA. Poor people don’t insure their things, but it’s really not expensive.

CR: So the emergency authority could just drop off a van with a generator and computer and supplies, and the CHWs could run it.
TF: Yes. They give two days warning of a hurricane, but they can position the vans ahead of time. They would know where people are who need help, at least the clusters of people. When I was talking with the Coast Guard about my Mom, I knew there were 70+ people needing to be evacuated – send a helicopter for them, not just for one person.

CR: If you had to pick one thing you miss the most about New Orleans, what would it be?
TF: People are more friendly there. I’m saying “hey” to my neighbors here, and they ask, “where are you from?” I say “New Orleans” and everybody gives me sympathy. My husband can’t call everybody “darlin’” or “sugar,” they look at him like he’s crazy. Everybody’s in a rush here. But it’ll be the weather that kills us.

CHW Network Corner: CHWs Are Organizing!

CHW Network Corner: CHWs Are Organizing!

Across the country, at all levels (statewide, locally, and nationally), CHWs are organizing professional associations or networks. CHW associations advocate for CHWs and the communities they serve. They give CHWs a means of gaining additional skills, accessing support and recognition, and sharing resources and strategies with peers.

This regular newsletter feature highlights the ongoing organizing efforts of CHWs across the country. We urge CHWs to contact their local networks and get involved! If there is no network in your area, think about starting one. Contact the network nearest you for information and strategies about organizing.

We recognize the enormous energy and commitment of CHWs as they organize. We also know that this is only a partial list of CHW associations. If you know of others, please let us know! Contact the Newsletter Editor, Gail Ballester, at:, or (617) 624-6016.

State and National CHW Networks

Wandy D. Hernandez, Chair, Chicago Health Connection, 957 W. Washington Boulevard, Chicago, IL 60607, Phone (312) 243-4772 Fax (312) 243-4792; Zeida L. Estrada, Secretary
Gateway to Care, Harris County CAP 6201 Bonhomme #243-S Houston, TX 77036, Phone (713) 783-4616 Fax (713) 785-3077;

Arizona Community Health Outreach Workers Network (AzCHOW), Of, By, and For Community Health Outreach Workers;;
Lourdes Fernandez, Co-Chair; Flor Redondo, Co-Chair,; Belen Feather, Secretary.

The Community Health Worker/Promotoras Network, Maria Lemus, Executive Director, Vision Y Compromiso, 2536 Edwards Ave., El Cerrito, CA 94530; (510) 232-7869; (510) 231-9954 fax; e-mail:, or Maria at:

REACH-Workers – the Community Health Workers of Tampa Bay. Please contact Michelle Dublin, Chairperson of the network, at (727) 588-4018,

Community Outreach Workers Association of Maryland, INC. (COWAM), 259 North Lanvale Street, Baltimore, MD 21217, (410) 664-6949 or (410) 669-7960, Dwyan Monroe, President;

Massachusetts Community Health Worker Network (MACHW), Lisa Renee Siciliano, Director,, 978-729-5379, University of Massachusetts Office of Community Programs, 222 Maple Avenue, Shrewsbury, MA 01545.

Michigan Community Advocate Association (MICAA), Contact: Maria Alvarez deLopez,; President-Roshawnda S. Thompson -; (616) 356-6205 or (616) 827-2094 or (616) 366-2759.

Minnesota CHW Peer Network out of the Minnesota International Health Volunteers,
122 W. Franklin Ave. #522, Minneapolis, MN 55404, LuAnn Werner (612) 230-3255 or Andrea Leinberger (612) 230-3254,

New Mexico Community Health Workers Association (NMCHWA), P.O. Box 81433
Albuquerque, New Mexico 87198, or BJ Ciesielski,, (505) 272-4741.

NEW YORK CITY - Community Health Worker Network of NYC; 425 E. 25 Street; New York, NY 10010; (212) 481-7667; Sergio Matos, Elena Schwolsky, Rita Taylor, and Romy Rodriguez;;

ROCHESTER - Rochester Outreach Workers Association (ROWA), Latisha Williams, Chair, (585) 274-8490;; Lucinda Colindres, (585) 244-9000, ex. 454.

Oregon Community Health Workers Association, 9000 N. Lombard Street--2nd Floor, Portland, OR 97203, (503) 988-3366 x28686, Teresa Ríos,, or Veronica Lopez Ericksen,

CHW SPIG Policy Committee Update

SPIG Policy Committee Continues To Work On CHW Definition

It is hard to believe a year has passed since the last Annual Meeting. The SPIG Policy Committee has been diligently working on a CHW definition. This definition will serve as an umbrella term which will unite the general common principles of CHWs nationwide. A survey was included in the packets at Unity 2005 which all CHWs received upon registration. The surveys were collected, and we will be using this information to help us with the definition. The SPIG Policy Committee is also researching the steps required to eventually become an occupation with the Bureau of Labor Statistics.

If you have an interest in policy issues that affect CHWs, please consider joining the policy committee. New ideas are always welcome. For additional information regarding the policy committee or the definition, please contact Maria Alvarez de Lopez at

MACHW Scores a Victory for CHWs in Massachusetts: Update

In November, the Massachusetts Community Health Worker (MACHW) Network and all CHWs in the state reached a milestone with the successful integration of our first CHW authored legislation into both state legislatures’ versions of a comprehensive health care reform bill. The “CHW bill” was initially filed as House #2751 – “An Act Providing for Investigation and Study by the Department of Public Health Relative To Community Health Workers.” The legislature's comprehensive health care reform bills aim to ensure insurance coverage and access to care for all Massachusetts residents. Each branch of the legislature has overwhelmingly passed their versions of the health care reform bills (House #4463, the Senate #2042). Each version includes sections on CHWs and outreach, as well as amendments that strengthen the role of CHWs in increasing health care access, reducing health disparities and enhancing community wellness.

The history of the original CHW legislation began with the work and research of three MACHW board members with technical assistance from Massachusetts Public Health Association (MPHA) and some key legislative allies. The primary authors were two CHWs -- Lisa Renee Siciliano, MACHW director, and Durrell Fox, New England HIV Education Consortium (NEHEC) and one of MACHW’s founding members. They are also the both past chairs of MACHW’s board of directors. They were joined by another MACHW board member and Geoff Wilkinson, executive director of MPHA. State Rep. Gloria Fox, the bill’s lead sponsor, and her legislative staff gave valuable technical assistance and insight.

The “CHW bill” was successfully filed in December 2004. The Joint Committee on Public Health (including members from the House and Senate) reported the bill out of committee favorably and sent it to the Joint Committee on Healthcare Financing in June 2005, after hearing testimony from Massachusetts CHWs. In September 2005, a small group supporting the bill (the two CHW authors, MPHA director and a staff member from Rep. Fox’s office) met with members of the leadership of the Healthcare Financing Committee to give insight and answer questions about the overall intent and purpose of our bill. After that meeting we were informed that there was a movement to integrate our bill into a comprehensive, progressive health care reform bill being designed.

Now that both sides of the legislature in Massachusetts have approved health care reform bills that include CHW language, the next step will be the appointment of a conference committee with members from both sides that will hammer out details to create a bill that integrates the House and Senate versions. This means we still have work to do to maintain the strongest possible CHW language in the final version of the health care reform bill to be signed into law by the governor.

MACHW coordinates several initiatives focused on creating a supportive environment for the sustainability and further growth and development of the CHW profession and CHWs in Massachusetts. We do this by spearheading a CHW advocacy agenda that includes legislation-policy development, advocacy training programs and advocacy opportunities for CHWs and other community members to add their voice to policies and legislation that impact their families and communities. We continue to work with our public health departments and other employers of CHWs to create “real” changes, by reforming how CHWs are supported and financed. We also work to promote acknowledgement of our critical role in access to healthcare and human services, and in eliminating health disparities and its root causes.

MACHW is proud to demonstrate an example of a truly CHW-led legislative-policy initiative. We feel this is critical to the growth and development of CHWs in our state and throughout the country.

We thank all of the members of the Massachusetts House of Representatives who overwhelmingly approved their bill, which includes the CHW-drafted legislation verbatim as well as four CHW amendments offered by Rep. Gloria Fox. We thank all members of the Senate who offered CHW amendments, who helped us strengthen CHW language in their bill and who voted for it. We also hope to thank the governor for signing the final version, which we hope retains the strongest possible CHW language.

For more information about MACHW, please visit our link on MPHA’s Web site: For more information about legislation in Massachusetts, visit:

During the APHA Annual Meeting, please attend the CHW SPIG session (#4213.0, Tuesday, Dec. 13, 2:30-4 p.m.) entitled “Current Policy Issues for CHWs.” During this session we will discuss policy issues of relevance and of importance to all CHWs in the country.

World AIDS Day, December 1, 2005

World AIDS Day, December 1, 2005


The 18th Annual observance of World AIDS Day on Dec. 1 had the theme “Stop AIDS. Keep the Promise.” With the current funding climate and pending reauthorization of the Ryan White Care Act, the observance this year reminds people that AIDS is alive and well in ALL communities. This is true for all cultures, age groups, socioeconomic levels, religions and races. That said, it is also important to acknowledge the widening HIV/AIDS ethnic and racial disparities which continue to disproportionately affect and impact communities of color, and particularly women and youth. I urge everyone to visit the Web sites of your local or state health departments, CDC or HRSA HIV/AIDS Bureau to see the glaring disparities in the rates of HIV infection in the African American and Latino communities.

I’ve been a CHW in the field of HIV/AIDS for 14 years, with much of that time spent doing street outreach, HIV counseling and testing. During that time I have also been a case manager for adolescents/young adults living with HIV. During these years I’ve seen, and continue to see, shifts in seroprevalence rates and resources in different communities. I’ve also been dismayed over the last four years as there have been steady funding cuts for HIV programs that focus on outreach, prevention, peer education and even some direct care services. We must stand up in larger numbers to demand appropriate HIV/AIDS funding and resources. This will not be achieved by the work of a few advocates; we need many more. I urge all CHWs to join local efforts in advocating for restoring funding for HIV/AIDS programs and services. We have yet to see the full impact of the cuts from recent years, but many of us fear that Massachusetts and many other states will see a spike in new rates of HIV, as well as increases in AIDS diagnoses, as people have less access to information, resources, care and treatment.

Since 1988 there have been many themes for World AIDS Day including Communication, Community Commitment, Children, Youth, Women, Stigma and Discrimination. This year’s theme, “Stop AIDS. Keep the Promise" is an appeal to governments and policy makers to ensure that they meet the targets they have agreed to in the fight against HIV and AIDS. On World AIDS Day last year I was honored to co-present with Ervin “Magic” Johnson at three events in Boston. The visibility of these events helped to re-energize those of us who have been doing HIV/AIDS work for years, and also served as a vehicle to pull new people throughout the community into the fight against HIV/AIDS. We continue to turn World AIDS Day into a rallying cry for sustained action and awareness. We must capitalize on the renewed energy many of us get as we attend events in Massachusetts, New England and across the world during the week of World AIDS Day.

The Red Ribbon is an international symbol of AIDS awareness that is worn by people year round and particularly on World AIDS Day to demonstrate care and concern about HIV and AIDS, and to remind others of the need for their support and commitment. The red ribbon started as a "grass roots" effort, and as a result, there is no “official” red ribbon. Many people make their own. It's easily done -- just use some ordinary red ribbon and a safety pin!

What can CHWs and others do to advocate and show their support?
  • Raise awareness of HIV and AIDS in your area and community.
  • Get more educated about HIV/AIDS and educate others.
  • Get involved in advocacy coalitions.
  • Contact legislators and policy-makers regarding HIV/AIDS resources.
  • Wear a red ribbon, and ask others to do the same.
  • Protect yourself -- this is the first and best way to stop the spread of HIV.
  • If you don’t know your status, get tested.
There were many events across the country on and around World AIDS Day. On Dec. 1, there was a Women and HIV conference (details posted on & That evening, MAP for Health hosted their 10th Anniversary celebration and commemoration of AIDS in the Asian Pacific Islander community. I urge you all to help build more unified multicultural bridges in our fight against AIDS (see There was also a week of World AIDS Day related events in Portland, Maine (see

APHA Membership Information

For those of you who are not members of the CHW Special Primary Interest Group or APHA itself, please consider joining us! If you are a member of APHA, the SPIG also welcomes you to join us as a primary member.

If you are unable to select CHW SPIG as your primary affiliation in APHA, please consider electing the CHW SPIG as a secondary section, and you will receive our CHW newsletter!

For those of you who are not yet members of APHA, there are many options for membership.
  • A Special Community Health Worker subsidized membership ($65 annually for those whose income is under $30,000 annually).
  • A consumer subsidized membership ($65 annually for those who do not derive income from health-related activities).
  • A Student/Trainee subsidized membership ($50 annually for those enrolled in a college or university or occupied in a formal training program).
  • Regular membership is $160 annually.
Memberships include all benefits such as the American Journal of Public Health and The Nation’s Health.

For details on how to become a member of APHA and how to designate the CHW SPIG as your Section/SPIG, please call (202) 777-APHA. You can also check out APHA's Web site at
or e-mail

In the event you cannot become an official member of APHA, we still need your wisdom, support, knowledge and power. Please feel free to contact any of the officers listed in this newsletter about the CHW SPIG and how you can be involved.

APHA 2005 Community Health Worker SPIG Executive Board

Chair/Governing Council Representative
Durrell Fox
New England HIV Education Consortium
Massachusetts Community Health Worker Network
23 Miner Street
Boston, MA 02215
(617) 262-5657

Chair Elect and Member Retention
Sergio Matos
Community Health Worker Network of NYC
(718) 703-9340

Susan Mayfield-Johnson
Center for Sustainable Health Outreach
University of Southern Mississippi
Southern Station Box 10015
Hattiesburg, MS 39406-0015
(601) 266-6266

Governing Council Representative
Lisa Renee Siciliano
Massachusetts Community Health Worker Network
(508) 764-5328

Program Planners 2005
Elena Schwolsky
NYC Asthma Initiative
(212) 690-1198, extension 101

Tammi Fleming

Policy Committee Chair
Maria Alvarez De Lopez
Michigan Community Advocate Association
Grand Rapids, MI
(616) 633-5509

Liaison to Other APHA Sections, SPIGs and Caucuses
Tori Booker
Migrant Health Promotion
224 W. Michigan Ave.
Saline, MI 48176
(734) 944-0244

Carl Rush
NJ AHEC Program
(856) 397-3937

Communication/Continuing Education
Nell Brownstein
Centers for Disease Control and Prevention (CDC)
4770 Buford Hwy NE MS K47
Atlanta, GA 30341-3717
(770) 488-2570

Newsletter Editor
Gail Ballester
Massachusetts Department of Public Health
Boston, MA 02108
Phone: (617) 624-6016
Fax: (617) 624-6062

Immediate Past Chair
Teresa Ríos
Community Capacitation Center
Multnomah County Health Department
(503) 988-3366 Ext. 28686

Former Chair
Yvonne Lacey
Berkeley Health Department
1767 Alcatraz Avenue
Berkeley, CA 94703
(510) 644-6500

Immediate Past Governing Council
June Grube Robinson
724 Hoyt Ave.
Everett, WA 98201
(425) 249-2019

Lee Rosenthal
2250 East 8th Street
Tucson, AZ 85719
(520) 882-2105 x2