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Community Health Worker - Archived Newsletters
Section Newsletter
Summer 2006

Message from the Chair

I want to extend a warm greeting to all our members and supporters. As I write this message with summer almost upon us, the weather has finally broken here in the Northeast. After three weeks of heavy rainfall, the sun has finally emerged, and although many of us are feeling spring fever, we are also focused on emerging issues for community health workers and the field of community outreach. Our efforts are concentrated on a number of important fronts. Our Community Health Worker Special Primary Interest Group at APHA continues to grow and mature as an integral part of our larger organization. Our two Governing Council representatives are working hard to give voice and attention to issues facing CHWs across the nation. Our standing policy committee is taking the lead in efforts to address issues of policy and practice important to our field - such as self-determination, CHW definition, credentialing and certification. Our Program Planning Committee has been working to complete our program for the 134th APHA Annual Meeting and Exposition, scheduled for the week of Nov. 4, 2006 in Boston. We have developed a full three-day program with innovative and interactive oral sessions, roundtables and special sessions. This year our reception will be hosted by local community-based organizations that employ CHWs. Our special committee to liaison with other sections, SPIGs and caucuses has been developing relationships with those groups in order to establish contacts and cooperative efforts. And our Membership Committee continues its efforts to recruit and retain members.

Our newsletter editor, Gail Ballester, has put together this comprehensive and informative edition of our newsletter to provide an update of our current activities.

Our CHW Research section highlights an article by Dr. Nell Brownstein of the Centers for Disease Control and Prevention that investigates the training of CHWs in Alabama's Black Belt to reduce health disparities associated with heart disease and stroke. Dr. Brownstein has been a strong advocate of CHWs and has published her work in numerous professional journals.

As you can imagine, our CHW Policy Update section includes several pieces on evolving legislative, research and organizational issues relevant to our field. Our governing council representatives, Lisa Renee Siciliano and Durrell Fox have written an article on the Massachusetts Health Care reform platform that includes a report on recently passed legislation in support of CHWs in that state. Dr. Jackie Scott of the Georgetown University Law Center wrote a report on the progress in the formation of the National CHW Network that aims to bring together local, statewide and regional associations of CHWs across the United States and the Native American Nations. And Carl Rush of Community Health Resources, LLC, includes an article on his efforts to put together a conference for researchers and administrators to describe a research agenda for the development of the CHW field.

This newsletter also contains reports from our Policy Committee, and The CHW Network Corner contains a listing of established and emerging CHW organizations. We have also included an article on our planned program for the APHA Annual Meeting and Exposition in November.

Please let me take advantage of this opportunity to thank all those who worked so hard to make this newsletter such a success. We deeply appreciate all you effort and support in the interest of moving our field forward and establishing CHW leadership of our field.

For comments, please contact me at Sergio@chwnetwork.org or our newsletter editor, Gail Ballester.

We Look Forward to Seeing You in Boston!

Please join us in historic Boston for APHA’s 134th Annual Meeting and Exposition on Nov. 4-8, 2006!

Continuing in our tradition of combining scientific papers with voices from the field and time for interaction, the SPIG has developed a full program of oral, poster, and roundtable sessions to learn about and discuss the current field of Community Health Worker Programs. Session titles include:

  • Capacity Building and Training for CHWs
  • CHWs as Integral Members of the Health Care Delivery Team
  • Documenting Outcomes and CHW Program Evaluation
  • New and Emerging Roles for CHWs, Including Researchers, Patient Navigators, Trainers, etc.
  • Other Issues of Importance to CHWs
  • Public Health & Human Rights: The Role of CHWs

In addition, we invite you to attend other activities such as our regular business meeting and reception. We are also planning a special session to highlight some of the cutting-edge programmatic and networking activities that have been done in Massachusetts. Please see the next issue of the newsletter for more details. We look forward to seeing you and to advancing the field of Community Health Workers together!

CHW Policy Committee Update

The Policy Committee has been working diligently on creating a definition for Community Health Workers to serve as an umbrella term for Community Health Workers. At this time there are a number of CHW definitions, and by no means is the umbrella definition to take the place of existing ones within the already established CHW associations or networks. The Policy Committee has been researching the steps to take to have this CHW definition added to the Bureau of Labor Statistics Standard Occupational Classification list. It is important for a CHW definition to be added to SOC, so that data can be collected. The Policy Committee has reached out to known CHW networks, and associations for feedback. Many have responded, and some have not. Now is not the time to discuss whose definition is better, or who will or will not participate with this important task. Now is the time to unite. If CHWs continue to be nameless, we will continue to be faceless.

It is imperative for all organizations, networks and associations who are concerned about the profession of Community Health Workers to embrace one definition which we can all live with. We have a choice. We can step to the plate and accept responsibility for our profession (yes, I used the word profession), or step aside and let someone else decide what we do. I believe this definition should come from CHWs. I would like to extend an open invitation to all Community Health Workers to participate in this important task of creating this definition. The CHW SPIG Policy Committee meets every 2nd Thursday of the month at 2:30-3:30 p.m. Eastern Time, via telephone. Feel free to contact me at (616) 391-3473 if I can be of further assistance.

Massachusetts CHWs Impact Health Care Reform

Massachusetts Gov. Mitt Romney signed a groundbreaking health care reform bill into law in March of this year, which you have probably heard about. The information you may not have yet is that the CHW legislation written by the Massachusetts Community Health Worker Network is included in the bill! The health care reform bill is now Chapter 58 of the Acts of 2006 and the CHW bill, drafted as "An Act Providing for Investigation and Study by the Department of Public Health Relative To Community Health Workers" has become Section 110 of the new health care reform bill. In addition to Section 110, Chapter 58 also places CHW representation on the state Public Health Council and provides funding for outreach and enrollment for the state Medicaid program. This is a victory for Massachusetts CHWs and speaks to the role of CHWs in increasing access to health care and reducing health disparities.

Section 110 mandates the Department of Public Health to conduct the study, assemble an advisory council to develop the study, interpret its results and make recommendations to the legislature for a sustainable community health worker program. The advisory council will be chaired by the Commissioner of Public Health or his designee and will include representation from MACHW, the Office of Medicaid, Department of Labor, Outreach Worker Training Institute of Central Massachusetts AHEC, Community Partners’ Health Access Network, Massachusetts Public Health Association, Massachusetts Association of Health Plans, Boston Public Health Commission, Massachusetts Center for Nursing, Massachusetts Medical Society, Massachusetts Hospital Association, the Massachusetts League of Community Health Centers and the MassHealth Training Forums. The composition of the advisory council of both public and private entities will assist in creatively funding and sustaining CHW programs. The Department of Public Health will report the findings to the legislature by Jan. 1, 2007.

While this is indeed a victory, CHWs now need to ensure implementation. MACHW has met with Commissioner of Public Health Paul Cote to discuss moving the law forward. MACHW has been working with the Division of Primary Care and Health Access on CHW issues, but this marks the first time MACHW representatives have met with the Commissioner. He understands the important work of CHWs, and we look forward to collaborating with him. In addition, MACHW will play an active role to ensure that CHWs maintain a seat on the Public Health Council and that outreach and enrollment dollars reach CHW programs.

To view Chapter 58 in full visit www.mass.gov/legis/laws/seslaw06/sl060058.htm. A summary of Chapter 58 is available at www.mass.gov/legis/summary.pdf. For additional information on the MACHW Network or our legislative efforts, please contact Lisa Renee Siciliano at lrsiciliano@aol.com or (508) 856-4852.

Community Health Workers: Closing Gaps in Families’ Health Resources

Policy Brief No. 14 of the National Human Services Assembly, March 2006

The Family Strengthening Policy Center of the National Human Services Assembly issued a detailed policy brief about the key role CHWs play in assisting families. It states: "Low-income families face multiple barriers to accessing timely, quality services necessary to protect their health. A wide variety of organizations have found community health workers can play a critical role in helping families manage their health." What follows are a few excerpts from the policy brief.

Overview 
A wide variety of public, nonprofit and corporate organizations have found community health workers can play a critical role in helping families manage their health. Specifically, CHWs leverage their insiders’ understanding of the families they serve to expand and enhance their health resources. Only a small subset of CHWs provides medical care.

Facing an ever-diversifying demographic base, health and human service practitioners want to increase the use of CHWs. Their experience indicates CHWs are particularly effective in reaching vulnerable and underserved families. These practitioner perspectives are mirrored by a growing research base that indicates CHWs increase underserved populations’ access to health care.

Changes in public policies would help CHWs become a sustainable and highly effective component of health and human service delivery. Organizations serving families with children also can take steps to realize the potential of CHWs.

Are CHWs Effective? 
A growing body of research is confirming what practitioners have known for years, that CHWs are effective in:

  • Improving access to and use of health care, including preventive health and chronic disease management.
  • Increasing health knowledge.
  • Improving health indicators.

However, these results are not consistently achieved in all CHW programs. The most effective services appear to be in improving access to health care.

In the landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine similarly concluded: "Community health workers offer promise as a community-based resource to increase racial and ethnic minorities' access to healthcare and to serve as a liaison between healthcare providers and the communities they serve."

Studies and experience suggest CHW programs can achieve other results:

  • Increase enrollment in health insurance programs.
  • Initiate service development or expansion in underserved communities.
  • Increase clients’ use of community resources.
  • Collect data to inform for policy.

Many programs claim CHWs are cost-effective, but relatively few have conducted rigorous analyses.

Going from the Margins to the Mainstream 
Despite positive outcomes, CHWs are underutilized in many community settings. Going to scale will require overcoming four critical challenges that are interrelated:

  • Inadequate funding keeps CHW programs from achieving their potential.
  • Within the health and human service sectors, CHWs often are not recognized as legitimate providers.
  • The lack of direct reimbursement for CHW services by Medicaid and other programs serving low-income families compounds the first two challenges.
  • The lack of accepted CHW standards – such as a definition, core competencies and scope of practice – impedes CHWs’ ability to link families with a full range of community supports.

Additionally, the policy brief makes some policy recommendations. These recommendations and the entire policy brief can be found at: www.nassembly.org/fspc/practice/documents/Brief14.pdf.

Gathering Planned to Create National CHW Research Agenda

Dozens of top researchers, government and health industry officials and CHWs will gather in Dallas early next year for two days to resolve the need for more conclusive research on the CHW field.

Several studies in recent years have noted that while CHWs appear to produce significant results in improving the health of communities, there is a shortage of solid quantitative evidence need to justify policy decisions like greater reliance on CHWs in Medicaid and other public programs. This lack of an "evidence base" is believed to be a major factor holding back advancement of CHWs as a recognized field.

The conference will produce a document representing a national consensus on the research agenda needed on CHWs, their cost-effectiveness and workforce development needs. This agenda will serve as a guide to funders and researchers in creating the necessary research projects. An ongoing task force will advocate for completion of the agenda.

Supporters of the conference include The California Endowment, the Northwest Area Foundation and the California Health Care Foundation, with other requests for support pending.

For more information contact Carl Rush at (210) 745-0560 carl@chrllc.net or Lee Rosenthal at (915) 747-8233 elrosenthal@utep.edu.

Update: National CHW Network

CHWs are moving forward to make a national CHW network a reality. During a productive conference call in mid-November, a group of CHWs and CHW supporters began looking at existing national organizations that may serve as useful models for a CHW network. The group will continue to make comparisons between established associations, which helps to clarify the CHW vision for a national network and the design of an effective organization.

The group’s next step is to recruit a Steering Committee to shape the vision for a national CHW network. This group will make key decisions about the structure of the network and its administration, including (1) how membership and leadership of the organization will be structured, (2) where the organization will have its headquarters, and (3) what kinds of benefits will be provided for members. It is therefore crucial that the members of the Steering Committee represent the diversity of the CHW field, in terms of practice area, race, ethnicity and geography. Diverse opinions from the very beginning of the discussions will be instrumental in building an inclusive and effective national network.

A national network can give CHWs the strength of a unified voice and the opportunity to bring the successes of the various state-level CHW associations to a national scale. A national CHW network will be able to focus energy on promoting federal legislation affecting CHWs, and it will work to ensure that CHW concerns and experiences are represented in the policy-making process. A national network will also bring together the diverse community of CHWs into an interconnected unit, improving CHWs’ ability to communicate with and learn from each other’s experiences.

In order to keep the process of shaping the national network CHW-driven, the group needs CHWs to come forward and commit to bringing the network into existence. The Harrison Institute at Georgetown is ready to serve in an advisory capacity and to provide research, organizational, or other help, as directed by CHWs on the Steering Committee. Development of the CHW network will advance this summer, with more conference calls taking place and progress being made.

If you would like to be involved, or for more information, please contact Elinor Ament at the Harrison Institute, esa23@law.georgetown.edu, (508) 524-6434.

Training Community Health Workers to Reduce Health Disparities in Alabama’s Black Belt: The Pine Apple Heart Disease and Stroke Project

We are very pleased to highlight CHW research in this newsletter. Dr. J. Nell Brownstein, who serves as the Communications Chair for the SPIG, and who works at the Centers for Disease Control and Prevention, has submitted the following abstract of her recently published research. If you would like a copy of the whole article, please call Nell at (770) 488-2570, or e-mail her at Jnb1@cdc.gov.

ABSTRACT: African American women have significantly higher mortality rates from heart disease and stroke than White women despite advances in treatment and the management of risk factors. Community health workers (CHWs) serve important roles in culturally relevant programs to prevent disease and promote health. This article describes the Pine Apple Heart and Stroke Project’s activities to (1) revise the Women’s Wellness Sourcebook Module III: Heart and Stroke to be consistent with national guidelines on heart disease and stroke and to meet the needs of African American women living in rural southern communities; (2) train CHWs using the revised curriculum; and (3) evaluate the training program. Revisions of the curriculum were based on recommendations by an expert advisory panel, the staff of a rural health clinic, and feedback from CHWs during training. Questionnaires after training revealed positive changes in CHWs’ knowledge, attitudes, self-efficacy, and self-reported risk reduction behaviors related to heart disease, stroke, cancer, and patient–provider communication. This study provides a CHW training curriculum that may be useful to others in establishing heart disease and stroke programs in rural underserved communities.

Melissa C. Kuhajda, PhD; Carol E. Cornell, PhD; J. Nell Brownstein, PhD, MA; Mary Ann Littleton, PhD; Varena G. Stalker, MPA; Vera A. Bittner, MD, MSPH; Cora E. Lewis, MD, MSPH; James M. Raczynski, PhD

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 Newsletter Editor Gail Ballester at gail.ballester@state.ma.us or (617) 624-6016.

State and National CHW Networks

COMMUNITY HEALTH WORKERS NATIONAL NETWORK ASSOCIATION
Wandy Hernandez, Chair, Chicago Health Connection, 957 W. Washington Boulevard, Chicago, IL 60607; 312-243-4772; Zeida Estrada, Secretary; Gateway to Care, Harris County CAP 6201 Bonhomme #243-S, Houston, TX 77036, (713) 783-4616; www.chwnna.org
.

Arizona
Arizona Community Health Outreach Workers Network (AzCHOW), Of, By, and For Community Health Outreach Workers; www.publichealth.arizona.edu/azchow/
; Lourdes Fernandez, Co-Chair chachaml@hotmail.com; Flor Redondo, Co-Chair, redondos1271@aol.com; Belen Feather, Secretary.

California
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; email: chwpromotoras@aol.com, or Maria at: mholl67174@aol.com.

Orange County CAA (Certified Application Assistor ) Task Force, a non-profit professional association for Care Coordinators, Health Advocates, Promotoras etc. They meet once a month for program updates, training and to share best practices as well as to network. Contact: Maria Wahab, Chair, Children's Hospital of Orange County, 455 S. Main St., Orange, CA, 92868-3874; Office: (714) 516-4334; Fax: (714) 532-8785; E-mail: mwahab@choc.org.

Florida
REACH-Workers – the Community Health Workers of Tampa Bay. Please contact Michelle Dublin, Chairperson of the network, at (727)-588-4018 or Michelle_Dublin@doh.state.fl.us.

Maryland
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; dyamira34@yahoo.com.

Massachusetts
Massachusetts Community Health Worker Network (MACHW), Lisa Renee Siciliano, Director, lrsiciliano@aol.com, (508) 856-4852, University of Massachusetts Office of Community Programs, 222 Maple Avenue, Shrewsbury, MA 01545.

Michigan
Michigan Community Advocate Association (MICAA), Contact: Maria Alvarez deLopez, maria.alvarez@spectrum-health.org; President-Roshawnda S. Thompson - RoshawndaT@cssgr.org; (616) 356-6205 or (616) 827-2094 or (616) 366-2759.

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

New Mexico
New Mexico Community Health Workers Association (NMCHWA), P.O. Box 81433, Albuquerque, New Mexico 87198, nmchwa@correocaliente.com or BJ Ciesielski, bciesielski@salud.unm.edu, (505) 272-4741.

New York State
NEW YORK CITY - Community Health Worker Network of NYC; 425 E. 25 Street; New York, NY 10010; (212) 481-7667 phone; Sergio Matos, Elena Schwolsky, Rita Taylor, and Romy Rodriguez; http://chwnetwork.org/; ror9001@cpphealth.org.

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

Oregon
Oregon Community Health Workers Association, 9000 N. Lombard Street--2nd Floor, Portland, OR 97203, (503) 988-3366 x28686, Teresa Ríos, teresa.c.rios@co.multnomah.or.us, or Veronica Lopez Ericksen, xiomara.t.lopez@co.multnomah.or.us.

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 subscriptions to 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 www.apha.org or e-mail membership.mail@apha.org.

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 2006 Community Health Worker SPIG Executive Board

Chair
Sergio Matos
Community Health Worker Network of NYC
(718) 703-9340
sergio@chwnetwork.org

Immediate Past Chair/Governing Council Representative
Durrell Fox
New England HIV Education Consortium
Massachusetts Community Health Worker Network
23 Miner Street
Boston, MA 02215
(617) 355-8421
Dfoxnehec@aol.com

Secretary
Crystal M. Brown
crystalmbrown@comcast.net

Governing Council Representative
Lisa Renee Siciliano
Massachusetts Community Health Worker Network
(508) 856-4852
Lrsiciliano@aol.com

Program Planners 2006
Tammi Fleming
Public/Private Ventures Inc.
2000 Market St., Suite 600
Philadelphia, PA 19103-3231
(215) 557-4487
TFleming@ppv.org

Elena Schwolsky-Fitch
Director of Training & Staff Development
New York City Asthma Initiative
2238 135th St., 2nd Floor, room 231
(212) 676-2574 (Voicemail only)
eschwols@health.nyc.gov

Policy Committee Chair
Maria Alvarez deLopez, CHW
MOMS - Mothers Offering Mothers Support
Spectrum Health Hospital
75 Sheldon SE, Suite 203
Grand Rapids, Mi. 49503
Phone: (616) 391-3473
Fax: (616) 391-6185
maria.alvarez@spectrum-health.org

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

Carl Rush
(210) 745-0560
carl@chrllc.net

Communication/Continuing Education
Nell Brownstein
Centers for Disease Control and Prevention
4770 Buford Hwy NE MS K47
Atlanta, GA 30341-3717
(770) 488-2570
Jnb1@cdc.gov

Newsletter Editor
Gail Ballester
Massachusetts Department of Public Health
Boston, MA 02108
Phone: (617) 624-6016
Fax: (617) 624-6062
gail.ballester@state.ma.us