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Community Health Worker - Archived Newsletters
Section Newsletter
Winter 2006

Message from the Chair

Greetings! Welcome to all community health workers (CHWs), our allies and our advocates.

I write this first letter as the new chairperson of the Community Health Worker SPIG with excitement and hope for the future. APHA is the largest organization of public health professionals in the world. As an integral part of this global organization, the Community Health Worker SPIG stands poised to advance the CHW movement and help integrate CHWs more fully into the healthcare system with dignity and respect.

As health professionals we find ourselves in especially troubling times. There is a lot of bad news. You have heard and lived it all. Continuing and increasing inequalities in health and social justice among poor, working poor and middle income families are alarming. The prevalence of chronic disease in these communities is frightening. Recent reports show asthma and diabetes prevalence rates as high as 20% in poor and working poor neighborhoods in NYC. HIV and AIDS incidence is increasing again. Obesity, hypertension and heart disease continue to shorten life expectancy and quality of life throughout the U.S. Mental health problems are affecting all sectors of our society and continue unchecked. Current economic policies have led to increasing poverty and decreased opportunity all across America. Poverty, in fact, continues to be our most pressing public health crisis. Our middle class is quickly eroding as economic policies that favor the very rich continue.

In spite of these enormous problems, the federal government continues policies that diminish social supports and generate poverty. Government support for child care, after-school programs, youth development and summer jobs have been all but eliminated in favor of tax cuts for the very rich. Restrictions in the Medicaid program are excluding those who need it most. Medications are too expensive for most Americans – who often have to choose between buying medications or feeding themselves and their families. War is killing our children and eroding our tradition of mature and intelligent global leadership.

Enormous challenges such as these may seem overwhelming or even cause some to lose heart. But this is where we have good news. Community health workers (CHWs), who are trusted members of the communities they serve and function as frontline public health professionals, face these challenges every day. Furthermore, they practice in a way that supports community development and individual empowerment. CHWs serve as community advocates -- linking people to services, bridging gaps between institutions and communities and helping inform health and social service institutions. CHWs often work with limited resources and diminishing support. They are driven by a passion and commitment to community. As stated by the World Health Organization in 1992, "…CHWs are supported by the health system but not necessarily as part of its organization." In fact, CHWs have a long and noble tradition of service to community that is often independent of politics or healthcare systems. From Barefoot Doctors to Promotores, Village Health Workers, Community Health Representatives and Outreach Workers, CHWs have been helping health and social systems reach communities for many years and in many cultures. Governments and organizations change but CHWs persist. We are a part of the very fabric of society.

The enormity of the public health crises we face today, however, has led health systems to look to the CHW model as a way of accessing communities that are difficult to reach with traditional public health approaches. CHWs work as community follow-up workers in the comprehensive case management of HIV/AIDS prevention and treatment. CHWs work as health educators and outreach workers in chronic disease management programs for asthma, diabetes and hypertension. Private businesses such as managed care organizations and social service organizations hire CHWs to find people in need of services and to lower the cost of chronic disease management. Even business-academic partnerships are developing in support of CHWs. This is exciting and provides an opportunity for us to develop our practice and establish our role as frontline public health professionals.

So, I remain excited about the coming years that I will serve the Community Health Worker SPIG at APHA. There are certainly significant challenges before us. But through the hard work done by those who came before us, we stand poised to assume leadership of our profession and determine our future – a future where we can inform policy and practice issues that affect our field. We also have within our grasp the ability to make the healthcare system in the United States more responsive, appropriate and accessible to the communities we serve – a moral responsibility that the system has failed to address. Our immediate past chair is fond of quoting the Reverend Dr. Martin Luther King when he said "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane." I look forward to the coming years as we come together in the struggle against these social injustices and blaze a path to the future for the field of community health workers.

CHW Policy Update: Patient Navigator Bill

In 2005, Congress passed the Patient Navigator and Chronic Disease Prevention Act, a giant step forward for CHW recognition on a national level. This legislation defines the role of the patient navigator and authorizes a five-year, $25 million demonstration grant program to fund pilot patient navigator programs. The task of patient navigators is to help patients with cancer or other chronic diseases navigate their way through the highly complicated health care system. The bill provides funding for (1) entities that employ patient navigators, such as public or nonprofit private health centers, hospitals, cancer centers, rural health clinics; and (2) increased community outreach programs to make people aware of the need for prevention screenings and clinical trials. The bill also gives a general description of the duties and responsibilities for entities that will be eligible for funding and for the types of patients that are eligible for the services specified. The Health Resources and Services Administration of the Department of Health and Human Services will administer the grant program.

Unfortunately, the bill was not funded during this year’s appropriations cycle. Because the bill was passed after White House budget priorities were set, funding for it was not included in this year’s appropriations bills. The program could potentially be funded in subsequent years, but $25 million over five years on a nationwide scale is unlikely to have a significant direct impact on community health workers. Despite these challenges, passage of the bill signifies congressional and presidential support of funding for CHW work and programs. Further federal developments may be possible, and state governments can step into this gap left by lack of federal funding to support CHW programs in similar ways.

For more information please contact Alix Pereira at arp23@law.georgetown.edu or Julia Richardson at jer38@law.georgetown.edu.

CHWs as Interventionists in the Prevention and Control of Heart Disease and Stroke

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: A considerable body of research indicates that community health workers are effective in improving chronic disease care and health outcomes. Much of the focus of cardiovascular research involving CHWs has been on hypertension because of its high prevalence and because it is a major risk factor for cardiovascular, cerebrovascular, adrenal diseases. Adding CHWs to the patient–provider team has a beneficial effect on the quality of care for populations most in need. CHWs have contributed to significant improvements in community members’ access to and continuity of care and adherence to treatment for the control of hypertension. CHWs assume multiple roles, including patient and community education, patient counseling, monitoring patient health status, linking people with health and human services, and enhancing provider patient communication and adherence to care. Current recommendations for CHWs to be interventionists on healthcare teams and in community-based research increase opportunities for CHWs to play an important role in eliminating disparities in heart disease and stroke. Adequate translation of research into clinical practice remains a major challenge, however. Addressing this issue, which has national implications, will require sustainable funding; appropriate reimbursement; enhanced efforts to incorporate CHWs into healthcare teams; better utilization of their skills; improved CHW supervision, training, and career development; policy changes; and ongoing evaluation, including a reporting of costs.

J. Nell Brownstein, PhD, Lee R. Bone, RN, MPH, Cheryl R. Dennison, CRNP, PhD, Martha N. Hill, RN, PhD, Myong T. Kim, RN, PhD, David M. Levine, MD, ScD, (Am J Prev Med 2005;29(5S1):128–133) © 2005 American Journal of Preventive Medicine

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 spring, 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.

CHWs Hosted Packed Program in Philly and Look Forward to Boston!

The Community Health Worker Special Primary Interest Group (CHW SPIG) hosted a very successful and well-attended program in Philly this past December. Anyone who is familiar with the work of CHWs knows that they are flexible and resilient, so it was no surprise that our program planning last year was co-led by Tammi Fleming, a CHW from New Orleans. Our original program had been designed to highlight local CHW efforts in New Orleans, and with much grit and determination, our program in Philly was reshaped to feature the extraordinary efforts of CHWs in response to Katrina! In fact, with scholarship support from the Harold and Grace Sewell Trust Fund, organized by the SPIG, several CHWs were able to attend, for the first time, the APHA Annual Meeting.

We were all inspired by their courage, as well as a diverse program co-planned by Elena Schwolsky featuring sessions on CHW capacity-building, program evaluation and integration into the health care team, among other topics. Our sessions were, for the most part, co-presented by community health workers and all of them were overflowing. Thanks to all of those who helped to make this program such a success.

This year’s 2006 program in Boston will also continue our commitment to community health worker presenters as we have issued our Call for Abstracts and look forward to the many abstracts we anticipate receiving. The 2006 APHA Annual Meeting & Exposition theme, "Public Health and Human Rights," will focus on human rights issues in areas with which CHWs are very familiar: immigrant rights, indigenous rights, and social justice, to name a few.

The CHW SPIG has worked hard this year to expand our visibility and recognition within APHA. We look forward to continued collaboration with other SPIGs, sections and caucuses as we plan for Boston 2006. We hope you can join us as we continue to increase understanding and recognition of CHWs and their vital role in public health!

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: 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; e-mail: 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. 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.

Community Health Workers take on HIV/AIDS in the Caribbean

As the HIV/AIDS epidemic ravages the countries of the Caribbean, community health workers are taking on the challenge.

I am a community health worker and the International Coordinator of the US-Caribbean HIV/AIDS Twinning Initiative. The Twinning Initiative is an international project funded by the Human Resources and Services Administration to share best practices, increase primary care capacity, use technology to train HIV/AIDS providers and build an infrastructure in the Caribbean region to facilitate the provision of services. In order to build infrastructure, we are helping governments develop and implement CHW programs to address the crisis of HIV and AIDS in the region. The Initiative began by "twinning" with Trinidad & Tobago and Guyana but has extended to include the nations of the Organization of Eastern Caribbean States (St. Lucia, Dominica, St. Kitts, Grenada, St. Vincent and Antigua) and the Bahamas. This project also includes training clinical staff and helping clinical facilities to implement practice management efficiencies such as medical records and monitoring systems. We also help organizations develop technological capacity by providing computer equipment, software and training. For this article, I will focus on the CHW component of the project.

In these Caribbean countries, HIV infection and AIDS is increasing in both incidence and prevalence. New cases of HIV are doubling every few years. In Trinidad, 60 percent of new cases are in women aged 14- 24. Accurate numbers are hard to collect because of the limited capacity for monitoring and evaluation coupled with enormous stigma and discrimination associated with being HIV+. Many of these countries are relatively small societies where most residents know of each other and there are few safeguards to protect confidentiality. In its 2003 report, the Ministry of Health noted that "Most people living with HIV infection in St. Lucia were not reported to MOH for a number of reasons; including reluctance among people to seek voluntary counseling and testing due to concerns about stigma and discrimination. People often have HIV tests performed out of country to avoid disclosure issues. Those who have the means do not seek health care services in their own countries because treatment is not readily available through the public health system." These circumstances combine to create many obstacles to testing, monitoring and treatment. Discrimination and social hysteria prevalent in the region results in severe consequences for anyone testing positive. People who test positive often suffer abandonment by their friends/families, loss of employment, loss of residence and social isolation. It is no wonder that residents of these countries are hesitant to get tested.

In response, the healthcare systems in these countries are turning to CHWs to access communities at risk for HIV/AIDS. CHWs are conducting outreach, supporting people living with HIV/AIDS and helping link people to services. They are encouraging people to get tested. They help HIV+ persons to reintegrate with their families and society. They promote safer sex practices, including abstinence and condom use. They work in homes, churches, barber shops and hair salons – anywhere they can meet with people. They stop people on the streets to talk about HIV and AIDS. They frequent clubs and street festivals. During Carnival celebrations and other social events, these CHWs are out in numbers handing out condoms and encouraging people to protect themselves. Because of the trust they enjoy from their communities, the CHWs in the Caribbean are able to reach communities with messages that are culturally and linguistically appropriate. Because of their passion for community, they serve people that other health professionals are afraid to treat. In these countries, it is CHWs that people turn to for their healthcare needs.

And their work is not limited to HIV and AIDS. CHWs in the Caribbean do home visits to help people learn how to monitor their sugar intake. They help people change their diets to limit the damage from diabetes and high-blood pressure. They even do home care where they treat wounds and change dressings. In St. Lucia, a cadre of CHWs works with the elderly to help them develop their social capital and lead fuller lives. According to the nurse who runs the program, this effort alone has increased the life expectancy in St. Lucia by 10 years in the last decade. Some CHWs work in the public health system where they do disease screening, health education and patient advocacy. Still others work for non-government organizations.

A major part of my work is meeting with CHWs to determine their training needs and develop programs that meet those needs. In focus groups designed to assess their training needs, CHWs often report that they receive training in the health issues addressed by their programs but very little training in the core skills and competencies they need to conduct their work. They are very clear that they need training in communication skills. They also want training in informal counseling and behavior change. They want to know more about popular education and experiential learning methods. They are invariably interested in learning how to help people become more empowered and build capacity in their communities. And they want to know more about setting personal boundaries and professional behavior -- that’s a big one. In response to these needs, we have developed a 35-hour training program that develops the core competencies that have come to describe the work of CHWs. These include many of the skills identified in the "National Community Health Advisor Study" published in 1998 – a policy research project of the University of Arizona funded by the Annie Casey Foundation. A unique aspect of the CHA Study was that it was informed and driven by CHWs who contributed their time and wisdom to the project. This is important because by involving CHWs the authors were able to produce a quality product that continues to support the growth and development of the CHW field here in the US and abroad. This speaks volumes for the importance of involving CHWs as active participants in research and policy issues relevant to our field.

Having worked with hundreds of CHWs in the region, I am continuously impressed with the passion these extraordinary workers bring to their work. Some of them travel miles (on foot) to visit their clients. Most of them make very little money and yet they serve out of a commitment to their communities. They struggle with many of the same issues as CHWs here in the U.S. They want more opportunity for training. They want stable funding and support. They want to be respected by their colleagues in the public health sector. They want to be heard.

In an effort to include CHWs in our twinning efforts, our program was able to fund two CHWs from St. Lucia to attend the recent annual conference of the Community Health Worker Network of NYC which was held at the Pennsylvania Hotel in midtown Manhattan. They were a huge hit at the conference where they ran a session on "International Perspectives for CHWs." They discussed their many challenges and successes. They shared case studies from their work and how they struggle with limited resources. They developed a deep sense of camaraderie with American CHWs who shared time with them. During the two days following the conference, the CHWs from St. Lucia visited community-based and government programs that employ CHWs in various arenas. They visited maternal-child health programs, chronic disease management programs and even spent time at a COBRA program that utilizes CHWs to perform comprehensive case management for people living with HIV and AIDS. At each of these sites they were able to share time with other CHWs and exchange stories from the field. It was a wonderful experience for all those involved.

Working with CHWs in the Caribbean has really expanded my vision for the field and continues to give me energy and enthusiasm for the work ahead. We hope to continue this "twinning" between CHWs here in the U.S. and those working in the Caribbean as a model for the exchange of information, resources and best practices between fellow public health professionals.

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 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
Program Specialist
NJ CHW Institute
NJ AHEC Program, UMDNJ-SOM
2 Laurel Rd. E., Suite 3200
Stratford, NJ 08084
856-566-6724
856-566-2754 fax
browncm@umdnj.edu

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
NJ AHEC Program
(856) 397-3937
rushch@umdnj.edu

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
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