1. APHA 138 th Annual Meeting and Expo - “Social Justice” Presented at the Community Health Worker Section November 8, 2010 - Session 3022.0 Colorado Convention Center - Denver, CO Sergio Matos – Community Health Worker Network of NYC Jacqueline Martinez – NYSHealth Foundation Sally Findley – Columbia University Mailman School of Public Health April Hicks – Columbia University CHW Initiative

2. The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Sergio Matos Jacqueline Martinez Sally Findley April Hicks No relationships to disclose

3. Leading Causes of Death, 1900 Leading Causes of Death, 2000

4.  Preventing/managing chronic disease  Rebuilding community power  Spiraling health care costs  Managing care for populations with complex needs Difficult life circumstances Multiple chronic conditions Mental health and substance abuse Multiple social and economic challenges Depression

5.  Burgeoning literature demonstrating CHW effectiveness across many different conditions  CHWs are the solution to what ails us  Several states have started the process  Large workforce – 11,000 in NYS  CHWs provide an efficient business model  CHWs help meet mandates of federal legislation and policies Patient Centered Medical Homes Patient Protection and Affordable Care Law Chronic Care Model Health Homes

6. Who are Community Health Workers? Frontline public health professionals Trusted members of the communities they serve Share life experiences and circumstances with population served Agents for change – micro and macro level

7. Liaisons between communities and health and social services Improve access Improve the quality and cultural appropriateness of service delivery help people integrate disease prevention and management regimens into their daily situation Build community by combating social isolation and exclusion Address social determinants of health Lower health care costs

8. Increased access and quality of services Improved health outcomes, especially for chronic conditions Reduced/eliminated persistent inequities in health outcomes Increased social capital & community connectedness Healthier communities and individuals Lowered health care delivery costs fewer resource-intensive ED visits Fewer hospitalizations Increased use of prevention and primary care services

9.  Increased access health insurance coverage increased & more consistent for children (RCT in Boston)  Lower costs 40% reduced ED visits – 27% reduced Medicaid expenses (diabetes) – average savings $2,245 per patient per year (Baltimore)  Return on Investment ROI of $2.28 per dollar invested (underserved men in Denver)  Cost savings Decreased per capita expenses 97% in an asthma program (Hawaii)

10. Large CHW workforce –11,000 in NY  No standard reimbursable/billable scope of practice No training standards or credentialing process Lack of a sustainable funding streams Predominance of short-term categorical funding of health Health care system focus on narrowly defined issues in narrowly defined units of attention Priority use of experimental design for evaluations

11. Establish sustainable financing for the CHW workforce in NY Organize CHWs and CHW stakeholders Develop CHW leadership Standardize CHW scope of practice Implement statewide training and certification standards for CHWs – under CHW leadership Identify and secure stable financing streams and reimbursement/billing mechanisms for CHWs Public Private Corporate

12.  Identify and support strategically located clusters of CHW activity Locate existing or emerging CHW networks Contact concentrations of stakeholders Approach large employers of CHWs NYC, Albany, Buffalo/Niagara Falls, Rochester, North Country (Adirondacks)  Foster local leadership Provide support (not governance) Support preserving local character and identity Maintain humility and respect  Utilize training and conferencing as organizing tools Training in core competencies motivates CHWs One day conferences, forums and CHW learning days  Financial and technical support to emerging networks Laptops, printers, A/V equipment  Many face to face meetings (and more…)  Converge regional centers of activity into statewide federation

13. Scope of practice Training Standards Certification Stable Financing!!!

14.  NYSHealth Foundation Committed to the health of New Yorkers Recognizes the vital role of CHWs Launched Diabetes Initiative  CHW Network of NYC Independent professional association of CHWs 400 members from over 250 organizations Policy and training institute  Mailman School of Public Health, Columbia U Education of the public health workforce is our charge; includes exploring best practices for educating CHWs as members of the public health workforce Research with 40 studies in NY community, 13 concerning CHWs; survey leadership to support initiative with CHW surveys and market analysis

15.  Be absolutely diligent in your visioning  Develop clear and consistent messages  Preserve core principles throughout the process Self determination CHW leadership  Be flexible but principled  Consider appropriate governance of the CHW practice from beginning  Maintaining CHW leadership is a constant effort – not a one-shot deal  Be prepared to negotiate multiple stakeholder agendas and cultures  Draw on the experiences of others

16. New York State Health Foundation 2-Year grant November 2009 – October 2011 $490,000 award Legislative/policy advocacy with NYSHF Public relations support from NYSHF Kellogg Foundation $370,000 award - supplemental support Communications Meeting/Conference activities External evaluation

17. Sergio Matos, Exec Dir Community Health Worker Network of NYC 212-304-6415 sergio@chwnetwork.org Sally Findley, Clinical Professor Columbia University 212-304-5790 sef5@columbia.edu Jacqueline Martinez, Sr. Prg. Dir NYSHealth Foundation 212-584-7672 martinez@NYSHealth.org April Hicks, Co-Director CHW Initiative of NYS Columbia University 212-304-7311 ah2874@columbia.edu