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Brazos Valley Community Health Centers a division of BVCAA, Inc. Julie Ribardo, PhD Director of Health Education & Prevention February 2008.

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Presentation on theme: "Brazos Valley Community Health Centers a division of BVCAA, Inc. Julie Ribardo, PhD Director of Health Education & Prevention February 2008."— Presentation transcript:

1 Brazos Valley Community Health Centers a division of BVCAA, Inc. Julie Ribardo, PhD Director of Health Education & Prevention February 2008

2 About BVCAA, Inc. BVCAA, Inc. is a private not for profit agency Serving the 7 counties of the Brazos Valley since 1972 Providing health and social services to the underserved Mission Statement  To assist in the empowerment of individuals, families and communities to reach their full potential economically, educationally, health-wise, culturally and socially

3 Brazos Valley Community Action Agency, Inc. Health Services  Brazos Valley Community Health Centers (5 locations) Bryan-College Station CHC Grimes County CHC (Navasota) Robertson County CHC (Hearne) Madison County CHC (Madisonville) Leon County CHC (Centerville) College Station Community Health Center  Women, Infant, and Children (WIC) nutrition program  Family Planning Clinic in Washington County Community Services  Elder Aid  Head Start and Early Head Start  Food Services – Senior Nutrition  Energy and Housing Services  Child Care Management Services

4 What is an FQHC? Federally Qualified Health Center  Over 3000 FQHCs nationwide  Over 49 FQHCs in Texas All focus on medically underserved populations  Rural and urban  Migrant  Homeless Affordable health care  Sliding fee scale  Benefiting those at 200% or below of the Federal Poverty Income Limits Comprehensive package of services

5 Brazos Valley Community Health Centers Mission Statement  We strive to eliminate health disparities by offering quality primary and preventive health care to the medically underserved of the Brazos Valley Bryan-College Station Community Health Center became fully operational as an FQHC in December 2002 Expansion of satellite CHC’s Robertson County CHC in February 2004 Grimes County CHC in July 2004 Madison County CHC in August 2005 Leon County CHC in December 2006 College Station CHC in October 2007

6 B-CS Community Health Center Services include  Medical care (adults and pediatrics)  Dental care  Pharmacy Pfizer Sharing the Care program  Client Services Registration and eligibility determination Medical Case management Medication Assistance Program (MAP)  Health education  HIV Prevention  WIC nutrition program

7 B-CS Community Health Center Co-located agencies provide comprehensive package of services  TAMU Counseling and Assessment Clinic  Prenatal Clinic  Project Unity – Medical Case Management  TDHS – Medicaid Screening and Enrollment  Brazos Transit System

8 Brazos Valley Community Health Centers Adult Medicine 4 Family Practice Physicians 1 Family Nurse Practitioner 1 Women’s Health Nurse Practitioner 2 Physician Assistants 1 Dir. of Adult Health, RN 1 RN 1 Dir. of Quality Management, RN 2 LVNs 14 nursing staff (CNAs/CMAs/MAs) Dental Services 2 Dentists 4 Dental Assistants 2 Dental Students (periodically) Pediatric Medicine Medical Director/Pediatrician 1 full-time Pediatrician 1 part-time Pediatrician 1 Pediatric Nurse Practitioner 1 Director of Pediatrics, LVN 2 LVNs 4 nursing staff (CNAs/CMAs/MAs)

9 Brazos Valley Community Health Centers Over 16,918 unduplicated clients in 2007 Over 40,000 encounters in 2006 (dental & medical) Gender  66% Female  34% Male Race/Ethnicity  57% Hispanic  19% African American  20% White  1% Asian/Pacific Islander  1% Other Language  40% identify English as primary language

10 Brazos Valley Community Health Centers Poverty Level  66% 100% and below  29% 200 and below  3% Over 200%  2% Unknown Health Insurance Status  61% of clients are uninsured  31% of clients have Medicaid  2% of clients have Medicare  2% have CHIP (public insurance)  3% have private insurance

11 Health Education Department Overview

12 Health Education Department Mission  We strive to provide quality health education services to clients of the Brazos Valley Community Health Centers and individuals in the Brazos Valley in an effort to increase the practice of healthy behaviors Services  Patient Education  Community Education  HIV Prevention  Breast and Cervical Cancer case management  Staff Development

13 Health Education Department Staff  Director of Health Education  Full-time Staff Health Educator, Desiree Flores Health Educator, Carolina Diaz-Puentes HIV Prevention Specialist, Derek Gentry HIV Prevention Specialist, John Phelps BCCS, open  Health education interns/students  Volunteers Varies each semester

14 Patient Education Community Health Education Center (CHEC)  Health Education resource center at the CHC  Open Monday through Friday from 8:00 am – 5:00 pm  Services available by walk-in or appointment  Services include Public access computers for online health information Individual sessions with a health educator Brochures and health education written materials  Education and information provided on any health topic

15 Patient Education Diabetes and heart disease self-management  Individual educational sessions, coordinated visits, group sessions, and follow-up phone calls  Health education services include: assessment of educational needs, collaborative goal setting with patients, problem solving, action planning and follow-up Diabetes and heart disease prevention  Individual sessions for children and their caregivers Tobacco Use Cessation  Individual sessions to assist in quitting tobacco  Group series of 4 classes Family planning/reproductive health  Group classes twice a week in each language

16 Patient Education Partnering with Texas Cooperative Extension on two community education programs  Do Well, Be Well with diabetes (5 week program)  Diabetes Cooking School (4 week program) Partnering with Area Agency on Aging to offer Stanford Chronic Disease Self-Management Program  Living Well Brazos County (6 week program)

17 Community Education Promotores (Lay Health Advisor) Program  Implementing first promotores program in the Brazos Valley  Trained 9 volunteers to date Training includes: logistics of being a promotora, safety, professionalism, confidentiality, resources in the community, facilitating access to affordable health and social services, evaluation and the health topic of their choice (nutrition and family planning) Quarterly trainings and monthly meetings also provided to continue to increase skills and provide support to the volunteers  Volunteers conduct health education within their community and facilitate access to affordable health and social services  Volunteers began conducting outreach in their communities June 2005 on nutrition education

18 Community Education Educational Outreach  Programs on a variety of topics including Reproductive health, healthy relationships, communication skills, motivation for change, stress management, preventing diabetes and heart disease and much more!  Information dissemination through health fairs  Program advertisement through flyers at clinic, PSAs, press releases, and flyer distribution through network of local social and health service providers Tobacco use cessation program Teen pregnancy/STI prevention program Partnerships with community organizations  Do Well, Be Well with Diabetes  Cooking School

19 HIV Prevention HIV Prevention services  HIV counseling, testing and referral (CTR) Free anonymous/confidential CTR is provided at the community health center, local health and social service agencies, correctional facilities, and TAMU  Community Education and Outreach Includes street outreach, condom distribution, and education/presentations on HIV prevention

20 Breast & Cervical Cancer Services The Breast and Cervical Cancer Services program (BCCS) offers clinical breast examinations, mammograms, pelvic examinations, and Pap tests throughout Texas at no or low-cost to eligible women

21 Staff Development Staff development  Train staff once per month on a variety of topics including Stress management Cultural competency Communication skills Work styles Diabetes and heart disease basics  Health education staff provide training or coordinate guest speakers  Provide additional training as needed Departmental trainings Agency wide trainings and health services wide trainings

22 Intervention Details

23 Health Disparities Collaboratives FQHCs are invited to participate in National Health Disparities Collaboratives  BPHC began Collaboratives in 1997 with focus on Diabetes  Currently implementing Collaboratives on Diabetes Cardiovascular Disease Depression Cancer Asthma Redesign system to improve chronic illness care for patients with a specific condition  Chronic Care Model  Improvement Model  Learning Model Refer to for more informationhttp://www.healthdisparities.net/

24 Recipe for Improving Patient Care Know, apply, and monitor evidence based guidelines and standards of care Know and apply the Care Model Conduct PDSAs

25 Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization The Care Model Improved Outcomes

26 ActPlan StudyDo Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?

27 PDSAs Questions to ask yourself  What changes can we make that will improve our environment?  What changes can we make to better serve our patients?  What changes can we make to improve patients’ clinical measures?

28 Improved Outcomes Diabetes Guidelines  < 7.0% HbA1c  > 90% of patients with 2 HbA1c in last year  >70% of patients with self management goal  > 75% of patients with ACE/ARB  > 60% of patients on statin  > 40% of patients with blood pressure < 130/80  > 90% of patients with foot exam in last year

29 Improved Outcomes Cardiovascular Disease Outcomes  > 50% of hypertensive patients with blood pressure <140/90  > 90% of patients with 2 blood pressures in last year  > 80% of patients with fasting lipid profile documented  > 60% of patients with LDL cholesterol < 100 mg/dl  > 70% of patients with documented self management goal  > 90% of patients on aspirin or anti-thrombotic agent use

30 Benefits Better patient care Better disease management More patient participation Higher level of patient satisfaction Documented improvement of health status

31 Challenges Provider buy-in Data entry Resistance to change Reinforcement of implemented changes

32 What is Self-Management? “ The individual's ability to manage the symptoms, treatment, physical and social consequences, and lifestyle changes inherent in living with a chronic condition.” Barlow et al, Patient Educ Couns 2002;48:177

33 Self-Management Support Emphasize the patient’s active and central role in managing their illness Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving and follow-up Organize internal and community resources to provide ongoing self-management support to patients

34 Patient Education vs. SMS Information and skills are taught Usually disease-specific Assumes that knowledge creates behavior change Goal is compliance Health care professionals are the teachers Skills to solve patient identified problems are taught Skills are generalizable Assumes that confidence yields better outcomes Goal is increased self-efficacy Teachers can be professionals or peers

35 Self-Management in Office Practice Glasgow RE, et al (2002) Ann Beh Med 24(2):80-87 Personal Action Plan 1. List specific goals in behavioral terms 2.List barriers and strategies to address barriers 3.Specify Follow-up Plan 4.Share plan with practice team and patient’s social support ASSESS : Beliefs, Behavior & Knowledge ADVISE : Provide specific Information about health risks and benefits of change AGREE: Collaboratively set goals based on patient’s interest and confidence in their ability to change the behavior ASSIST : Identify personal barriers, strategies, problem-solving techniques and social/environmental support ARRANGE : Specify plan for follow-up (e.g., visits, phone calls, mailed reminders

36 Self-Management Partnership with Center for the Study of Health Disparities at TAMU  Diabetes Prevention and Management Project funded by National Institutes of Health (NIH) for 3 years  Staffed by Dir of Health Education and students from HLKN

37 Self-Management Intervention is informed by evidence-based practices guidelines, and standards, specifically,  National Health Disparities Collaboratives Including implementation of the Chronic Care Model and Improvement Model  National Standards for Diabetes Self-Management Education (2000) Developed by task force, including representatives AADE, American Diabetes Association, American Dietetic Association, Centers for Disease Control and Prevention  American Association of Diabetes Educators A Core Curriculum for Diabetes Education, 5 th edition (2003)  Chronic Disease Self-Management Education Program Developed by Lorig, K. et al at Stanford University

38 SMS Program Components Adult providers refer patients to health education Health education staff provide three specific services for patients with diabetes  Individual diabetes self-management education  Group self-management education and goal setting  Coordinated visits  Group nutrition education classes

39 Self-Management Tools Self-Management Goal Sheet  Patient selects one of 11 goals  10 are preset goals, one is individual Personal Action Plan  Specific plan  Barriers to changing behavior  Plans to overcome barriers  Confidence in ability to change behavior  Social support Health Education Notes Page  Topics covered  Materials distributed  Concerns expressed by the patient  Goal setting notes  Follow-up plan

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41 Personal Action Plan 1. Goal: something the patient WANTS to do 2. Describe the specific plan HowWhere WhatFrequency When 3. Barriers to changing behavior 4. Plans to overcome barriers 5. Confidence rating (1-9) 6. Social support 7. Follow-Up plan

42 Follow-up for Self-Management Educ Health education staff call patients in 1-2 weeks  Check on self-management goal(s)  Answer questions  Provide support Health education staff schedule follow-up appointments in 3-5 weeks  Total number of visits is individualized  Likely 3 visits

43 Self-Management Achievements 85% met their goal Decrease in HbA1c

44 Challenges of Self Management Project Partnership  Decision making  Financial management of grant  Sustainability  Research and benefiting the community Students  Holiday coverage  Supervision and management

45 Tobacco Cessation Program Fresh Start Smoking Cessation Program  American Cancer’ Society’s smoking cessation program  Complete online facilitator training  Four one hour sessions  Review of tobacco cessation programs

46 Teen Pregnancy Prevention Program Safer Choices   School-based program  High risk youth from all racial and ethnic backgrounds  Grades 9 through 12

47 Teen Pregnancy Prevention Program Safer Choices  The curriculum is skill-based and interactive. Curriculum focuses on knowledge, social norms, attitudes, and skills to avoid sex or use condoms Includes practical activities to build skills in communication, delay the initiation of sex, and promote condom use by sexually active participants

48 Teen Pregnancy Prevention Program Safer Choices  Effective in increasing condom use and use of other contraceptive methods decreasing the frequency of sex without condoms decreasing the number of sexual partners without condoms

49 Teen Pregnancy Prevention Program School/Community Program for Sexual Risk Reduction Among Teens  8riskreduction.htm 8riskreduction.htm  School-based intervention  Overall goal of reducing unintended pregnancy  K-12, multiethnic, and rural youth

50 Teen Pregnancy Prevention Program School/Community Program for Sexual Risk Reduction Among Teens  Instruction is designed to increase knowledge, decision-making skills, communication skills, self-esteem, and to align values with those of the community  Effective in delaying initiation of sexual intercourse assisting males in increasing condom use reducing teen pregnancy rates

51 Chronic Disease Self-Management Program (CDSMP) Stanford Patient Education  Living Well ______ County 6 weekly sessions for 2 ½ hours Skill based course  Teaches skills needed in the day-to-day management and treatment of chronic disease and to maintain and/or increase life’s activities

52 HIV Testing & Counseling Protocol based counseling   Evidence based intervention  Focuses on plan-based counseling Framework provided for risk reduction specialists

53 HIV Testing & Counseling Protocol based counseling  Essential elements Introducing and orienting client to the session Enhancing client's self-perceived risk Exploring client's most recent risk Reviewing client's previous risk reduction experiences Summarizing patterns of risks and triggers (putting risk in context) Negotiating a realistic and acceptable risk reduction step Identifying sources of support and providing referrals Summarizing and closing the session Supporting test decision counseling (when appropriate) Providing results simply and supportively Providing partner elicitation (when appropriate)

54 Program Development Tobacco Cessation as an example  Determine needs of patients (target population)  Research evidence-based programming  Develop program objectives and plan  Train providers on program  Advertise program  Implement program  Evaluate program

55 Assessing Need Focus groups Surveys Government websites Interview  Community leaders  Patients  Program participants

56 Challenges Funding Recruitment & retention Services are not billable Justifying existence Change (adaptation and resistance) Referrals from providers Patients recognizing value of health education

57 Training Motivational interviewing  es/index.asp Introductory counseling course Cultural competency  thinkculturalhealth.org Learn second language

58 Partners University/junior college Health department Local health educators  Hospitals, health department, doctor’s offices

59 Partners Local organizations  March of Dimes, American Heart Association, ACS  Texas AgriLife Extension office  Domestic Violence Shelter  Juvenile Justice Program  Adult Probation programs  Faith based organizations (churches)

60 Partners Local organizations  Alternative Education Program  Drug treatment facilities (BVCASA)  School districts  Boys & girls clubs  4-H clubs  Homeless shelter  Local employers

61 Random Thoughts Business of health education  Vision & mission  Strategic plan  Goals & objectives  Funding sources  Quality assurance  Managing employees (hiring, evaluating, disciplining)

62 Random Thoughts Staying current in field  Conferences Serving as a resource  Leading trainings  Patient education materials Serving as the marketing department Change, politics, and administration

63 Random thoughts Materials  Translation  Content  Literacy level Rapport building with community

64 Summary It’s fun! It’s hard work You will be under appreciated at times You can significantly impact the lives of people

65 Skills Needed as a Health Educator Public speaking Teaching and training Partnering and diplomacy Public relations, marketing and advertising Evaluating program goals and objectives Researching Grant writing Reporting Counseling and communication skills Organizing and program coordination Visioning Working with a team and independently Ability to analyze data Ability to assess needs Like people genuinely

66 Certified Health Education Specialist (CHES) Competencies Assess Individual and Community Needs for Health Education Plan Effective Health Education Programs Implement Health Education Programs Evaluating Effectiveness of Health Education Programs Coordinating Provision of Health Education Services Act as a Resource Person in Health Education

67 Example Job Description for Health Educator Responsibilities include, but are not limited to:  Assist with the design, organization, implementation and evaluation of health education presentations, classes, programs, and campaigns  Identify, order and organize educational materials for the clinic  Staff health fairs as needed  Assist with staff development and training of volunteers  Assist in completing various obligations and objectives of current grants  Attend bi-monthly meetings and trainings  Assist with other activities/projects as needed Required:  Bachelor’s degree in community health, health education, or related discipline  Working knowledge of health education principles and techniques, including use of behavior change theories  Desire to work with medically underserved population  Excellent written and verbal communication skills, strong organizational skills, and keen attention to detail Preferred:  Fully bilingual (English/Spanish)  1-2 years of experience in health education or public health


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