1. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Community Health Workers: Providing Essential Services in Rural America Rural Health Network Development Grant Program Grantee Meeting Alana Knudson, PhD August 2, 2010 ~ Washington, DC

2. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Applying Evidence-Based Models in Rural Communities Community Health Workers

3. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Focus on Community Health Workers Focus of the first module is on CHWs Why HRSA is interested in CHWs Context from the literature – No definition of CHWs – Little information available in terms of models/best practices/resources

4. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Operational Definition of CHW Lay members of communities, paid or volunteer, who work in association with the local health care system; Usually share ethnicity, language, socioeconomic status, and life experiences with the community members served; May provide: interpretation & translation; health education & information; assistance in receiving needed care; informal counseling & guidance; advocating for health needs; and direct services, i.e., first aid, BP screening. Community Health Workers National Workforce Study. March 2007. bhpr.hrsa.gov/healthworkforce/chw/3.htm

5. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Other Names for CHWs Community health advisors Lay health advocates Promotores(as) de Salud Outreach educators Community health representatives Peer health promoters Peer health educators

6. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Models of Care Using CHWs Member of care delivery team – Provides case management with lead provider – Responsible for coordination of care Navigator – Assists individual in navigating health care system, services, & providers Screening and Health Education Provider – Works with individuals with specific health conditions, i.e., asthma and diabetes – Accesses hard-to-reach populations & provides screenings, care methods

7. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Models of Care cont’d Outreach/enrolling/informing agent – “Outreach worker” – Reaches individuals eligible for benefits and enrolls them or brings them to a health care provider Organizer – Promote community action around a specific topic/issue – More commonly volunteers than paid workers

8. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Opportunities Extends access Expands networks Supports partnerships Enhances credibility of community organizations Increases educational opportunities for participants Provides applicable skills

9. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Challenges Payment issues – Difficult to determine payment amount – Part-time staff Evaluation – Impact Sustainability – Funding – Reimbursemenet

10. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Building the CHW Toolkit CHW Toolkit Objectives:  Organize available resources online  Use Q&A format to seed thinking  Be useful to grantees and other rural communities at different levels of knowledge/stages of implementation of CHW programs  Provide resources that can help grantees, future applicants, and rural communities, more generally, to identify and apply relevant CHW evidence-based models to their projects

11. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS How will the CHW toolbox be used? Learning: Who are CHWs and what are their roles? Hiring: What do we need to think about when hiring CHWs? Modeling: Are there model CHW programs that may offer best practices? Training: What types of training materials and approaches are available? Adapting: How do we create a program that meets the needs of our community? Evaluating: What benefits are we seeing, and what’s the next step? Measuring: How do we measure the value of our CHW program? Implementing: What resources will we need to implement a CHW program? Sustaining: What do we plan for sustainability of our CHW program? Funding: What resources are available for implementing CHW programs? Disseminating: How do we disseminate our best practices to other communities?

12. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Organization of Modules  Module 1: Introduction to Community Health Workers  Module 2: Model CHW Programs  Module 3: Training Approaches for CHWs  Module 4: Implementation of CHW Programs  Module 5: Funding and Sustainability  Module 7: Measuring and Evaluating the Impact of CHW Programs  Module 8: Dissemination of CHW Resources and Best Practices

13. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS 1 - Introduction to CHWs (Example) Questions  Who are CHWs?  Is there a standard definition of CHWs?  What are the roles of CHWs?  What are the advantages of including CHWs in my intervention? Key Resources  Resources on role of CHWs  Research on CHW interventions  Links to websites that focus on CHWs  Links to federal websites  Glossary of definitions/terms  Leadership speeches/ testimony  Press releases Objective: To introduce grantees, future applicants, and rural communities to CHWs and their roles.

14. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Questions for Discussion

15. Rural Health Research Center NORC WALSH CENTER F OR R URAL H EALTH A NALYSIS Contact Information Alana Knudson, PhD Co-Director, Walsh Center for Rural Health Analysis 301-634-9326 Knudson-alanal@norc.org Michael Meit, MA, MPH Co-Director, Walsh Center for Rural Health Analysis 301-634-9324 meit-michael@norc.org Ira Moscovice, PhD Mayo Professor and Division Head of the Division of Health Policy and Management at the University of Minnesota 612-624-8618 mosco001@umn.edu