1. Center for Rural Health Agents of Change: Promotoras Transforming Communities Tuesday, September 22, 2015

2. Promotoras Transforming Communities Martha Monroy, MA REACH Program Director University of Arizona, Mel and Enid Zuckerman College of Public Health Floribella Redondo,BS President Arizona Community Health Worker Association

3. Are any of you promotoras?

4. Have you worked with promotoras?

5. What roles do promotoras in your community play?

6. Provide linkages to culturally relevant providers and care Advocate for family, friends, and provider social support for health improvements Provide education, training, and support for healthy lifestyles, chronic disease prevention and management Assist families and friends with navigation to needed services including health, basic needs (food, shelter, clothing, medication) transportation, social, and government support Work with institutions & organizations to provide culturally relevant services. Educate about needs and barriers to care and services Assist organizations with understanding community history and cultural issues Organize services in convenient locations Individual Knowledge, Skills, Attitudes Interpersonal Family, Friends, Providers, Social Supports Organizational Organizations, Institutions Community Relationships among organizations PSE change Local, State, National Figure 1 REACH U.S. Major Roles for Community Health Workers Cosgrove. et al Provide education, training, and support for healthy lifestyles, chronic disease prevention and management Assist with navigation to needed services including health, basic needs (food, shelter, clothing, medication) transportation, social, government support Address gaps in health literacy, communications, education, employment Assist with screening for eligible services and completion of applications Advocate for local, state, and national health, social and environmental policy changes Facilitate\lead PSE change, inrform that change Communicate community needs to policy makers Disseminate policy changes to communities Bridge gap between needs and services in community Identify and develop strategies to address the social determinants of health Address social and health Enhance community capacity and infrastructures to provide culturally relevant services

7. Juan y la Ficha

8. Promotoras are uniquely qualified to create PSE change Already address social determinants of health through direct services: health education, insurance and other benefit enrollment, etc. Are members of the communities they serve and understand the assets, challenges and culture Generally Spanish-English bilingual. Are trusted community members Successfully engage community members

9. Promotoras have a deep understanding of social factors that influence health in their communities

10. Paseando en Bicicleta

11. Promotoras successfully engage community members

12. Local Partner Organization Location Urban or Rural Years prior experience with PSE Example PSE change instituted under RSC Campesinos Sin FronterasYuma County, Arizona Rural 10 years Created environmental change in local supermarkets that highlighted and increased healthy food options North Country HealthCare Flagstaff, Arizona Urban 5 years Increased access to healthy food options through partnering with Market on the Move and a system of fresh produce distribution in target neighborhoods Mariposa Community Health Center Santa Cruz County, Arizona Rural 24 years Developed policies that integrated physical activity opportunities into schools. Sea Mar Community Health Centers Skagit County, Washington Rural None Expanded the number of Latino-owned stores in Latino neighborhoods offering 10 or more fresh produce items. Benton County Health Services Benton County, Oregon Rural 7 years Instituted healthy food procurement in government facilities and Increased SNAP use 19.2% from 2011 to 2012.

14. The Next Door, Inc. Hood River, Oregon Rural 8 years Expanded the local farmers market to locations where most Latinos reside including culturally appropriate foods/signage/activities. Pima County REACH Tucson, Arizona Urban 10 years Created a community cycling center Created environmental changes in local grocery stores Created systems change in clinics Texas A & M Hidalgo County, Texas Rural None Established summer healthy meal and physical activity locations for local children. Gateway to Care East End, Houston Texas Urban None Increased the number of home daycare providers enrolled in Child and Adult Care Food Program (CACFP) and aligned with national standards for provision of healthy food/beverage. National Center for Farmworker Health Buda, Texas Rural None Established a community task force dedicated to increasing safe options for walking and bicycling.

16. How to Support Promotoras in PSE Change at local level Provide ongoing training for promotoras in topics they identify Engage the support of policy makers Stable funding

17. Opportunities for Engagement Build awareness of the CHW environment in your communities/agencies/organizations CHW input and public health perspective represented Strengthening the role of CHWs and improve successful integration in significant areas such as – Infrastructure – Workforce Development – Financing Mechanisms – Evaluation

18. How to Support Promotoras/CHWs in PSE Change at a State Level

19. What contributes to CHWs advocating for themselves and their profession? Membership in a CHW association (4 x more likely) Job description includes “advocacy”; “working with community leaders” and/or “working with other CHWs” (1.5-2 x more likely). Being employed in a state with a statewide professional association, credentialing process or CHW legislation were not more likely to advocate for their profession.

20. Expressions of CHWs/Promotoras 1.CHW’s want a state certification 2.CHW’s want to be recognized as a professional workforce 3.CHW’s recommend that supervisors be trained on the scope of practice of the workforce 4.CHW’s Recognition from other health professions 5.CHW’s would like to have opportunities for professional development within their organization 6.CHW’s recommend that AzCHOW is the official professional organization representing the workforce “Certification is to have a voice and recognition that we exist, and that our work and delivery is very important so that our community is educated”

21. Questions?

22. Thank you! Martha Monroy mmonroy@email.Arizona.edu Floribella Redondo floribella@azchow.org