1. Meeting the Promise of Racial and Ethnic Minorities’ Interest in Health Care Careers
Cheryl Ulmer and Jason Patnosh
APHA, November 7, 2007
Community HealthCorps
APHA Session Ethnic & Racial Disparities: Hospital System Level Solutions

2. Build a HealthCorps Enroll the uninsured in SCHIP and other programs.
Act as nonmedical support staff (e.g., caseworkers, health educators) in underserved communities.
Interest young people in nursing and medical careers.
You may have seen a September 2007 issue of Time magazine making a case for universal national service. One of the ten parts of their plan was to build a HealthCorps.

3. HealthCorps Exists Now
Enrollment of about 700 for program year 2007.
Serving at over 100 delivery sites in urban and rural areas of 19 states, DC and Puerto Rico.
Founded by National Association of Community Health Centers (NACHC) in 1995 with 117 enrollees placed in Community Health Centers (CHCs) in the first year.
Part of AmeriCorps
While such a HealthCorps exists now, it could be greatly expanded.

4. Accomplishments in first 10 Years
Over 2500 volunteers provided more than:
411,000 outreach and case management encounters to assist underserved receive and better utilize primary and preventive care.
321,000 patient encounters for health education and chronic disease self-management.
170,500 encounters to link patients with other health and social services (e.g., housing, employment, child care).

5. Joining HealthCorps
Eligibility: U.S. Citizen, U.S. National, or lawful permanent resident; 18 years and older, 17 year olds with guardian’s permission
Terms of year long service: 1700 hour (full time), 900 hours (part-time), quarter time (450 hours)
Benefits: Living allowance, health insurance, child care, training, educational award, student loan forebearance
Educational Award: $4725 for full time, prorated for other service time
Not all benefits are available for part and quarter time members.

6. Who Joins? Age range: 17-77 years, median age 24 years
Minority race/ethnicity: 58% from ; 71% in
College graduate: 41-42%
Home community: about half from local community; characterized by more nonwhite race, Hispanic ethnicity, unemployed young people, and poor people than U.S.
Gender: 80-88% female
Comparisons with the overall AmeriCorps program finds that there is a greater percentage of minorities and persons with a college degree in HealthCorps. Compared with the United States as a whole, the home communities of HealthCorps members have more nonwhite race (particularly black and Asian), Hispanic or Latino ethnicity, and poor people, as well as a greater portion of female heads of households, unemployed young people, and linguistically isolated households (Changing Lives). One in four HealthCorps members come from a community where 26% or more of individuals and 20% or more of families have incomes below the federal poverty level (Changing Lives).

7. What is the Impact on Volunteer?
Increases interest in health care or social work as a career.
Increases interest in Community Health Centers as a work environment.
Increases knowledge of health issues.
Offers educational opportunities not available to many of their parents.
Expands job skills.
Giving Back self-assessment of before and after service.

8. Interest in Health Care or Social Work as a Career Increases
66% interested at entry, but 83% at exit.
27% increase in interest among high school (HS) only grads and those with some college or an associate degree.
Many college graduates join to gain health care experience as they apply to medical and public health programs (Giving Back).

9. Increase in Knowledge of Barriers and Health Disparities
Before serving, more than half of all members say they had little or no knowledge of health barriers and disparities.
After serving, more than 80% had a significant gain in knowledge.
Even 75% of those who self-assessed themselves as having a great deal of knowledge beforehand had a significant gain.
(Giving Back)

10. Members Gain in Knowledge of Specific Health Care Services
Gain in knowledge of specific subjects may vary according to the content of members’ assignments, but all get training in 10 Core Competencies. (Giving Back)

11. Training in 10 Core Competencies
Community Health Advocacy
Patient Relations
Professional Development
Cultural Competency
Civic Engagement
Health Outreach
Health Education
Emergency/Disaster Preparedness
Case Management
Primary Care Environment
Programs offer a minimum of hours per month of training, team building events and/or service projects using the Ten CCs as the cornerstone. This training distinguishes HC from other AmeriCorps programs.

12. Most Members Gain “A Lot” of Experience Participating in a Work Environment
77% in being a reliable member of a working staff by coming to work on time
72% in solving unexpected problems
72% in learning how to gather and analyze data
69% Managing time when under pressure
76% in negotiating, compromising and getting along with co-workers
74% in taking guidance from others
53% in leading a team by taking charge and motivating co-workers
The scale for gaining work experience skills is: “little or none,” “some” or “a lot” (Giving Back). Unemployment rates for young people (20-24 year olds) in the communities these HealthCorps members come from averages 9% (Changing Lives). Some come from communities where the unemployment rate is as high as 35% for young women and 43% for young men.

13. Service Activities Most Often Performed
48% Scheduling appointments, making reminders, and follow up
29% Providing outreach services
27% Teaching health education classes
27% Providing info about CHC services
24% Translating for patients
19% Enrolling patients in health insurance
About 70% of those scheduling and 40% translating and enrolling in health insurance are high school graduates only; while more doing chronic disease management and health education are college graduates of have some college. (Giving Back)

14. Members’ Plans Immediately After HC
Regardless of educational level equivalent percentages plan to work, go to school and/or continue in HC (Giving Back).

15. About 80% of Members at all Education Levels Plan to Go to School within Next Year
76% of HS grads, 82% of those with some college, and 87% of college grads. (Giving Back)

16. Most Frequently Planned School Choices
17% Nursing school (including 2% NP or CNM)
14% Four-year college
13% Medical school
12% Health-related trade school
9% Social work graduate program
7% Two-year college
6% Public health graduate program
6% Other health-related graduate programs
(Giving Back)

17. Planned School Choices by Current Education
High School Graduate only
Some College/ Associate Degree
College Graduate or More
23% Health-related trade school
35% Four-year college
24% Medical school
20% Nursing school
19% Nursing school
15% Public health
11% Non-health trade school
17% Two-year school
15% Other health-related graduate schools
9% Two-year college
13% Health-related trade school
12% Social work graduate program
9% Four-year college
9% Social work graduate program
7% Other graduate programs
(Giving Back)

18. Education Award = Benefit to HealthCorps Members
76% of HealthCorps members serving in earned an education award.
Comparable to overall AmeriCorps average even though HC has a higher percentage of minority group members.
In 1999 HC had 65% minority vs. 54% for AmeriCorps (Changing Lives).

19. Using Earned Education Award
63% of members from 1995 to 2003 used a portion of their earned award.
Two-thirds of these members used their award for new educational opportunities rather than loan repayment.
By August 2004, HealthCorps members had earned $4.7 million in education awards; members had used $2.6 million on loan repayment and school tuition.
Awards are most often used within the first year after service, but they have7 years to utilize their awards. (Changing Lives)

20. Who’s at Risk of Not Going to College?
U. S. Census data show the likelihood of going to college is decreased by:
low family income,
minority race, and
having no family members who previously attended college.
In HealthCorps, 74% of minority members earned an education award and 60% use their earned award.
(Changing Lives)

21. HC Members with Less Education are Less Likely to Have Parents Who Have Graduated from College
National Census Bureau statistics indicate that young people whose parents did not attend college are half as likely to attend college as those whose parents did go. Yet HC members appear to be going to school in greater numbers. (Graph from Giving Back)

22. Percent of 1995-2002 HC Members Earning and Utilizing Awards as of August 2004
Rates of earning and using awards is much lower for black members than other race and ethnic groups; however, it is somewhat impressive given the differential in college graduation rates before entering HC. Whites make up 42% (475 persons), blacks 29% (333), Hispanics 18.5 (211), Asian/PI 8.35 (94). College graduation rates are whites 65%, blacks 16%, Hispanics 25%, Asian/PI 69%. (Changing Lives)

23. Education Award Challenges
Attrition (not completing and not earning an education award) is:
among non-white members
among young persons (ages 22-29)
among the better educated (completed
bachelor’s degree)
African-American HealthCorps members are less likely to earn an award and even if an award is earned, less likely to spend it than other race/ethnicity groups. The lower rate of uptake of awards by black members may be more attributable to level of comparative educational attainment at enrollment than race (Changing Lives).

24. Program Solutions Additional mentoring for educational placement.
Target at risk groups for follow-up. Majority of members who use their awards do so within the first year.
Utilize performance measures on rates of earning and using awards. Earning rates varied from 50% to 94% by program site.
Develop educational and job placement partnerships within communities (e.g., credit for volunteer experience, scholarships).
Since a majority of members who use their awards do so within the first year after completing their service, groups that historically have been at risk for not using their earned award might be the primary target of follow-up in the year after exiting the program for further assistance in educational placement and accessing their award. (Changing Lives)

25. States with HC Programs
California
Colorado
District of Columbia
Florida
Idaho
Kansas
Louisiana
Maine
Massachusetts
Michigan
Mississippi
Missouri
New York
Puerto Rico
Tennessee
Texas
Utah
Washington
Wisconsin
Even at sites without HC specific programs, often the 1000 CHCs around the country also have other types of AmeriCorps volunteers. While some of their work day experiences may be similar, they may not have had as extensive training as HC volunteers.