1. Empowering Communities through Lay Health Advisor Certification Programs Elizabeth M. Whitley, Ph.D., R.N.

2. Denver Health Medical Center 911 Medical Response Rocky Mountain Poison and Drug Center Rocky Mountain Regional Trauma Center Denver Health Medical Plan Rocky Mountain Center for Medical Response to Terrorism School-based Health Centers Denver CARES Denver Health Foundation Family Health Centers Correctional Care Denver Public Health

3. Lay Health Advisors, aka Community Health Workers Outreach to underserved communities to Improve access to health and other services Improve access to health and other services Promote client knowledge and behavior change through health education Promote client knowledge and behavior change through health education

4. Denver Health (DH) CHW Requirements Indigenous to community Indigenous to community HS diploma/GED HS diploma/GED Desire to serve Desire to serve Interest in Health Interest in Health Bilingual preferred Bilingual preferred

5. DH Community Outreach target populations Geographic (i.e., 5 West neighborhoods) Geographic (i.e., 5 West neighborhoods) Racial/Ethnic (i.e., Latinos) Racial/Ethnic (i.e., Latinos) Special Populations (i.e., Men) Special Populations (i.e., Men)

6. DH, prior to 2000 On the job training conducted by DH resource intensive and inconsistent On the job training conducted by DH resource intensive and inconsistent CHWs lacked basic work readiness skills CHWs lacked basic work readiness skills

7. DH/CCD partnership Create, implement and evaluate a standardized academic education certificate program Create, implement and evaluate a standardized academic education certificate program Provide CHWs with basic transferable skills necessary to succeed in health care workforce and communities Provide CHWs with basic transferable skills necessary to succeed in health care workforce and communities Entry for individuals into health careers and higher education Entry for individuals into health careers and higher education

8. CHW certificate program Workplace, academic and vocational skills Workplace, academic and vocational skills 17 credit hours 17 credit hours 1 semester or over 1 year 1 semester or over 1 year Clinical internship/field experience Clinical internship/field experience

9. CHW Certificate Program Curriculum COM 126 Communication for Healthcare COM 126 Communication for Healthcare CIS 118 Intro to PC Applications CIS 118 Intro to PC Applications AAA 109 Advanced Academic Achievement AAA 109 Advanced Academic Achievement CHW 120 Community Health Issues CHW 120 Community Health Issues CHW 130 Community Health Resources CHW 130 Community Health Resources CHW 297 Field Experience CHW 297 Field Experience

10. The partnership CCD coordinates and administers program and delivers workplace core CCD coordinates and administers program and delivers workplace core DH obtains grant funding for tuition and fees, helps recruit students, delivers vocational core, arranges field experiences and evaluates the program DH obtains grant funding for tuition and fees, helps recruit students, delivers vocational core, arranges field experiences and evaluates the program Community partners offer field experiences, faculty to teach vocational core and employment Community partners offer field experiences, faculty to teach vocational core and employment

11. Program Outcome Measures Students must Complete curriculum with at least a C average Complete curriculum with at least a C average Pass competency based testing Pass competency based testing

12. Program Results Majority female, low income and minority Majority female, low income and minority 30% of those who start drop out before mid-term 30% of those who start drop out before mid-term 100% of those who have passed courses passed competency based testing 100% of those who have passed courses passed competency based testing

13. Program Results Of 20 graduates from first 2 programs, 19 still employed in health work 2 years after earning certificate. Of 20 graduates from first 2 programs, 19 still employed in health work 2 years after earning certificate. 10 students completed 3 rd program and all still employed in health work after 1 year. 10 students completed 3 rd program and all still employed in health work after 1 year. 8 students completed 4 th program in August 2007. 8 students completed 4 th program in August 2007. 5 th program began Fall 2007. 5 th program began Fall 2007.

14. Program Results Program now offered Statewide through Community Colleges Program now offered Statewide through Community Colleges Program being replicated in other states Program being replicated in other states

16. Financial Effectiveness of CHWs What is the financial impact of a CHW intervention with a particular population on the health system?

17. Prerequisites to determining financial effectiveness Robust evaluation Robust evaluation Database to track CHW activities Database to track CHW activities CHW participation CHW participation Integrated information system Integrated information system

18. Free Pregnancy Testing (FPT) Return on Investment: New patients who deliver at DH following free test in 2004 ROI of 6.9:1.0 DH increased revenue of $251,680

19. FPT Conclusions Increased access to DH services for underserved pregnant women. Increased access to DH services for underserved pregnant women. Concurrent increase in overall DH deliveries. Concurrent increase in overall DH deliveries. New Medicaid insured patients to DH. New Medicaid insured patients to DH. Improved prenatal care. Improved prenatal care. New system revenue of $251,680 annually. New system revenue of $251,680 annually.

20. Men’s Health Initiative (MHI) January 1, 2003 – June 30, 2004 Subset of 590 men Utilization increased and improved and uncompensated care reduced ROI of 2.28:1.0 DH savings of $95,941 annually

21. MHI Conclusions Increased access to health care services for underserved men. Fostered more appropriate use of system. Decreased total patient charges and uncompensated care. Saved DH system $95,942 annually.

22. Acknowledgements Community Voices is funded by the W.K. Kellogg Foundation and administered by the Morehouse School of Medicine Center for Primary Care Community Voices is funded by the W.K. Kellogg Foundation and administered by the Morehouse School of Medicine Center for Primary Care Thanks to Community Health Works of San Francisco for breaking the ground and paving the way. Thanks to Community Health Works of San Francisco for breaking the ground and paving the way.