1. COMMUNITY HEALTH WORKERS Dr. Carolyn Jenkins, Professor CON, APRN- BC-ADM, RD, LD, FAAN, Principal Investigator, REACH U.S. SEA-CEED And Virginia Thomas, BS, Community Evaluation Coordinator, Outreach Worker, REACH U.S. SEA-CEED, Former REACH 2010 CHA

2. DEFINED The United States Office of Management and Budget proposed to recognize CHWs in their 2010 Standard Occupational Classification (SOC) (The Federal Register, 2008) The Community Health Worker National Workforce Study: “Community health workers are lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve”.

3. TITLES Identified by many titles: -Community Health Advisors/Workers -Lay Health Advocates/Workers -Promontories- (a term used mainly in Latino and Hispanic communities) -Outreach Educators -Community Health Representatives -Peer Health Promoters -Peer Health Educators

4. REACH 2010 Florene Linnen and Everlina Lance covered Georgetown County; Shelia Powell, Gail Smith, Virginia Thomas, and Anna Johnson served in Charleston County providing: Culturally-appropriate health education and information (self-management of Dm) Assisted people in receiving the care they needed - access to some direct services Gave informal counseling and guidance on health behaviors Advocated for individual and community health needs Affected a reduction in diabetes related health disparities

5. Interventions & Trainings Worked with CDE to teach Dm self- management classes -provided disease process, nutrition, physical activity and foot care curricula Community needs assessment -identified community needs (meds, supplies, transportation, groceries, funds) Organized “walk and talk”, focus and support groups

6. continued Created other opportunities for change (nutrition demonstration, walking trails, exercise classes, health fairs and others Identified and supplied resources to meet needs (medication enrollment, funds, etc.) Encouraged seeking primary care visits & dm self-management training Created quilting diabetes, Praisercize (scarf praise dancing), computer classes thru NLM

7. Five major models describing roles in which CHWs have served HRSA (2007): Care delivery team member Navigator Screening and health education provider Outreach-enrolling-informing agent (Outreach Worker) Organizer

8. Improved Diabetes Outcomes in Communities: Disparities Reduced Reduced between 11-24% the disparity in number of persons getting A1C, lipid, and kidney testing, eye examinations, and blood pressure control over a 24 month period (Jenkins, McNary, Carson, et al., 2004) Reduced amputation rate by 54% for persons in Charleston County over a 7 year period and Georgetown County over a 3 year period (CDC At A Glance 2009)

9. Factors Influencing Outcomes National socioeconomic and political environment Community Health systems and Potential international macroeconomic policies (Hanes, Sanders, Lehmann, et. al,., 2007)

10. Community Factors Informal and formal leaders, local legislators, other community systems Family history, family connection, community cohesion, geographic area/geography of the community Caring/Trust-Often heard was “We want to know how much you care before we care how much you know”

11. continued Although in African American Communities Diabetes is common, growing, serious, costly, and potentially preventable many communities were underserved with few resources for care, medication, and education about self- management. Having a ‘touch of sugar’ or a ‘little sugar’ was an inevitable part of life while systems to help had to be located to promote control and prevent complications.

12. WHERE ARE THEY NOW? The CHWs have accomplished much: Florene Linnen & Everlina Lance led Georgetown to “All American” Recognition; Flo is still CEO of CORE Group while Everlina is a MH Counselor Shelia Powell & Anna Johnson have directed senior and tutorial programs respectively and are now councilwomen for their communities Sharon Burns and Sharon Cash work for a prominent doctor and health center as educators and patient navigators respectively

13. WHERE ARE THEY NOW ? Beverly Highland represents a Dm company & returned to N. Carolina to care for relatives Virginia Thomas is Secretary of the Charleston County Dm Coalition serving Chas, Berkeley & Dorchester Counties, REACH Community Evaluation Coordinator, community grant writer, Chair of NCNW Health Committee and serves on the Wellness Committee for the 30 churches in the Baptist Association