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In Service to Community Giving the Story a Name: The Community HealthCorps National Impact Evaluation Findings & Research conducted by the University of El Paso (UTEP) October 3, 2010
When serving in AmeriCorps through the Community HealthCorps of the National Association of Community Health Centers (NACHC), Members work hard to help people gain access to health services and lead healthier lives. Here at NACHC, we want to make sure that story is told to those who fund and support AmeriCorps. To that end, NACHC sponsored the first national, independent evaluation of the Community HealthCorps – carried out by a team based at the University of Texas at El Paso (UTEP) under the direction of Dr. E. Lee Rosenthal, MPH. The goal of the evaluation is to learn about the impact Community HealthCorps Members have had on the individuals, the clinics, and the communities; as well as the impact on AmeriCorps Members’ careers and other life choices. The research and findings included in this report are on behalf of the UTEP evaluation team as of October 3, 2010. Media materials such as images and video are courtesy of Community HealthCorps programs during the 2010-11 program year. Purpose of this Evaluation
Evaluation Findings Profiles of Community HealthCorps Sites & Members
Community HealthCorps Host Sites Host sites apply competitively to NACHC to serve in three-year program cycles Host sites consist of: - Federally Qualified Health Centers - Health Center Controlled Networks - Primary Care Associations Continued…
Community HealthCorps Host Sites (continued) From the beginning of the program in 1995 to 2008, a number of Community Health Centers and agencies have been sub-grantees or “host sites” in NACHC’s Community HealthCorps. These organizations include:
Massachusetts League of Community Health Centers
Community HealthCorps Members: Member Demographics Between 1995 and 2008, NACHC estimates that it has had 2,807 Community HealthCorps Members serve with approximately 15% serving two terms Female = 80%; Male = 20%
Closely reflective of the health care workforce overall where women represent about 75% of U.S. health care practitioners / technical health occupations & about 90% are in health care support occupations [U.S. Department of Labor, 2009]
Community HealthCorps Members: Member Roles Six common Member roles were identified from the member work plans developed by host agencies: Community Outreach - Members serve as a bridge to the community for the host agency. Members conduct outreach to provide information about health center services and programs, health issues, and to identify medically underserved community members. Health Education Assistance - Members provide culturally and linguistically appropriate health education with groups and one-on-one to address prevalent health issues such as tobacco and other drug use, HIV/AIDS, and high blood pressure. Enrollment in Health Insurance & Health Services/Programs - Members assist patients with understanding and completing paperwork to enroll in health insurance plans, prescription assistance programs, and health center programs; they also provide referrals to other health and social services. Translation Services - Members commonly serve as Spanish-English interpreters in medical clinics for non-Spanish speaking health care providers. These Members often translate health education and other health center materials from English to Spanish, and create new material in Spanish. Additionally, some members who perform this function provide other direct services, such as outreach, navigation, application assistance, and health education for patients and others in communities in languages other than English; Spanish is the ‘other' language they cited most frequently. Continued…
Community HealthCorps Members: Member Roles (continued) Other Patient Assistance in Health Services - Members help schedule appointments, conduct follow-up calls, provide support in languages other than English, and provide transportation assistance to services. At several sites, Members help patients to participate in health screenings (e.g., depression, dental, diabetes, asthma, and cancer). As health peer coaches, Members are encouragers and advocates and help with tasks such as patient flow, and taking blood pressures in outreach settings. Patients are helped to understand appropriate emergency room use. Patients needing food and other social assistance are identified and linked with community and agency services. Medical and financial services, mental illness screenings, housing vouchers, and social service referrals are often set up by Members for homeless or near homeless persons. Volunteer Generation - Members mobilize and support others to volunteer in meeting ongoing needs, such as arranging transportation, facility improvements like painting, reading assistance, organizing health fairs, and neighborhood distribution of health promotion materials (e.g., on healthy eating).
Community HealthCorps Members: Examples of Specialty Focus Areas Examples of specialty programs where Members may serve are varied and include programs such as the following: Doulas - Some Members assist women as doulas, working in areas such as developing a birth plan, assisting during labor and delivery, providing prenatal education on a variety of subjects including nutrition, the importance of exercise, and resting positioning, as well as providing comfort measures to promote a positive birth experience. Members provide culturally appropriate prenatal and postpartum education and support, including assistance navigating maternity services, procedures, and facilities. Reach Out and Read Coordination - Some Members serve in pediatric waiting rooms in order to reach parents and children together during their visits to a health center, such as during a well-child checkup. In the Reach Out and Read Program, children are invited to read to a leader or other volunteer reader. Members also read to children and distribute donated books for families to take home – this is seen as an accompaniment to other Member roles such as health education. Medication Assistance Program Coordination - Members assist patients by identifying, applying for, and coordinating their enrollment in assistance programs for medications, vaccines, and diabetic testing, which are administered by pharmaceutical companies and other organizations. Members also provide follow-up with these patients to check on enrollment status and medication availability. Childhood Obesity- Members serve participating children by promoting healthy lifestyles, engaging community youth in physical activity, and providing nutritional education. Fitness program activities conducted by Members often extend to the parents, siblings, and other patients.
Evaluation Findings Community HealthCorps Impact on Others
Impact on Individuals & Families Over a Five Year Period (2003-08) Access & Utilization of Health Care 72,000 people per year received assistance in increasing access to care:
Members referred individuals to health programs & insurance plans
Members aided patients in accessing medication assistance
Over 120,000 individuals per year received assistance in improving care utilization: Members assisted health center staff to identify patients who needed follow-up care assistance such as reminder calls, making appointments, translation, and transportation. Health Education Over 110,000 individuals per year benefited from health education provided by Community HealthCorps members: Members facilitated workshops, hosted health fairs, and conducted one-on-one/group health education sessions with community residents.
Impact on Community Health Center & Other Program Host Agencies Members positively impact the health center/agency: Administrators perceive the positive impact of AmeriCorps members on health center/agency as “Very Significant” or “Significant”. Members’ impact on health center/ agency was recognized as being significant in the hours of service, patient flow, continuity of care, programs’ implementation, and delivery of services. “The impact that this collaboration has had on the community is almost immeasurable. We have screened over 1,600 patients with 560 being scheduled for follow-up care…Members’ involvement in health fairs, scheduling patients for appointments; arranging free transportation for patient appointments…scheduling patient education classes; providing navigation and translation services, while ensuring cultural sensitive services are provided, demonstrates the impact of the AmeriCorps Community HealthCorps on individuals and families.” -Health Center Administrator Response (Source: Community HealthCorps Administrator/Program Coordinator Survey 2009) Continued…
Impact on Community Health Center & Other Program Host Agencies (continued) Members helped host agencies interface with outside agencies: Members reported varied activities with others outside the host agency including contact with staff from community and faith-based organizations. Members facilitated partnerships and collaborations. Examples of these collaborations consisted of working with social workers to provide adequate referrals, and working with architects, city officials, and representatives of other non-profit organizations to generate ideas and activities to facilitate changes in the community. OneMember reported: “The highlight of the month was establishing a new collaboration … [between the health center] and (local agency), a non-profit who works to educate new mothers on parenting and early childhood development.” One Administrator praised a Member’s efforts to address teen dating violence at a school-based health center: “…working with the Dean of the 9th grade students, she instituted an assembly of 9th graders who were educated about the effects of teen dating violence on individuals. This Member had guest speakers come into the school.... The school drama club put on a skit to demonstrate what teen dating violence looks like and the many forms [it] can take.”
Impact on the Community & Volunteerism Members recruited an average of 3,000 other community volunteers per year, thus benefitting nearly 50,000 persons from activities associated with the volunteers recruited (program years 2003-08): Members assisted in the recruiting, training, developing, and managing non-AmeriCorps volunteers. Members collaborated with others, especially in disaster preparedness & response: Members were involved in food and clothing drives, environmental clean-up, and volunteering in disaster relief shelters. Members report that they contribute to community improvements beyond health care: Members were involved in dealing with problems such as high crime as well as unclean and unsafe community environments. Members participated in community clean-ups, helping to secure ordinances, planting trees, and improving community gardening, in general. According to both Administrators and Alumni, members impact the community significantly: Administrators perceive that members positively impact the community through assisting with health education and disease management.
Evaluation Findings Community HealthCorps Impact on Members “Community HealthCorps not only gave me the experience I needed to become accepted into grad school, but inspired me with such fervent passion to improve the mental, physical, and emotional health of my community, the global community, and the underserved communities that need a hand up. My continued education and career are not just a job to me. Community HealthCorps was the opportunity that helped me realize what my dream for the world is. I'm working towards it every day, and I have never felt happier just knowing I found my place. Thank you.” -Alumni Survey Respondent, Community HealthCorps Evaluation, 2009
Member Training & Skills Development Members report building important career confidence & skills during their service: Skills noted included professional development, health outreach, case management, and an appreciation for underserved populations. Alumni described an increase in self-confidence, self-efficacy and professional development. Members develop cultural & linguistic competence as well as compassion for others: Members assisted patients with little or no English proficiency addressing social barriers. Members observe that learning opportunities come in many forms: Members reported that learning came from formal trainings and interactions within the community. Alumni report that service provided valuable skill development & their knowledge about: Health disparities, patient relations, professional development, cultural competency, health outreach, and health education Administrators perceive that training & service builds members’ skills on-the-job & for the future.
Member Academic & Career Pathways Members join in order to get involved in health issues: About 1/3 indicated that they already had an interest in pursuing an education in the health sciences before serving in Community HealthCorps. (Applicant data; WBRS, 2009) About 1/3 reported that they had joined to enhance an application for admission to a health sciences program. (Alumni survey, 2009) Members’ interest in a health career increased as a result of their service (Alumni survey, 2009):
About 2/3 of alumni reported having interest in a health career before their service experience.
81% of alumni indicated that they had these high levels of interest after their service experience.
About 2/3 of alumni reported that their service influenced education choices and/or career choices.
Member Academic & Career Pathways (continued) One Member wrote: “I am just about finished with my first term of volunteering with the Community HealthCorps and am very excited. During my placement, I have learned about the field of social work and have decided to change my major from Psychology. Working in the Social Services Department of my Community Health Center has enlightened me of the services available to CHC patrons [patients].” Continued…
Member Academic & Career Pathways (continued) In the Community HealthCorps Administrator/Program Coordinator Survey 2009, health center Administrators shared many stories of their Members’ accomplishments and experiences. How Members can gain valuable health education training through their affiliation with Community HealthCorps service: “Two of the Community HealthCorps … [P]rogram Members have received licenses and certification as Master Trainers through the Stanford University Chronic Disease Self Management Course. These Members underwent training by Stanford University which equipped them with the knowledge and ability to teach elderly patients techniques to self manage problems stemming [from] chronic medical conditions.” One Member went beyond expectations and initiated a health outreach program. This Member continued to serve in that program and has gained necessary knowledge and skills in specific health outreach to make it a career: “When our program began in 2006, we also began the Cancer Services Program (CSP), which was and is administered by a Member. The program provides low cost or no cost cancer screenings and treatment to women and men who are underinsured or uninsured. In 2008 the Member hired for the position in 2007 continued to serve in a different capacity on the program as a staff Member. This was due to her expertise and growing skills as a Member, and making her an essential element of the program and its success. In 2009 this same Member was promoted to a supervisory capacity, and is now in supervision of CSP, Family Planning Benefit programming, and eligibility and enrollment into medical insurance entitlements.” An Administrator also shares: “Each year a Member has increased their professional development so much that the Center has hired one Member each year to work in our nursing department. This year we have three Members who are pursuing their goal to become a physician or midlevel provider. Numerous other Members are pursing studies to become LVN's (Licensed Vocational Nurses), x-ray technicians, ultrasound technicians, and other studies related to the medical field.”
Use of Education Award An Administrator shared how a Member’s experience and training in the Community HealthCorps enabled her to apply her acquired skills in case management to work at a health center: “Another Member is being hired by the health center she is doing her service at when she completes her service year on 8/31/2009. She will be working as a case manager for teenagers with HIV/AIDS. She is going to use her education award to complete her Master's Degree program in Social Work.” Members consider Education Awards a valuable incentive to serve: 65% of alumni reported that the AmeriCorps Education Award was important in their decision to enroll. (Alumni survey, 2009) Black & Hispanic members are disproportionately more likely to participate in service with “no award” or only a “partial award” granted (WBRS database, 2009): Higher %’s of Black and Hispanic members vs. White members completed their service with “no award” (37% and 23% vs. 14%, respectively). Black members were more likely than White members to receive a “partial award” (15% vs. 8%). Most Education Award payments are made to 4-year colleges & universities (WBRS database, 2009): About ½ (49.9%) of the Education Award payments were made to colleges/universities, followed by lending institutions (33%) for repayment of student loans.
To view the video, click the play button beneath the box below: Video credit: Heart of Texas Community Health Center (Program Year 2010-11)
Evaluation Conclusions A Special Thank You & Acknowledgement of the Evaluation Team
Acknowledgements from the Evaluation Team Thank you to the staff at National Association of Community Health Centers (NACHC) for ongoing assistance throughout the implementation of this evaluation. We particularly wish to acknowledge National Director, Jason Patnosh, for his leadership and guidance at the agency and support of this evaluation effort overall. We also recognize and applaud the tremendous energy, insightfulness, and capacity of Director of Program Development and Evaluation, Savolia Spottswood, who has served as the guide and liaison between our team and NACHC throughout this evaluation.
We believe that an evaluation must truly engage stakeholders in order to lead to the deepest learning and for lessons learned to be applied. We have been lucky to have a diverse Technical Advisory Group (TAG) which includes both administrators from the program sites and Community HealthCorps Alumni as well as a number of outside experts. We thank each member for their participation in the planning and implementation of the evaluation. A complete list of TAG members and their alternates can be found in the Appendices.
Credit is also due to the Corporation for National and Community Service, California Volunteers, New York Volunteers, and the One Star Foundation, for their support of the program and these evaluation efforts. Additionally, corporate supporter, Covidien, should be credited for their financial support that allowed the majority of this evaluation to be funded.
Finally, I would like to thank the Evaluation Team that included many students and researchers, as well as experts in the Community Health Worker field. All of these individuals kindly shared their time and talent to the dedicated review of the data to improve our understanding of the Community HealthCorps Program.
E. Lee Rosenthal, Ph.D., M.P.H. Principal Investigator October 3, 2010
Evaluation Team Members (University of El Paso [UTEP])
To view the full Community HealthCorps Impact Evaluation Report from the University of El Paso, click here.