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  • PRESENTER NOTES: This presentation was developed by the MI Diabetes Partners in Action Coalition (DPAC) Training & Education Program Workgroup. The workgroup’s efforts focused on developing strategies for the promotion of training programs aimed at allied health professionals and lay health workers. These groups of workers are either employees or volunteers of programs or projects that aim to improve the health status of underserved communities and to increase access to health care and social services in those communities. To help people better understand the role of the community health worker, a presentation was developed about CHWs, their role in addressing diabetes, required competencies and skills, and training needed to prepare CHWs. Also, this presentation will share the experience of a DCHW project.
  • The Training and Education Workgroup of the Michigan Diabetes Partners in Action (DPAC) developed this presentation for interested parties to use when considering the development or utilization of a DCHW program.
  • Learning Objectives:
  • PRESENTER NOTES: The community health worker term encompasses an array of health practitioners known nationally and internationally by many different titles. Some of the names for these practitioners are: Family Health Advocates (FHAs), Community Health Advocates, Community Health Advisor, Community Health Worker, Outreach Educator, Community Health Representative, Peer Health Promoter and other titles. ACTION: READ THE DEFINITION ON THE SLIDE TO THE AUDIENCE REFERENCE: AADE Position Statement. “Diabetes Community Health Workers. The Diabetes Educator. 2003; 29(5):818-24.
  • PRESENTER NOTES: In the Community Health Worker National Workforce Study, estimates were made of paid CHWs (MI – 76 percent) and of volunteer (MI – 33 percent) in each of the 50 States; as well as estimates of the various occupations likely to be CHWs. These occupations include: counseling, substance abuse, educational-vocational counseling, health education, and other health and community services. CHWs work in not-for-profit and for-profit organizations such as schools, universities, clinics, hospitals, physician offices, individual-family-child services, and educational programs. ACTION: READ SOME OF THE EXAMPLES LISTED IN THE THIRD BULLET POINT OF WHERE DCHW ARE EMPLOYED IN THE STATE OF MICHIGAN. REFERENCE: If you want to read more about the employment of CHWs nationwide, check out this web link to a national study of CHWs: U.S. Department of Health and Human Services, Health Resources and Services Administration. Community Health Workers National Workforce Study (http://bhpr.hrsa.gov/healthworkforce/chw/AppI.htm)
  • PRESENTER NOTES: CHW is not been viewed as a career because positions are short-term, poorly compensated, and lack recognition from other professionals. This is clearly illustrated by the wage scales listed on this slide. Some view the CHW position as a stepping stone to other health and social service careers. Only California and Texas have a career ladder set up for career advancement in the field. REFERENCE: U.S. Dept. of Health and Human Services, Health Resources and Services Administration. Community Health Workers National Workforce Study. 2005. Access at http://bhpr.hrsagov/healthworkforce/chw/AppI.htm
  • PRESENTER NOTES: DCHWs are members of target communities, share the same cultural beliefs and values, social and ethnic characteristics, and speak the same language, as the target population. DCHWs are role models for change. They disseminate information and educate families. REFERENCE: Michigan Public Health Training Center October 9, 2007
  • PRESENTER NOTES: Knowledge about DCHW competencies is an important element when an organization is developing a program that will utilize DCHW. The Training and Education Program Workgroup recommends the adoption of the “Community Health Advisor (DCHW)” core roles and competencies outlined in The Final Report Of The National Community Health Advisor Study; “CHW Chapter Three: Core Roles and Competencies of Community Health Advisors” . Competencies include qualities and skills that DCHWs need to be effective. Orientation and training for DCHWs should provide opportunities to develop and enhance the skills outlined in this presentation.
  • PRESENTER NOTES: Knowledge about the personal traits of an effective DCHW is also important for organizations who are developing programs or seeking to integrate DCHWs into their diabetes services. Some of the personal characteristics of a DCHW include: Member of the community being served, have a healthy self-esteem and are able to remain calm, friendly, outgoing and sociable, patient and compassionate, open-minded and non-judgmental, willing and able to work independently, and caring and empathetic. ACTION: PRESENTER HAS OPTION TO SKIP SLIDES 7-9 IN INTEREST OF TIME.
  • PRESENTER NOTES: Other personal characteristics of DCHWs include: people who are committed and dedicated; respectful and honest; open and eager to grow, change, and learn; dependable, responsible and reliable; flexible and adaptable; desire to help people and community; persistent, creative, and resourceful. Many will describe themselves as “people persons”.
  • PRESENTER NOTES: Lastly, organizations/programs seeking to utilize DCHWs need to be knowledgeable about the skill set that ensures effective services provided by DCHWs. These include: Communication Skills Ability to listen Ability to use language appropriately Ability to speak language of community Ability to document work Interpersonal Skills Friendly and sociable Counseling skills (ability to develop rapport, maintain confidentiality & terminate client relationship) Relationship building skills (ability to develop trust, make people comfortable, & meet people where they are) Ability to work as a team member Ability to work appropriately with diverse groups of people Teaching Skills Ability to share information in a group or one-on-one Ability to use appropriate and effective educational techniques Ability to plan or conduct a class or presentation Ability to respond to questions about a variety of topics Ability to find requested info and report back to client Knowledge Base Know about the community and resources Know about specific health issues Knowledge of the health and social service systems ACTION: READ SOME OF THE SKILLS LISTED UNDER EACH OF THESE LARGER CATEGORIES OF SKILLS, BUT NOT NECESSARILY ALL.
  • PRESENTER NOTES: Service Coordination Skills, such as: Ability to identify and access resources Ability to network and build coalitions Ability to make appropriate referrals Ability to provide follow-up Advocacy Skills, such as: Ability to speak-up on behalf of community and individuals and to withstand intimidation Ability to use language appropriately Ability to overcome barriers Capacity-Building Skills, such as: Empowerment skills (ability to help people identify their own problems and ability to work with clients to identify strengths and resources). Leadership skills (ability to: strategize, motivate, build relationships, deliberate and interpret experience, create an action program and accept responsibility). Organizational Skills, such as: Ability to set goals Ability to develop an action plan Ability to prioritize Ability to manage time wisely ACTION: READ SOME OF THE SKILLS LISTED UNDER EACH OF THESE LARGER CATEGORIES OF SKILLS, BUT NOT NECESSARILY ALL.
  • PRESENTER NOTES: The training outlined in this presentation is a guideline only. The actual training needs of the DCHW are determined by the organization after a careful analysis of the kinds of activities to be conducted, and the skill set needed to promote the success of the DCHW as well as the unique characteristics of the individual employee/volunteer. Listed here are many examples of specific training that a DCHW might participate in and apply in their job assignments. ACTION: READ AND EXPAND ON SOME OF THOSE LISTED HERE – EMPHASIZE SPECIFIC TRAINING DEVELOPED OR OFFERED IN MICHIGAN, AS BELOW: The CHW training provided by Wayne State University provides an excellent foundation for the CHW and incorporates much of the training outlined in this presentation. (“Empowerment Skills for Family Workers” Training Series, Wayne State University - College of Urban, Labor and Metropolitan Affairs – Skillman Center for Children; contact Joan Blount @ 313-827-7113 OR http://www.skillmancenter.wayne.edu/empowerbookapril2005.pdf) There are 91 DSMT programs in Michigan and attendance of one of these courses, most of which are 10 hours, is an excellent, cost effective way to obtain the specialized diabetes knowledge necessary for DCHWS and it is also an excellent way for the DCHW to begin building a relationship with the diabetes educators in their community and paving the way for collaboration. Go to www.michigan.gov/diabetes for a list and contact information for these programs. REFERENCE: U.S. Department of Health and Human Services, Health Resources and Services Administration. Training Community Health Workers: Using Technology and Distance Education. April 2006, pages 1-43. (ftp://ftp.hrsagov/ruralhealth/TrainingCHW.pdf)
  • PRESENTER NOTES: Continuing with training needs:
  • PRESENTER NOTES: Listed on this slide are a few national and Michigan state organizations supporting the needs of CHWs. American Public Health Association 800 I Street, NW Washington, DC 20001 202-777-2742 202-777-2534 (fax) Michigan Community Advocate Association (MICAA) Grand Rapids, MI 616-356-6205 contact: Lisa Marie Fisher The CHW training provided by Wayne State University provides an excellent foundation for the CHW and incorporates much of the training outlined in this presentation. (“Empowerment Skills for Family Workers” Training Series, Wayne State University - College of Urban, Labor and Metropolitan Affairs – Skillman Center for Children; contact Joan Blount @ 313-827-7113 OR http://www.skillmancenter.wayne.edu/empowerbookapril2005.pdf)
  • PRESENTER NOTES: Pictured here are participants during a cultural competency training.
  • PRESENTER NOTES: Suggestions for training include: regular agency sponsored trainings, diabetes education classes or continuing medical education sessions sponsored by a partnering or other organization, hospital, clinic, education materials, self-study modules, internet resources, and local, regional, state and national trainings, workshops and conferences. Department of Health and Human Services, Health Resources and Services Administration. Training Community Health Workers: Using Technology and Distance Education. April 2006; pages 1-43. (http://
  • Here are some examples of the personal successes reported by DCHWs (Diabetes Community Health Workers) who are known as Family Health Advocates (FHAs) from the REACH Detroit Partnership.
  • PRESENTER NOTES: Evaluating the services and impact of Diabetes Community Health Workers can be very challenging. To date there are only a few published evaluations of community health worker programs and even fewer preliminary attempts to gather and review these evaluations. Some examples include; DCHW focus groups to assess their knowledge of diabetes and how to support formalized Diabetes Self-Management Training (DSMT) efforts provided by a Certified Diabetes Educator (CDE), client file audits, and phone surveys of clients serviced by DCHWs.
  • PRESENTER NOTES: A greater number of participants who participated in a REACH survey through the Family Health Advocates (FHAs) stated that their DCHW helped them to reach their goals through the motivation and support they provided. Education on diabetes and healthy eating were other prominent ways that participants said that they were helped by their DCHWs.
  • PRESENTER NOTES: This same survey indicated that the majority of respondents (over 90%) were quite comfortable with contacting their DCHW with questions and needs, and rated their DCHW as empathetic to the African American or Hispanic experience. Nearly 90% of respondents reported that their DCHW had good to excellent follow-through on client issues.
  • PRESENTER NOTES: From the same survey, over 90% of respondents reported a good-to-excellent relationship and satisfaction with the their DCHW. In the spirit of follow-through and serving as a liaison to health care providers, a majority again reported good-to-excellent service from their DCHW.
  • PRESENTER NOTES: Funding to support the activities of DCHWs may come from a wide variety of public and private sector sources, including: Private foundations Federal Agencies, such as the Centers for disease Control (CDC), National Institutes of Health (NIH) and its various branches, and United States Department of Agriculture (USDA) State and local agencies and health departments
  • PRESENTER NOTES: DCCT = Diabetes Control and Complications Trial (intensive management of Type 1 diabetes) UKPDS = United Kingdom Prospective Diabetes Study (aggressive treatment of Type 2 diabetes) THE DCHW AND THE DIABETES CARE TEAM Team care is a necessary component of chronic disease management per the DCCT and UKPDS diabetes trials. Skills and roles of different health care providers should be integrated and coordinated. A collaborative model between the DCHW and the diabetes educator is an important element of promoting successful diabetes self-management REFERENCES: The Diabetes Control and Complications Research Trial Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329 (14): 977-986. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in subjects with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853. http://ndep.nih.gov/diabetes/pubs/TeamCare.pdf
  • DCHWs can advocate for the need to obtain important services such as DSMT provided by CDEs and can help remove barriers to access through their relationships with their clients and with other health care professionals. Diabetes educators are specialists in diabetes education and behavior change, however, people may be reluctant to participate in education services available due to cultural or other barriers. *Diabetes self-management support (DSMS) =The provision of ongoing services and care that promote achievement and maintenance of behavior changes necessary to prevent complications and enhance quality of life. The provision of DSMS is increasingly being recognized as an essential element for successful self- management of diabetes. However, for DSMS to be most effective, services should be broad-based and multidimensional. The DCHW, because of their community base and through their identification with the cultures they represent, are key providers of DSMS. Important interventions provided include: Promote trust to facilitate participation in DSMT provided by diabetes educators Working with people after DSMT to help ensure achievement and maintenance of behavior change goal/s.
  • PRESENTER NOTES: In summary, both nationally and regionally, and in multifaceted ways, DCHWs contribute significantly to translating and supporting the formal diabetes education provided by Certified Diabetes Educators. Because DCHWs may have the same cultural and ethnic backgrounds as the communities they serve, they can facilitate access to Diabetes Self-Management Training (DSMT) and other important diabetes care services and serve as a liaison to the medical community for the vulnerable populations they service. To end this presentation, these are some examples from a Diabetes Outreach Network (DON) survey completed in 2006 with 6 of the DONs regarding the use of DCHWs for various DON Outreach educational efforts. One CHW is a “recipient of a kidney transplant and has previously provided lay health training for kidney patients and other CHW’s.” One CHW “has a spouse with Type 2 diabetes and natural talents and skills at social marketing.” Another CHW is “African American and has established relationships with support group leaders over the past few years.” Another CHW is “African American and has worked in health outreach programs.” Another CHW “has established relationships with support group leaders over the past few years.” Community health workers are resources to their communities and to the advocacy and policy worlds on several levels. Community health workers can connect people to health care and collect information relevant to policy. They are natural researchers who, as a result of direct interaction with the populations they serve, can recount the realities of exclusion and propose remedies for it. As natural researchers, they contribute to best practices while informing public policy with the information they can share. In this light, community health workers may also be advocates for social justice. (Perez LM and Martinez J. Community Health Workers: Social justice and policy advocates for community health and well-being. Am J Public Health. 2008; 98:11-14).
  • PRESENTER NOTES: For more information on DCHWs in the state of Michigan, please contact us. Thank you.

Transcript

  • 1. Diabetes Community Health Workers: A Piece of the Health Care Puzzle Diabetes Partners In Action Coalition (DPAC) Training & Education Program Workgroup
  • 2. Purpose
    • To provide awareness of and information about the role of the Diabetes Community Health Worker (DCHW) in addressing prevention or self-management of diabetes, particularly with underserved populations.
  • 3. Learning Objectives
    • 1. Describe four skills that are demonstrated by an effective DCHW.
    • 2. Identify training components required to become a DCHW.
    • 3. Explain the unique role of the DCHW as part of an integrated diabetes management
  • 4. Who are Diabetes Community Health Workers?
    • Diabetes Community Health Workers (DCHWs) are community members who work as bridges between their ethnic, cultural, or geographic communities and healthcare providers to help their neighbors prevent diabetes and its complications through self-care management and social support, including community engagement.
    • AADE Position Statement. “Diabetes Community Health Workers. The Diabetes Educator. 2003; 29(5):818-24.
  • 5. Workforce Size & Characteristics
    • Michigan-Specific Data
    • 2,724 total CHW workers: 1,807 paid CHWs (66%); 917 volunteer CHWs (34%)
    • Occupations: counseling, substance abuse, educational-vocational counseling, health education, and other health/community services
    • In Michigan: Federally Qualified Health Centers, Detroit Department of Health & Wellness Promotion, University of Michigan, Diabetes Outreach Networks, Access, Indian Health Services, Spectrum and St. Mary’s Hospital, Henry Ford Health System, etc.
  • 6. National Pay Rates
    • New Hires
    • 64% paid below $13 per hour
    • 3.4% paid at or near minimum wage
    • 21% paid $15 or more per hour
    • Experienced CHWs
    • 70% paid $13 or more per hour
    • 50% paid $15 or more per hour
    Michigan Public Health Training Center October 9, 2007
  • 7. DCHWs: Promoters of Healthy Lifestyles
    • Members of target communities
    • Share cultural beliefs and values
    • Share social and ethnic characteristics
    • Eliminate communication barriers
    • Act as role models for change
    • Disseminate information and educate families
  • 8. Recommended Competencies of Diabetes Community Health Workers
    • The Final Report Of The National Community Health Advisor Study; CHW Chapter Three: Core Roles and Competencies of Community Health Advisors
    • Competencies include personal characteristics, qualities, and skills that DCHWs need to be effective
  • 9. Personal Characteristics of DCHWs
    • Relationship with the community being served
    • Personal strength and courage (healthy self-esteem and able to remain calm)
    • Friendly/outgoing/sociable
    • Patient and compassionate
    • Open-minded/not-judgmental
    • Motivated and capable of self-directed work
    • Caring and empathetic
  • 10. Personal Characteristics of DCHWs (cont.)
    • Committed/dedicated
    • Respectful and honest
    • Open/eager to grow/change/learn
    • Dependable/responsible/reliable
    • Flexible/adaptable
    • Desire to help the community
    • Persistent
    • Creative/resourceful
  • 11. Skills of Diabetes Community Health Workers
    • Communication
    • Interpersonal
    • Teaching
    • Knowledge Base
  • 12. Skills of Diabetes Community Health Workers (cont.)
    • Service Coordination
    • Advocacy
    • Capacity-Building
    • Organizational
  • 13. DCHW Training-Options
    • Community Outreach Worker (WSU – 160 hrs.)
    • “ Empowerment” education (developed at U of M Diabetes Research and Training Center (DRTC)
    • Attend a Diabetes Self-Management Training (DSMT) program provided by Certified Diabetes Educators (10 hours)
    • DSMT programs: www.michigan.gov/diabetes
  • 14. DCHW Training-Topics
    • Human Subjects” (IRB) training
    • Human enhancement skills
    • Mental health (signs of depression, stress)
    • Case management skills
    • Cultural diversity/ competence training
    • Conducting assessments and collecting health data
  • 15. DCHW Training-Topics
    • Computer skills and use of the Internet
    • Group facilitation/delivery of diabetes curriculum
    • Behavior modification techniques – goal setting skills
    • Understanding health disparities
    • Other training needs
  • 16. National and State CHW Organizations/Trainings
    • American Association of Community Health Workers (part of APHA, American Public Health Association) [email_address]
    • Michigan Community Advocate Association (MICAA)
    • Grand Rapids, MI
    • Lisa Marie Fisher @ 616-356-6205)
    • Wayne State University: “Empowerment Skills for Family Workers” Training Series
    • Joan Blount @ 313-827-7113
  • 17. Diversity Training
  • 18. Ongoing Competency Component to DCHW Training
    • Ensures that the DCHW maintains current knowledge about the treatment and self-management of diabetes
    • Provide frequent and regular diabetes education opportunities
    • Suggestions for training
  • 19. DCHW Personal Successes
    • Survey showed a significant increase in knowledge of diabetes and self- management
    • Learning about diabetes prevention and complications and how to educate others
    • Perceive selves as making a difference, influencing change, small steps, “help get over the wall”
  • 20. DCHW Personal Successes (cont.)
    • Increasing ability to relate to clients and gain their trust
    • Learning about computers
    • Helping each other with resources and other DCHW tasks
    • Learning to work with people across cultures
    • Developing their own healthier eating and exercise habits
  • 21. DCHW Evaluation
    • DCHW focus groups and survey administered to assess previous and current knowledge of diabetes and self-management, attitudes, expectations, and assessment of the intervention
    • DCHW client file audits, include quarterly review of all files with follow up procedures, including a specific timeline for completion, second review, and follow up action
    • DCHW effectiveness phone survey
  • 22. How DCHWs Helped REACH Participants Meet Their Goals
  • 23. Responses To Rating Questions E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable, SC/NC=Somewhat Comfortable/Not Comfortable
    • 96% of respondents reported feeling either very comfortable or comfortable contacting their DCHW for needs or services.
    • 93% of respondents rated their DCHW understanding of their experiences as an African American or Hispanic as excellent or good.
    • In terms of doing what they said they would do, 87% of respondents rated their DCHW as excellent or good.
  • 24.
    • 94% of respondents reported either E/G:
      • relationship with DCHW
      • satisfaction with DCHW
    • Respondents rated DCHWs on their ability to:
      • get them services to improve their health (E/G=85% and F/P=15%)
      • help them with relationship with their doctor (87% and 12%) and communication with doctor (E/G=76% and F/P=16%).
  • 25. Funding
    • Private foundations
    • Federal (CDC, NIH, USDA)
    • State and local agencies and health departments
  • 26. The DCHW and the Diabetes Care Team
    • Team care is a necessary component of effective chronic illness management per DCCT* and UKPDS** (NDEP*** Team Care booklet)
    • Skills and roles of different health care providers should be integrated and coordinated
    • The DCHW is an important member of this team, particularly for high risk populations.
    *The Diabetes Control and Complications Research Trial Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329 (14): 977-986. **UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in subjects with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853. ***http://ndep.nih.gov/diabetes/pubs/TeamCare.pdf
  • 27. The DCHW and the Diabetes Care Team
    • DCHWs augment
    • the role of the diabetes educator
    • and other diabetes care team members
      • Promote trust to promote access to DSMT and other health care services
      • Provide diabetes self-management support after Diabetes Self-Management Training
      • Help diabetes educator provide culturally sensitive care/education
  • 28. DCHW: An Important Piece of the Health Care Puzzle
    • Important role of the diabetes health care team, esp. for vulnerable populations
    • Provide access to and act as liaison with diverse populations
    • Serve as resources to their communities and to the advocacy and policy worlds*
    *Perez LM and Martinez J. Community Health Workers: Social justice and policy advocates for community health and well-being. Am J Public Health . 2008; 98:11-14.
  • 29. Thank you!
    • For more information, contact:
    • Dawn Crane
    • (517) 335-9504
    • [email_address]
    • or
    • REACH Detroit Partnership
    • www.reachdetroit.org