Best Practices: Community Health Workers and Positive Impact on Community Change
Best Practices:Community HealthWorkers and PositiveImpact on CommunityChangeGrassroots impacts of CommunityHealth Workers, Promotoras and LayHealth Workers in relation to theupcoming roles of Patient Navigatorswith the Affordable Care Act.
Arizona Rural Women’s Health NetworkMembers• Eastern Arizona Area HealthEducation Center• Greater Valley Arizona AreaHealth Education Center• Northern Arizona Area HealthEducation Center• Western Arizona Area HealthEducation Center• Mogollon Health Alliance• Time Out, Incorporated• Arizona Department of HealthServices• Mariposa Community HealthCenter• Arizona Alliance for CommunityHealth Centers• Arizona Office of Rural Health-University of Arizona-MEZCOPH• Payson Chapter AmnestyInternational
The Role of The Community HealthWorker or PromotoraCommunity Health Workers (CHWs) are frontline public healthworkers who are trusted members of and/or have an unusually closeunderstanding of the community served. This trusting relationshipenables CHWs to serve as a liaison/link/intermediary betweenhealth/social services and the community to facilitate access toservices and improve the quality and cultural competence of servicedelivery. CHWs also build individual and community capacity byincreasing health knowledge and self-sufficiency through a range ofactivities such as outreach, community education, informalcounseling, social support and advocacy. (APHA)
The Promotora ModelSpanish word for “promoter” and inthis context also can refer tocommunity health workers.Promotoras live in the communitiesin which they work. They are theknowledge keepers for thatcommunity. They are not usuallyformally educated, but serve as awealthy of knowledge for thosepeople needing to access services inthe community. They are trustedadvisors, educators and able toreach those in underserved areas.
The Definition of the CHW or Promotora can bebroad- however is built on these coredefinitions:1. Bridging and providing culturalmediation between communitiesand health and social servicesystems2. Providing culturally appropriatehealth education and information3. Ensuring people get servicesthey need4. Providing informal counselingand social support5. Advocating for individual andcommunity needs6. Providing direct service, such asbasic first aid and administeringhealth screening tests7. Building individual andcommunity capacity
Why is the Promotora/CHW/CHA ModelConsidered a Best Practice?The National Community Health AdvisorStudy, conducted by the University ofArizona, found an array of benefits associated withCHA outreach & education services in underservedcommunities, such as decreases in ER visits, areduction in the length of hospital stays, and fewermedical complications when patients do receivemedical attention. Because CHA outreach focuses onthe individual, services are provided in a cost-effective and culturally sensitive manner thateliminates many barriers that prevent some fromobtaining medical care. As a result, a greater senseof trust develops between the community and theformal health care system.
Community CapacityOpportunities Communities can benefits from newleadership. CHWs & Promotoras areusually very well respected communitymembers and can help with capacitybuilding. The Promotoras/CHWs are positiverepresentatives of their respectiveagencies and will act as advocates forthe community. Both CHWs & Promotoras are wellversed in the assets and needs of theircommunities.
Amazing Community Health Worker andPromotora Work here in Arizona!
ACA: Marketplace - Patient Navigators•Each Marketplace is required to have at least two (2)types of entities serve as Navigators- one (1) must bea community and consumer focused non-profit• Must be trained to ensure they have expertise in the needs ofunderserved and vulnerable populations (e.g. rural, people livingwith HIV/AIDS)• Navigator grantees could include individuals and organizationsthat often target their outreach to specific ethnic, geographic orother communities although all Navigators should have ability tohelp any individual who seeks assistance
Navigator Eligibility• Eligible entities:• Self employed individuals• Public and private entities including non-profitorganizations, tribes and tribalorganizations, unions, chambers of commerce, etc.• Ineligible entities:• Health insurance issuers and their subsidiaries• Associations that include members of, or lobbies onbehalf of, insurance industry• Recipients of any direct or indirect consideration fromhealth insurance issuer in connection with enrollment
Navigator Program Management•In the Federal Marketplace- HHS funds andawards funding for Navigator grants•States choosing to build their own Marketplacewill build their own Navigator programsincluding awarding and overseeinggrants, developing standards and ensuringadherence to programmatic requirements
Non- Navigator Assistance Personnel(In-Person Assistance Personnel)•A “non-Navigator assistance program” is aprogram established to fulfill consumerassistance, education and outreachfunctions.•HHS does not anticipate operatingnon-Navigator assistance programs in theFFM.
CACs in the Marketplace• Certified Application Counselor.What does this mean to us and those we serve?• States building own Marketplace- Navigator and CAC, but may choosewhether or not to have a non-Navigator assistance program.• States working with CMS- Must have a Navigator, non-Navigatorassistance program and a CAC program.• The Federal Marketplace- Navigator program, CAC program, but is notanticipated to have non-Navigator assistance personnel.
Get the latest resources to help people apply, enroll andget coverage at- Marketplace.cms.gov
Thank you!Kim Zill, MSNetwork DirectorArizona Rural Women’s Health Networkkimberlyz@aachc.org700 E. Jefferson St. | Suite 100 | Phoenix, AZ 85034Phone: 602-288-7544 | Fax: 602-252-3620