Diabetes CommunityDiabetes Community
Health Workers:Health Workers:
A Piece of the HealthA Piece of the Health
Care Puzzle...
PurposePurpose
 To provide awareness of and informationTo provide awareness of and information
about the role of the Diab...
Learning ObjectivesLearning Objectives
 1. Describe four skills that are1. Describe four skills that are
demonstrated by ...
Who are Diabetes CommunityWho are Diabetes Community
Health Workers?Health Workers?
Diabetes Community Health Workers (DCH...
Workforce Size & CharacteristicsWorkforce Size & Characteristics
Michigan-Specific DataMichigan-Specific Data
 2,724 tota...
National Pay RatesNational Pay Rates
New HiresNew Hires
 64% paid below $13 per hour64% paid below $13 per hour
 3.4% pa...
DCHWs:DCHWs:
Promoters of Healthy LifestylesPromoters of Healthy Lifestyles
 Members of targetMembers of target
communiti...
Recommended Competencies ofRecommended Competencies of
Diabetes Community Health WorkersDiabetes Community Health Workers
...
Personal Characteristics ofPersonal Characteristics of
DCHWsDCHWs
 Relationship with the community beingRelationship with...
Personal Characteristics ofPersonal Characteristics of
DCHWs (cont.)DCHWs (cont.)
 Committed/dedicatedCommitted/dedicated...
Skills of Diabetes CommunitySkills of Diabetes Community
Health WorkersHealth Workers
CommunicationCommunication
Interpers...
Skills of Diabetes CommunitySkills of Diabetes Community
Health Workers (cont.)Health Workers (cont.)
Service Coordination...
DCHW Training-OptionsDCHW Training-Options
 Community Outreach Worker (WSU – 160 hrs.)Community Outreach Worker (WSU – 16...
DCHW Training-TopicsDCHW Training-Topics
 Human Subjects” (IRB) trainingHuman Subjects” (IRB) training
 Human enhancemen...
DCHW Training-TopicsDCHW Training-Topics
 Computer skills and use of the InternetComputer skills and use of the Internet
...
National and State CHWNational and State CHW
Organizations/TrainingsOrganizations/Trainings
 American Association of Comm...
Diversity TrainingDiversity Training
Ongoing CompetencyOngoing Competency
Component to DCHW TrainingComponent to DCHW Training
 Ensures that the DCHW maintain...
DCHW Personal SuccessesDCHW Personal Successes
 Survey showed a significant increaseSurvey showed a significant increase
...
DCHW Personal SuccessesDCHW Personal Successes
(cont.)(cont.)
 Increasing ability to relate to clientsIncreasing ability ...
DCHW EvaluationDCHW Evaluation
 DCHW focus groups and survey administered toDCHW focus groups and survey administered to
...
How DCHWs Helped REACHHow DCHWs Helped REACH
Participants Meet Their GoalsParticipants Meet Their Goals
How FHA Helped Par...
Responses To Rating QuestionsResponses To Rating Questions
E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfor...
 94% of respondents reported94% of respondents reported
either E/G:either E/G:
 relationship with DCHWrelationship with ...
FundingFunding
Private foundationsPrivate foundations
Federal (CDC, NIH, USDA)Federal (CDC, NIH, USDA)
State and local ...
The DCHW and theThe DCHW and the
Diabetes Care TeamDiabetes Care Team
 Team care is a necessary component ofTeam care is ...
The DCHW and theThe DCHW and the
Diabetes Care TeamDiabetes Care Team
DCHWs augmentDCHWs augment
the role of the diabetes ...
DCHW: AnDCHW: An
Important Piece ofImportant Piece of
the Health Care Puzzlethe Health Care Puzzle
 Important role of the...
Thank you!Thank you!
For more information, contact:For more information, contact:
Dawn CraneDawn Crane
(517) 335-9504(517)...
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Diabetes Community Health Worker

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Diabetes Community Health Worker

  1. 1. Diabetes CommunityDiabetes Community Health Workers:Health Workers: A Piece of the HealthA Piece of the Health Care PuzzleCare Puzzle Diabetes Partners In Action Coalition (DPAC)Diabetes Partners In Action Coalition (DPAC) Training & Education Program WorkgroupTraining & Education Program Workgroup
  2. 2. PurposePurpose  To provide awareness of and informationTo provide awareness of and information about the role of the Diabetes Communityabout the role of the Diabetes Community Health Worker (DCHW) in addressingHealth Worker (DCHW) in addressing prevention or self-management ofprevention or self-management of diabetes, particularly with underserveddiabetes, particularly with underserved populations.populations.
  3. 3. Learning ObjectivesLearning Objectives  1. Describe four skills that are1. Describe four skills that are demonstrated by an effective DCHW.demonstrated by an effective DCHW.  2. Identify training components required to2. Identify training components required to become a DCHW.become a DCHW.  3. Explain the unique role of the DCHW as3. Explain the unique role of the DCHW as part of an integrated diabetespart of an integrated diabetes managementmanagement
  4. 4. Who are Diabetes CommunityWho are Diabetes Community Health Workers?Health Workers? Diabetes Community Health Workers (DCHWs)Diabetes Community Health Workers (DCHWs) are community members who work as bridgesare community members who work as bridges between their ethnic, cultural, or geographicbetween their ethnic, cultural, or geographic communities and healthcare providers to helpcommunities and healthcare providers to help their neighbors prevent diabetes and itstheir neighbors prevent diabetes and its complications through self-care managementcomplications through self-care management and social support, including communityand social support, including community engagement.engagement. AADE Position Statement. “Diabetes Community HealthAADE Position Statement. “Diabetes Community Health Workers.Workers. The Diabetes Educator.The Diabetes Educator. 2003; 29(5):818-24.2003; 29(5):818-24.
  5. 5. Workforce Size & CharacteristicsWorkforce Size & Characteristics Michigan-Specific DataMichigan-Specific Data  2,724 total CHW workers: 1,807 paid CHWs2,724 total CHW workers: 1,807 paid CHWs (66%); 917 volunteer CHWs (34%)(66%); 917 volunteer CHWs (34%)  Occupations: counseling, substance abuse,Occupations: counseling, substance abuse, educational-vocational counseling, healtheducational-vocational counseling, health education, and other health/community serviceseducation, and other health/community services  In Michigan: Federally Qualified Health Centers,In Michigan: Federally Qualified Health Centers, Detroit Department of Health & WellnessDetroit Department of Health & Wellness Promotion, University of Michigan, DiabetesPromotion, University of Michigan, Diabetes Outreach Networks, Access, Indian HealthOutreach Networks, Access, Indian Health Services, Spectrum and St. Mary’s Hospital,Services, Spectrum and St. Mary’s Hospital, Henry Ford Health System, etc.Henry Ford Health System, etc.
  6. 6. National Pay RatesNational Pay Rates New HiresNew Hires  64% paid below $13 per hour64% paid below $13 per hour  3.4% paid at or near minimum wage3.4% paid at or near minimum wage  21% paid $15 or more per hour21% paid $15 or more per hour Experienced CHWsExperienced CHWs  70% paid $13 or more per hour70% paid $13 or more per hour  50% paid $15 or more per hour50% paid $15 or more per hour Michigan Public Health Training Center October 9, 2007
  7. 7. DCHWs:DCHWs: Promoters of Healthy LifestylesPromoters of Healthy Lifestyles  Members of targetMembers of target communitiescommunities  Share cultural beliefsShare cultural beliefs and valuesand values  Share social and ethnicShare social and ethnic characteristicscharacteristics  EliminateEliminate communication barrierscommunication barriers  Act as role models forAct as role models for changechange  Disseminate informationDisseminate information and educate familiesand educate families
  8. 8. Recommended Competencies ofRecommended Competencies of Diabetes Community Health WorkersDiabetes Community Health Workers  The Final Report Of The NationalThe Final Report Of The National Community Health Advisor Study;Community Health Advisor Study; CHWCHW Chapter Three: Core Roles andChapter Three: Core Roles and Competencies of Community HealthCompetencies of Community Health AdvisorsAdvisors  Competencies includeCompetencies include personalpersonal characteristics, qualities,characteristics, qualities, andand skillsskills thatthat DCHWs need to be effectiveDCHWs need to be effective
  9. 9. Personal Characteristics ofPersonal Characteristics of DCHWsDCHWs  Relationship with the community beingRelationship with the community being servedserved  Personal strength and courage (healthyPersonal strength and courage (healthy self-esteem and able to remain calm)self-esteem and able to remain calm)  Friendly/outgoing/sociableFriendly/outgoing/sociable  Patient and compassionatePatient and compassionate  Open-minded/not-judgmentalOpen-minded/not-judgmental  Motivated and capable of self-directed workMotivated and capable of self-directed work  Caring and empatheticCaring and empathetic
  10. 10. Personal Characteristics ofPersonal Characteristics of DCHWs (cont.)DCHWs (cont.)  Committed/dedicatedCommitted/dedicated  Respectful and honestRespectful and honest  Open/eager to grow/change/learnOpen/eager to grow/change/learn  Dependable/responsible/reliableDependable/responsible/reliable  Flexible/adaptableFlexible/adaptable  Desire to help the communityDesire to help the community  PersistentPersistent  Creative/resourcefulCreative/resourceful
  11. 11. Skills of Diabetes CommunitySkills of Diabetes Community Health WorkersHealth Workers CommunicationCommunication InterpersonalInterpersonal TeachingTeaching Knowledge BaseKnowledge Base
  12. 12. Skills of Diabetes CommunitySkills of Diabetes Community Health Workers (cont.)Health Workers (cont.) Service CoordinationService Coordination AdvocacyAdvocacy Capacity-BuildingCapacity-Building OrganizationalOrganizational
  13. 13. DCHW Training-OptionsDCHW Training-Options  Community Outreach Worker (WSU – 160 hrs.)Community Outreach Worker (WSU – 160 hrs.)  ““Empowerment” education (developed at U of MEmpowerment” education (developed at U of M Diabetes Research and Training Center (DRTC)Diabetes Research and Training Center (DRTC)  Attend a Diabetes Self-Management TrainingAttend a Diabetes Self-Management Training (DSMT) program provided by Certified Diabetes(DSMT) program provided by Certified Diabetes Educators (10 hours)Educators (10 hours)  DSMT programs: www.michigan.gov/diabetesDSMT programs: www.michigan.gov/diabetes
  14. 14. DCHW Training-TopicsDCHW Training-Topics  Human Subjects” (IRB) trainingHuman Subjects” (IRB) training  Human enhancement skillsHuman enhancement skills  Mental health (signs of depression, stress)Mental health (signs of depression, stress)  Case management skillsCase management skills  Cultural diversity/ competence trainingCultural diversity/ competence training  Conducting assessments and collectingConducting assessments and collecting health datahealth data
  15. 15. DCHW Training-TopicsDCHW Training-Topics  Computer skills and use of the InternetComputer skills and use of the Internet  Group facilitation/delivery of diabetesGroup facilitation/delivery of diabetes curriculumcurriculum  Behavior modification techniques – goalBehavior modification techniques – goal setting skillssetting skills  Understanding health disparitiesUnderstanding health disparities  Other training needsOther training needs
  16. 16. National and State CHWNational and State CHW Organizations/TrainingsOrganizations/Trainings  American Association of Community HealthAmerican Association of Community Health Workers (part of APHA, American Public HealthWorkers (part of APHA, American Public Health Association)Association) pam.chapman@spectrumhealth.orgpam.chapman@spectrumhealth.org  Michigan Community Advocate AssociationMichigan Community Advocate Association (MICAA)(MICAA) Grand Rapids, MIGrand Rapids, MI Lisa Marie Fisher @ 616-356-6205)Lisa Marie Fisher @ 616-356-6205)  Wayne State University: “Empowerment SkillsWayne State University: “Empowerment Skills for Family Workers” Training Seriesfor Family Workers” Training Series Joan Blount @ 313-827-7113Joan Blount @ 313-827-7113
  17. 17. Diversity TrainingDiversity Training
  18. 18. Ongoing CompetencyOngoing Competency Component to DCHW TrainingComponent to DCHW Training  Ensures that the DCHW maintains currentEnsures that the DCHW maintains current knowledge about the treatment and self-knowledge about the treatment and self- management of diabetesmanagement of diabetes  Provide frequent and regular diabetesProvide frequent and regular diabetes education opportunitieseducation opportunities  Suggestions for trainingSuggestions for training
  19. 19. DCHW Personal SuccessesDCHW Personal Successes  Survey showed a significant increaseSurvey showed a significant increase in knowledge of diabetes and self-in knowledge of diabetes and self- managementmanagement  Learning about diabetes preventionLearning about diabetes prevention and complications and how to educateand complications and how to educate othersothers  Perceive selves as making aPerceive selves as making a difference, influencing change, smalldifference, influencing change, small steps, “help get over the wall”steps, “help get over the wall”
  20. 20. DCHW Personal SuccessesDCHW Personal Successes (cont.)(cont.)  Increasing ability to relate to clientsIncreasing ability to relate to clients and gain their trustand gain their trust  Learning about computersLearning about computers  Helping each other with resources andHelping each other with resources and other DCHW tasksother DCHW tasks  Learning to work with people acrossLearning to work with people across culturescultures  Developing their own healthier eatingDeveloping their own healthier eating and exercise habitsand exercise habits
  21. 21. DCHW EvaluationDCHW Evaluation  DCHW focus groups and survey administered toDCHW focus groups and survey administered to assess previous and current knowledge ofassess previous and current knowledge of diabetes and self-management, attitudes,diabetes and self-management, attitudes, expectations, and assessment of theexpectations, and assessment of the interventionintervention  DCHW client file audits, include quarterly reviewDCHW client file audits, include quarterly review of all files with follow up procedures, including aof all files with follow up procedures, including a specific timeline for completion, second review,specific timeline for completion, second review, and follow up actionand follow up action  DCHW effectiveness phone surveyDCHW effectiveness phone survey
  22. 22. How DCHWs Helped REACHHow DCHWs Helped REACH Participants Meet Their GoalsParticipants Meet Their Goals How FHA Helped Participants Meet Goals 0 2 4 6 8 10 12 14 16 Type of Help NumberofRespondents Menu Ideas Exercise Information Exercise Encouragement Event Information Regular Contact Attends Meetings Attends Doctor Visits Diabetes Education Motivation/Support Reminders Glucose Monitoring Education Journey to Health Classes Health Eating Education Information about Medications Recommendations/Referals Other
  23. 23. Responses To Rating QuestionsResponses To Rating Questions E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable,E/G=Excellent/Good, F/P=Fair/Poor, VC/C=Very Comfortable/Comfortable, SC/NC=Somewhat Comfortable/Not ComfortableSC/NC=Somewhat Comfortable/Not Comfortable  96% of respondents reported feeling either very96% of respondents reported feeling either very comfortable or comfortable contacting theircomfortable or comfortable contacting their DCHW for needs or services.DCHW for needs or services.  93% of respondents rated their DCHW93% of respondents rated their DCHW understanding of their experiences as an Africanunderstanding of their experiences as an African American or Hispanic as excellent or good.American or Hispanic as excellent or good.  In terms of doing what they said they would do,In terms of doing what they said they would do, 87% of respondents rated their DCHW as87% of respondents rated their DCHW as excellent or good.excellent or good.
  24. 24.  94% of respondents reported94% of respondents reported either E/G:either E/G:  relationship with DCHWrelationship with DCHW  satisfaction with DCHWsatisfaction with DCHW  Respondents rated DCHWsRespondents rated DCHWs on their ability to:on their ability to:  get them services toget them services to improve their healthimprove their health (E/G=85% and F/P=15%)(E/G=85% and F/P=15%)  help them withhelp them with relationship with theirrelationship with their doctor (87% and 12%)doctor (87% and 12%) and communication withand communication with doctor (E/G=76% anddoctor (E/G=76% and F/P=16%).F/P=16%).
  25. 25. FundingFunding Private foundationsPrivate foundations Federal (CDC, NIH, USDA)Federal (CDC, NIH, USDA) State and local agencies andState and local agencies and health departmentshealth departments
  26. 26. The DCHW and theThe DCHW and the Diabetes Care TeamDiabetes Care Team  Team care is a necessary component ofTeam care is a necessary component of effective chronic illness management per DCCT*effective chronic illness management per DCCT* and UKPDS** (NDEP*** Team Care booklet)and UKPDS** (NDEP*** Team Care booklet)  Skills and roles of different health care providersSkills and roles of different health care providers should be integrated and coordinatedshould be integrated and coordinated  The DCHW is an important member of this team,The DCHW is an important member of this team, particularly for high risk populations.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. 27. The DCHW and theThe DCHW and the Diabetes Care TeamDiabetes Care Team DCHWs augmentDCHWs augment the role of the diabetes educatorthe role of the diabetes educator and other diabetes care team membersand other diabetes care team members Promote trust to promote access to DSMTPromote trust to promote access to DSMT and other health care servicesand other health care services ProvideProvide diabetes self-management supportdiabetes self-management support after Diabetes Self-Management Trainingafter Diabetes Self-Management Training Help diabetes educator provide culturallyHelp diabetes educator provide culturally sensitive care/educationsensitive care/education
  28. 28. DCHW: AnDCHW: An Important Piece ofImportant Piece of the Health Care Puzzlethe Health Care Puzzle  Important role of the diabetes health careImportant role of the diabetes health care team, esp. for vulnerable populationsteam, esp. for vulnerable populations  Provide access to and act as liaison withProvide access to and act as liaison with diverse populationsdiverse populations  Serve as resources to their communitiesServe as resources to their communities and to the advocacy and policy worlds*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. 29. Thank you!Thank you! For more information, contact:For more information, contact: Dawn CraneDawn Crane (517) 335-9504(517) 335-9504 craned@michigan.govcraned@michigan.gov oror REACH Detroit PartnershipREACH Detroit Partnership www.reachdetroit.orgwww.reachdetroit.org

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