Bringing issues to light and Making Change through Public-Private Partnerships

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Bringing issues to light and Making Change through Public-Private Partnerships: Lessons Learned from a Statewide Community Health Worker Advisory Council in Massachusetts Gail Hirsch, M.Ed. Office of Community Health Workers Massachusetts Department of Public Health Stephanie Anthony, J.D., M.P.H. Key Associate University of Massachusetts Medical School, Center for Health Law & Economics New England Regional Minority Health Conference October 14, 2009

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Background on CHWs, Legislative Mandate, & Advisory Council

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DPH Priorities Support the accomplishment of social insurance change. Take out racial and ethnic incongruities. Advance wellbeing in the working environment, school, group, and home. Oversee constant malady. Construct general wellbeing limit at the neighborhood and state levels.

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Background: the Emerging Profession 1960's forward – Mass. DPH gets to be biggest funder of CHW projects 1994 forward: Internal DPH team to characterize and consider the field Building outside joint efforts with key partners to advance CHW workforce improvement 2000-2003 - Federal (HRSA) framework give for statewide CHW system, overview, and approach advancement 2000 - Formation of statewide CHW proficient affiliation (Massachusetts Association of Community Health Workers - MACHW) 2002 forward - MACHW organization with Massachusetts Public Health Association and financing from BCBS of MA Foundation

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Defining Community Health Workers Public wellbeing specialists who apply their one of a kind comprehension of the experience, dialect, or potentially culture of the populaces they serve keeping in mind the end goal to do at least one of the accompanying parts: Provide socially suitable wellbeing instruction, data, and effort in group based settings Provide coordinate administrations, for example, casual guiding, social support, mind coordination, and wellbeing screenings Advocate for individual and group needs Provide social intervention between people, groups, and wellbeing and human administration suppliers (framework route) Build individual and group limit Assure individuals have admittance to required administrations

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What makes CHWs interesting? CHWs are recognized from other wellbeing experts since they: Are enlisted basically for their comprehension of the populaces and groups they serve Conduct exceed a critical segment of their time Have encounter giving administrations in group settings

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Community Health Educator Enrollment Worker Family Advocate Family Planning Counselor Family Support Worker Health Advocate Health Educator HIV Peer Advocate Outreach Worker Outreach Educator Patient Navigator Peer Advocate Peer Leader Promotor(a) Promotor(a) de Salud Street Outreach Worker Youth Outreach Worker CHWs work under numerous occupation titles

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Community-based Primary Care TB Prevention and Control Domestic Violence Crisis and Outreach Services for GLBT Communities Early Intervention Environmental Health Outreach and Education Family Initiatives HIV/AIDS Bureau Lead Poisoning Prevention Rural Domestic Violence and Child Victimization Youth Violence Prevention Men's Health Services Disease Prevention Refugee and Immigrant Health Sexual Assault Prevention and Survivor Services Suicide Prevention WIC Nutrition Program Women's Health Network DPH is biggest business of CHWs

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Background: the Emerging Profession 2005 - MDPH CHW report "Group Health Workers: Essential to Improving Health in Massachusetts" 2006 Universal Health Care Reform (Chapter 58, Acts of 2006) has two CHW segments: MACHW situate on Public Health Council Section 110, wellbeing incongruities arrangement on CHWs

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MA Legislative Mandate CHWs co-wrote the bill that got to be Section 110; CHW authority improvement vital Long time association with state, CHW workforce, different supporters was vital to consideration Legislature perceived the significance of CHWs in: extending access to medicinal services disposing of wellbeing variations

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Legislative Mandate to DPH (Section 110) Conduct examination of the CHW workforce: Use and subsidizing of CHWs CHW part in expanding access to social insurance CHW part in killing wellbeing inconsistencies Convene a statewide CHW Advisory Council Inform the examination & translate the discoveries Develop suggestions for an economical CHW program in MA, including preparing, accreditation and financing Submit a report of the discoveries and proposals to the Legislature

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CHW Advisory Council 30 associations and offices (14 named in enactment): State offices CHW preparing programs Health arranges Health care and group based associations CHW workforce Health mind suppliers Employers of CHWs Foundations Academic establishments Health strategy advocates

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Four Workgroups Finance Explored an assorted qualities of financing instruments so as to create suggestions for feasible financing for the CHW workforce. Examine Employed an assortment of research strategies, including writing audits, scratch witness meetings, and center gatherings, to decide CHWs' effect on: 1) expanding access to human services; 2) disposing of wellbeing incongruities; and 3) cost-viability. Overview Developed and directed a review of CHW bosses to assemble information on the utilization and subsidizing of CHWs in Massachusetts. Workforce Training Developed proposals for a standard CHW preparing educational modules and statewide accreditation program .

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The Workforce 3,000 CHWs in Massachusetts Primarily ladies (76.2%) overall, 36-40 years of age People of shading (50.8%) Bi-or multi-lingual (58.6%) Have a degree past HS (60%)

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CHWs Serve Vulnerable Populations 30% of CHWs utilized by offices serving provincial customers Most customers accepting or qualified for freely financed medical coverage At-hazard populaces: substance mishandle scatters destitute people migrants and displaced people at hazard for or living with HIV/AIDS teenagers seniors

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CHW Funding CHWs work at CHCs, doctor's facilities, CBOs, lodging powers, foreigner and exile affiliations and religious associations Funding is temperamental Cyclical, absolute gifts Job precariousness, undermining CHW viability Turnover is high; groups are helpless Sources for subsidizing for CHWs: 49% state offices 26% government 21% private establishments 4% - different sources: non-benefit offices, program expenses, wellbeing arranges MDPH - biggest funder in state: $18+ million

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Impact of CHWs Increase Access to Care CHWs Improve Health Care Quality CHWs Reduce Health Disparities CHWs Improve Service Delivery Reduced hospitalizations and utilization of crisis offices Improved self-administration of wellbeing conditions

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Outcome-based studies demonstrate CHWs have constructive effects: Assist people and families to acquire and keep up medical coverage Increase access to and utilization of preventive instruction, screenings, and treatment administrations Encourage the utilization of multidisciplinary care groups, broadening the limit of essential care suppliers Reduce pointless utilization of earnest care

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Outcome-based studies indicate CHWs have constructive effects: Improve administration of endless illnesses, for example, diabetes, asthma and related wellbeing conditions, including hypertension Enhance tolerant wellbeing proficiency Strengthen socially skilled supplier rehearses (hierarchical adequacy)

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Research confirm: CHWs are viable in substantial measure because of social, etymological, ethnic, or potentially different encounters they impart to the populaces they serve. CHWs profoundly successful with defenseless populaces, incorporating individuals with low earnings and racial, ethnic, and phonetic minorities.

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Research confirm: CHWs can help essentially enhance results of care groups: perform assortment of exercises help patients decrease dangers of inconveniences from endless sicknesses enhance consistence with endorsed treatment arranges enhance understanding self-administration

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Recommendations for a Sustainable CHW Program In four ranges: Statewide CHW Identity Campaign Strengthen Workforce Development: Training and Certification Expand Financing Mechanisms Infrastructure to Ensure Implementation of Recommendations

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Statewide CHW Identity Campaign Encourage offices to receive the CHW expression and definition, including MDPH Implement a CHW mindfulness crusade focused to CHWs, managers, approach creators, suppliers and groups Incorporate the CHW part into preparing and instruction of wellbeing and human administration suppliers

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Strengthen Workforce Development: Training and Certification Stabilize flow subsidizing for preparing of CHWs and CHW administrators Expand statewide access to preparing Establish a Board of Certification of CHWs

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Expand Financing Mechanisms MDPH prescribes social insurance funders to consider fusing CHWs into their different installment systems: Public payers , including MassHealth (Medicaid) and Commonwealth Care (state sponsored medical coverage) Private division associations Public offices, through awards and contracts Private establishments through gifts

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Infrastructure to Ensure Implementation of Recommendations Establish "Office of Community Health Workers" (now at DPH) Establish a Board of Certification of CHWs Establish continuous statewide CHW Advisory Council

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Next Steps Report in managerial survey Submit answer to Legislature House and Senate Ways and Means Committees Joint Committee on Health Care Financing CHWs in progressing Health Care Reform (Chapter 305, 2008) Cost regulation Primary care workforce advancement Improved quality

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Next Steps House, No. 4130 – An Act to Establish a Board of Certification of CHWs (at DPH Division of Health Professions Licensure, anticipating hearing at HC Financing) Ongoing duty - keep on working with key open and