If You Want to Go Far, Go Together: State-Level Efforts to Expand Integration of the Community Health Worker Workforce into Health Service Delivery
ARM 2018 areas of focus addressed Characteristics and outcomes of interprofessional and team- q based models of care [Licensed and] unlicensed health professional career q trajectories Impacts of emerging care delivery and payment models on q the workforce Workforce implications of health care and social service q integration Impacts of health professions’ regulatory and practice q environments on effective use of the health workforce Strategies that support practice in high need areas (e.g., q medically underserved, rural, primary care)
Presentations u Aunima Bhuiya, CDC: How Are State Public Health Agencies and Their Partners Supporting CHW Workforce Development? u Deborah Fournier, ASTHO: CHW Policy Tracking and State Learning Collaboratives u Ashley Wennerstrom, Tulane University School of Medicine: Preliminary Results from the CDC CHW Certification Study u Rep. June Robinson, Washington State Legislature: Washington State Approach to CHW Workforce Development and Financing
Why CHWs are important – and different u Evolution of health care includes u Greater accountability and shared responsibility for population health u Greater focus on social determinants of health u Greater attention to health equity and persistent disparities u CHW practice is relationship-based rather than transactional u Characteristics of high-performing CHWs are unconventional and challenging to incorporate into policy u Standards and definitions for the profession are coming into focus
HOW ARE STATE PUBLIC HEALTH AGENCIES AND THEIR PARTNERS SUPPORTING COMMUNITY HEALTH WORKER WORKFORCE DEVELOPMENT? Presented By Aunima Bhuiya AcademyHealth Annual Research Meeting Policy Roundtable June 25, 2018 NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION DIVISION FOR HEART DISEASE AND STROKE PREVENTION | DIVISION OF DIABETES TRANSLATION
AGENDA 1. Background on the CDC CHW Workforce Development Study 2. Recent CHW workforce development activities reported by states implementing CDC chronic disease programs 3. Examples within specific states at different points in the process 4. Insights from state health departments
BACKGROUND CDC NCCDPHP-funded programs (known as • 1305 and 1422) from 2013-2018 all 50 states, 4 large city health departments • and territories CHW-related strategies to promote: • community-clinical linkages, provision of self- • management programs; and on-going support for adults with high blood • pressure diabetes https://www.cdc.gov/chronicdisease /about/state-public-health- actions.htm 30 of the funded states chose to work on • increasing CHW engagement in health systems and programs
PURPOSE OF THE CDC CHW WORKFORCE DEVELOPMENT STUDY Better understand how state public health agencies and their • partners including CHWs collaborate to advance CHW workforce development ARM themes addressed: career trajectories, impact of payment • models, implications of health care and community and social service integration, and impact of regulatory and practice environments
6 CATEGORIES OF STATE-LEVEL CHW WORKFORCE DEVELOPMENT ACTIVITIES 1. Including CHWs in state- 2. Supporting the self- 3. Generating local level health systems determination and evidence on CHW transformations organization of the state contributions CHW workforce 4. Convening stakeholders 5. Conducting outreach and 6. Preparing and to develop statewide CHW providing training and recognizing CHWs through workforce definitions and technical assistance to standardized training standards employers and/or certification
1. INCLUDING CHWS IN STATE-LEVEL HEALTH SYSTEMS TRANSFORMATIONS § Including CHWs in new value- based care models (e.g., ACOs and PCMHs) § Adding CHWs to the state’s public health, health care, and workforce plans
2. SUPPORTING SELF-DETERMINATION AND ORGANIZATION OF THE STATE CHW WORKFORCE § Convening CHWs to discuss workforce development § Surveying CHWs and employers § Assessing CHW training needs § Developing a CHW website § Promoting CHWs leadership positions in planning groups
3. GENERATING LOCAL EVIDENCE ON CHW CONTRIBUTIONS § Conducting local CHW effectiveness studies § Developing a business case or value proposition for CHW contributions in the state § Evaluating the impact of statewide certification § Disseminating evidence to stakeholders
4. CONVENING STAKEHOLDERS TO DEVELOP STATEWIDE CHW WORKFORCE DEFINITIONS AND STANDARDS § Learning from CHWs, experts, and other states § Building consensus among stakeholders about general approach § Setting specific occupation and training standards § Pursuing coverage through the state Medicaid program § Engaging health care champions
5. CONDUCTING OUTREACH AND PROVIDING TRAINING AND TECHNICAL ASSISTANCE TO CHW EMPLOYERS § Undertaking educational campaigns about CHWs in health care § Assessing employer capacity for CHW integration § Holding employer trainings on including CHWs in health care teams § Providing technical assistance and evaluation support to clinical sites
6. PREPARING AND RECOGNIZING CHWS THROUGH TRAINING AND/OR CERTIFICATION § Training CHWs on chronic disease management § Developing core competencies and statewide training programs § Recruiting CHWs for training/certification § Creating registries of trained/certified CHWs § Developing internships and continuing education
NUMBER OF STATES (OUT OF 30) REPORTING ACTIVITY IN EACH CATEGORY 1. State health system s 6. CH W training and/or transform ations 13 certification 22 2. W orkforce self- determ ination and organization 5. Providing 20 training and technical assistance to em ployers 3. Local evidence 23 11 4. Convening stakeholders to develop definitions and standards 23
TWO STATES STARTING THE PROCESS: UTAH AND KENTUCKY § Helped to organize the state CHW workforce by holding events and supporting the new statewide CHW association § Worked with partners to advance workforce development policy § Developed a business case for CHW contributions using local evidence
A STATE A LITTLE FURTHER ALONG IN THE PROCESS: MASSACHUSETTS § Developed a method for evaluating the impact of certification § Promoted upcoming CHW certification and continued to standardize and improve the quality of training programs § Provided technical assistance to clinical sites working to include CHWs in health care teams
INSIGHTS § Facilitators and barriers § In general, states reported that CHW integration sites need: clinic leadership support; • CHW role definition, workflow, and feedback mechanisms; • partner resources and protocol for sharing data; and • CHW and supervisor training. • § In general, states reported needing: identification of CHWs; • CHWs to address social determinants of health; • a defined CHW continuing education process; • buy-in from all stakeholders; and • a statewide workforce infrastructure. •
CONCLUSION A wide array of CHW workforce development activities across the states participating in the • 1305 and 1422 programs; extent of implementation varied Most states are thinking about certification, training, and financing • Early stage in the process •
ACKNOWLEDGEMENTS Colleen Barbero, PhD, MPPA Erika Fulmer, MHA Bina Jayapaul-Philip, PhD Sharada Shantharam, MPH Refilwe Moeti, MA Centers for Disease Control and Prevention. State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (1305) Centers for Disease Control and Prevention. State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke (1422) The preliminary findings and conclusions of this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
THANKS! ABHUIYA@CDC.GOV NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION Division for Heart Disease and Stroke Prevention | Division for Diabetes Translation The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Op Opportunities for State Public Health Agencies to Su Support an and Integrate the CHW Workf kforce: CH CHW Policy Trac acking ng and and Stat ate Lear arni ning ng Communi Co unities Deborah Fournier, JD Senior Director, Clinical to Community Connections Association of State and Territorial Health Officials
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CHW Policy Tracking 2018
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