Traditional Health Workers: Oregon’s model Community Health Workers, Peer Support Specialists, Peer Wellness Specialists, Personal Health Navigators, and Doulas
Traditional Health Worker Types • Community Health Worker : a trusted, trained community member who promote, advocate and organize for improved health in their communities. • Peer Wellness Specialist: an individual who has lived experience with a psychiatric condition(s) plus intensive training, who works as part of a person- driven, health home team, integrating behavioral health and primary care to assist and advocate for individuals in achieving well-being. • Peer Support Specialist : an individual who provide supportive services to a current or former consumer of mental health or addiction treatment. • Doula : a birth companion who provides personal, nonmedical support to women and families throughout a woman's pregnancy, childbirth, and post- partum experience. • Personal Health Navigator : an individual who provides information, assistance, tools and support to enable a patient to make the best health care decisions.
Oregon’s Traditional Health Workers Community Health Workers, Peer Wellness and Peer Support Specialists, Personal Health Navigators, Doulas
Traditional Health Workers … • Reduce costs associated with health care • Understand and address the social determinants of health • Address health disparities in culturally-appropriate ways • Support integration and whole person care An effective THW workforce consists of individuals • from the community served • who have shared “lived experiences” • who are representative of the population served
Oregon THW Legislation • HB 3650 (2011) Requires State to establish criteria, descriptions, and education/training requirements for community health workers, peers, personal health navigators, and other providers not regulated by the State • SB 1580 (2012) Requires utilization of these workers in Health Systems Transformation • HB 3407 (2013) Establishes the THW Commission. The Commission advises the Oregon Health Authority on THW policy and program issues.
More Oregon THW Legislation • HB2024 (2015) Adds oral health training requirement for certification of all THWs • HB 2304 (2017) Adds Peer Support Specialists and sub-worker types (Family and Youth Support Specialists) to THW Commission
Traditional Health Worker Commission and Subcommittees Commission Training Evaluation Metrics Systems Integration Program & Scoring (TEMPS) Subcommittee Subcommittee Payment Models workgroup
CERTIFICATION OHA-approved training program Introduction to the training, Core curriculum certification, and hiring Assessment process of THWs Certification REGISTRY OHA Registry Enrollment Care providers Other care CCOs providers EMPLOYMENT Continuing On Site Education Training CONTINUED LEARNING
THW Training CERTIFICATION OHA-approved training program Core • Training programs must submit curriculum application to Oregon Health Assessment Authority for approval Certification • Applications reviewed by TEMPS REGISTRY Sub-committee OHA • Must meet requirements Registry Enrollment established in rules • Requirements specific to worker Care providers Other care CCOs providers type EMPLOYMENT • Approved training programs listed on THW program website Continuing On Site Education Training CONTINUED LEARNING
THW Certification CERTIFICATION OHA-approved training program Core curriculum Assessment • Must be 18 Years of age Certification • Must meet training requirements REGISTRY through OHA approved process OHA • Must submit a completed application Registry Enrollment for registry • Must pass a criminal background Care providers Other care CCOs providers check EMPLOYMENT Continuing On Site Education Training CONTINUED LEARNING
THW Registry CERTIFICATION OHA-approved training program Core curriculum • Once certified, THWs are enrolled on the Assessment THW Registry Certification • Registry available through Office of Equity & REGISTRY Inclusion website OHA • Names and contact information of certified Registry Enrollment THWs available to CCOs and other healthcare providers Care providers Other care CCOs providers EMPLOYMENT Continuing Education CONTINUED LEARNING
THW Employment CERTIFICATION OHA-approved training program Core curriculum • Definitions and scope of practice of THW Assessment worker types on OEI website Certification • Roles need to be clearly defined and understood by all team members REGISTRY OHA • Supervision should be specific to the Registry Enrollment worker type • Additional on-site training/continuing Care providers Other care education should be provided or verified CCOs providers through employer (20 hours every 3 years EMPLOYMENT to maintain certification) Continuing On Site Education Training CONTINUED LEARNING
Examples for Integrating Public THWs Health • Partners with CBOs to conduct Community Community Assessment • Connects to a PCPCH • Identifies diabetes Health Workers • Receives Diabetes Self disparity and related high Management utilization rates in information demographic-specific • CBO trains CHWs in Chronic Disease • Receives culturally community and linguistically Self-Management • Subcontracts with CBO appropriate services • CBO deploys CHWs in this serving specific community • Receives regular community check-ins by CHW • CHWs enroll community members • Finances outreach, disease in plan and teaches Chronic Disease • Engages in more self-management, and appropriate Self Management service coordination utilization • CHW provides ongoing support and system navigation Community CCO Member
Intensive Case Examples for Integrating Management THWs • Enrolls person with Personal disabling condition in Health Plan. • Connects person with Navigator Plan employed Personal • Is enrolled in Plan Health Navigator • Connects to PCPCH (PHNav) • Works with new member to • Experiences well- • Intensive case understand the Plan coordinated care management services • Connects member with a PHPCH • Has a direct connection funded through • Provides coordination between to Plan for potential capitated portion of future challenges PCPCH and specialty care global budget • Experiences increased • Provides support to member to satisfaction assure smooth transition and ongoing care CCO Community Member
Examples for Integrating Clinical THWs Services Doula • Identifies a woman who • Is enrolled in Plan entered the country as a • Connects to PCPCH refugee, who is 4 months • Receives culturally and pregnant and has • Serve on health care team linguistically appropriate experienced refugee- • Referral for THW services care related trauma made by licensed provider • Receives behavioral • Enrolls woman in Plan health and doula • Doula provides support • Connects woman to services before, during and after culturally specific • Poor birth outcomes pregnancy behavioral health services averted • Refers woman for services addressing refugee related Community trauma issues CCO/PCPCH Member
Examples for Mental Health Integrating THWs &/or Addictions • Partners with CBOs to conduct Community Assessment Peer Support • Connects to other • Identifies peer support services if the individual Specialists disparity and related high requests this type of utilization rates in support demographic-specific • Receives culturally and community linguistically appropriate • Subcontracts with CBO • CBO trains Peers to provide support services serving specific community and navigation of systems • Receives regular check- • Finances outreach, support • Deploys Peers in this community ins by the peer activities, utilization within • Peer meets individuals where they’re other systems (jail, child • Engages in more at and supports them in exploring new welfare, hospital, etc.) appropriate utilization wellness and recovery goals • Peer provides ongoing support and system navigation Community CCO/County Member
Some ways THWs can be paid through Medicaid OREGON Coordinated Care Organizations Traditional Health Workers CBOs Hospitals Health Plans
Examples of other payment models for THWs Peer Support Specialists Community Health Workers Oregon providers can purchase peer Oregon providers currently purchase services through funding sources CHW Services with: such as: • Federal or state grants (public • Federal (SAMHSA, TANF, Medicaid) health; prevention & education) • State and Local Funding, Private • Foundation Grants funding • Community Benefit funding • Drug Courts (federal, state and • Community Health Centers local funding) (Alternative Payment Model) • DOJ funding • Pathways
“I can do things you cannot, you can do things I cannot. Together we can do great things.” -Mother Teresa
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Resources Office of Equity and Inclusion http://www.oregon.gov/oha/oei/Pages/index.aspx Traditional Health Worker Program http://www.oregon.gov/oha/oei/Pages/Traditional- Health-Worker-Program.aspx Tip Sheets for Working with THWs http://www.oregon.gov/oha/OEI/Documents/Tradition al-Health-Worker-Tip-Sheet-9-2016.pdf
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