COMMUNITY HEALTH WORKERS IN CALIFORNIA: Sharpening Our Focus on Strategies to Expand Engagement JANUARY 2015

COMMUNITY HEALTH WORKERS IN CALIFORNIA: Sharpening Our Focus on Strategies to Expand Engagement   JANUARY 2015 – 40 pages

http://www.phi.org/uploads/application/files/2rapr38zarzdgvycgqnizf7o8ftv03ie3mdnioede1ou6s1cv3.pdf

CONTENTS:

Acknowledgements………………………………………………………………………………………………….2 Executive Summary…………………………………………………………………………………………………..3 Introduction ……………………………………………………………………………………………………………….6 Background ………………………………………………………………………………………………………………..8 Discussion Themes Design Considerations in Team-Based Care…………………………………..17 Skills, Recruitment, and Training of CHWs…………………………………………………………………..20 Organizational Capacity for Engagement …………………………………………………………………..23         Building Analytic Capacity ……………………………………………………………………………………….25     Taking the Engagement of CHWs to Scale: Recommendations……………………………………30       Appendix A………………………………………………………………………………………………………………33

TAKING THE ENGAGEMENT OF CHWs TO SCALE: RECOMMENDATIONS

The combined findings from the CHWA statewide assessment and technical consultation meetings provide a credible evidence base to inform the design of strategies that strengthen the engagement of CHWs in comprehensive team-based care in a variety of settings. While CHWs are extensively engaged by safety net providers in the state of California, there is no organized infrastructure to facilitate the rapid dissemination of innovations, develop expanded models of care that include primary prevention activities, build analytic capacity, develop functional links with mainstream providers, and ensure regional access to externally-validated training programs for CHWs and other providers. Common job definitions, recognized standards for core competencies, and a well-defined scope of practice that clarifies working relationships with other members of the care team are needed for both safety net organizations that currently engage CHWs, as well as mainstream organizations that are considering their engagement. These steps will not only provide a clear delineation of their roles and responsibilities, but also a framework for organizations to provide ongoing CHW training, supervision, and support to ensure optimal coordination and efficiency.

There is also a need to evaluate, refine, and replicate new delivery models and better document their impact upon patient experience, cost savings, and population health outcomes. Public policy development and targeted resource allocations are needed to build stable funding mechanisms, facilitate data sharing and service coordination across institutions, and to help organizations scale and formalize their engagement.

To ensure definitive progress in these areas — and to use the invaluable input provided by leaders from safety net organizations who participated in the three regional technical consultation meetings — we offer the following eight recommendations.

Recommendation #1

Establish a statewide clearinghouse to facilitate the rapid sharing of innovations, tools, best practice delivery models, and research support resources. The clearinghouse would engage a statewide network of stakeholders; this network would serve several functions: contribute knowledge, expertise, and resources; serve as a learning collaborative to inform the field on the design and evaluation of practical strategies; support the development of shared resources for the implementation of programs; and advocate for public policies to bring the engagement of community health workers to scale.

Recommendation #2

Develop a landscape analysis that outlines a scope of practice for CHWs that accommodates alternative approaches to team-based care and variations in the roles of other team members, and encompasses the full range of services and activities in clinical and community-based settings. The scope will also identify specific core competencies that will be required to demonstrate that CHWs have acquired or developed the necessary skills to complete the tasks to a satisfactory proficiency level through educational qualifications and/or work experience.

Recommendation #3

Conduct an independent assessment of employer-based, independent, and academic institution-based training programs across the state of California that describes content, scope and intensity, time frame, prerequisites, pedagogical models, geographic focus, and identified competencies. Findings from the assessment will be used to develop a comprehensive strategy to strengthen existing programs and ensure optimal regional access to training resources for both the entry of new CHWs and the additional skill development and advancement of existing CHWs.

Recommendation #4

Implementation of recommendation #3 will provide an evidence-based framework for consideration of competency-based certification standards for both new and existing training programs and for the individuals who complete the appropriate training. Certification of existing CHWs would be enabled through an employer-based examination process. A key consideration in the establishment of certification standards is to be cautious about the establishment of formal education prerequisites that may marginalize current CHWs with advanced knowledge, but lack formal educational training. On a parallel basis with the development of certification standards, the field would benefit from the development and promulgation of employer guidelines for effective recruitment, deployment, and professional development, and formalizing seniority and experience.

Recommendation #5

Identify regional sites to pilot the establishment of centralized data repositories that facilitate the integration of community-level data collection efforts and support the expanded use of collaborative data sharing tools for patient care management. These could start with a focus on Medicaid and uninsured populations among a subset of safety net and mainstream providers, and serve as precursors to regional health information exchanges. These pilot efforts would allow organizations to track and coordinate patient care at a community or regional level and enable the documentation and allocation of cost savings among providers and community based partners. 

Recommendation #6

Provide targeted technical assistance to community health clinics to develop or adapt existing evaluation tools to monitor and disseminate program outcomes. Technical assistance will include analysis and potential care redesign and team member role adjustment to facilitate increased accountability, clarity of function, and attribution of outcomes. Where appropriate, tools developed and/or refined as part of technical assistance will be disseminated as a clearinghouse function (see Recommendation #1).

Recommendation #7

Partner with mobile health technology organizations that are working internationally to adapt existing tools and leverage lessons learned to support mobile data collection, point of care decision support, and case management by CHWs and pilot those interventions with selected communities and organizations.

Recommendation #8

Develop a set of standard metrics that effectively capture outcomes associated with services and activities undertaken by CHWs to address the social determinants of health. The combined use of mobile technology by CHWs (recommendation #7) with standard metrics to document social determinants of health would inform strategies to develop social support systems and contribute to improved health outcomes at the population health level.

Closing Paragraph

Expanding the engagement of CHWs offers an immense opportunity to both enhance quality in our health care delivery system and to significantly expand efforts to address the social determinants of health in our communities, particularly in low-income neighborhoods where health inequities are concentrated.

While California safety net providers have been actively innovating in the use of CHWs, there remains an urgent need to focus attention and resources, rapidly disseminate emerging lessons and existing tools, and strategically build on what has been accomplished so far. The input provided by safety net providers through the CHWA statewide assessment and three regional technical consultations has informed the specific actions recommended in this report.

We look forward to working with colleagues, community stakeholders, and CHWs to realize community health workers’ full potential as critical intermediaries between the health care delivery system and broader efforts to improve health in our communities.

Appendix A: CHWA Technical Consultation Meetings List of Attendees (Note ZERO CHW)

 

 

 

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