Community Health Workers (CHW) Orientation ToolkitEdward M. Kennedy Community Health Center

Worcester, Framingham, Milford MA

CHW Orientation Toolkit and related trainings, documents and resources were developed with financial support from the Commonwealth Corporation Health Care Workforce Transformation Fund. The Center for Health Impact (CHI) is the lead on this grant and Kennedy CHC is the employment partner.

Mass League of Community Health CentersCommunity Health Institute 5_5_2016

Marcia Nascimento, Community Health Worker Supervisor, FraminghamSue Schlotterbeck, Director, Health Equity

This grant provides funding (2/2015-1/2017) for:

• CHI to run two 80 hour CHW Core Competency trainings for Kennedy CHC CHWs and CHWs from partner agencies.

• Kennedy CHC to develop and pilot a CHW Orientation Toolkit which standardizes the orientation process for new CHWs and standardizes the practice for current CHWs. The toolkit includes training materials, policies and procedures, basic education guidelines and resources.

Why CHWs ?

Equality EQUITY

3

Patient Centered? Patient Centered!

• Overview of CHW Organizational Structure at Kennedy CHC• CHW Vision• CHW Role and Job Description• CHW Orientation Toolkit

• Folders and content• Checklist for new hires• Examples:

• Electronic Health Record CHW Template • Training Materials• Policies and Procedures• Basic Education Guidelines• Resources• Data and Outcomes• Feedback from Providers and CHWs

What is a Community Health Worker?

A Community Health Worker is a trusted member of and/or has an unusually close understanding of the community served.

What are Social Determinants of Health? The complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities.

(from CDC website)

Why did we embark on this effort?

• Need for clarity due to growing and changing CHW role

• Consistency in knowledge base among CHWs

• Breadth of information to cover during orientation

• Unifying the team and standards of practice at multiple sites

• Integration into PCMH model

• Recruitment and Retention – working at top of license

WORK PLAN:

1. Vision

2. Core and Specialty Roles

3. Update Job Descriptions and Job Titles

4. Improve Integration of CHWs into PCMH

5. Training Plan

6. Orientation

7. Assessment Tools and Resources

8. Standard of Practice

9. Sustainability and Funding

10. Productivity and Measures

VISION

Create and implement a CHW model that:• Improves patient outcomes• Increases access to care• Addresses social determinants of health• Positions the health center for future

reimbursement for CHW services (certification ,data)

• Provides a bridge between the community and the health center

How do CHWs help us achieve our vision?

Developing a Standardized CHW Job Description:

– Brainstormed -current or suggested CHW roles

– Put 52 roles identified into survey monkey and asked staff to identify if they thought role was a core or specialty or should not be a role of a CHW

– Shared results and worked together to clarify the CHW role and job description

CHW Orientation Toolkit Folders (electronic):

• Orientation Checklists• NEXTGEN Documentation, Assessment,

Communication with Staff• Communication with Patients (Motivational

Interviewing, Engagement, Working with Interpreters)• Job Description, Competencies, Values, Ethics, Vision,

Social Determinants of Health, PCMH, Boundaries• Resources-Procedures-Basic Education Guidelines• Staff Meetings• CHW Trainings

Checklist for new hires:• Topic• Timeline (1 week – 6 months)• CHW Reviewed Documents • Demonstrated by:

Teach Back Observation In Writing Role Play/Case Scenario

• Suggested Trainer• Sign Off by Trainer• Date

Kennedy CHC Developed a CHW Electronic Health Record Template for NEXTGEN

• Basic CHW Template

• Psychosocial Assessment Template

Case to Document: HTN, FOOD INSECURITY, EVICTION LETTER• CHW Name – SELECT NAME• Type of Contact - FACE TO FACE-Warm Handoff• Special Project- NO SELECTION• Psychosocial Assessment Template – CLICK TO OPEN • Basic Education Provided- LEGAL SERVICES, HYPERTENSION,

HOUSING RESOURCES

Documentation Continued:• Direct Services Provided- SNAP application, Fuel Assistance

application• Referral- Chronic Self Management Program, Food Assistance,

Legal Services• Risk Factors and Plan and Follow Up• Time Spent• Create document

Examples: Policies and Procedures:

• Home visits and Contacts outside the health center• Transportation Policy and Agreements• PT1 Procedures• Psychosocial Assessment Protocols• Domestic Violence Flowsheet and Screening Policy• Reporting Abuse and Neglect Policy• Special Outreach Projects

Examples: Basic Education Guidelines

AsthmaDiabetesHypertensionBehavioral Health HIV, STDs, Hepatitis CPrenatal, Postpartum, Newborn

Examples: ResourcesMass 211 Worcester Connections Family Resource GuideYWCA, YMCAESL, GED, Head Start, Citizenship ClassesWorkforce CentralFood ResourcesFall Prevention ClassesHealth Insurance Assistance

Examples: Resources (continued)

Resource Cards (for DV)DV Serving AgenciesRefugee Serving AgenciesSubstance Use Treatment and Support ServicesUtilities AssistanceParenting GroupsYouth GroupsHousing, SheltersLegal Services Help with taxes

Examples: Training Documents

CORE SKILLS OF MOTIVATIONAL INTERVIEWING

• Open-ended questions

• Affirmations (Acknowledge the positives!)

• Reflections (Let the patient know we are listening)

• Summary

Motivational Interviewing – Empathy, Affirmations and Reflections

Modern Family Youtube Video

https://www.youtube.com/watch?v=7hFAv8z8xmw

Data and Outcomes:EHR DataSpecial Projects:Outreach to connect interested patients from local pediatric practice that was closing:582 children interested becoming our patients and 416 (71%) were seen

CHWs connecting patients to Chronic Disease Self Management Groups:

"My action plan is three days I don't eat after 6pm. Started to walk every Saturday. I feel good! I now won't eat anything heavy after 6pm. I feel better like my body has changed. I don't feel the acid I used to feel. I haven't lost weight yet but my body just feels better!"

"My action plan was to get rid of caffeine, coffee, tea six days a week. My blood pressure when I take it is more stable and lower when I don't have caffeine. One night I had caffeine and I could feel it. Really felt difference with caffeine. Next week action plan is seven days without caffeine."

Data and Outcomes:

CHW Well Child Visit Project :Conducted interventions to address health disparity. 2012-2013 data shows a 22% increase in WCV among Asian children and a 20% increase in our Arabic speaking children.

2011-2012 % WCV 2012-2013 % WCV

Arabic Speakers 54% 74%

Asian 61% 83%

All Children 70% 75%

How are we doing? Annual Provider Survey and

Biannual CHW Training Survey

Provider responses all sitesFramingham, Milford & Worcester

(37 out of 38 providers responded the survey = 97 % responses)

A0

0%

B1

2%

C37

95%

D1

3%

A

B

C

D

Based on providers responses all sites (Framingham, Milford & Worcester)

I connect the patient to the resources they need

I ask another staff (not a CHW) to connect the patient to the resources they need

I connect the patient to an EMKCHC CHW for assistance

Other:

Question 1:What do you usually do when a patient needs help with the social determinants of health (such as food, security, educational needs, employment, housing, domestic violence, and

other psychosocial issues that affect health (not including mental health concerns)?N=37 (some providers selected multiple responses)

Provider responses all sitesFramingham, Milford & Worcester

(37 out of 38 providers responded the survey = 97 % responses)

A11

27%

B5

13%C2

5%

D18

45%

E4

10%

A

B

C

D

E

CHWs are not usually available to assist the patient

I am not sure a CHW can help with these needs

It is easier to provide the assistance myself

Not applicable, I always refer patients to CHWs to address these needs

Other: Based on providers responses all sites (Framingham, Milford & Worcester)

Question 2:When patients have needs (such as those listed in question 1 and you don't refer them to a

CHW, why don't you refer them to a CHW? N=37 (some providers selected multiple responses)

Provider responses all sitesFramingham, Milford & Worcester

(37 out of 38 providers responded the survey = 97 % responses)

A9

24%

B23

60%

C0

0%

D0

0%

E3

8%

F3

8%

Question 3:If you connect the patient to a CHW,

do you feel the patients' needs get resolved?N=37 (some providers selected multiple responses)

A

B

C

D

E

F

Always

Most of the time

Almost never

Never

I don't know

Other:Based on providers responses all sites (Framingham, Milford & Worcester)

Provider responses all sitesFramingham, Milford & Worcester

(37 out of 38 providers responded the survey = 97 % responses )

A3

8% B7

19%

C13

35%

D9

24%

E5

14%

Question 4:Do you feel that having a CHW as part of your practice saves you time during your clinical sessions? If YES, on average how much time does a CHW save

you during one 4 hour session ( a, b, c, d)If NO, please explain why not (e)

N=37

A

B

C

D

E

More than 50% of my time in a session (over 2 hours)

25-50% of my time in a session (1-2 hours)

10-24% of my time in a session (24-59 minutes)

I don't know

If NO, please explain why not

Based on providers responses all sites (Framingham, Milford & Worcester)

SAMPLE QUESTION FROM CHW TRAINING FEEDBACK SURVEY:Did you attend the safety training with Ramon/Leo in Worcester or with Sue /Marcia in Framingham? Y or N (If no, skip to the next section 2)

Rate your understanding of CHW safety guidelines and tips for safety awareness prior tothis training VERY GOOD GOOD FAIR POOR

Rate your understanding of CHW safety guidelines and tips for safety awareness after this training VERY GOOD GOOD FAIR POOR

Describe one thing you learned about safety awareness during this training: ______________________________________________________________

Do you feel you need more training about safety? Y or N, If yes, what type of training would be helpful to you?

SAMPLE QUESTION FROM CHW TRAINING FEEDBACK SURVEY:Did you attend the Substance Use/Addiction/Recovery Training in NOVEMBER 2015? Y or N (if no, skip ahead to section 3)

Imagine a patient with substance use concerns comes to see you; prior to this training how confident would you have been addressing this patient’s needs. (rate on a scale of 0-5, 5=very confident and 0=not confident at all)

0 1 2 3 4 5

Imagine a patient with substance use concerns comes to see you; after this training how confident are you addressing this patient’s needs. (rate on a scale of 0-5, 5=very confident and 0=not confident at all)

0 1 2 3 4 5

Do you feel you need more training about Substance Use/Addiction/Recovery? Y or N, If yes, what type of training would be helpful to you?

WHAT QUESTIONS DO YOU HAVE?

THANK YOU!