>> Josh Prasad: All right. Welcome everyone to
the Community Connected Health Initiative Webinar focused on innovation in the community health
workforce. My name is Josh Prasad. I am the director of HRSA's Center for Innovation within
the U.S. Department of Health and Human Services. And I have the distinct pleasure of kicking off
this great session. And before I introduce our distinguished opening remarks, I
want to table set with all of you. This event is a series that is focused on the
power of innovation, technology, and the human connection to meet people in their own communities
and achieve better health.
It's a partnership between HRSA's Center for Innovation and the White
House Office of Science and Technology Policy. Our goal is to continue to highlight, share,
listen, and learn from community stakeholders at the grassroots and grass top levels,
so hopefully, lead to meaningful change. We've brought numerous speakers together,
who we will get to in just a second. We want all of you to engage while watching.
We'll be holding a live Q and A session with our featured speakers later on in the session. As you
watch our lightening talk speakers, we want you to ask questions and we will share those during
our question and answer session. For those of you watching on Zoom, you can enter your questions
about the lightning talks into the chat box. For those on HHS Live, please tweet us your
questions at #CCHroundtable.
Some of you are also invited to small listen-only breakout sessions
later in the day. These are happening in a second Zoom link which we'll talk about later. But now,
it's my great pleasure to introduce Dr. Carrie Wolinetz, who is the Deputy Director of Health
and Life Sciences for the White House OSTP. Prior to joining there, she served as the acting
Chief of Staff for the Director of the NIH, as well as the Associate Director for Science
Policy and the Director of NIH's Office of Science Policy. She will describe the focus on equity
within today's efforts as well as the foundation of future efforts in the Community Connected
Health series. Carrie, please take it away. >> Carrie Wolinetz: Thank you so much, Josh. I am
very excited to be here today to welcome you to the second in the series of three Roundtables
dedicated to community connected health. First, I want to welcome all of the participants
who are joining us together on Zoom.
The folks who are tuning in via livestream out there
and the organizers of this Roundtable from the White House OSTP as well as our partners at
the Health Resources and Service Administration, HRSA Center for Innovation. This has
really been a wonderful partnership. The goal of the event today is to hear from
the participants and everyone who is tuned in, and that includes community health workers,
doulas and midwives, peer health workers, and others who promote health with equity and
individual wellness while sharing life experiences with the communities that they serve. We're so
excited to have you here today. We want to hear from all of you about what is needed to accomplish
this vision for community connected health. We envision that community connected health is
going to be able to capitalize on the power of innovation and technology together with the human
connection to meet people where they are in their own communities in order to achieve better health.
To us, community connected health really has dual meanings. If you think about the term
connected, it refers to both the virtual, technological connections that allow people
to lead healthier lives.
But it also refers to the connections within a community, whether
that community is the place that you live, the background that you're from, or even the language
that you speak. As the Deputy Director for Health and Life Sciences here at the White
House Office of Science and Technology Policy, I am a strong believer in
technology as a force for good. But it's usually necessary but insufficient.
It is not a solution in and of itself. Technology is powerful as a connection extender
when it increases the ability of humans to connect with those around them. What we want to know
is how can technology increase connections for health care and decrease the barriers to living
healthier lives for the people who need it most. We have some ideas for what this vision for
community connected health might look like. Maybe it's a primary care doctor
reaching a patient during their lunch break for a virtual appointment via
a telehealth or telemedicine platform.
Or maybe it's when a person goes into their
local community health center. They're able to seamlessly connect with a specialist or a care
provider via a telemedicine modality right there, on the spot, in their own community, after
their primary care doctor told them they needed it during their initial appointment. Or
maybe it's a community health worker, hopefully like some of you tuning in today, visiting a
client's home, armed with a tablet to refer them to the appropriate social service, update
their health records, and really reflecting the individual need of that patient. And it's really
about that last example that we're turning to you here today. While we're interested in the
intersection of technology and community health, collectively, with our colleagues at HRSA Center
for Innovation, we're also genuinely interested in the needs of innovative ideas related to
the community health workforce generally.
We understand that the COVID-19 pandemic has
changed all of our lives and, in particular, your field, for both good and bad. Among other
things, community health workers became frontline workers even more dramatically than they had been
previously — contact tracers, vaccine educators. And while demands were placed upon
you that you may never have expected, we also saw funders begin to invest in
community health workers in a new way. The federal government, well, where I sit, is
no exception. There are funds from the CARES Act and American Rescue Plan. The CDC established a
program that put trained community health workers in areas that have been hit hardest by COVID-19
and areas with longstanding health disparities. In some ways the pandemic condensed 10 years'
worth of change in the community health workforce into two years. We want to make sure that
we don't go backwards. We're looking ahead to the next 10 years, a decade outward, to protect
the gains made for the community health workforce and to figure out what else we need to accomplish
a vision of community connected health. How can we build on what has worked?
And how can we change for the better things that are — represent lessons
learned, that didn’t work so well? And to that end, we want to hear from you,
both today and through ongoing and future opportunities.
To get the juices flowing, we're
going to kick things off with a public webinar portion. We'll be hearing from some thought
leaders. And I am so grateful that they have joined us today in the community health workforce
through a lightening round of presentations followed by a public question and answer session.
After that, invited participants will spend even more of their precious afternoons. And again,
sincere gratitude for your participation. To participate in these breakout sessions — these
more in-depth conversations are going to allow us to dive deeper into three themes, understanding
how community health workers interact with technology and data, opportunities for sustainable
financing for community health workforce, and understanding the unique role of community
health workers in our health care system. We are cognizant that with just a handful
of lightning talks and breakout sessions, there will be a lot of viewpoints that we won't be
able to represent in the time allotted. So, if you are joining us via the HHS livestream, hello, and
welcome.
I really encourage you to get in touch to give us your thoughts after the session. We have
issued a request for information on strengthening community health through technology that is now
open until March 31st. So, if you turn to Google or your favorite search engine and search off
OSPP Community Health RFI, you should get to the right place in the Federal Register.
You can also just drop us a line via email at connectedhealth@ospp.eop.gov. I'm going to
repeat that again, connectedhealth@ospp.eop.gov. Your input will help us in the federal government
define and advance the set of actions, programs, and maybe even policies to make progress for
the vision for community connected health.
This event today is just the start, just
the tip of an iceberg of possibilities. And while we will be thinking about what
it is we can do, we want you, the experts, your colleagues, your organizations, your friends,
and neighbors to think creatively about this, too. How can you capitalize on the power of innovation
and technology to meet people in their own communities and achieve better health? We
generally want to hear your ideas in this space. So, with that, again, I thank you for
spending your time with us today. I'm incredibly excited about these opportunities
and your thoughtful contributions, moving forward to transforming community health,
individual wellness, and health equity. Thanks again to our partners at HRSA and
with that I am going to turn it back to Josh. >> Joshua Prasad: Fantastic. Let's get
started with our lightning talk speakers. The HRSA CFI and the White House OSTP have
organized the Community Connected Health Initiative. And these lightning talks speakers
can curate real world perspectives on innovation in the community health workforce. I want to
mention that the views and perspectives presented here do not necessarily reflect those of the
federal government, but instead are perspectives directly from leaders and problem solvers
in the communities and workforce themselves.
The goal in this initiative is to talk about
the innovations in the places where people live, learn, work, play, and get their care. That's why we're so excited to have these four
amazing lightning talk speakers come share their stories and perspectives from the world of
peer support and community health workers. First up is Dr. Shreya Kangovi, the executive
director of the Penn Center for Community Health Workers. I'd like to mention that there will
be a Q and A session following our lightning talk speakers. For those on Zoom, please use
the Q and A function.
And if you're watching on HHS Live, tweet your questions to hashtag
#CCHroundtable. Now, take it away Dr. Kangovi. >> Shreya Kangovi: Hi, everyone. My name is
Shreya Kangovi and I'm a practicing primary care doc and the executive director of the
Penn Center for Community Health Workers at the University of Pennsylvania. At the
Center, our mission is to enable community health workers to advance health equity.
And primarily we serve this mission by designing and testing and disseminating
IMPaCT, which is a standardized, scalable, infrastructure that allows community
health workers to do their best work. And it includes hiring practices, training at all levels,
social and behavioral science informed workflows, and infrastructure to support community
health workers in the work they do every day. You're going to hear a lot about who community
health workers are from my various esteemed co-speakers. But from my perspective, I think
there's three hallmarks that really are core to the identity of community health workers.
Number
one, they share life experiences with people they serve. They have been there, they get it.
Number two, they are trustworthy by design. In a best practice model, community health workers are
hired specifically for personality attributes like empathy and listening and reliability. And the
third piece is that they transfer power to the individuals and families they serve. They aren't
folks who are going to go through a checklist or tell people what to do. They listen, they
get to know each individual's life story, and they ask each person, you know, "Shreya, what
do you need in order to live your best life?" And then they do that, whether it is planting
an urban garden, battling an eviction notice, helping somebody to get access to a COVID-19
vaccine or high-quality primary care. Over the past several years community health
workers have been increasingly acknowledged as a critical workforce, particularly because of
the core role they played in COVID-19 pandemic response. The evidence to support community health
workers is quite incontrovertible. There have been dozens of randomized control trials, which
are the highest quality of scientific evidence, that support community health workers'
ability to improve chronic disease management, access to preventive services, and primary care,
improve the quality of care, both inpatients and outpatients, improve patient satisfaction, reduce
hospitalizations and have a return on investment. My team and I demonstrated in a
randomized trial that there is a $2.47 return on every dollar invested
by the payer within the fiscal year.
So, I think from a scientific perspective, the
case for community health workers' effectiveness is very, very clear. Yet there are only 80,000
community health workers in the United States. And just to level set, that is
compared to over 5 million nurses. And so, there are not nearly enough community
health workers in order for them to play the role that they could play on advancing public
health, health equity, and social justice.
So, over the past year or two, my team and I have
talked to hundreds, if not a thousand, community health workers and asked them as well as other
stakeholders, like community-based organizations, public health departments, Medicaid
agencies, health care organizations, what do we need to do in order to
scale up this already proven workforce? And the answers really pointed to two specific
federal policy levers. Number one, there needs to be sustainable financing for this workforce,
which has heretofore relied on patchwork of grants for demonstration projects.
Number
two, and this is, I think, really critical, when the funding comes, it needs to be coupled
with guardrails that protect the community health worker identity and professional identity
and the quality of services that they provide. So, let me drill down on those two federal policy
levers a bit and I'll actually start with the quality piece. My team partnered with NCQA,
the National Committee for Quality Assurance, as well as various other community stakeholders
across the country, to ask the question, "What do community health workers need in order to do their
best work?" And the results of this inquiry took us to listening sessions with stakeholders all
across the country, as well as a scan of all of the literature, both domestic and international,
that could shed a light on this question.
And it really points to several domains that
were just reported in a recent white paper, that employers actually need to be held accountable to
in order to make sure that the community health workers they hire or partner with are able to
do their best work. And it includes things like hiring true community health workers who, again,
share life experience with those whom they serve and who have the personality attributes that I
mentioned earlier that enable them to build trust. It includes paying community health workers a
fair wage and providing career ladders for them, having manageable caseloads, so that
they are actually able to do the work of building trust in their community.
Having workloads that enable that power sharing that we talked about and a
holistic, person-centered approach to service as well as supportive supervision and
infrastructure to keep them safe, things like PPE and safety protocols to keep them safe while they
are doing their work in homes and communities.
So, I encourage folks to take a look at
this document because these best practices are critical if we are to ensure that any funding
actually has a return on its investment. And also, I fear that if we don't have these types of
guardrails, if we do have funding, anybody might just be able to say, "I'm a community health
worker," you know, "I've taken a training and I'm certified as a community health worker." And I
worry that that will actually cause a co-opting of this workforce. So, I think that the quality
guardrails are a critical piece to ensuring the professional identity and also the quality of
services that community health workers provide.
Then that just leaves, you know, how do
we fund this. And, you know, in my mind, Medicaid is a key funding mechanism because,
it is — it is the largest public payer. There are 75 million Americans enrolled, and growing,
who are enrolled on Medicaid, and many of them face socioeconomic challenges in
addition to health challenges. And community health workers are very, very
well-suited to serve this population. And yet, Medicaid, in statute, should
allow for community health workers to be paid for the full range of services that they
provide. Sub-regulatory guidance has actually had the effect of limiting Medicaid coverage to a
pretty narrow scope of mostly clinical services. And so, we think that CMS — and we encourage
CMS to clarify that Medicaid preventive services covers the full range of evidence
and forms of support that community health workers provide, including addressing
the social determinants of health.
Finally, I wanted to talk about what role
technology has in enabling this workforce and more broadly in advancing health equity.
Billions of dollars have been invested into technology-based social determinants of health
solutions. And yet, I am a little concerned that the pace of investment has outstripped the
evidence here. Many of the approaches that we are commonly seeing, such as light touch,
or entirely digital navigation platforms, or intensive, multidisciplinary case
management or care management teams, have actually not — many of them are
incredibly sophisticated, are very intuitive, but they haven't really been born out by
well-designed studies.
In fact, many studies have actually pointed to minimal engagement and
null effects on outcomes like health or costs. And so, I think it's important for us to, again,
to use science as our guide and make sure that the technology is really marrying science with
a workforce that is capable of executing social justice on the ground. And so, I think the future
is really about tech enabling community health workers to do their best work. Technology, in my
opinion, shouldn't be a substitute for community health workers. I don't think technology is going
to solve problems of injustice all on its own. I think that technology needs to be centered
around community health workers, co-designed by community health workers, profit community
health workers, and really enable them to do the work that they are already doing on the ground,
which is advancing equity in our communities. Thank you so much. I am sorry I can't be
there for the lightness of the Q and A round, but I am really excited to hear
about follow-ups from this meeting. >> Joshua Prasad: Thank you, Dr. Kangovi.
Next up, we have Dr. Twylla Dillion, from Health Connect One here to share her perspective
on how peer support is helping maternity care.
>> Twylla Dillion: Hello, I am Dr. Twylla
Dillion, executive director at Health Connect One. At Health Connect One, we collaborate with
Blacks, Browns, and Indigenous Communities to ensure birth equity through safe
and healthy pregnancies and births, thriving babies and families,
and successful early parenting. Since 1986, Health Connect One has worked
with maternal child health organizations hospitals, and grass roots organizers to co-design
community-based peer to peer support programs for birthing families. We provide customized
coaching, training, technical assistance, and program development services to our
partners in the field of maternal child health to support underserved, under-resourced,
rather, communities, and families. Together, we take action and share knowledge with
community health workers including community-based doulas and breastfeeding peer counselors to
amplify their voices and support their work. We partner with community health workers
and community-based organizations to advance the perinatal community health
worker field and call for fair pay.
We have worked with over 50 community
organizations and non-profits in primarily low-income communities and
communities of color across 20 states to co-design programs and initiatives that
provide culturally reflective, perinatal support for birthing families and babies. Through
the culturally reflective support, knowledge, and guidance that Health Connect One
programs bring to birthing families, parents who are often dismissed upon
arrival due to institutional racism and a broken system have a guide to help them
safely navigate their birthing journey. Our programs put communities in touch with their
own strengths, needs, skills, and collective power through our essential components.
Our five
essential system components include employ women who work from the community, extend and intensify
the role of doulas, collaborate with community stakeholders, facilitate experiential learning,
using Health Connect One's training curriculum, and to value the doula's work with salary,
supervision, and support. Our model is a train the trainer model, which means our programs
are scalable to support community needs. The programs can grow as needed. As communities
need more doulas, you train more doulas. They say necessity births invention. During the
pandemic, we've expanded our work to innovation. We created a story book called "Birthing Families
Need Your Support," highlighting the challenges faced by birthing people and the birth workers who
served them during the pandemic. This storybook has provided useful information for policy makers
as they move swiftly to support the needs of birthing families, including legislation to admit
doulas into the delivery room when access was limited due to hospital restrictions.
Our ongoing
COVID-19 cartoons with guidance, with culturally reflective, and linguistically appropriate
content. These cartons have been shared on social media and several partner sites have re-posted
and provided printouts for those we serve. We have launched our learning management
system, also known as an LMS, for all training, the virtual, hybrid, or in-person.
This tool provides a one-stop content access, and we are building out tools for collaboration
through communities of practice for our partner sites to work together. This tool ensures that
training is possible regardless of current COVID restrictions. We are in the midst of several
trainings across the nation right now and as we are booking into the spring, summer, and fall,
the elements will allow us to adapt as needed. We've also been chosen to establish the
state-wide, doula learning collaborative, also known as the DLC in New Jersey. This work
is an excellent culmination of the work and knowledge of Health Connect One. This project will
increase the number of trained community doulas, support doulas in engaging
with multiple health systems, and processing reimbursement claims
through Medicaid for their services.
The thing we're proudest of, our program data
for the last four years has shown astounding results for black birthing people, the largest
community we serve. We've reduced pre-term birth by 19 percent, C-sections by 23 percent,
low birthweight by 24 percent, and increased breastfeeding at six weeks by 22 percent. We are
proud to have grown and adapted despite COVID-19 and look forward to continuing to support
birthing families across the nation. Our innovation, growth, and expansion
during the pandemic are indications of the recognition that community-based
perinatal supports are receiving.
We are committed to continuous
quality improvement to ensure that our curriculum and programs are up-to-date
and responsive to community and doula needs. For more information on our work, please visit
our website or follow us on social media. We are open to partnership and look forward to connecting
during the sessions following this presentation. >> Joshua Prasad: Thank you so much, Dr. Dillion.
A quick reminder for those of you who want to participate in our question-and-answer session.
Please use the Q and A function on Zoom or tweet your question if you're watching on HHS Live to
#CCHroundtable. Next up, we have Sylvia Juarez, a community health trainer from the office of
community empowerment in Maricopa County, Arizona.
>> Sylvia Juarez: Community health workers and the implementation
of Million Hearts in Maricopa County. Below are three strategies that we realized to
improve health equity in public housing. The first one stems from the smoke-free policy prohibiting
all lit tobacco products inside dwelling units, common indoor areas, and administrative
office buildings by July 31st, 2018. Our office identified this as an opportunity
to support PHAs in applying this policy using state allocated tobacco funding. Additionally,
our office received a 30,000 grant to implement Million Hearts in the community.
Its
ABCS model promotes smoking cessation and blood pressure screening to
prevent stroke and heart disease. Housing coordinators participated in
tobacco cessation skills workshops and teams of health educators and PHWs completed
DP screening and tobacco education training. The community education piece focused
on integrating different areas to adjust mental health, physical activity, and nutrition
education. Our partners included the Cesar Chavez Foundation, Mercy Housing, City of Phoenix,
schools, and community-based organizations. Before implementing these strategies with
PHAs, health educators assessed housing coordinators to evaluate their readiness
to participate. Based on that result, health educators facilitated a general
presentation to senior residents to discuss expectations, such as the importance of
participating in activities and establishing a health committee to ensure they had a platform
to communicate their needs and concerns.
Our team began activities described in Phase
1 only if the majority of senior residents decided to participate. In 2017, the Health
Services Advisory Group, HSAG, did a study to measure the participation rate at Casa Pedro
Ruiz, a senior low-income facility managed by the Cesar Chavez Foundation. And their report
showed that 89 percent of the senior population at the facility had participated consistently in
CHW-led activities throughout the previous year. Parents, mainly Spanish speaking
immigrant women living in the neighborhood who sometimes volunteered there,
also participated in Phase 3 of the program. Their participation slowly fostered a sense
of belonging and community with the elders. The lack of access to public transportation was
a huge concern for senior residents at Casa Pedro Ruiz and they voiced it consistently during
the monthly senior health committee meetings. These discussions encouraged our team
to request an AmeriCorps volunteer to help facilitate data collection activities
in collaboration with parents in the community. Our team led a walkability assessment, a SWOT
analysis, surveys and focus groups with residents.
During the pandemic, community members began
meeting online every week to discuss other challenges such as access to healthy food,
street and school safety, park maintenance, and the need for community education in
Spanish. The city of Phoenix Neighborhood Specialist has been an important ally in
addressing different community issues and was instrumental in registering the community
group as an association on June 24th, 2020. Our team completed a community needs assessment
report with the data collected, which was later utilized by association members to advocate
for improving access to public transportation. The association was successful in advocating
for the extension of the MARY Circulator, which will now include their
neighborhood as of April 2022.
The Cesar Chavez Foundation, specifically Casa
Pedro Ruiz served as a fertile ground for the development of the association. Its members are
proud of having participated in the following: the extension of a circulator route, the
completion of a school art mural, the distribution of face mask and monthly food boxes, coordinating
a health fair, keeping what used to be a dumping ground clean and safe for kids and the
neighborhood, and for continuously providing free weekly online community training in Spanish on
issues such as domestic violence prevention to the importance of getting vaccinated against COVID-19,
parenting workshops, and leadership training.
The Reduce the Risk Coordinator
for the Cesar Chavez Foundation and the executive director
Salud en Balance and co-founder of the Perry Park neighborhood association
are both CHWs and have been essential in the development of the association and its success
in building relationships with partners to help promote health equity and sustainable
change in their community. Thank you. >> Joshua Prasad: Thank you, Sylvia. Last up, we
have Denise Octavia Smith, the executive director of the National Association of Community
Health Workers. And a quick reminder, right after this presentation, there will be a
Q and A session. For folks on Zoom, be sure to use the Q and A function. If you are watching on
HHS Live, tweet your questions to #CCHroundtable. >> Denise Octavia Smith: Thank
you for inviting me to discuss innovation in the community health workforce.
My
name is Denise Octavia Smith. I am a community health worker and the executive director of the
National Association of Community Health Workers, NACHW. NACHW was founded in April
of 2019, and has aa vision to see community health workers unified across geography, ethnicity, sector, and experience. To
support communities to achieve health, equity, and social justice. CHWs are predominantly
female and persons of color and members of communities who experience marginalization due
to income, ethnicity, language, and gender, whose unique professional expertise and personal
identity emanate from our shared life experience. We live like, look like, and often
are affected by the same diagnoses, inequities, and structural barriers to health and
wellbeing as the persons we serve.
As a result, we are unique stakeholders, pursuing
equity in systems transformation and representing both provider and patient and
community member voices. Yet despite 60 years of research on CHW effectiveness across a range of
chronic disease and public health intervention, two decades of recognition by the APHA,
landmark workforce development studies, and a unique Department of Labor classification,
CHWs still lack national professional identity, self-determination in our roles and career
advancement, and federal and state level policies and funding to sustain our work and the work of
our CHW associations networks and coalitions. To the question at hand, transforming community
health, individual wellness, and racial and health equity through CHW integration requires
three things. I want to briefly describe each one and I'll just provide a short example of each
during the COVID pandemic from our perspective.
Number one, amplify and support CHW expertise and
leadership capacity. In May 2020, we cofounded the Community-based Workforce Alliance, which
developed a playbook to advance CHW integration into COVID response. It's used currently
in the CDC 2110 and 2109 national programs to train state, county, and local health
departments on recruitment, interviewing, hiring, training, supervising, and supporting
best practice. And this is best practice that comes from CHW using a racial equity-based
principle and focused on sustainability. Number two, build the capacity of our
CHW and community-based organizations and CHW employers. NACHW collaborated with
the Centers for Disease Control and Prevention to develop their first training on CHW
roles during the pandemic in April of 2020. We also supported their resources for a community
health workers webpage and co-authored a report called "From Crisis to Opportunity" to help
employers understand what CHWs need in their places of work to protect themselves and adapt
their services and approaches during the pandemic.
In response to the recent White
House launch of covidtest.gov NACHW developed and implemented a multilevel
multimedia initiative to disseminate this and three other federal free testing opportunities
to frontline CHWs and CDOs. With over 2 million visits to our website in
just one week, we recruited over 7,000 CHWs and CDO orgs as partners. We
trained over 1,600 from 49 states, Puerto Rico, and Washington, D.C., and the Northern Mariana
Islands and implemented a capacity assessment survey about math and testing. From this data,
NACHW has developed five recommendations on how states and the federal government can improve
COVID-19 testing and mask distribution. And number three, sustain our workforce
advancement and integration through equitable policies and funding. Administrative
barriers and limited funding models mean that many of these dollars remain inaccessible to CDOs,
deepening systemic racism and power imbalances that hinder CDOs and CHWs. NACHW and our partners
hosted a summit in June of 2021 with HRSA to help over 650 community-based organizations apply
for HRSA funding and access tools to increase their data driven decision making and strategies
in their proposals.
We also released a national CHW policy platform in February of 2021 endorsed
by thousands of CDOs, CHWs, and our networks, so that public and private institutions
can respect, protect, and partner with us. These recommendations, which come directly from
our profession will now lead the discussion of state and federal workforce development
policy funding discussions. Innovation must take place with and through the leadership
of the CHW workforce to ensure diversity, advocacy, system transformation, patient and
community voice, and structural change.
I want to thank you so much for your time today
and for allowing our comments on behalf of the national association and our national
members and partners. We thank you so much. >> Joshua Prasad: Thanks so much to all of
our speakers and now I'll toss it over to my colleague Jackie Ward to
lead our Q and A session. >> Jackie Ward: Thanks. My name is Jackie Ward
and I'm the assistant director for Community Connected Health here at the White House
Office of Science and Technology Policy. So, I want to welcome our speakers and ask them to
turn their cameras on so that would be Denise, Twylla, Sylvia, and stepping in for Shreya, who
is on a very well-deserved vacation is Cheryl Garfield. And Cheryl is the lead CHW at the Penn
Center for Community Health Workers.
So, while they are all getting their cameras on, I also will
just put a plug in for Zoom participants to use the Q and A function on Zoom to send
any questions that you have along. So, while the questions are percolating with our
audience, Cheryl, I am going to direct the first question to you, which is that Shreya talked
about the ability to reduce health inequities through technology that enables community
health workers. And I think that echoes how Carrie opened our session. At least here at
the Office of Science and Technology policy we view technology as an extender and a tool,
but not the solution in and of itself.
And Shreya also talked about incorporating
CHWs into the design of these tools. So, I just was curious if you could expand upon
this or give any example from either your own personal experience or that of other CHWs about
where the use of technology has worked well. >> Cheryl Garfield: Yes. Hi,
everyone, good afternoon. Yes, during the pandemic we were able to reach
more patients than we ever had before by sending out a mass text to all the patients
who were ever seen at Penn, whether it was at the emergency room, a doctor's appointment.
If
— you might not have been a patient or at Penn, per se, like go to the doctor's there, but if
you were ever seen in any other local hospital, we sent out a mass text to all of those patients,
you know, describing what services we were offering and if they would be able — if they
could use a community health worker during COVID. Me personally, when I go out to home visits. I
use my computer. We all have laptops that we take with us. And we connect to our phone, which is
given to us also, from our employer. So, we take our tablets and we are able to connect and go to a
patient home and be able to do those applications, apply for businesses, apply for services, wherever
it may be, with them through that technology. But also, I want to make sure that people
understand that technology is great. Everybody doesn't have technology
and most of our elderly people don't. And that's why it is important that technology
is to help the community health worker and not to exit out the community health worker.
Because people still need the community health worker and on a more personal level, like
a one-on-one.
So, that's how technology helps us. >> Jackie Ward: Thanks, Cheryl. I really
appreciate that. And I think maybe just building on that question, I'll just sort of open this up
to everyone. But I've been thinking a lot about that question of digital literacy and whether
that is, you know, on behalf of the community health workers who maybe during the pandemic had
to, you know, increase their technology or digital — technology skill set or digital literacy. Or,
the other view of community health workers maybe being the person that goes into a home and helps
somebody become more technologically savvy or digitally literate.
And I just — I feel like that
sort of touched on what you just said, Cheryl, but I wonder if Denise or Twylla or Sylvia has any
sort of insights or comments there on that front. Maybe, I'll start — I don't want to put too many
people on the spot. But Denise, I see you unmuted. >> Denise Octavia Smith: Yeah, well, you know,
I mean, I'll start where Chery left off. Not only is there the technological barrier
across the country, broadband access, you know, Internet and technology
literacy that I think all of us on this panel have seen evidenced in communities.
And in particular, I just want to lift up our tribal nations, who during the COVID pandemic
have really been advocating.
And there has been a lot of activity around that that
is substantial, but also, you know, the majority of community health workers are working
at community-based organizations in communities. Some of us are still considered volunteers
or paraprofessionals in other words, we don't have some of the structural supports
that are required to stand up a telehealth program or project. And then finally, there
is just the financing piece because of a sort of a lack of national professional identity. I
think Shreya began to voice over some of those comments in terms of the way that Medicaid is
sort of rolled out across our 50 states. But we have issues with just reimbursing CHW
services and recognizing our role to be extenders for all manner of technology and
service delivery as those two things intersect. >> Jackie Ward: Twylla or Sylvia, do you have
any comments on the digital literacy piece? >>Twylla Dillion: I co-sign everything Denise just
said.
It was excellent. I think something we have recognized during the pandemic is that we've
had to adapt, right. So, specifically talking about birth workers, if you can't get into a
hospital to support someone during a delivery, folks have had to use FaceTime during a delivery,
right. I just had a baby, I was staying — I am on maternity leave. I can't even imagine having a
doula on FaceTime, having a lactation support be a FaceTime. That is what has been happening. And
it's because community health workers, as I know everyone on this call knows, are so committed to
supporting the community that even in instances when you can't be there in person, you find a
way to make it happen. So, that is telehealth, right? How come that is not covered? How come
that can't be reimbursed via Medicaid. People are already doing it because they care too much not
to support community members. But that's something that I've definitely seen and heard a lot from
the storybook that we did. We had a lot of input around providing telehealth and FaceTime calls
for people who they couldn't be with in person.
>> Sylvia Juarez: Yeah. So, on our end
what we have noticed is that for, like, the parents who are younger, it has been easier
for them to participate in the Zoom trainings, and it has facilitated them participating in those
trainings because they don't have to get, like, a babysitter. Sometimes it's difficult for them to
leave their home if they have small children. So, for the parents it has facilitated their
participation and training. But for the elders it has been very difficult because CHWs have not been
able to go into senior homes during the pandemic and show seniors how to download, like, the
Zoom app or show them how to login to meetings. So, for those seniors we have tried to have,
like, small activities in outdoor spaces. But technology is a challenge
for older participants.
>> Jackie Ward: Thanks, Sylvia. And I'll go
ahead and let you know I am going to toss the next question to you, too. And it's, I think,
really building on that concept of thinking about how you build trust with, particularly the
older community and so, you know I think the funds that came in to support tobacco cessation
and the Million Hearts model and sort of the weaving of all of those programs together. And
I think one of the other key innovations you mentioned was integrating a sense of belonging.
And so, acknowledging that that is really hard during the pandemic when you can't access, you
know, skilled nursing facilities for instance. I'm wondering, maybe from before the pandemic
or now, can you talk a little bit more about how CHWs and the organizations that you work
with build trust with the community of elders? >> Sylvia Juarez: Yes.
So, our community health
workers are Spanish speakers. Most of them are of Mexican descent. And so, the senior residents
of Casa Pedro Ruiz are Mexican immigrants. And so, the parents started participating in different
activities they held. Cultural events celebrating Mother's Day, bringing in mariachis. You
know, they had, like, a fashion show. And so, the parents were very involved in doing volunteer
work in the community. So, the main thing here is that the CHWs and the senior residents share
a language, they share culture, traditions, lived experience. And so, we have also had
activities where parents and senior residents participated. And even during the pandemic, like,
physical activity in the park, which was outdoors, and so it was multigenerational activity
that was held.
So, I think the important thing here is also to mention that a lot of the
immigrant women that we work with, they haven't been able to see their loved ones in a very long
time because of immigration status or because of their economic status. And so, when they visited
the Senior HUD facility, it was, like, visiting, you know, a grandmother, a grandfather, an
aunt that they hadn't seen in a very long time. So, the sense of family started to grow.
It was basically having parents and seniors coming together and participating in
different events. So, I think that just sharing, in speaking the same language and
traditions and all of that just fostered that sense of belonging. And then our
health educators are also bilingual. So, it's basically having someone that speaks
the language that you speak that looks like you that understands where you are coming
from.
I think that that had a big role in it. >> Jackie Ward: Thanks, Sylvia. So, this question
is kind of general, but I will — I think I'll first call on Denise, just so you can prepare
yourself to unmute. And thinking about the training and best practices and knowing that
the National Association of Community Health Workers plays a role in that, like, where
the best place for training and continuing, you know, continuing education, for instance,
or best practices to live.
Is it a sort of layered approach of there being, you know, the
organizations, local, state, and then sort of national associations to all have a role there?
Is it better to have — and I think, you know, Twylla, I'll also say I am interested in hearing
your perspective, knowing that it sounds like you all do it in-house, a little bit? But just
thinking about those different levels of training, and not talking really about certification,
but just how a community health worker enters the workforce and where that door opens, how they
get training. So, Denise, I'll call on you first. >> Denise Octavia Smith: Sure. I mean, I love
that you started there. How do CHWs enter the workforce? Just because it always makes me reflect
on my own pathway, you know, the extent that my grandmother, through her faith, my mom through
her HIV advocacy, you know, brought me in as a young person. And then my own lived experience
of being a survivor of a rare chronic disease, someone who has experienced homelessness,
you know, and many other things that sort of, that bring forward my commitment and
my alignment, why I do what I do.
So, here are a couple of things in no particular
order because you asked a massive question. Let me just start by saying the
national association, we're a young organization. We'll be three years old in April
of 2022. And one of the things that our founding board of directors really determined is that we
were not, as a national association, going to centralize training, right? We weren't
going to say, "Come here, to NACHW, and get trained here. We're the place to come.
And there are many reasons for that. But let me just say one of them is just the diversity
you see is the diversity on this panel, right? There are cultures and communities and
histories and languages and expertise that is diverse as our population in the United
States. And when we center lived experience and cultural alignment, you cannot say that
one model or one thing is best for all people. One pathway to a career is not best for
all people.
Some people do need to sit in a classroom and get, you know, that sort of didactic
training. Other people need to learn by doing, right, and some people need to be mentored.
There need to be apprenticeship programs or hybrid programs. So, first we want to be flexible.
Because, as Shreya mentioned, we need CHWs in our workforce. We need them for clinical
services, we need them in public health, we need them in behavioral health to address structural
racism and the social determinants of health. One of the best strategies particularly during
this time of CARES Act and American Rescue Plan funding is to center deep and authentic
investment. That means direct contracting and partnerships for recruitment, training,
hiring, continuing education of CHWs in our community-based organizations, in our non-profits,
in our CHW or Promisora or NCHW-led organization.
This investment is unprecedented, and our
communities will not have the sort of recovery that we use to talk about in the early months of
the pandemic. I used to hear people say, "We are six months in, what does the recovery look like?"
Now we're waiting for the mental health pandemic to hit us and we all see those signs. Evictions
are on the rise once again. So, we are still in the mix of all of the impacts in our community.
It's important that we center investment, not as a gift, but an acknowledgement of the
expertise that is in communities, the deep trust, the commitment, the tried-and-true strategies
and relationships as well as the expertise. Many of our CDOs have developed these
trainings and competencies that are now nationally endorsed by the American Public Health
Association in the C3 Core Consensus Project and many other things. So, NACHW,
we serve as sort of an amplifier of our CDOs and our Promisora, our CHW networks,
and associations, they are doing the great work, and we want to make sure that that is integrated,
that that is scaled and that that is sustained.
>> Jackie Ward: Thanks, Denise. Super-great
perspective, and I feel like, you know, the impetus for us having this event
today is to dive deeper into a lot of those things you just talked about.
So, I am hoping in the breakout sessions we'll be able to have a more robust discussion
about some of those things in particular. I wonder, back to the question about training,
you know, Cheryl, as a CHW, I'm curious how you came into the workforce, and you know, if you have
thoughts on sort of different levels of training, and if there is sort of an ideal model, or more
of a flexible model, like Denise just said. >> Cheryl Garfield: Yes, I came into the training
— I came into being in IMPaCT, exactly nine years ago. And the training, I loved the training,
it was a month's training. I think as long as you're hiring the right person for the job
because that is what's most important. Everybody can't be a community health worker, no matter
what the level of degree is. A community health worker is someone like, everyone is saying, from
the community, that has that lived experience, that's maybe been through some of the
things that other people have been through. And we have continuous training, I think that's
important to keep up with, you know, with what's going on in society today.
So, continuous training
is very, very important. So, I always like to say that, you know, I wouldn't say — it's what like
Denise said, it's not one particular program that I would say, "Oh, just take this training." No,
it's got to be the training for the right person, for that particular community, at that
particular time. So, that's what I would say. You know, we have continuous training.
Every month we have something different. And each program is designed different.
Because I take so many trainings at NACHW, because I like your trainings, you know. So,
it's different. But that's what I would say. Hire the right person for the job, first and
foremost. That's the most important thing. That they're not hiring people
because they have these degrees. >> Jackie Ward: Right. >> Cheryl Garfield: And it's outsourcing the natural helpers, because that is what a
community health worker is, a natural helper. And empathy is not something you can be
trained in. It's something that you have. >> Jackie Ward: Thanks so much, Cheryl. Twylla,
I think Health Connect One might have a different model here.
So, I'm curious if
you want to weigh in on that, too. >> Twylla Dillion: Sure. I'm not sure if
we're dissimilar to what anyone has said already. I think Denise is very familiar with our
programs, and some of the folks who work with us. And what we do is we go in, we're partnering with
an organization typically to provide training. And in that process, we have an idea
of who we are going to be serving. And the recruitment process for whoever is going
to be training is to match, as much as possible, who we are going to serve, right. So, really
making sure that we are finding folks from the community who have a vested interest in improving
their community, right.
That's something that I know we've gotten, we've talked about, is
having that vested interest, being a part of the community, and being able to bring all
that they know and their own lived experience into their work daily. And having that empathy,
absolutely, not coming in as an outsider, right. Something that doesn't work that we do see
over and over again is people coming in on parachutes and then getting scurried away at
the end of the day. That's not going to work, right. Having someone who just graduated
from their social work program — and I have nothing against education, I have been in school
forever.
But I know this doesn't work. Okay? So, bringing people from the outside in, to be there
for the day, and then to leave, is not going to be effective. It's for people who have shared
experience with those they're working with. So, when we do peer lactation, we have folks who
have had a successful breastfeeding experience. When we have doulas, we have people who
have had either support from a doula or had an experience that they want to share
with other people. So, they have had to have gone through something themselves to really be
able to convey what's necessary to be authentic, right? I mean, I think a lot
of what we're talking about is that authenticity that you don't
get from someone from the outside. We also are patching up holes that
are in the health care system. The fact that there is not necessarily a
reflection in you when you see a provider, right. A lot of the providers are of a different
ethnic background or a different financial status. And they can't really necessarily relate
to who those folks who are in front of them whereas someone from the same community can.
And
they have incredibly valuable work that isn't necessarily compensated in a way that is making up
for the differences they're making in the health system. You all can probably hear my baby in the
background. I am going to go grab her real quick. [laughter] >> Jackie Ward: Thanks, Twylla. Right on
cure, too. So, I think we have time for one, maybe two more questions.
Sylvia, I wanted to ask you, I loved your community network image and sort
of, you know, the vast web of connections between different organizations.
And so, I think
it addresses, you know — it addresses a lot of the different programs going on in the giving
community. I'm curious if you have advice or lessons learned for other localities, either
county governments or otherwise, who might be looking to mimic some of the successes
your programs in Maricopa County have had? >> Sylvia Juarez: Yes, I think one of
the important things is making sure that when an organization goes into the community
that they have the willingness to listen, and to provide interpreting services, quality
interpreting services if they don't speak the language. Because that is one of the things
that we encountered from the very beginning, with local government offices where they were
going and wanting to have an interactive meeting, but they either didn't have an interpreter
or the quality of the interpreting services, you know, wasn't what was expected.
So, I think
that that is something that — even, like, public health departments or local government
offices need to include into their budget is interpreting services or hiring bilingual
staff. Or, if you are working with the refugee population making sure that you
have a representative from that community. So, I would say that that is something
that is extremely important. Also, I think with the work that we have done we've also
realized that community members take their work very seriously. And so, we still haven't
identified a way to compensate their time. So, I think just acknowledging that, going in,
that you have volunteers that are donating their time and energy to improve their
community. I think going in with humility and, like I said, listening and being consistent
as well. Because I worked with some organizations that say, "Yes, we'll do this and we'll follow
up," and then we never hear back from them.
So, I think that being consistent and respectful
of the community that you're working with builds a sense of trust. Because you know, a lot
of the community members that we worked with, they have not had a positive experiences working
with their local government or with police. So, just making sure that we're being respectful of their time and of the work that they are
doing and elevating their concerns, as well. You know, with our project with the extension
of the circulator, the bus, you know, as public health we could have just ignored that because,
you know, access to public transportation is an issue across the board.
But we acted on that, and
we were very clear in saying we are going to work with you. We're going to walk next to you and
we're going to identify ways to get things done. We were not promising that this project would
be a success, but that we are going to work with them. So, I think acknowledging the work
that is being done and being very clear that we are here to support you, but you're doing
the work. And so, I don't know if that answers the question but just being very respectful
and humble when working with the community. >> Jackie Ward: Yeah, no, that does answer
the question and I really appreciate that. And I think you know, to your first point of
insuring that there are people who can speak the same language and doing that well, I think also
speaks to your last point of walking with people. So, we're nearing our time to end in this
session, and I want to give a few minutes break to our panelists and to those of us who are here
on Zoom before we go into our next invite only break out session.
So, I just want to wrap this
part by thanking you all for attending today and for your great presentations and being
willing to answer a lot of questions as they came up through the chat, or from Twitter. And
so, I also want to say a big thank you to my partners at the HRSA Center for Innovation for
their diligence in getting this off the ground. And so, this is just the beginning of what we
are calling community connected health.
And we truly are looking forward to engaging
with all of you and those who are tuned in on HHS Live. And we want to encourage you
to continue joining us on this series of Roundtables. We have another one scheduled
for March 3rd. And to respond to our RSI, where we can take formal feedback through the
government. I think we have sent that link out in several emails to participants. But if you
are just listening in and you want to Google, or search on your search engine of choice,
OSTP Community Health RSI. I think that will get you to the right place, or you can drop us
a line directly at connectedhealth@ostp.eop.gov. So, thank you again. For those of you who have
been invited to attend the Roundtable breakout session, we'll give you a few minutes break
and ask you to hop over to the next link, where we'll start at 2:05 p.m.
Thanks everyone..
