HATTIESBURG – Community health workers are integral and powerful promoters of health, wellness and disease prevention in their communities. And the only national center promoting community health worker programs in the U.S. is the Center for Sustainable Health Outreach (CSHO) located at the University of Southern Mississippi (USM).
Jennifer Downey, CSHO`s communications director, says community health workers are people who work in the communities they call home, acting as liaisons between their clients and the healthcare system. Their familiarity with the people they serve and the problems those people face makes them a critical part of the health and human services systems.
“Typically, community health workers are serving those hard-to-reach, underserved populations,” Downey said. “They address barriers, such as language and culture, that have kept those folks from appropriately accessing the traditional health and human services systems.”
She describes community healthcare workers as members of the healthcare process who are “in the trenches.” One of their primary roles is to take away the fear associated with the health and human services systems, and to let people know what resources are available to them.
“They’re also there to spot signs and symptoms of problems, so that they can then help those folks get care,” Downey said. “They can also serve as patient navigators who help them access those services-staying there with them in the emergency room, and acting as a translator if necessary between that patient and the healthcare providers.”
CSHO co-director Dr. Agnes Hinton said that community health workers are key components of the healthcare system. “They are often the key to overcoming the communication barriers between community members and service providers,” Hinton said.”Their services are really valuable.”
The methods by which community health workers serve their communities vary widely. Some focus only on specific conditions, while others work with problems of many different kinds. Some do home visits, while others are based out of clinics and hospitals.
Families at the greatest health risk are often those who are least likely to be appropriately served by the health care system. Because of language barriers, lack of money, cultural beliefs or mistrust of the system, many people do not receive healthcare and preventive services.
Hinton said that because community healthcare workers are members of the communities they serve, they can provide culturally, linguistically and otherwise appropriate outreach, prevention, intervention and treatment services, which are based in, and reflect, the value systems of the community.
“In a number of communities across the United States, the community health worker (CHW) is reemerging as a vital link between communities and healthcare providers,” Hinton said. “CHWs educate individuals and communities and facilitate access to needed services. They provide formal and informal community-based case management and case coordination services. They also educate providers and healthcare systems and help craft services that are more responsive to the communities being served. They support community empowerment by providing information, leadership and advocacy on issues impacting community health and well-being.”
CSHO provides support and technical assistance to community health workers and CHW programs in the following areas: program development and support, program funding and sustainability strategies, public policy development, strategic planning assistance, program evaluation and education and training. CSHO also facilitates partnerships with funders, policy makers, health systems and community organizations.
The center, which is a partnership between USM and the Harrison Institute for Public Law of Georgetown University, also serves as a national point of contact for CHWs to provide them with reliable, up-to-date information on emerging trends in the field.
The center works to promote community health care workers across the country, and also has a number of demonstration projects in Mississippi including 10 Maternal/Infant Health Outreach Worker Programs and the Deep South Network for Cancer Control that serves the Hattiesburg-Laurel area and 20 Delta counties. The cancer network has received five years of funding from the National Cancer Institute to implement a project to improve cancer awareness in the African-American population in both poor, rural and urban areas of Alabama and Mississippi.
Cancer incidence rates are 10% higher for African-Americans than for Caucasians, and mortality rates for African-Americans are double that for Caucasians. Hinton said although the causative factors associated with this disparity are yet to be fully determined, there is a need to reduce the disproportionate burden of cancer among minorities.
“The network`s objectives include the training of community volunteers to function as lay health advisors, educating about cancer and promoting screenings like mammograms and Pap smears, as well as recruiting African-Americans for clinical trials and recruiting minority investigators,” Hinton said.
“The Deep South Network for Cancer Control`s initial focus was on breast and cervical cancers, and has been expanded over time to focus also on prostate and colorectal cancer, nutrition and those cancers linked to tobacco use.”
The program uses the Community Health Advisor model, which recruits and trains volunteer natural helpers to improve individual and community health. The model is based on the premise that as members of the community they serve, the trained community volunteers can provide cancer awareness and prevention services within the cultural, linguistic and other value systems of the community.
“The ultimate goal of the project is to reduce the disproportionate cancer mortality and morbidity rates for African-Americans,” Hinton said. “By encouraging the use of early detection methods and reducing the fear of clinical trials, the community volunteers can reduce the effects of cancer in African-Americans. In addition, the training of minority investigators may ultimately create a larger group of investigators addressing the disproportionate burden of cancer among minorities.”
The CSHO`s funding has declined from nearly $2 million in 1999 and 2000 to about $481,000 in 2003, and the center has been told by the Mississippi congressional delegation not to expect any more congressional earmark funding for the center. That has made supplementing the center`s income with other grant funding critical.
A case in point is a grant from the W. K. Kellogg Foundation to fund the Community Access to Care Community Health Worker Inventory Project. Working with federal and other organizations, CSHO will develop a national inventory of programs that involve community health workers (CHWs), including their evaluation methodologies, and an annotated bibliography of published articles describing CHW program evaluations.
By the end of the projects, CSHO will develop a comprehensive inventory of programs involving CHWs, a comprehensive listing of current evaluation methodologies used by each CHW program site, along with all instruments currently used by the programs and an annotated bibliography of all published articles regarding CHW programs.
“The need for this project grew out of a realization that while several databases of selected CHW programs exist, the information is neither comprehensive nor easy to access,” Hinton said. “Additionally, not enough is known about evaluation tools used by community health worker programs. The databases created through this project will be very useful to a variety of users. For the first time, contact information about CHW programs will be available to those seeking to distribute information to, or collect information from, community health worker programs. States may find the information useful as they examine certification/licensure issues for both CHWs and CHW training programs, as well as for workforce projections. Organizations seeking to replicate pilot pro
ams would also find this information valuable.”
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.
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