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CHOW/Promotora Model

Carlos Londono, MPH                            Community Health Education Department (CHE) 

• Health for ALL

“Health for All”

Alma Ata (1978) CHE (2000)

Mission

Tiburcio Vasquez Health Center, Inc(TVHC) is dedicated to promoting the 

health and well‐being of our community by providing accessible, high‐quality 

care. 

Our individual and organizational commitment is to ensure this human 

right through quality service, advocacy and community empowerment.

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CHOW/CHW programs

• Setting Up?

• Strengthening?

– Increasing quality

– Train new ones?

– Improving effectiveness and knowledge of CHW

– Improving systems

– Bringing community into planning & management 

• Scaling up?

Trained vs. Active Promotoras de Salud

No.

Year

Where are we now?

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Defining Community Health Workers

WHO ‐ Key Concepts 

"Community health workers 

• should be members of the communities where they work, 

• should be selected by the communities, 

• should be answerable to the community for their activities, 

• should be supported by the health system but not necessary part of it, and 

• have shorter training than professional workers" 

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CHW/CHOW/Promotoras

• Provide health information

• Provide direct service

• Agents of change (leaders)

Community Health Education Dept (CHE) Team 

• CHOWS

• Program Specialists

• Promotoras

Promotoras de Salud

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Community Health  Dept

Promotoras Program

Chronic Diseases

E&E 

PromotorasHorarias (5)

Lead Promotorasde Salud (15)

Promotoras de la Comunidad

Ventanillas de Salud Program ( 

CHOW

Promotoras

Cultura y BienestarProgram

MHS

CHOW/Promotor

CHOW/Promotor

Placed Based: HPN‐Ashland 

CHOW

Promotor

Other Projects/ Initiatives

PromotorasAdvisory Board

Where have we come from? 

Best Practices 

Health Promotion ‐ Basics 

Health promotion is carried out by and with people, not on or to people. It improves both the ability of

individuals to take action and the capacity of groups, organizations or communities to influence

the determinants of health

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Addressing Health Disparities

• Socio Ecological Model 

– Racism 

– Social Determinants

• Education, 

• Health and health access

• Economic stability,  

• Social and community context 

• Neighborhoods & build environments

• Bio Medical Model

– Disease Prevention

– Health Education

– Behavioral Change

TVHC CHE Promotoras Framework  

Prevention (Health 

Promotion) 

Primary Health Care

Popular Education 

LEADERSHIP

PROGRAMS

Promotoras Academy

Leadership Development

• Health Promotion is the process of enabling people to increase control over, and to improve, their health

6‐week Leadership 

Training 

CHE Health Program‐Specific training

Outreach Activities; 

Health Fairs, Tabling, 

Community Presentations, Advocacy

Advocacy & Community Involvement Initiatives

Holiday Event

Feedback &; Recognitions

Beginning of Year 

Recruitment/Program Planning

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Core Competencies 

Competencies: Qualities

• Relationship with community being served

• Desire to help community

• Empathy

• Persistence

• Creativity/Resourcefulness

• Personal strength and courage

• Respectfulness

Competencies: Skills

• Communication skills

• Interpersonal skills

• Service coordination skills

• Knowledge base

• Teaching skills

• Capacity building skills

• Advocacy skills

• Organizational skills

CHOW/Promotoras Roles

• Providing culturally appropriate health education

• Advocating for individual and community needs

• Cultural mediation between communities and health and social services

• Informal counseling and social support

• Building individual and community capacity

• Assuring people get the services they need

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Main Programs (Funders) FY 16‐17; Annual 

Program Goals 

(People to Reach)

Target Jan‐

Mar 2017

People 

Reached Jan‐

Mar 2017

Performance 

QIII

1. “Ventanillas de Salud” (Consulate of Mexico in San 

Francisco)

#people reached10,000 2,500 2,946 118%

1. Promotoras de Salud:

2.1 Community Care Collaborative (ACPHD & Vera Long Foundation)

# Promotoras Trainings  

# Families with kids 0‐5 y.o

# community members reached

#referrals** 

2.2 Healthy Eating/Chronic Diseases (NCLR)

#Active Promotoras

# People reached

#Cooking Demonstrations

#Grocery Store Visits

#Referrals** 

3

100

4,500

8

1,200

8

25

1

0

1,125

8

300

2

7

1

8*

2,670

27

18

0

0

100%

N/A

237%

338%

6%

N/A***

N/A***

1. Cultura y Bienestar – Mental Health Early Prevention 

Interventions (ACBHCSA‐LCDLR)

#people reached

#activities 

#One‐on‐One

600

170

134

150

42

34

99

63

66

66%

150%

194%

Referrals Jan Feb Mar Apr May Jun Jul Aug Sep

1 Prevention Information # Health Session (group and/or Individual)

Total People reached (health Topics)

# Other Topics (labor, laws, educa, fiance, social)

Total People reached ‐ other topics

2 Screenings#people that received a Dx test

# people with Borderline or abnormal/REF

3 Immunizations #Children who received Iz

#Adults who received Iz

4 Referrals#Children referred to PCHH

#Children Enrolled in PCHH (follow up)

#Adults referred to PCHH

#Adults Enrolled in PCHH (follow up)

#Children referred to other health/social programs

#Adults referred to other health/social programs

#people referred to SNAP

#Children assited in Enrolling into Health Insurance

#Children Enrolled

#Adults assisted in Enrolling in Health Insurance 

#Adults Enrolled

5 Other#Families informed/referred to WIC

#Families informed/referred MH

CHE Programs 2016‐2017

Promotoras Academy

Community Empowerment 

Liason

Lead Promotoras

Chronic Diseases Prevention

Lead Promotoras

Volunteer Promotoras

Eligibililty & Enrollment 

Outreach and Education

Lead Promotoras

Mental Health Early 

Prevention Interventions Collaborative

CHOWs

Ventanillas de Salud

CHOW

Lead & Volunteer Promotoras

Hayward Promise 

Neighborhood Collaborative  

CHOW

CSUEB‐OS

PH Rn

Lead & Volunteer promotoras

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Impact 

• HPN program 

HPN is……

• a collaborative that was formed to address poverty in the City of Hayward by developing a place‐based “cradle‐to‐career” effort to support families who live in the Jackson Triangle Neighborhood or have a child in one of the HPN target schools. 

• The HPN cradle‐to‐career pipeline goes beyond the traditional K‐12 education by articulating and connecting to early childhood programs and preschool, 2‐year and 4‐year colleges and universities, and adult education.

• From its inception HPN has tracked 15 initiative level indicators (e.g. long‐term outcomes) 

Preliminary report focuses on three of the areas where HPN has achieved initial success:

• 5% increase in enrollment to PCHH (health coverage)

• Stronger community engagement leading to better HPN results 

• Improved Kindergarten readiness and early childhood education access; and

• Two‐generation approaches leading to school success.

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Success of Model / Best practices 

• Principles of Primary care & Health Promotion

• Core competencies

• Working with the Community 

• Leadership model approach

• CLAS programs

• Outreach “capacity”:

– Health Information, Health Education, referrals

• Community based teams 

• Other Key Factors…..

TVHC CHW Model Development 

Community Setting 

•10‐session training

•Leadership

Promotora de la Comunidad

•20‐session training

•Leadership & Outreach 

•Coaching 

Promotora de Salud

•Weekly Activities

•Trainings

•>3 years exper.

•Specific Programs

Lead Promotorade Salud

Clinical Setting 

CHOW

CHW/Patient Navigator

Care Coordinator/Case manager

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Community Health 

Thank you 

35

www.tvhc.org

Community Health Workers Department

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For over 25 years…St. John’s has utilized trained Community Health Works (Promotoras) to conduct:

OUTREACH EDUCATION PROGRAM SUPPORT LEAD ADVOCACY EFFORTS

St. John’s Community Health Workers are an experienced, motivated and empathetic team of African America, Central American, and Mexican immigrants who live in South Los Angeles. 

Community Health Workers

•Community Health Workers provide much needed information and education regarding the importance of prenatal care, well child examinations, immunizations, STD prevention, chronic disease management, oral health, and many other topics.

•Through these outreach efforts, service area residents learn about St. John’s low‐cost services and are able to request appointments.

•Health promoters link individuals and families in the community to available health care services by networking with schools, community organizations, and social services programs.

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Community Health Workers

*Right to Health monthly meetings

*Political Education Workshops

*Educational presentations on various health

*Help to increase awareness and knowledge of health conditions

*Provide knowledge to support healthy lifestyles

*Group and One-on-One education regarding:

-Nutrition -Prenatal Care-Disease Management -Child Safety-Reproductive Health -Pediatric Literacy-Family Planning - Dental Health

and more…

Community Health Workers

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• 8,500 patient visits for 3,864 children suffering from housing‐related health conditions.

• 1,457 Community Health Worker home‐based case management visits to 398 children. 

Asthma – 82% diagnosed as controlled by provider

Elevated blood lead levels – 100% demonstrated reduced blood lead levels upon    follow  up. 

• HRSA designation to target and serve homeless individuals and families through its Warner Traynham Health Center, and its Washington High School based health center and mobile clinic

• The program also includes homeless services case management and community outreach for hard-to-reach populations to increase access to primary medical, dental, behavioral health care and support services for homeless and housing insecure patients.

• Services Include: -Comprehensive primary medical care- TB Screening-Substance abuse screening and counseling services-Targeted case management-Links to resources and referrals-Well-woman checkups-Behavioral health services-Screenings for chronic diseases, including diabetes, hypertension, and cholesterol, STI/HIV Testing

-Health insurance enrollment assistance-Health education

Community Health Workers

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In January 2011, St. John’s embarked on an innovative project designed to engage with and develop the leadership capacity of our patients and community members through Right to 

Health Committees.

Through organized community action, the committees are creating:

-Rights to Health Communities have grown to 450+ community members.

-Patient advocacy infrastructure

-A body of health care constituents that are educated and organized

Community Health Workers

St. John’s Board of Directors recognizes the valuable work performed by its Community Health Workers, and as such is committed to sustaining these positions.

• Resources

• HRSA 330 Funding

• Private Foundations

• Individual Donors

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*Clinic opened April 2014 

*Community Health Workers began to   conduct outreach to the community in 

January 2014

Total visits for: 

2014/18,614

2015/21,700

2016/22,367

Total patient visit revenue $3.3 million for 2014

Community Health Workers Department