First Nations Community HealthSource

Community Health Worker Model by Linda Stone, CEO

New Mexico’s urban Indian health center Located in Albuquerque, NM Established in 1972 Mission: To provide a comprehensive and culturally appropriate

health delivery system that addresses the social, emotional, spiritual and physical needs of urban Indians and other underserved populations in Albuquerque and the surrounding areas

Core services: Medical, Dental, Behavioral Health, Traditional Healing

Other services: HIV prevention education, Diabetes prevention education, social services, case management, patient navigation/community health worker, Medicaid enrollment/education, WIC, homeless outreach and case management, vocational development, housing assistance

10,000 urban Indians served in 2014

First Nations Community HealthSource

The State of New Mexico is extremely rural and encompasses vast isolated regions of Native American Reservation land and some of the last frontier of the west.

Albuquerque is one of three metropolitan areas in the State

Albuquerque is bordered by the Pueblos on all sides Large urban Indian community (est. 55,000) Service area is southeast Albuquerque which is one of

the most distressed areas of the City of Albuquerque Area has the largest concentration of American

Indians

Service Area

Albuquerque has the highest percent of Native Americans of any other city in the nation (10.5%), according to Indian Health Service

Massive migration away from Indian Country and Native Americans who left their tribal communities and are now living in urban areas ‘on or near’ their tribal land

Estimated 50,000 American Indians from more than 250 tribes living in Albuquerque

Significant income disparity exists with the American Indian community—median household income of $23,440 compared to $38,272 for non-Indians and a per capita income of $8,679 compared to $20,884 for non Indians—50% of American Indians live below 100% of the Federal Poverty Level

88-97% of children are enrolled in free/reduced lunches American Indians experience multi-generational poverty that results in a

low quality of life, high chronic disease rates (i.e., diabetes, cardiovascular disease, substance use, depression), poor oral health outcomes and reduced live expectancy

Target Population

The CHR/CHW model has been widely used by Indian Health Services since 1968 when 250 CHR/CHWs were trained in Alaska

Originally used to prevent the transmission of TB By 1974, 1003 CHR/CHWs employed by Indian Health

Services Creation of CHR/CHWs:

◦ Need for more involvement of AIs in their own health programs and in identifying and addressing their own health problems

◦ Need for greater understanding between AIs and Indian Health Services

◦ Need to improve cross-cultural communication between Indian communities and health care providers

◦ Need to increase basic health care and instruction in Indian homes and communities

Community Health Worker Model: History

Overall Goals: To improve the health knowledge, attitudes and

practices of American Indians by promoting, supporting, and assisting the Indian Health Services in delivering a holistic and integrated health care program

To address health care needs through the provision of community oriented primary care services including Traditional Native healing services using community based, well trained and medically guided health care workers

Goal of the CHW Model

Foundation of the CHW Model: Medicine Wheel

Provide preventative services in areas of need that are not otherwise available to American Indians

Provide home visits and home based services Provide transportation services Acts as a liaison/advocate for communities Provide language translations as needed Facilitate communication between the community member and health care

provider Develop program plans that address specific community health care needs Assess community health care resources Provide or assist in demonstrations, training sessions and community

meetings in the areas of safety, nutrition/diabetes, environmental needs, chronic disease and other health concerns

Provide health care education and facilitate understanding using the Native language and culturally appropriate materials

Provide health promotion/disease prevention information and instructions in self help services that address chronic health problems

Objectives of the CHW Model

Provide outreach to community members Serve as a community heath promoter/educator Serve as a health advocate Serve as a health paraprofessional Conduct home visits Conduct health assessments Provide transportation services as needed Role models in the communities they serve Plan and organize community health promotion and disease

prevention activities and facilitate learning (e.g., immunizations, well baby clinics, safety in the home, medication adherence counseling, dangers of substance use, etc.)

Create linkages to other needed services

Core Duties of CHW

Need is significant among urban Indian community of Albuquerque

CHWs are in growing demand Strong advocates who come from the same

community Health promotion/disease prevention

activities by CHW have been helpful with lowering mortality rates

Need for CHWs

Closing: Case Vignette Presentation

Thank you!

The End