Empowering Communities through Lay Health Advisor

Certification Programs

Elizabeth M. Whitley, Ph.D., R.N.

Denver Health Medical Center

911 Medical Response Rocky Mountain Poison

and Drug Center

Rocky Mountain Regional Trauma

Center

Denver Health Medical Plan

Rocky Mountain Center for Medical

Response to TerrorismSchool-based Health Centers

Denver CARES

Denver Health Foundation

Family Health Centers

Correctional Care Denver

Public Health

Lay Health Advisors, aka Community Health WorkersOutreach to underserved communities Outreach to underserved communities

to to Improve access to health and other Improve access to health and other

servicesservices Promote client knowledge and Promote client knowledge and

behavior change through health behavior change through health educationeducation

Denver Health (DH)CHW Requirements

Indigenous to communityIndigenous to community HS diploma/GEDHS diploma/GED Desire to serveDesire to serve Interest in HealthInterest in Health Bilingual preferredBilingual preferred

DH Community Outreach target populations

Geographic (i.e., 5 West Geographic (i.e., 5 West neighborhoods)neighborhoods)

Racial/Ethnic (i.e., Latinos)Racial/Ethnic (i.e., Latinos) Special Populations (i.e., Men)Special Populations (i.e., Men)

DH, prior to 2000

On the job training conducted by On the job training conducted by DH resource intensive and DH resource intensive and inconsistentinconsistent

CHWs lacked basic work CHWs lacked basic work readiness skillsreadiness skills

DH/CCD partnership

Create, implement and evaluate a Create, implement and evaluate a standardized academic education standardized academic education certificate programcertificate program

Provide CHWs with basic Provide CHWs with basic transferable skills necessary to transferable skills necessary to succeed in health care workforce succeed in health care workforce and communitiesand communities

Entry for individuals into health Entry for individuals into health careers and higher educationcareers and higher education

CHW certificate program

Workplace, academic and Workplace, academic and vocational skillsvocational skills

17 credit hours17 credit hours 1 semester or over 1 year1 semester or over 1 year Clinical internship/field Clinical internship/field

experienceexperience

CHW Certificate Program Curriculum

COM 126 Communication for HealthcareCOM 126 Communication for Healthcare CIS 118 Intro to PC ApplicationsCIS 118 Intro to PC Applications AAA 109 Advanced Academic AAA 109 Advanced Academic

AchievementAchievement CHW 120 Community Health IssuesCHW 120 Community Health Issues CHW 130 Community Health ResourcesCHW 130 Community Health Resources CHW 297 Field ExperienceCHW 297 Field Experience

The partnership

CCD coordinates and administers CCD coordinates and administers program and delivers workplace coreprogram and delivers workplace core

DH obtains grant funding for tuition DH obtains grant funding for tuition and fees, helps recruit students, and fees, helps recruit students, delivers vocational core, arranges delivers vocational core, arranges field experiences and evaluates the field experiences and evaluates the programprogram

Community partners offer field Community partners offer field experiences, faculty to teach experiences, faculty to teach vocational core and employmentvocational core and employment

Program Outcome Measures

Students must Students must Complete curriculum with at least Complete curriculum with at least

a C averagea C average Pass competency based testingPass competency based testing

Program Results

Majority female, low income and Majority female, low income and minorityminority

30% of those who start drop out 30% of those who start drop out before mid-termbefore mid-term

100% of those who have passed 100% of those who have passed courses passed competency courses passed competency based testingbased testing

Program Results

Of 20 graduates from first 2 Of 20 graduates from first 2 programs, 19 still employed in programs, 19 still employed in health work 2 years after earning health work 2 years after earning certificate.certificate.

10 students completed 310 students completed 3rdrd program program and all still employed in health and all still employed in health work after 1 year.work after 1 year.

8 students completed 48 students completed 4thth program program in August 2007.in August 2007.

55thth program began Fall 2007. program began Fall 2007.

Program Results

Program now offered Statewide Program now offered Statewide through Community Collegesthrough Community Colleges

Program being replicated in other Program being replicated in other statesstates

Financial Effectiveness of CHWs

What is the financial impact of a CHW intervention with a particular population on the health system?

Prerequisites to determining financial effectiveness Robust evaluationRobust evaluation Database to track CHW activitiesDatabase to track CHW activities CHW participationCHW participation Integrated information systemIntegrated information system

Free Pregnancy Testing (FPT)

Return on Investment: New patients who deliver at

DH following free test in 2004 ROI of 6.9:1.0 DH increased revenue of

$251,680

FPT Conclusions

Increased access to DH services for Increased access to DH services for underserved pregnant women.underserved pregnant women.

Concurrent increase in overall DH Concurrent increase in overall DH deliveries.deliveries.

New Medicaid insured patients to DH.New Medicaid insured patients to DH. Improved prenatal care.Improved prenatal care. New system revenue of $251,680 New system revenue of $251,680

annually.annually.

Men’s Health Initiative (MHI)

January 1, 2003 – June 30, 2004 Subset of 590 men Utilization increased and

improved and uncompensated care reduced

ROI of 2.28:1.0 DH savings of $95,941 annually

MHI Conclusions

Increased access to health care services for underserved men.

Fostered more appropriate use of system.

Decreased total patient charges and uncompensated care.

Saved DH system $95,942 annually.

Acknowledgements

Community Voices is funded by the Community Voices is funded by the W.K. Kellogg Foundation and W.K. Kellogg Foundation and administered by the Morehouse administered by the Morehouse School of Medicine Center for School of Medicine Center for Primary CarePrimary Care

Thanks to Community Health Works Thanks to Community Health Works of San Francisco for breaking the of San Francisco for breaking the ground and paving the way.ground and paving the way.