Training Post-Prison Health Workers Online: A National Partnership

1. Training Post-Prison Health Workers Online:A National Partnership Alma Avila, MPH Program Director, City College of San Francisco, Community Health Worker Certificate Amie Fishman, MPH Project Director, City College of San Francisco, Transitions Clinic Network CCSF Collaborative

2. The project described was supported by Grant Number 1CMS331071-01-00 and 1C1CMS331300-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. • Disclaimer: The contents of this publication are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

3. Health Care Innovation Award (HCIA) • 3 year award: Collaboration among CCSF, UCSF, Yale and community clinic consortium • Train and employ formerly incarcerated individuals to be Community Health Workers (CHWs) working in primary care clinics • 11 clinics in 7 states and Puerto Rico • Serving recently released prisoners with chronic conditions • Evaluation to measure: • Increased access to primary care • Improved quality of care • Lower health care cost

4. Why focus on re-entry? • 700,000 federal and state prisoners are released to the community annually • High prevalence of chronic conditions; diagnosed for the first time while incarcerated • Isolated from the community, health and social services • Limited access to medical care and medication post prison • 12 times increased risk of death in first 2 weeks after release • More likely to use emergency department for primary health care

5. Transitions Clinic Network • Community-based intervention that provides transitional care and a primary care medical home for recently released patients with chronic conditions and their families • Employs formerly incarcerated CHWs as part of a clinical team to outreach, enroll and support them in primary care and other social services • Partners with county health departments, academic institutions, community clinics and prisons to provide primary care to the re-entry community • Eleven clinics across the country currently in operation with approximately 5 more in development

6. Why Community Health Workers • Members of the same communities as clients, which helps to build trust and understanding • Meet the clients “where they are at” and build a bridge to primary care • Assist with patient navigation in a culturally relevant manner • Help to advocate for clients • Evidence-based model: • Reduced emergency room visits = decreased health care costs • Increased access to primary care • Coordinated care = improved quality of care

7. Post Prison Health WorkerCertificate (PPHW) • Trains and prepares frontline community health workers to work with and promote positive health outcomes for formerly incarcerated communities • 20 units – 2-3 semesters for completion • Core Competencies • Case management • Culturally responsive outreach • Client centered intake and counseling skills • Community organizing and advocacy • Internship component • Developed in partnership with Transitions Clinic

8. Program Features • Performance-based Training Program • Reality-based Education • Internship • Partnership with Employers

9. Course Demonstration

10. Course Demonstration

11. Use of videos in courses • As introductions to key learning points • There are over 150 videos to embed in online and in-person courses on core competencies, roles of CHWs, working with clients, and more The following 2 videos demonstrate the following learning outcomes. See if you can identify one example for each key points as you watch the videos Key learning points • How to: • Begin the client interview • Build rapport • Welcoming the client • Making the client feel comfortable • Apply active listening skills

12. Course Demonstration • Role Play: • First Meeting, CHW & Client – 01 Demo • First Meeting, CHW & Client – 01 Counter Examples? • Questions are then asked in forum or discussion boards: • What were some of the differences between the first and second interview in making the client feel more comfortable in the interview? • What were some of the skills used? • Name 2 positive and 2 negative “non-verbal” communications methods used.

13. Challenges • Technology barriers: • Student learner literacy • Faculty literacy • Access (computers, webcams, videos, external sites) • High level of support needed for success • Practice-based learning online • Group work: • Conflict resolution • Giving / receiving critical feedback • Community building • Employer and peer discrimination

14. Challenges continued • “I guess not sitting in a class is still different for me. I know the engagement of a classroom is somewhat missing.” • “I have a large amount of people who support me at the job. The only problem is time factor to do all that the job requires and getting the time to complete school work. Since I work at two locations it makes it harder.” • “It just felt as though I could not keep up this semester. I will have to assess and re-organize for the future.” • “I need a little support with understanding the newness of technology as a whole; I just came home from 27 years of incarceration. There is no internet in New York State prisons.”

15. Highlights and Opportunities • Increased workforce opportunities in the expanding health field for historically marginalized communities • Expansion of online certificate program provides greater access to remote areas and areas without training opportunities • Opportunities to collaborate or partner with other regional training institutions or clinics • Creation of culturally relevant videos and training resources • Development of online facilitator’s guide to accompany Foundations for Community Health Workers textbook

16. Resources: CHW Textbook and facilitator’s guide

17. Resources: PPHW certificate

18. Resources: Digital Stories • Jermila’s story • Tracy’s story

19. Contact Info Alma Avila Amie Fishman aavila@ccsf.eduafishman@ccsf.edu City College of San Francisco MUB 353 50 Phelan Ave San Francisco, CA 94112 The contents of this publication are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services.