New Mexico State University

1. New Mexico State University SoAHEC: Utilization of Promotoras to Reach Out to Rural Communities Beatriz Favela, LMSW Program Director New Mexico State University

2. SoAHEC is part of the national network of Area Health Education Centers (AHECs). Today, 56 AHEC programs with more than 235 centers operate in almost every state and the District of Columbia. New Mexico State University

3. New Mexico State University

4. AHEC Goals • Provide Clinical Training for a) medical students, physician assistant, pharmacy, family nurse practitioner, certified nurse midwife, physical therapy, occupational therapy, dental hygiene, med lab sciences and interdisciplinary program students, and b) family practice and dental residents. • Provide health career preparation opportunities for Southern New Mexico rural, under-represented and disadvantaged minority students and from Health Professional Shortage Areas. • Provide licensed health professionals in New Mexico with the opportunity to secure and maintain professional license through educational opportunities. New Mexico State University

5. Programs • Chronic Disease Self-Management Program • Train-the-Trainer • Four-day Training • Community Workshops • Six-week course New Mexico State University

6. Southern AHEC • Our mission is: To serve as a culturally competent regional resource and training center for youth, the health workforce, and communities of New Mexico. New Mexico State University

7. A Unique Approach • Area of coverage • Unique approach utilizing Promotoras to reach out to Southern NM Communities New Mexico State University

8. The world needs more promotoras http://www.youtube.com/watch?v=pQ8YBpKF0jI http://www.youtube.com/watch?v=pQ8BpKF0jl New Mexico State University

9. Promotoras/Community Health Workers • There are over 1.3 million community health workers worldwide (The World Health Organization) New Mexico State University

10. Roles of Promotores (as) include: • Managing care and care transitions • Ensuring cultural competence • Providing informal counseling • Building community capacity to address health care issues • All of the above New Mexico State University

11. Answer e) All of the above New Mexico State University

12. Promotores (as): Who are they and what do they do? • A lay member of a community • Who applies his or her unique understanding of the experience, language, and/or culture of the populations he or she serves in order to bridge individuals, and communities. • Shares knowledge about health and human services, provide culturally appropriate health education and information, ensure people receive the services they need. • Provide direct services such as informal counseling and social support, and advocate for individuals and community needs. New Mexico State University

13. True or False • The Department of Labor recognizes Community Health Workers/Promotores (as) as a profession, and has developed a formal definition? New Mexico State University

14. Answer: True New Mexico State University

15. Definition of a Community Health Worker Promotores(as) U.S. Department of Labor (DOL 21-1094) • CHWs (21-1094) ASSIST INDIVIDUALS AND COMMUNITIES TO ADOPT HEALTHY BEHAVIORS. • CONDUCT OUTREACH FOR MEDICAL PERSONNEL OR HEALTH ORGANIZATIONS TO IMPLEMENT PROGRAMS IN THE COMMUNITY THAT PROMOTE, MAINTAIN, AND IMPROVE INDIVIDUAL AND COMMUNITY HEALTH. • MAY PROVIDE INFORMATION ON AVAILABLE RESOURCES, PROVIDE SOCIAL SUPPORT AND INFORMAL COUNSELING, ADVOCATE FOR INDIVIDUALS AND COMMUNITY HEALTH NEEDS, AND PROVIDE SERVICES SUCH AS FIRST AID AND BLOOD PRESSURE SCREENING. • MAY COLLECT DATA TO HELP IDENTIFY COMMUNITY HEALTH NEEDS. EXCLUDES “HEALTH EDUCATORS” (21-1091). BUREAU OF LABOR STATISTICS, STANDARD OCCUPATIONAL CLASSIFICATION, 2010) New Mexico State University

16. Other Titles used • Community Health Workers • Community Health Advisors • Lay Health Advocates • Promotores (as) • Outreach Educators • Community Health Representatives • Peer Health Promoters • Peer Health Educators

17. Roles of CHW • Creating more effective linkages between susceptible populations and the health care system. • Managing care and care transitions • Ensuring cultural competence • Providing culturally appropriate health education • Advocating for underserved individual to receive appropriate services • Providing informal counseling • Building community capacity to address health care issues

18. True or False The first systematic use of community health workers arose in the United States in the 1950’s? New Mexico State University

19. Answer: False New Mexico State University

20. The first systematic use of community health workers arose in China. After the Chinese Revolution of 1949. New Mexico State University

21. What type of education do Promotoras/CHW receive? • On-the-job training • Formal training • Train-the-Trainer Programs • Certified Leaders • Physicians • Nurses • Others New Mexico State University

22. Other programs served by CHW • Support populations in their transition from home health serves in the prevention and/or management of chronic conditions. • Conduct community-wide educational classes on nutrition, physical activity and smoking secession. • Implement diabetes-focus programs for American Indian and Alaska Native populations.

23. Barriers to Healthcare Poverty Limited English skills Lack of health insurance Unemployment Immigrant and refugee status Homelessness Inability to access transportation New Mexico State University

24. The Impact Promotoras/CHW have in Communities • CHWs often work in rural areas where the medical model of health care is limited or non-existent. • CHWs in New Mexico and other states have been effective health educators and service providers. • Often involved in community organizing and the development of health and social service projects and are an important link in the health delivery model. • They serve as interpreters and a direct link in accessing health care. • Many of them are Medicaid On Site Application determiners and have been instrumental in signing people on to Medicaid. New Mexico State University

25. What are the advantages of including Promotoras/CHW in rural programs? • Typically: • Members of the community they serve • Skilled at building community capacity • Culturally competent • Have the trust of the community • One-on-one relationships with consumers • Liaise between providers and consumers • Benefit: • They Facilitate improvement in Health status and quality of life in rural communities

26. Evaluating the Effectiveness of Promotoras or CHW • CHWs often share the priority population’s • language, • ethnicity, • religious beliefs, and • social characteristics, • CHWs can develop a connection between the health care system and their own community. • Their interventions may also be more appropriate than professional-driven approaches for affirming and strengthening a community’s own assets to improve health. • CHWs can understand and harness a community’s strengths in order to promote better health behaviors. New Mexico State University

27. Evidence for Effectiveness of CHWs in Diabetes Education and Self-care • Six-month self-management program control group • Completed the program • Improved knowledge and self-care • Greater declined in A1C values New Mexico State University

28. Effectiveness of mammography promotion • Randomized controlled trial with control group • Increased use of mammography • Greater in communities with no female physician New Mexico State University

29. Other Studies… • Hypertension Care and Control in underserved urban African American men • Outcomes: Greater reduction in blood pressure and higher rates of blood pressure control • Maternal Outcomes for Families of Children with Chronic Illness • Outcomes: Decreased in anxiety for all mothers regardless of disease group • Healthy Homes Project: To decrease exposure of indoor asthma triggers • Outcomes: Greater quality of life, urgent health services use declined significantly and symptom days decreased. New Mexico State University

30. Other studies… Cervical cancer screenings Colorectal cancer prevention Blood pressure Immunization Prenatal care Teen pregnancy Migrant farm workers mothers and children New Mexico State University

31. Why are we successful • SoAHEC values and trusts the presence that CHW/Promotoras have in their community. • SoAHEC recognizes the meaning of home visits and community presentations/trainings and allows CHW/promotoras to work within a well-known area. • SoAHEC equips CHW/Promotoras to succeed in the community by providing a variety of tools, information etc. • SoAHEC compensates CHW/Promotoras by offering a stipend. (not payment since the work they do has not price value)

32. SoAHEC believes in the value of Promotoras • SoAHEC recognizes the ability of community organizing that CHW/promotoras have. • SoAHEC developed a support system to assist Promotoras with their community work by: • Providing Training on a variety of topics • Offer Support • Emotional/Empowerment • Moral/Education • Guidance/Advise • Friendly environment

33. Conclusion: A Mutual Relationship Promotoras Believe and Support the mission of SoAHEC Trust SoAHEC to equip them with training, education, materials and other support Count on SoAHEC Willing to learn a variety of topics • SoAHEC: • Value the work of the Promotoras • Trust Promotoras to deliver quality community work • Can count on Promotoras • Does not limit Promotoras to a specific program

34. http://www.youtube.com/watch?v=KyZTObQM3HU http://www.youtube.com/watch?v=KyZTObQM3HU New Mexico State University

35. QuestionsThank you! New Mexico State University