Lay Health Promoter (LHP) Program Working Group of Creciendo Juntos

1. Lay Health Promoter (LHP) ProgramWorking Group of Creciendo Juntos • Jan Wolfe, FNP Co-facilitator of the Lay Health Promoter Working Group, Creciendo Juntos Clinical Director, Rural Health Outreach Program • Lindsey Holcomb, MS Co-facilitator of the Lay Health Promoter Working Group, Creciendo Juntos Outreach Advocate, Sexual Assault Resource Agency

2. Creciendo Juntos (Growing Together) is an inter-agency and inter-community network for issues related to the Latino/Hispanic community in Charlottesville City, Albemarle County, and surrounding areas. www.cj-network.org • Lay Health Promoter Program (LHP) is a working group of Creciendo Juntos. The LHP has been used successfully in Latin America to enhance health services to underserved populations. The model utilizes informal support systems in communities, typically training several members as “promotoras” who, in turn, engage and inform their families, friends, and neighbors on important health issues and connect them to their medical services.

3. Magda Bullock, a lay health program instructor, and a student select and weigh fresh fruit at a local market. JMU/Harrisonburg program.

4. Activities to date • May 2007, start of LHP working group meetings. Linda Hemby, Dilcia Colindres, Jan Wolfe, Martha Trujillo, Ivonne Lopez, and Lindsey Holcomb. • Discussion with Karen Bunn, Director of LHP program at Cross Over Health Center in Richmond, VA. • Creciendo Juntos September plenary with LHP group and Karen Bunn. • Hispanic outreach fair in Southwood, September 2007. • Began conducting health needs assessment among residents in Southwood, November 2007-present.

5. US Census Bureau stats on Latinos in Charlottesville/Albemarle • In 1990, the Latino population was at 1.16% of a total population of 108,381. • In 2000, grew to 2.52% of a total population of 124,258 individuals. • In 2005, grew to 4.25% of a total population of 161,712 individuals. • Census figures show that during the last decade, the Latino population in Virginia increased 105.6%, compared to the overall population growth of 14.4%. (Nowak 2004) • Similarly, while the total population of Central Virginia grew by 21.6%, the increase for Latinos was 151.8%. (Nowak 2004) • A recent report indicates that Latino growth may be even higher in our area. “School enrollment is a strong indicator of the trends in the general population, and these figures represent a 384% increase in the LEP student body over the past nine years in Albemarle, and a 555% increase over ten years in Charlottesville.” (Charlottesville/Albemarle Commission on Children and Families, 2005) Most of these LEP students are Latinos.

6. Southwood The 100-acre Southwood Mobile Home Park is located off of 5th street extended, about a mile from the 120 exit of interstate 64. It was opened in the mid 1970s and contains some 360 trailers. Actual number of residents is unknown; estimates are between 1,800 and 3,000. All of its residents are low income; over half are Spanish speaking Mexicans, Salvadorans and Hondurans.

7. Overview of Southwood Health Survey • Latino residents of 65 trailers were interviewed, between October 20th and November 15th, 2007. • Comparison: 19 Latinos in 3 focus groups in January. • A draft report: February 16th • Report presented: March • Linda Hemby, sociologist coordinating survey and tabulating results.

8. Already recognized health needs from conversations with Latinos in Southwood • Mental Health -stress, anxiety, and depression related to immigration, language barriers, and other unknowns. • Chronic disease management -respiratory diseases, diabetes, kidney problems. • Birth control

9. Top ten leading causes of death in the U.S. in 2002 for Latinos • Heart disease • Cancer • Unintentional injuries • Stroke • Diabetes • Chronic liver disease and Cirrhosis • Homicide • Chronic lower respiratory disease • Pneumonia and Influenza • Birth defects Source: http://www.vdh.virginia.gov/healthpolicy/minorityhealth/hispanic/index.htm

10. Goals of the LHP program? • Initiated as a means to meet the obvious need for basic health knowledge of Latino residents in Charlottesville/Albemarle area. • Established to empower and equip Latino citizens to be involved in the process of improving their health, the health of others, and the health of their communities. • Program based on the idea that individuals who understand disease prevention and wellness are more likely to remain in good health, become efficient health educators in their communities, and good health care consumers when they do require medical attention.

11. Trained LHP will be able to: • Effectively help others access the heath care system and resources they need, thus reducing the number of individuals who postpone early treatment. • Participate in a variety of community outreach events and possibly volunteer with health related organizations (depends on a variety of factors) • Use this educational outreach opportunity as a stepping stone to other opportunities (continue their education, acquire pt/ft paid position, etc.)

12. Program Outline • First class from the Southwood community. After 1st class: Latinos in the Charlottesville/Albemarle area. • LHP program offered without charge to Southwood residents who are interested in becoming LHP. • 15 participants per class. • 28-hour course taught over an 7-week period. 4 hours/week. • Begin September 9th, 2008 until November 20th. • Classes meet twice a week (Tuesday/Thursday) from 6-8pm. • The hope is to hold classes at the Boys and Girls Club space in Southwood. Awaiting confirmation.

13. Program outline contd. • Fall 2008 class & Spring 2009 class: 30 participants. • Training content will range from basic information about medical resources in the community, hand washing and healthy eating habits, to more complicated issues such as detection of high blood pressure, breast cancer, and diabetes to a name a few. Modified as survey results become available. • Classes are structured to encourage participation and sharing of experiences. • Participants recruited from flyers, newspaper articles (Nuevas Raices), radio PSA’s, church bulletins, word of mouth, etc.

14. Participants receive 28 hours of instruction and are required to give back 20 hours within a 9-month period. • Record card to keep track of their time. Signatures are required. • At the completion of their time they are awarded $9.00/hour. The minimum # of hours completed to still receive payment is: 14 hours. • 20-hours can be accomplished by: • -talking about what was learned with family, friends, and/or community neighbors. • -helping with outreach events (fairs, screenings, etc.) planned by the LHP program or other health related organization. • -volunteering/interning with health related agencies who might be in need of an interpreter, educator, someone to design handouts/materials, etc.

15. Volunteer/intern program • Solicit volunteer/intern positions with local health/service organizations. • Allow trained/graduated lay health promoters to select from the options and seek out those positions on their own. • It is up to the local organization and the lay health promoter to work out a schedule since we only require them to give back 20 hours total. • Organization signs the record card.

16. Other options for documented LHPs. • Attend ESL classes or go to the interpreter/translator training in Harrisonburg (out of their pocket) • Continue to help with outreach fairs and events in the commmunity. • Continue on with education (PVCC, CATEC, etc.) • Apply for PT/FT jobs

17. Undocumented? • For those without their papers we will see if there are any health/service organizations willing to take on an undocumented volunteer. • If not, undocumented lay health promoters will have these options to complete their necessary hours: -educate their families, friends and neighbors about what they learned. -volunteer with outreach fairs and screenings coordinated by creciendo juntos, churches, community groups, etc. • Can work towards getting their papers. • Take ESL classes if needed.

18. Program budget Plan A: $15,000 • Part-time administrator: $12/hour at 20 hours a week=$11,520 • 30 participants x 20 hours at $9.00/hour=$5,300 • Materials (videos, handouts, etc.) = $300.00 • Food during training = hopefully donated • Childcare: work with Madison House or a church=donated • Photocopies = made by trainers/presenters Plan B: $0.00 • No money given to LHP’s, no PT administrator. RHOP would handle coordination of training • # of participants decreased from 15/class to 7-8/class • Training condensed to 8 hours training (4 sessions) focused on: Diabetes, high blood pressure, community resources, and importance of hand washing. • Participants or churches donate food • Still provide child care (Madison House, church, etc.): donated service

19. Funding • Currently seeking funding through: -BAMA Works -CACF -local congregations -State Farm? -other ideas?

20. Evaluation component • Creation of pre and post tests for each class session to determine learning. • Community service evaluation: creation of a simple checklist for agencies or folks they worked with re: knowledge base, dependability, would you participate in our volunteer/internship program again, etc.?  • Evaluation at end of program in November to identify pros and cons of program. Ask participants if they would recommend program, what would you change, favorite parts, etc.?

21. Graduation • Graduation ceremony: November • Inspirational speaker: former lay health promoter • Certificates of accomplishment • Develop a newsletter to keep graduates connected with upcoming outreach events, job opportunities, continuing education opportunities, etc.

22. Ways to get involved • Serve as a trainer/instructor • Logistics • Creation of evaluation tools • Financially: donate, grant writing, fundraising, etc. • Promotion/marketing • Other donations: food/snacks for LHPs, child care, materials, etc. • Other ideas?