Diabetes Community Health Workers: A Piece of the Health Care Puzzle

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Diabetes Community Health Workers A Piece of
the Health Care Puzzle
Diabetes Partners In Action Coalition (DPAC)
Training Education Program Workgroup
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Purpose

• To provide awareness of and information about the
  role of the Diabetes Community Health Worker
  (DCHW) in addressing prevention or
  self-management of diabetes, particularly with
  underserved populations.

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Learning Objectives

• 1. Describe four skills that are demonstrated by
  an effective DCHW.
• 2. Identify training components required to
  become a DCHW.
• 3. Explain the unique role of the DCHW as part of
  an integrated diabetes management

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Who are Diabetes Community Health Workers?

• Diabetes Community Health Workers (DCHWs) are
  community members who work as bridges between
  their ethnic, cultural, or geographic communities
  and healthcare providers to help their neighbors
  prevent diabetes and its complications through
  self-care management and social support,
  including community engagement.
• AADE Position Statement. Diabetes Community
  Health Workers. The Diabetes Educator. 2003
  29(5)818-24.

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Workforce Size Characteristics

• Michigan-Specific Data
• 2,724 total CHW workers 1,807 paid CHWs (66)
  917 volunteer CHWs (34)
• Occupations counseling, substance abuse,
  educational-vocational counseling, health
  education, and other health/community services
• In Michigan Federally Qualified Health Centers,
  Detroit Department of Health Wellness
  Promotion, University of Michigan, Diabetes
  Outreach Networks, Access, Indian Health
  Services, Spectrum and St. Marys Hospital, Henry
  Ford Health System, etc.

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National Pay Rates

• New Hires
• 64 paid below 13 per hour
• 3.4 paid at or near minimum wage
• 21 paid 15 or more per hour
• Experienced CHWs
• 70 paid 13 or more per hour
• 50 paid 15 or more per hour

Michigan Public Health Training Center October
9, 2007
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DCHWs Promoters of Healthy Lifestyles

• Members of target communities
• Share cultural beliefs and values
• Share social and ethnic characteristics
• Eliminate communication barriers
• Act as role models for change
• Disseminate information and educate families

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Recommended Competencies of Diabetes Community
Health Workers

• The Final Report Of The National Community Health
  Advisor Study CHW Chapter Three Core Roles and
  Competencies of Community Health Advisors
• Competencies include personal characteristics,
  qualities, and skills that DCHWs need to be
  effective

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Personal Characteristics of DCHWs

• Relationship with the community being served
• Personal strength and courage (healthy
  self-esteem and able to remain calm)
• Friendly/outgoing/sociable
• Patient and compassionate
• Open-minded/not-judgmental
• Motivated and capable of self-directed work
• Caring and empathetic

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Personal Characteristics of DCHWs (cont.)

• Committed/dedicated
• Respectful and honest
• Open/eager to grow/change/learn
• Dependable/responsible/reliable
• Flexible/adaptable
• Desire to help the community
• Persistent
• Creative/resourceful

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Skills of Diabetes Community Health Workers

• Communication
• Interpersonal
• Teaching
• Knowledge Base

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Skills of Diabetes Community Health Workers
(cont.)

• Service Coordination
• Advocacy
• Capacity-Building
• Organizational

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DCHW Training-Options

• Community Outreach Worker (WSU 160 hrs.)
• Empowerment education (developed at U of M
  Diabetes Research and Training Center (DRTC)
• Attend a Diabetes Self-Management Training (DSMT)
  program provided by Certified Diabetes Educators
  (10 hours)
• DSMT programs www.michigan.gov/diabetes

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DCHW Training-Topics

• Human Subjects (IRB) training
• Human enhancement skills
• Mental health (signs of depression, stress)
• Case management skills
• Cultural diversity/ competence training
• Conducting assessments and collecting health data

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DCHW Training-Topics

• Computer skills and use of the Internet
• Group facilitation/delivery of diabetes
  curriculum
• Behavior modification techniques goal setting
  skills
• Understanding health disparities
• Other training needs

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National and State CHW Organizations/Trainings

• American Association of Community Health Workers
  (part of APHA, American Public Health
  Association) pam.chapman_at_spectrumhealth.org
• Michigan Community Advocate Association (MICAA)
• Grand Rapids, MI
• Lisa Marie Fisher _at_ 616-356-6205)
• Wayne State University Empowerment Skills
  for Family Workers Training Series
• Joan Blount _at_ 313-827-7113

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Diversity Training
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Ongoing Competency Component to DCHW Training

• Ensures that the DCHW maintains current knowledge
  about the treatment and self-management of
  diabetes
• Provide frequent and regular diabetes education
  opportunities
• Suggestions for training

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DCHW Personal Successes

• Survey showed a significant increase in knowledge
  of diabetes and self- management
• Learning about diabetes prevention and
  complications and how to educate others
• Perceive selves as making a difference,
  influencing change, small steps, help get over
  the wall

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DCHW Personal Successes (cont.)

• Increasing ability to relate to clients and gain
  their trust
• Learning about computers
• Helping each other with resources and other DCHW
  tasks
• Learning to work with people across cultures
• Developing their own healthier eating and
  exercise habits

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DCHW Evaluation

• DCHW focus groups and survey administered to
  assess previous and current knowledge of diabetes
  and self-management, attitudes, expectations, and
  assessment of the intervention
• DCHW client file audits, include quarterly review
  of all files with follow up procedures, including
  a specific timeline for completion, second
  review, and follow up action
• DCHW effectiveness phone survey

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How DCHWs Helped REACH Participants Meet Their
Goals
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Responses To Rating QuestionsE/GExcellent/Good,
F/PFair/Poor, VC/CVery Comfortable/Comfortable,
SC/NCSomewhat Comfortable/Not Comfortable

• 96 of respondents reported feeling either very
  comfortable or comfortable contacting their DCHW
  for needs or services.
• 93 of respondents rated their DCHW understanding
  of their experiences as an African American or
  Hispanic as excellent or good.
• In terms of doing what they said they would do,
  87 of respondents rated their DCHW as excellent
  or good.

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• 94 of respondents reported either E/G
• relationship with DCHW
• satisfaction with DCHW
• Respondents rated DCHWs on their ability to
• get them services to improve their health
  (E/G85 and F/P15)
• help them with relationship with their doctor
  (87 and 12) and communication with doctor
  (E/G76 and F/P16).

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Funding

• Private foundations
• Federal (CDC, NIH, USDA)
• State and local agencies and health departments

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The DCHW and the Diabetes Care Team

• Team care is a necessary component of effective
  chronic illness management per DCCT and UKPDS
  (NDEP Team Care booklet)
• Skills and roles of different health care
  providers should be integrated and coordinated
• The DCHW is an important member of this team,
  particularly for high risk populations.

The Diabetes Control and Complications Research
Trial Group. The effect of intensive treatment
of diabetes on the development and progression of
long-term complications in insulin-dependent
diabetes mellitus. N Engl J Med 1993 329 (14)
977-986. UK Prospective Diabetes Study (UKPDS)
Group. Intensive blood-glucose control with
sulphonylureas or insulin compared with
conventional treatment and risk of complications
in subjects with Type 2 diabetes (UKPDS 33).
Lancet 1998 352837-853. http//ndep.nih.gov/d
iabetes/pubs/TeamCare.pdf
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The DCHW and the Diabetes Care Team

• DCHWs augment
• the role of the diabetes educator
• and other diabetes care team members
• Promote trust to promote access to DSMT and other
  health care services
• Provide diabetes self-management support after
  Diabetes Self-Management Training
• Help diabetes educator provide culturally
  sensitive care/education

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DCHW An Important Piece of the Health Care
Puzzle

• Important role of the diabetes health care team,
  esp. for vulnerable populations
• Provide access to and act as liaison with diverse
  populations
• Serve as resources to their communities and to
  the advocacy and policy worlds

Perez LM and Martinez J. Community Health
Workers Social justice and policy advocates for
community health and well-being. Am J Public
Health. 2008 9811-14.
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Thank you!

• For more information, contact
• Dawn Crane
• [phone]
• craned_at_michigan.gov
• or
• REACH Detroit Partnership
• www.reachdetroit.org