Taking it to the Streets: Community Health Workers Improve Access for Low-Income Residents
From 1993 to 1996, The New Community Corporation (NCC), the largest nonprofit housing corporation in New Jersey, worked with Project HOPE (Health Opportunities for People Everywhere), a worldwide humanitarian organization in health care, to train Community Health Workers. The aim was to provide Newark residents with better health information and greater access to existing health care services.
The Community Health Workers served in their own neighborhoods as adjuncts to professional staff. Their activities included peer outreach, interviewing, screening, health education, referrals and follow-up.
- NCC and Project Hope implemented a culturally and geographically appropriate 250-hour Community Health Worker curriculum.
- They trained 35 individuals, five more than projected.
- They recorded more than 30,000 encounters between Community Health Workers and clients in the areas of client advocacy, enrollment in Medicaid managed care plans and street outreach.
RWJF supported this project with a grant of $246,672 from December 1993 to February 1996.
Statistically, Newark, N.J., ranks at or near the top of many negative health and social indicators for the state including homelessness, education, unemployment, crime, hunger, and poverty. Residents' health outlook is poor despite several major teaching hospitals located in Newark and recent significant advances in health care technology.
Poor health status also is exacerbated by a long-standing shortage of office-based primary care physicians. This shortage leads to a reliance on hospital emergency rooms for primary care, which is not only expensive but results in discontinuity of care. Moreover, local health care centers, social services agencies, and drug treatment resources are overburdened with long waiting lists.
The disparity between the high supply of medical technology and health care in Newark and the pressing health care needs of many Newark residents presented an opportunity to develop new community-based approaches to reach residents and improve their health.
NCC, the largest nonprofit housing corporation in New Jersey, worked with Project HOPE, a worldwide humanitarian organization committed to helping communities attain lasting improvements in health care, to train CHWs.
The goal of the collaboration was to provide Newark residents with better information and greater access to existing health care services. CHWs were employed by local health care and social service agencies and worked in their own neighborhoods as adjuncts to professional staff.
Their activities included peer outreach, interviewing, screening, health education, referrals, and follow-up. Potential CHWs were identified by NCC's Center for Employment Training and selected according to criteria developed by the project's Community Project Advisory Committee, potential employers, and the program coordinator. The 200-hour CHW training curriculum was adapted from a highly successful Project HOPE health education program in the Lower Rio Valley in Texas.
The Community Project Advisory Committee was assembled from local health care and social service providers, community residents, local and state health officials, business and government leaders, and health professionals employed by community agencies. The advisory committee suggested the development of a culturally sensitive, job-related CHW curriculum; identified internship and employment sites for students; and developed strategies to guarantee long-term financial support for the project.
In NCC affiliates, and Newark health care and social service agencies such as Babyland and Newark Community Health Center, CHWs were hired to provide services such as identifying individuals in need of prenatal and pediatric care, as well as assisting those with chemical dependency or HIV/AIDS. CHWs worked with existing resources in the community to match services with clients' individual needs and to link them to programs such as Healthy Mothers/Healthy Babies, Medicaid, and welfare, and to health care providers.
During the funding period, project staff reported the following results to RWJF:
- Implemented a culturally and geographically appropriate 250-hour CHW curriculum, adapted from Project HOPE's Texas program.
- Trained 35 individuals, five more than projected. Within a month of completing all requirements, 70 percent of the first class, and 100 percent of the second and third classes found permanent employment. For a variety of reasons, such as childcare difficulties and, according to a report to RWJF, "lack of self-discipline," not all graduates retained employment.
- Recorded more than 30,000 CHW-client encounters in the areas of client advocacy, enrollment in Medicaid managed care plans, and street outreach.
- Developed a productive relationship with the state Medicaid agency, enabling some CHWs to become Health Benefits Coordinators under the Jersey Cares 2000 Medicaid Managed Care initiative.
The project produced a brochure to increase awareness about the program. Staff also used the brochures as introductory materials to meet the need for information requested by potential employers of new CHW graduates. The new graduates were profiled in the January 1995 issue of NCC's monthly newsletter.
AFTER THE GRANT
After the end of the RWJF grant period, the project received funds for two CHW classes from the Pfizer Foundation. The project planned to seek funding from other sources for an asthma education program using CHW services.
GRANT DETAILS & CONTACT INFORMATION
Using Community Health Workers to Improve Access for Low-Income People
New Community Corporation (Newark, NJ)
Dates: December 1993 to February 1996
Florence B. Williams
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Brochures and Fact Sheets
"Partnership for a Healthy Community," New Community Corporation, 1994.
Williams FP. "Partnership for a Healthy Community." New Community Clarion, 12(10): 10, 1995.
Report prepared by: Robert Mahon
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Program Officer: Pamela Dickson