Community Health Promoters Reach Medically Underserved
From late 1997 to the end of 2000, the Esperanza Community Housing Corporation provided internships for bilingual residents of a low-income neighborhood in South Central Los Angeles who had been trained as professional community health promoters. Esperanza developed the health-promoter training program to increase access to health and health care information, and to increase employment opportunities for neighborhood residents.
Under the first grant (ID# 029793), Esperanza, in partnership with three local organizations, developed advanced internships for 19 trainees who had completed five months of training in health issues in their community, health advocacy and preventive measures.
Under the renewal grant (ID# 037474), Esperanza collaborated with four local organizations to develop internships for an additional 22 community health promoters who had completed training. The 41 interns supported under the grants worked in roles related to early childhood immunization, lead poisoning case management and community education and outreach in primary health care.
- Esperanza reported that 16 of the 19 interns from the first group were employed in health or social services after the internship.
- Fifteen of the 22 interns from the second group gained employment in health care and six went on to additional schooling or to jobs outside the health field.
- Esperanza estimates that the interns supported under these grants reached some 20,000 community members through their health education activities.
The Robert Wood Johnson Foundation (RWJF) supported this project with two grants totaling $100,000 from November 1997 to December 2000.
These grants from RWJF supported the Esperanza Community Housing Corporation in training, mobilizing, and mentoring community health promoters, drawn from bilingual residents of a low-income neighborhood in South Central Los Angeles. A nonprofit organization based in the Maple-Adams/Hoover-Adams neighborhood (a federally designated medically underserved community), Esperanza was founded in 1989 to provide low-income families with affordable, quality housing and services.
According to the Esperanza project director, trained health promoters engaged in neighborhood outreach play a significant role in increasing knowledge of, and access to, preventive health care and treatment for residents of low-income neighborhoods. Esperanza reports that the training has frequently led to livable-wage-and-benefits employment opportunities for residents.
Under the first grant (ID# 029793), the Esperanza Community Housing Corporation developed advanced training internships for 19 community health promoters who were bilingual neighborhood residents. They had previously received five months of training in health issues in their community, health advocacy and preventive measures, and had served a six-month internship with a local health agency that provided on-the-job training, mentoring and practical experience in health promotion.
Esperanza developed the advanced training internships through partnerships with the Los Angeles County Childhood Lead Poisoning Prevention Program, Strategic Actions for a Just Economy, UCLA School of Public Health, South Central Family Health Center, the Los Angeles County Immunization Project and the California Hospital Medical Center's Parish Nurse Program.
Under the renewal grant (ID# 037474), Esperanza provided advanced internships for 22 of the 32 community health promoters who had completed the training program in 1999. To create the internships, Esperanza collaborated with Rescatando Salud, a women's empowerment/immunization promotion project, California Hospital Medical Center, the Healthy Homes Project and the Oscar Romero and Centro Latino de Educación Popular.
Esperanza received local, in-kind support for training and mentoring (estimated value of $35,000 for each grant period) from mentors and partner institutions, and $1,882,525 in additional funding from the U.S. Department of Housing and Urban Development, the California Endowment, the Local Initiatives Support Corporation and QueensCare Foundation.
Under the first grant (ID# 029793), Esperanza placed 19 community health promoters in internships at three sites:
- The County of Los Angeles Department of Health Services' Lead Poisoning Prevention Program engaged one community health promoter who was trained in lead poisoning risk assessment, case management, and education. Esperanza estimated that this program reached 320 community residents during the grant period.
- The Los Angeles County Immunization Project engaged 12 community health promoters to conduct outreach and education activities resulting in the immunization of approximately 2,400 children. The Immunization Project subsequently hired 10 of the 12 interns as part-time immunization outreach workers.
- The parish nurse program engaged six community health promoters and prepared them to conduct community health education in such aspects of primary care as prostate cancer screening, asthma prevention and management, diabetes screening and management and nutrition. An estimated 3,500 residents were reached over the grant period. The project director reported that after this internship, all six interns were hired by a health or social service agency.
Under the renewal grant (ID#037474), Esperanza placed 22 community health promoters in internships with four sites in Los Angeles:
- Rescatando Salud, a women's empowerment/immunization promotion project, engaged six interns who, according to the project director, were instrumental in outreach work aimed at improving immunization rates for children in the target area. Rescatando Salud collaborated with Esperanza, the County Immunization Project, South Central Family Health Center and the University of California, Los Angeles (UCLA), School of Public Health in the immunization project.
- California Hospital Medical Center mentored eight community health promoters who performed outreach activities. These included networking with community groups; promoting health awareness and community health councils and services, identifying resources for family-focused programs and coordinating and evaluating presentations.
- The Healthy Homes Project, which was developed from Esperanza's Community Health Promoter Program, engaged seven interns in outreach and education to approximately 2,000 neighborhood residents regarding environmental and structural hazards in old, derelict buildings. The interns helped identify and intervene in instances of possible lead poisoning by educating families, facilitating blood-level testing, promoting follow-up care and providing a link between families and the health care system. As a result of the outreach, 10 residents with health concerns got necessary medical attention.
- Oscar Romero and Centro Latino de Educación Popular collaborated to create a new internship site. One intern conducted a needs assessment to determine the value of a health education program aimed at Oscar Romero clinic patients. Interviews with patients with little or no literacy about their interaction with the health care system revealed a great need for a health-literacy program supported by childcare services.
- Esperanza estimates that the interns supported under these grants reached some 20,000 community members through their community health education activities in Los Angeles schools, local parishes, health fairs and community centers during the grant periods.
- Of the 22 community health promoters interns placed during this phase, 15 went on to employment either in the internship organization or in a health-related position. Six participants took jobs in other fields or pursued additional education.
Esperanza responded to numerous requests to share their experience with the community health promoter concept, among them: UCLA's School of Public Health, the Los Angeles County Community Health Councils, the Childhood Lead Poisoning Prevention Project Community Advisory Board, the Health Care Consortium (a network of providers and community-based organizations working to improve access to health care in central Los Angeles), St. John's Well Child Center and the South Central Family Health Center and Pediatric & Family Medical Center.
Esperanza's Community Health Programs director and the community health promoters spoke about the project at a number of forums, including the annual conferences of the American Public Health Association (1998, 2000 and 2002) and the quarterly meeting of the national Coordinating Council on Juvenile Justice and Delinquency Prevention in Washington, D.C. (December 1998). The project also received local and national media coverage, including a report in 2000 on the NBC News program, "Boswell Report," about environmental hazards in slum buildings, and a piece of Public Television's "Life and Times," produced in 2000 by KCET.
AFTER THE GRANT
To date, Esperanza has graduated 172 bilingual health promoters, most of whom are still engaged in health promotion activities. In response to growing demand for its community health promoter training, Esperanza is seeking to expand funding for the program. In collaboration with two of its community partners, Esperanza is developing a train-the-trainer manual that communities can use to replicate Esperanza's door-to-door outreach work related to residential environmental hazards. The grantee is seeking additional funding for this work.
GRANT DETAILS & CONTACT INFORMATION
Mobilizing Trained Community Health Promoters in a Medically Underserved Community
Esperanza Community Housing Corporation (Los Angeles, CA)
Dates: November 1997 to October 1998
Dates: January 2000 to December 2000
Nancy Halpern Ibrahim
Report prepared by: Marilyn Gross
Report prepared by: Kelsey Menehan
Reviewed by: Robert Crum
Reviewed by: Janet Heroux
Program Officer: James R. Knickman