June 16, 2015

Community Health Workers Make a Positive Impact in Arkansas

A R C H W A keynote speaker Kathryn Hall Trujillo, M P H

Kathryn Hall-Trujillo, MPH

Community health worker. In the health care world, it is an increasingly familiar term. The profession in 2009 received formal U.S. Labor Department designation, but in Arkansas well before that, community health workers (CHWs) have been doing a lot of good.

In a nutshell, CHWs help Arkansans be healthier and save the state a lot of money. A few examples: They teach parenting skills to young, low-income moms and help them prevent or space pregnancies – so that future babies have a healthy birth weight. This can cut down on huge sums billed to state Medicaid (and indirectly to taxpayers) for care of preterm babies. They help uninsured Arkansans get prescription drugs or sign up for health insurance. Both help lower costs associated with uncompensated care and a population that is too sick to work.

A CHW is a frontline public health worker, a trusted member of his or her community – someone who has a close understanding of the community served. Thus a CHW is able to serve as a link to health and social services, provide knowledge, support and advocacy that help individuals and communities become healthier and more self-sufficient.

The most notable, evidence-based example of the value of CHWs to Arkansas is the Tri-County Rural Health Network Community Connector Program, led by Ms. Naomi Cottoms and based in Helena. For more than 11 years, the program, now in 15 Delta counties, has linked elderly residents and adults with disabilities to services so that they can stay in their homes rather than enter a nursing home. A study led by UAMS College of Public Health faculty found that the program saved the state’s Medicaid system more than $2.6 million over three years.

That striking demonstration of CHWs’ financial impact gave the burgeoning CHW movement a boost in Arkansas.

Tri-County developed the Community Connector Program after hearing from the community that they do not access needed healthcare services because of lack of trust in the healthcare system, lack of knowledge about services, lack of financial resources and the need to prioritize other needs. COPH faculty member, Kate Stewart, M.D., MPH, had been involved with the Tri-County project from its start in 2003. Her work in public health in developing nations had convinced her that CHWs (also known as health navigators, promotoras, or lay health advisors) can reach and help people isolated from the health care system. Dr. Stewart partnered with Tri-County to develop and implement the program evaluation. From that success, they have continued as collaborators, and with others, founded the non-profit Arkansas Community Health Worker Association (ARCHWA) in 2012.

The ARCHWA hosted its third annual conference, on June 1 and 2 in Hot Springs. The event drew about 100 attendees – mainly CHWs from across Arkansas. Fifty-five CHWs stayed the second day for an all-day training with the keynote speaker, Kathryn Hall-Trujillo, MPH, a notable public health expert and Arkansas native.

The CHWs represented agencies and organizations where they are employed, including programs of the Arkansas Department of Health (ADH; helps low income single moms), UAMS Northwest (serves the Marshallese), Mid-Delta Community Consortium (provides prescription drug assistance), and Ventanilla De Salud, a health program of the Mexican Consulate, which, with support from UAMS COPH, provides health information and screenings to Arkansas Hispanic and Latino populations.

Also attending were UAMS faculty and staff, as well as representatives from UAMS COPH Arkansas Center for Health Disparities, ADH, Arkansas Department of Human Services, Arkansas Medicaid, UAMS Regional Health Centers, Arkansas Center for Health Improvement, Qualis Health, and non-profit organizations (e.g. AR Human Development Corporation, Arkansas Hunger Relief Alliance, Planned Parenthood).

Keynote speaker Kathryn Hall-Trujillo, MPH, told the story of her life’s work, saying, “I have always been a community health worker.” Her experience growing up in rural Arkansas lead to her founding an organization that uses the CHW model to provide resources and improve birth outcomes for women of color in the United States and 10 other countries.

Growing up in the tiny community of Moscow in Jefferson County, Ms. Hall-Trujillo understood the positive force of church volunteers in helping others in need. Fresh from graduate school with a degree in international public health from UCLA, she worked as a public health administrator for the state of California. Aware of the costs to the state associated with caring for pre-term, sick babies, she sought a solution and thought of the community caregivers she’d known in Moscow. Enlisting “volunteer church ladies” to provide education and support to expectant and new moms of color with few health resources seemed like the logical, lost-cost answer.

“It was a simple solution to a very complex problem,” Ms. Hall-Trujillo said.

She was later honored as California’s Woman of the Year by the state legislature for her service to the people of the state. And in 2007, she became an Ashoka Fellow, an international program focused on innovative solutions.

Based on the success of that project, she founded Birthing Project USA.  She is retiring as director and the international headquarters has relocated to Little Rock.)

The people on a high level – policymakers and economists – think about the savings in lives and costs associated with innovations in policies and health services, but they don’t consider the segments of the U.S. population that are cut off from those resources, she noted.

If we wish to make a dent in the cost of health care – running at 17 percent of the U.S. gross domestic product annually (World Health Organization), then everyone – not just a few – need to be connected to services, she said. “If people don’t access services, then we won’t get any better. For people to get better, you need to work with community.”

That’s where CHWs play a vitally important role.

“If you really want the (health) system to work, you really need to be inclusive – not just bring community health workers in to work with people, but harness their concern for people that they know and love – that for them are not just a ‘target population.’”

The ARCHWA is growing and is always welcoming new members—you do not have to be a CHW to join the Association. Visit www.archwa.org for more information and to join, or contact Jake Coffey at JCoffey@uams.edu or (501) 526-6630. ARCHWA’s focus over the next year will be to support CHW pilot projects across the state, the development of formal CHW training programs and assessing the need for a CHW credentialing process.