Post on 25-Dec-2015
transcript
Using Promotores/ Community Health Workers as Navigators to
Improve Clinical Outcomes.
Venus Ginés M.A.Instructor, Baylor College of
Medicine and Founder, Día de la Mujer
Latina
ObjectivesDiscuss the role of Promotores/Community Health Workers according to the parameters set by the state of Texas.
Identify the MINE Project – how Promotores and Community Health Workers Motivate, Inform, Navigate and Empower our Latino Community.
Describe the Promotores/Community Health Worker model and how it can be replicated across the country in a variety of healthcare services.
Who is a Promotor (a)- Community Health Worker?A person who, with or without compensation:
Represents the ethnic, socio/economic and educational traits of the population he/she serves;
Trained to bridge the gap that exists between communities and health and human service systems;
Respected and trusted by their neighbors and peers who provide informal counseling and social support;
Program Status –Jan 2011 Certified Promotores or Community Health
Workers Total number – approximately 1000Location - 52 counties Promotor(a) or Community Health Worker
Training and Certification Advisory Committee (9)
4 certified P/CHWs2 public members1 member with experience in adult education
and training of P/CHW2 professionals who work with P/CHW
Promotor (a) /CHW CurriculumCommunications Skills
Talking with someone who:
has a sexually transmitted disease,
may need mental health services
Interpersonal Skills • Health Literacy
• Cultural Competence
Service Coordination Skills
• CHIP/ CHIP Perinatal
• Understanding the role of community health centers
Capacity-Building Skills
• Teaching skills for behavior change
• How to motivate your patient & their family about follow up
Advocacy Skills • How to advocate about
health issues for Latinos or other minority groups
• How to advocate for children
Teaching Skills
• Plan + Effect Presentation
• Teach on “How to talk” to your doctor
Knowledge Base on Specific Health Issues • Breast Cancer & Survivorship• Cervical Cancer - Human Papilloma Virus
(HPV)• Cardiovascular – Diet & Nutrition• HIV/STD• Disaster Preparedness• Diabetes
Organizational Skills • How to prepare for a
Health Fiesta or cultural event
• How to prepare and analyze Pre and Post Surveys
Promotores/Community Health Workers delivering a culturally-specific health message.
1. Building relationships with the community2. Understanding the Culture3. Addressing the barriers - especially
MISTRUST4. Navigating patients through health care
system.
Understand Cultural Transformation: BUILD a Relationship with the CommunityKnow the demographics
Understand major issues affecting the community, (i.e. cancer, obesity, mistrust, etc.)
Search for trusted collaborators/partners within the Community
The Latino Population in the US
Latinos are the fastest growing group in the US
45 million (documented) –equal to 15% of the US Population + 12 million (undocumented)
By 2030 Latinos will represent 25% of the population with over 98 million
Sources: US Census Bureau American Community Survey 2007 & Population Projection Program
Acculturation Levels
Acculturation levels – Hispanic vs. Latinos
Latinos don’t all speak the same language
Latinos have different literacy levels
Cultural translations vs. literal translations
“Are you talking to me?”
Demographics: Latino Population
We are Young! 34% are age 18 or younger and living in poverty. The median age is 27 years.
Generational Status: the 3rd generation, who are more acculturated will adopt more mainstream medical care as US-born Americans.
Sources: US Census Bureau Community Survey 2007, Income and Poverty Rates; The Commonwealth Fund Health Insurance Survey 2005
Dia De La Mujer Latina
Diverse Historical Backgrounds
• Mexicans – 2/3 of the Latino population; at least 2
million seasonal/migrant workers; not welcomed but
desperately sought after for cheap labor.
• Puerto Ricans – US Citizens-travel back & forth
• Cubans – Exiled from Cuba – welcomed to US
• Central Americans – many refugees, have TPS,
• South Americans – Portuguese is the most spoken
language in South America-Brazil – 51% of population;
Italian is 2nd mostly spoken language in Argentina.
Cultural Values
American Latino
Career-OrientedTraditional MedicineLinear ThinkingMore directMeetings with
AGENDASTime is a Deadline
Family-OrientedFolk MedicineCircularMore indirectMeetings with FOODTime is a Guideline
Main Barriers to Healthcare
Accessibility
Affordability
Accountability Dia De La Mujer Latina
Accessibility Nationally, 37 % of Latino/Hispanics are
uninsured, compared to 16% for all Americans.
Many hospitals don’t have interpreters always available
High level of denial/understanding of specific risk factors.
Criteria and paperwork cause fearAbout 40% of Latino/Hispanics either do not
speak English at all or do not speak it well.
Dia De La Mujer Latina
AffordabilityEconomic status parallels educational status.
The poverty rates are 14% respectively for Cuban Americans, 31% for Puerto Ricans, and 27% for Mexican Americans, compared to 13.5% of all Americans.
31% of Latino/Hispanic children with working parents lack medical insurance coverage.
Undocumented immigrants don’t have the opportunity to buy health insurance, most rely on faith healers.
Dia De La Mujer Latina
Accountability Medical Mistrust and
fear are the most frequently cited barriers to care among Latino populations
Relationship building-are you here today and gone tomorrow
Who can I trust with my own and my families care and information?
Results: MAMMAS© Survey83% were aware of some form of medical abuse that
occurred.
89% believed mistrust contributes to the lack of participation into clinical trials.
71% felt that patients may have been deceived or misled by healthcare organizations.
74% believed that healthcare organization have experimented on patients without their knowledge.
78% felt that patient information is not always kept private.
80% were cautious about healthcare organizations.
87% stated that mistakes are usually covered up by healthcare organizations.
86% were conscious of the importance of cancer screening, but felt that fear may be hindering many from access to care.
Understanding the Mistrust
• Perception vs Reality
• History of Medical Abuse
Social Worker
Hospital Admin
Health Fiestas
Nurse, PAs &
Nurse Practitioner
DoctorResearchers
Promotores + Community Health
Workers
Patients
Evidence-Based Intervention
The Promotoras model is adaptable as evidenced by its use in addressing a number of community issues, including HIV/AIDS, Diabetes and other chronic illnesses, and community organizing. While their roles, job titles, responsibilities and activities may vary depending on client or community needs, they save lives.
Eliminating Disparities: Día de la Mujer Latina-Health Fiesta Outreach 2010
Dallas
Austin Houston
El Paso
San Antonio
Corpus Christi
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Edinburg (Valley
Orlando,FLHomestead, FL
Miami, FL
San Juan, PR
Washington, DC
Philadelphia, PA
New York City, NY
San Diego, CA
Seattle, WA
Día de la Mujer Latina-Cancer Outreach
Hialeah, FL
Chicago, IL
Lexington, KY
SavannahAugusta
Phoenix, AZ
Salt Lake City, UT
Denver, CO
Pueblo, CO
Des Moines, IA Erie, PA
Casper, WY
Augusta, GASavannah, GA
Atlanta, GA
Houston, TX
Indianapolis, IN
Columbus, OH
Jacksonville, FL
New Jersey, NJ
Raleigh, NC
Milwaukee, WI
Ann Arbor, MI
Sioux City, IA
Dallas, TXEl Paso, TX
San Antonio, TX
Corpus Christi, TX
Austin, TX
Maui, HI
Las Vegas, NVBurbank, CA
San Jose, CA
When Asked by the PLOS Medicine Journal …Which Single Intervention Would Do the Most to
Improve the Health of Those Living on Less Than $1 Per Day?
Paul Farmer of Partners in Health responded,
"Hire community health workers to serve them"