Title : Community Health Network Of Ct
link : Community Health Network Of Ct
Community Health Network Of Ct
good afternoon everyone. my name is monicavaldes-lupi, and i'm the chief program officer of the health systems transformation teamat the association of state and territorial health officials, astho. i'd like to welcomeyou to today's webinar from the new england regional health equity council. before webegin, however, i'd like to thank the federal office of minority health for their supportfor this webinar. we've worked very closely
Community Health Network Of Ct, with the team at omh and several regionalhealth equity councils to organize these webinars. in this particular webinar today, we'll describestrategies, resources, and tools used to promote equity through community health worker initiativethroughout the new england region. as many of you know on the call, there's differentdefinitions for community health workers or
chws. but one definition that we were usingfor the purposes of today's presentation is that a chw has been defined as a frontlinepublic health worker who's a _______ member of and/or has an unusually close understandingof the communities that they serve. it's entrusting relationships that enables the chw to serveas a liaison between health and social services in the communities to facilitate access toservices and improve the quality and cultural competence of service delivery. _______ shall_____ role facilitates addressing and ultimately reducing health disparities and helping communitiesachieve health equity. i'd also like to mention the resources thatyou can find at our astho website. on this link, you'll find resources on federal medicareand medicaid rulings, legislative tracking
and state efforts that facilitate and promotecommunity health worker programs. now some housekeeping points and logistics.if you have a question during this webinar, please post your question into the chat box,which you'll see at the lower left-hand corner of your screen at any time during the webinar.these questions will be answered during the q&a at the end of today's presentation. we'llalso open up the line for live questions from webinar participants. and finally, at theend of the webinar, you'll be directed to an evaluation survey. please take a few minutesto complete this survey because we use this information and any feedback that we get onour webinars to help us at astho design future webinars.
before starting with the presentation, we'reactually going to start with a polling question, and we have two polling questions that we'veincluded in the webinar. the first polling question is the ______. and this is to tryto get a sense of our participants who are on the call and your familiarity and workwith chws and the topic. so the first polling question you should see on your screen, andthe question reads, "are community health workers an integral part of your organizationstrategy to address health disparities?" please click on the right answer for you and theorganization where you work. and we're gonna go to the next slide to see the results. nextslide. it'll take a few minutes. it's calculating people's responses. are we able to move tothe next slide with the results for that poll?
yes. yes. okay. i think my screen must be frozen, soi'm gonna go ahead. so what i see in the response tab on the webinar, this is not a surprisethat the overwhelming majority of the participants on the call agree that chws play an integralrole in their organization strategy to address health disparities. so we'll move on to ourspeakers. we have some speakers on the call, and i'll just quickly walk over their biosfor everyone on the webinar. we're joined today by durrell fox. and ifyou know durrell, he's a community health work in massachusetts with over twenty-fouryears of experience starting with his work at children's hospital in boston and marthaeliot health center serving youth living with
hiv and coordinating peer education and communityoutreach programs. durrell has been involved extensively and actively in local, regionaland national initiatives and movements related to chw, hiv/aids and health equity. for fifteenyears he's been a minority aids initiative project director for the new england aidseducation and training center at umass medical school where he coordinates hiv-related trainingand technical assistance for providers in the region one states who are serving peopleliving with hiv. he's been a member of the new england rhec, which was started in 2011.and prior to that, was a member of the new england regional minority health committeefor ten years. we're also joined by lisa renee holderby-fox.ms. holderby-fox is a chw workforce consultant
and her clients have included the delmarvafoundation for medical care, ______ community health center, northeastern university andcentral massachusetts area health education center, ahec. her past work includes overseeingthe health equity activities at the community catalyst, and she was also founding executivedirector of machw, urban massachusetts association of community health workers. lisa serves asa content expert at local and national initiatives and has presented extensively at conferencesin the us and canada. she's worked to promote improved health in massachusetts and nationallyfor almost 25 years. she's appointed commissioner for the national healthcare workforce commission,which was created as part of the affordable care act.
following lisa we'll have geoffrey wilkinsonwho is now serving as the clinical associate professor at the boston university schoolof social work where he specializes in work with communities and organizations. geoffwill also be teaching health politics and policies for the bu school of public health.since 2007 until just last month he served as the senior manager at the massachusettsdepartment of public health overseeing their policy and planning efforts. he was foundingchair of the massachusetts board of certification of community health workers and has been involvedin chw policy and workforce development since 2002. prior to joining state government, heworked for fifteen years overseeing the massachusetts affiliates of the american public health associationand the national council of senior citizens.
following geoff's remarks, we'll be wrappingup the webinar with barbara ginley. barbara ginley is the project director and she receivedher ba in english and art history from bates college in lewiston, maine and went on toreceive her mph from unc chapel hill. she served as mmhp's executive director from 2000to 2013 and during that time, barbara directed maine's statewide primary care program formigrant and seasonal farmworkers. barbara's keen eye for the big picture and her confidencein the diverse strengths of our staff allows mmhp to meet the evolving needs of their patientsdespite the size of their organization. since the fall of 2014, barbara's taken on a newrole within the organization as the project director for the state's community healthworker initiative. this project builds on
their expertise in working with camp healthworkers and ______ and will offer communities the tools and skills to navigate the healthcaresystem. and so with those introductions, i'm goingto hand off the slides now to our colleague durrell fox. durrell. hello everybody. i hope you can hear me well.i want to thank astho and the office of minority health for their partnership on this webinarand welcome all of you from the new england, also known as, regional one health equitycouncil. we all felt it was important to host a call on this topic and provide a regionalperspective, as well as to look at how some states in this region contribute to our regionalchw movement.
i want to take a - give you some backgroundon the rhecs, which are part of the national partnership for action to eliminate healthdisparities. the vision of a healthy america brought together thousands of leaders to developthe national partnership for action to eliminate health disparities. efforts to end healthdisparities are inherently comprehensive community and systems change efforts. the npa's aboutchange, where there should be change, who should affect the change and the strategiesthat can be cohesively applied to implement the change. the npa is one of the first nationalmulti-sector community partnership-driven efforts. on behalf of health equity, it was sponsoredby the us department of health and human services
through its office of minority health. there'sbeen a sequence of activities that included regional meetings. community and stakeholderleaders throughout the country came together during summits. there was also a nationalpublic commentary period and numerous levels of review and analysis to develop the npa. the rhec or the regional health equity councilsare a key element of the national partnership for action. rhecs are comprised of practitionersfrom various sectors, including healthcare, education, transportation, technology andbusiness. the rhecs really are about working to mobilize regional action around commonissues related to health equity and specific to states in that region, to leverage federal,regional, state and local resources. they
work to infuse the goals of the npa into policiesand practices on the ground. also, we look to support and enhance state and communityefforts, as well as one of the critical points is sharing stories, lessons learned, successesfrom across the country, which happens through meetings and forums that bring our head membersand leadership together. here's just a quick snapshot of the regionalrhecs of the - and they fall in line with the hhs regions and in new england, we coverthe six states in new england for region one. next up, i just really wanted to give peoplea quick snapshot of the national partnership for action common priorities. in the fallof 2011, rhecs from across the country held their inaugural meetings. each rhec discussedthe goals of the npa, i'll show you the full
list of goals later, and identified prioritiesin their region. common priorities that emerged from the rhecs are shown on this slide. therhecs built on these priority areas to develop implementation strategies. in new england,one of our priority areas was community health workers. i just want to share with you the missionand vision of our regional health equity council in new england, which simply stated, "ourmission is to achieve health equity through cross-sector integration of actions and resourcesto optimize health for all where they live, work and play." and also simply stated, "ourvision is a new england free of health inequities." soon after our inaugural rhec meeting, wedecided that one of our priority areas would
be related to chws, as we saw them as a positivesolution for achieving health equity. and please note that we use the term positivesolution, which also was used in a recent health affairs article that some of us whoare presented coauthored. but we really want to illustrate how chws are just a part ora piece of the solution, but much more is needed to achieve true health equity, includingaddressing the social determinants of health or the determinants of health, if you may,the root causes of inequities and proving - and also, we look for things that are neededlike improving communities and transforming our healthcare and public health systems amongother systems in the us. i wanted to quickly draw your eye to the criticalrole that chws play in advancing health equity.
i know geoff will also touch on this later,but by design, the chw scope of practice, our competencies, our core roles and functionsare really connected to advancing health equity. on multiple levels, chws address the needsof clients in communities and systems by improving population health literacy, and that's workingwith individuals or groups in community or clinical settings, improving access to culturally-and linguistically-appropriate care and services in multiple settings. outreach, enrollmentand retention and appropriate care and services, including, but not limited to health insuranceprograms, some of the new transformations like patient-centered medical homes, healthhomes, et cetera. we also - scope of practice includes identifyingand addressing barriers to preventive and
wellness care and services. chws help buildindividual community and systems capacity to actually eliminate health disparities andachieve health equity. they do this in partnership with community members, other providers, policymakersand many other stakeholders. next, you already heard from monica earlier,but i wanted to illustrate and i never wanted to do a presentation about chws without offeringa nationally-developed chw definition that was provided by the apha chw section. thechw section, that effort starting back in 2006 to develop a nationally-recognized chwdefinition and also to create a federal job classification code. this led to the developmentand submission of a proposed national chw definition to the bureau of labor statisticsto develop a standard occupational code. and
this occurred back in 2009. in 2010, thoseefforts were successful in creating chw standard occupational code 21-1094. and i will saythat there were many people who contributed. over 1,000 comments were provided at thattime related to creating this code. thank you. part two of the definition - if you look atthe bolded areas, it's basically part of the functional words that are used in this definition,and these are key words that we felt were important to be in that definition. on thenext slide, that's the last portion of the definition. and it also - there's a note reallyabout the fact that although, unfortunately, the definition that we submitted was not usedfor the current standard occupational code.
although, it is used verbatim for the federalchw apprenticeship program. many of you are aware and took action and current effortsled by the chw section to amend the chw definition on the occupational code by submitting lettersand comments. i think all of you - that effort was led by the apha chw section, once again,and july 21st is when those comments closed. so we're looking forward to hearing more aboutthose efforts. i now want to shift to our new england rhecwork plan goal that's related to chws, which is to leverage chw organizing efforts in newengland, including chw training and credentialing efforts by assisting and developing disseminationof materials detailing the role of chws in achieving health equity and reducing healthdisparities. some of the strategies and action
steps under this goal including supportingchw workforce development and sustainability efforts in each state in new england, highlightingthat chw role in achieving health equity, as well as by some of the things i mentionedearlier around disseminating information and supporting data. these materials would helpinform the dialogue as each new england state continues their efforts around chw workforcedevelopment. we also look - one of the strategies is supportingthe new england community health worker coalition, its organizing and leadership efforts acrossnew england. you'll hear more about the regional coalition later from lisa renee. the rhecembraces the guiding principles of chw leadership and self-determination in defining the chwworkforce. and this made it important for
rhec to be directly connected to chw networksand associations in each state, as well as to the regional coalition. currently, barbarafrom maine, myself from massachusetts, and dannie ritchie from rhode island are appointedrhec members who are active in our state, local and in our regional chw networks andassociations. i also want to illustrate and demonstratethat chws, by design, address social determinants of health. you guys have seen many chartsrelated to the social determinants of health. we all know health isn't about health - isn'tjust about healthcare. it's about the social factors that contribute to achieving goodhealth outcomes. understanding the determinants of health is critical for devising strongpublic policy and action to promote health
equity and the elimination of health disparities.the world health organization states that a person's health is shaped by conditionsin which they are born, grow, live, work and age, including the health system. it alsois dependent on distribution of resources as well. social determinants include, butare not limited to housing, education, environment, jobs, transportation, food security and, ofcourse, healthcare. here's another model that many of us haveseen and used in the past a round the determinants of health. and i want to use this to kindagive a crosswalk of how new england - the chw core roles and competencies address thesocial determinants of health for our clients where they live, work, learn and play. someof the core competencies include outreach
methods and strategies where chws developeffective strategies and tools to reach different populations in communities and to engage themin real and equitable ways in their own health destiny. client and community assessment wherechws who have always understood that place matters can effectively assess physical environments,living conditions, employment and work conditions and their social support networks as we developsolutions with our clients to the things that ail them. cultural responsive and mediation is one ofthose key core competencies for chws where we are providing culturally- and linguistically-appropriateservices, serving as a bridge and cultural mediator in a bidirectional way between clients,communities, providers, policymakers and systems
and visa-versa. we also - one of the corecompetencies includes educating to promote health behavior change. and this is wherechws are addressing personal and health practices and coping skills by providing and healthand wellness-related education and other opportunities to support healthy behavior change, even inconditions that don't foster an environment for these healthy choices, e.g., food deserts,not having an area safe to walk, exercise, economic vibrancy, et cetera. and also reductionof stress and stressors in life. also, a very key component to our chw coreroles and competencies includes advocacy and community capacity building where we addressexpressed needs of clients and communities and involve health, public health, human service,public safety and others to address those
needs. this is a very busy slide, and you can getmore information on this from the npa and also any of the rhec websites, but this isreally our blueprint for action under the npa. and i wanted to also do a crosswalk toillustrate how chw roles and competencies, just as they're aligned with addressing socialdeterminants of health, they're also aligned with many of the goals and strategies withinthe national partnership for action, including goal one around awareness, increasing awarenessaround health disparities, the impact on the nation, et cetera. where under strategiesone and two, informing a healthcare agenda that addresses the needs of clients and communitieswe serve a role that chws play, as well as
developing and enhancing community providerpartnerships, which is strategy two under goal one. and then strategy three around communicationis something particularly related to providing culturally- and linguistically-appropriatemessages, materials and communications that chws are well versed in. i also wanted to go to leadership around strengtheningand broadening leadership to address health disparities. chws do this by focusing on strategyfive, which is where we provide leadership around community and systems capacity building.and then goal three we address around health systems and life experiences basically byaddressing strategy eleven, which is around health communications. and of course, goalfour around cultural and linguistic competency
is really what work force is built for, aroundwork force that is culturally competent, reflects the rainbow of the cultures we serve, as wellas the diversity inherent within the chw workforce. next, this is just another diagram that, really,as i wind down, i just want to illustrate that speaks really to the importance of addressinghealth and wellness at multiple levels in order to achieve health equity. although muchof our time and resources are spent in the medical care and in the smaller circle onthis diagram, we must shift more efforts and resources outside of medical care and evenoutside of the health services, the health sector in order to truly address the determinantsof health and achieve health equity for all. chws are well positioned to be the bridgeand to help lead these efforts.
in closing, i want to say that it's reallycritical at this time of activity throughout this country around chws to partner with chwnetworks and associations and also to develop and dessiminate more data related to the rolechws play in eliminating health disparities. i ask you to partner with, when possible,the rhec in your region and support some ongoing efforts and to enhance some new efforts tosupport chws, particularly to our role in addressing the determinants of health. pleaseensure that chws, including those who may be outside of the healthcare system, are seenas valued partners and integrated into the chw workforce and developing and sustainabilityefforts in each state. please note many of us have talked about this in the past, butthe h in chw really is for holistic public
health, wellness, et cetera. and at this criticaltime of public health and healthcare transformation, we need to support equitable partnershipswith the chw workforce in each state and each region and embrace the principle of chw leadershipand chw workforce self-determination, also known as kujichagulia to those who are familiarwith nguzo saba, the principles of kwanzaa. this is my contact information. i thank youall for listening. i now want to turn it over to the wonderful, marvelous lisa renee holderby-fox. thank you, durrell. good afternoon. i'd liketo start by saying that i'll be sharing an experience. it's not a how-to. i don't thinkthat you can take what i'm gonna say and replicate it exactly, nor should you, in your regions.but what i'm hoping is that folks will be
able to take nuggets and do something reallyinnovative in their regions. i'd like to thank the region one rhec, omh, and astho for theinvitation to share our experience with all of you today. i thought i would start by sharing the landscape,a little bit of the landscape for chws in region one. new england's like other regionsof the country and we're seeking creative and innovative ideas to promote health equity.also like other regions, chws are being embraced as partners in many of these efforts. thereare approximately 8,600 chws in region one. and i'll show you a breakdown by state injust a moment. i want you to know that each state is supporting chw activities, althoughthey may be doing that in different capacities.
and as you all know, funding has always beenan issue, unfortunately, for the chw workforce. and so that's one of the things that peopleare really trying to figure out here just like they are across the country. and in additionto financing chws, many states are also investing in education and training and, in some cases,credentialing of the workforce. and then finally, like other regions, thereare increasing numbers of statewide chw associations with massachusetts being the first followedby rhode island and connecticut. _______ something happened here. i'm gonna go back to the past slide for justa moment. these are the numbers that i was talking about in new england. so the numbersto the left are numbers that were cited in
the ______ national workforce study in 2007.and i was fortunate enough to be part of a team working on that report. and althoughthese are some numbers to begin with, the whole team believed that the numbers werelow. however, this being the first time that a national scan of chws where numbers werepublished, we're very excited. the numbers to the right were more recently updated bymassachusetts and rhode island. as you can see, the massachusetts and rhode island - i'msorry. the massachusetts numbers are consistent while rhode island is very different. i knowboth states continue to gather information and update the numbers as appropriate. so region one. i want you to know, just asdurrell mentioned, that all six states in
new england are part of region one. althoughwe're a small region, we can drive it in several hours tip to tip, we still have many healthinequities within the region. because of the size of the region, it's really prime forcross-state collaborations and partnerships. and i understand that many of the other regionsacross the country aren't necessarily as small or as easy to get to one part of the regionto the next. so we're very fortunate in this aspect. and like the other regions, we havean rhec and a regional health and human service office. so many efforts today are a result of pastwork. in the past, seeds were planted for future collaborations, partnerships and work.and i feel as though i would be remiss if
i did not spend a moment talking about thenew england regional minority coalition. several years ago the new england regional minorityhealth coalition came together and they came together for many years. and although thegroup no longer formally exists, for over ten years they met and hosted a biannual healthdisparities conference. the group was comprised of state health departments, community- andfaith-based organizations, health plans, federal representation and other stakeholders. thiseffort was supported by the office of region - of minority health region one, and stafffrom that office participated in meetings since inception. i wanted to give you this background to demonstrateour past efforts, but also to remind you that
our region was prime to really expand uponregional efforts. and although our prior regional efforts in region one - excuse me. also fromprior regional efforts in region one, we were able to develop some personal relationships,in particular, with omh, region one and retired admiral mike milner. for many years mike milnerand i had been discussing the potential for a regional effort to enhance public healthefforts while highlighting the chw workforce. in 2010 - i'm sorry. 2011, a small pocketof funding became available through omh and the massachusetts association of communityhealth workers was funded through this window of opportunity to host a regional chw summit. so what i want to tell you about the chw summitis that it was really designed - let me go
back one - to foster regional collaboration- _________. - to promote health equity. to develop a commonunderstanding of the chw workforce, strengthen the public health system's capacity to reach,engage and provide quality healthcare and support services to underserved communitiesby institutionalizing chws. and then finally, to enhance the collaboration amongst establishedand emerging chw organizations and others throughout new england. these were the objects.and as you can see, they were really focused on fostering and enhancing regional collaborationand promoting chws as partners in health equity work.
one of the methods to ensure appropriate chwworkforce needs would be met in the design and implementation of the summit. chws wereand continue to be engaged and provide leadership to this effort. once a fund - once funded,a planning committee was developed. members included representation from all six states,a mix of chws and other stakeholders, including jessica cates from the office of the assistantsecretary of health and human services. chws were also included in the list of summit presentersand led discussions. and i'll talk more about this in a moment, but chws are also engagedin leading the effort for the new england chw coalition as a result of a summit. the summit. i would like to tell you a littlebit more about the summit. the summit was
a day and a half and it was held in manchester,new hampshire, which is approximately a midway point for folks coming from all over new england.there were 50 participants and the breakdown is shown here. thirty-nine percent were chws,sixteen percent state and local health departments, fourteen percent federal agencies, ten percentwere employers, eight percent education and training entities and six percent each offunders and chw association staff. approximately five participants from each state plus federalagencies. several invitees were also members of the rhec. let me just say that we had developed- we had limited funding and we developed a 50-percent invite list for the first roundof invitees. and then we also had a secondary list, which really included people that wewould have loved to include in the primary
list, but because funding was limited, thatwas very difficult. let me say that no one refused the first roundof invitations. and when i say no one, i'm talking about we had responses, positive responsesfrom health commissioners across the region. many of them sent their designees if theycould not attend. and so we're really, really excited. and in the end, we had 50 participantsparticipate. the first day included presentations from all six states regarding their currentefforts around health equity and chws. we had a national landscape presentation of chwefforts happening across the nation. the massachusetts department of public health shared its effortsto integrate and support chws from a state health department perspective. and the firstday closed with region one hhs director chris
hager discussing the aca and opportunitiesto promote health equity and integrate chws in the work. day two the participants led the work by identifyingopportunities, discussing challenging - challenges, identifying who was missing from the discussionand, of course, next steps. so i want to say the summit was a huge success. and i'd liketo share some of the outcomes from that. the first outcome was something called compromisos.the summit closed with everyone making a compromiso. a compromiso a promise or a commitment. andlet me just say that folks who participated have really tried to keep those compromisos.i still get stopped often by people who participated in the summit letting me know that they'veeither completed what they promised to do
or they're still working towards completion.and many compromisos are ongoing. and examples of the compromisos were, "i'm gonna go backto my state and i'm gonna share this information." or, "i'm gonna get really involved in my statewideassociation." or, "i want to get to know the regional office much better." and so thatwas very exciting. another outcome was the development of thenew england chw coalition. participants really decided that they did not want the conversationto end at the close of the summit. they wanted to continue to have those conversations. andalthough this effort is currently unfunded, machw was donating staff time and the coalitionmeets by phone every other month. and they've also been able to pull together coalitionresponses to regional issues affecting chws.
more cross-state work is happening. and ialso have to say that if i didn't mention ongoing in kind support from region one, andin particularly betsy rosenfeld and jessica cates from oash, i'd be extremely remiss.and in fact, they facilitated a call with dr. nadine garcia so that we could share someof the work that was happening here in new england. and then finally, a few recommendations thati'd like to share and lessons learned. i've kind of combined them. and really, to engagechws in all facets of chws initiatives and programming. and as durrell said earlier,we're really all collectively working on chw leadership development. i'm gonna ask everyoneto support chw organizations and networks,
and whether that be through in kind support,financial or any other support you can offer these organizations is crucial in order forthem to succeed and be successful. collaborate on all levels. the summit has really taughtme and i'm sure others in the room that people are just eager to collaborate with each other.get to know what's happening in the states next to you. really, i want to encourage everybody on thephone and i'm gonna ask you to encourage others who aren't on the phone to really utilizethe regional hhs offices. staff is amazing there and they're really, really willing totake the time to help you with issues to be successful to eliminate health disparitiesand promote equity throughout the country.
and i would just say if you're going to tryto host a summit or a similar type of meeting, ask your participants for a commitment andask them to follow through with that. and then the final thing that i'd like to sayis just it's really important to build relationships over time. and one of the reasons that wewant to do this is because we're never sure when those windows of opportunities are gonnaopen up. and i'm sure that we've all been in situations where we're trying very quicklyto put together collaborations, and many times those aren't successful. it's really importantto build those relationships over time. thank you. i know that i just gave a lot ofinformation in a very short period of time, but my contact information is listed thereand i'm happy to have further discussions
with anyone if they're interested. and sowith that, i would like to hand this over to geoff wilkinson who is not only - he'sa wonderful chw supporter, ally, advocate, but he's also been a wonderful mentor to manychws here in massachusetts and so thank you for that, geoff. and the floor is yours. thank you very much, lisa renee. i reallyappreciate that introduction and all the leadership that you've provided. before i offer my remarks,we're gonna take another polling question. and so we invite people to address the question,"are there opportunities for chws to make a difference in addressing health disparitieswithin your community?" please answer yes, no or don't know. click one of the answersand we'll see the results as we're watching
together. i'm just gonna take a second tolet these post, but it looks like people are doing it pretty quickly. and we're also gettingan overwhelming response. obviously, people have drunk this kool-aid.durrell and lisa renee have been persuasive, and you're already doing this kinda work inyour communities. we're kinda - yeah, the response rate is creeping forward a littlebit. we've got 90 percent roughly answering yes. and i don't know just under ten percentof the responses. should we let this complete itself totally? or i think we probably canmove on. those numbers are holding steady, so i think i'll move on and talk about thework of one health department. as monica said at the outset, i've just, withinthe last three weeks, left the department
of public health in massachusetts, so i'mtalking about work that we did there. this is not an academic perspective yet. i alsorecognize that this is a statewide call and so before talking about how a state healthdepartment can support community health workers, i want to address eleven percent or so ofpeople who answered at the outset that this was not a focus of these partnerships becausei don't want to assume that people understand why it's so important to use community healthworkers from a state health department perspective in addressing health equity and in other goals. so let me just say why massachusetts has madethis such a priority and really compressing about twenty years into fifteen minutes here.there's a longstanding history of that kinda
long-term relationship building that lisarenee was talking about. first and foremost, nowadays, chws are really critical in addressinghealthcare reform objectives and the triple aim of healthcare form. and they are referencedspecifically in the federal affordable care act, as well as in our own healthcare reformlaw here in massachusetts. there's a lot of sophisticated research documenting the effectivenessof chws in several domains. i'm gonna summarize that briefly. and they are critically valuable in promotinghealth equity and addressing health disparities. they really serve as a bridge between clinicalcare and community prevention. and of course, for those us in public health, that is theessential challenge of healthcare reform.
how do we link our efforts to prevent injuryand disease with efforts that are fundamental to healthcare reform to improve integrationof care and improve health outcomes and reduce cost, improve quality? it's important forcommunity prevention not to get left out or poorly addressed, and chws are incrediblyeffective at that. there are four real important domains for chw impact. i'm gonna very brieflyaddress them. they increase access to medical insurance, but also to the use of preventativeservices. they can increase access to non-urgent care and, as durrell said, primary care andemerging model of care, patient-centered medical homes. and we think that they're gonna havea very critical role in the success of affordable - or accountable care organizations underhealthcare reform.
they are documented effective with vulnerablepopulations. and i won't read all of the populations. i'll trust that you can look at this slide.but chws are notably effective with the so-called high-risk, high-cost patients that are thefocus of a lot of healthcare reform initiatives and innovations now. and they are addressinghealth disparities. and in massachusetts, unfortunately while we're a recognized leaderin providing health services, we have documented disparities in these and other areas. andso we are like the rest of the country in this respect and we need innovations, we needa workforce that's singularly effective at reaching the most vulnerable folks typicallybecause they come from those communities that they serve.
chws are - have documented impact on the qualityof health services, notably in chronic disease management, which, of course, is another,i think, probably universal priority for health departments around the country and healthdepartment collaborations with health provider systems. they help improve the outcomes forcare teams where they're increasingly being integrated in patient self-management andcompliance with prescription drugs and other kinds of physician orders. they help strengthenpatient literacy and they also help strengthen provider literacy and competence. and so asa bridge, that is one of their most important contributions. and they have their increasinglybody of evidence return - rigorous return on investment research showing that chws invarious kinds of care collaborations have
impact on reducing cost for various chronicdiseases and for er utilization. so if you weren't already sold on the importanceof your health department promoting chws, i hope that provides some useful context.we think that chws deserve the moon and stars, but unfortunately, they're a poorly-supportedworkforce. they tend to have marginal pay and benefits, they tend to be funded on softmoney, grant money, they tend to have spotty supervision and workforce development, career-ladderopportunities. and so a lot of the work of the state health department of massachusettshas been to promote workforce development, as well as effective utilization of chws.and we've done this guided by something that durrell fox presented earlier, said, "nothingabout us without us." and it really comes
out of a community-empowerment philosophy.and you've heard recommendations from durrell and lisa renee, and i will end up repeatingthat, that it's really critical in whatever you do at the state health department to involvechws directly in the process and in the thinking up front about what you're doing, why andhow. in massachusetts, there are five general areasof support that we've provided to community health workers, and i just want to give youa few examples in each of these areas. the first, leadership, has been a public priorityof health commissioners over the last couple of administrations to support community healthworkers. and the current commissioner of public health in massachusetts, cheryl bartlett,is equally committed as her predecessor john
auerbach in supporting this workforce. andas in all things, public support from the public health leader really helps focus publicattention in policy and program development. we've also supported the development of astate-based community health worker association, and we're fortunate in massachusetts to havea real leader in this field, gail hirsch, who i believe is on the call, and i hope wecould empower her to answer questions if appropriate. but for some twenty years, she's been a nationalleader at the state health department directing the office of community health workers andhelping and even serving as a founding member of the board of the mass. association of communityhealth workers. that provides a voice for chws to speak as a workforce directly so thatit - again, this, "nothing about us without
us." and there's a lot that state health departmentscan do to support chw associations. we've committed a lot of dph staff and resources,including that office and gail's work and others. when i was a member of the commissioner'steam, leadership on chw issues out of the commissioner's office was a key area of responsibility.and so you can think about making that part of the portfolio responsibilities of seniorpeople in your health department. there's been a lot of work on fundraising support,promotion of funding opportunities, demonstration grants for chws. and massachusetts has integratedthem into the sim grant, federal sim grant that we won here. they're part of some cmmifunding. they're involved in medicaid waiver. we're looking at chws' roles as we think aboutsubmitting a state plan amendment for medicaid
to take advantage of the ruling by cms lastyear that medicaid can reimburse for preventive services that may be ordered by a clinicalprovider, but not necessarily provided by a licensed provider. that opens a huge windowfor utilizing chws. and in a number of policy-development areas,i'll summarize in a couple of minutes examples of that. our state health department is probablythe largest employer of chws through its contracts, and we use them in everything ranging fromlead paint poisoning prevention to hiv/aids and refugee services, chronic disease control,nutrition services, maternal and child health and other areas. we've done a lot of trainingand curriculum and development, including some innovative hybrid online and in-persontraining for chws and also supporting private
entities that provide training in the corecompetencies for chws. that's actually quite a significant priority for the health departmentto help build that infrastructure. we've done a lot of work on research, publications, partneringwith private organizations, including the state-affiliated american public health association,but also anti-poverty agencies, community colleges and others. and so i think that's an important role forthe state health department as convener and facilitator to be thinking about, "where arethe strategic opportunities, workforce investment boards, et cetera?" and then convening specificinitiatives, which may involve the development of programs, funding of programs and services,but also policy initiatives. and through gail's
work particularly, but through others, thestate health department has supported national networking and promotion of the chw movementthat durrell summarized and that has led to that department of labor classification, thatled to some of the successful work in the american public health association. statehealth department can be a valuable partner in that kind of work. so we've had roles in inserting language aboutchws and services they provide and disparities reduction in two significant state healthcarereform laws. we've done workforce assessments. and if you haven't done a lot of that, thiswork, if you don't have a twenty-year history, but you've got a solid current commitment,doing a workforce assessment may be a valuable
way to start to involve numerous parties andget a handle on what the workforce is, what their needs are, what the opportunities forintegration into healthcare reform maybe . we did a major report with recommendations asa result of a clause in a state healthcare reform law that led to one of the nation'sfirst state-based initiatives to credential this workforce. and we have a massachusettsboard of certification of community health workers that is developing a program thatwill operate under the auspices of the state health department to provide a certification. it is based on a clear definition of scopeof practice and core competencies for chws. it will also include standards for trainingprograms that prepares chws for presumptive
eligibility for certification. and we're lookingat all sorts of issues including continuing ed. renewals of certificates, reciprocitywith other states, et cetera. it's important because there was a strong consensus whenwe did our state workforce assessment and looking at workforce development recommendations.and i should say that was a process that involved about 40 stakeholders from all sectors. itwas very interesting that payers of health provider services and the insurance companies,providers themselves and chws had a united, strong consensus about the importance of credentialingand certification as a voluntary measure. so we have taken that forward and we thinkthat it will provide a kind of standard of quality on which payers and providers candepend and to provide workforce opportunities
for chws. and it will probably be criticalas we think about moving forward with the possibility of a state plan amendment formedicaid. so i have recommendations that are quite parallel to those you've already heard.it's very valuable and important for state health departments to support state communityhealth worker associations. there's no substitute for having chws at the table in thinking aboutwhatever work you may be doing. and it's disconcerting how easy it is for well-intentioned professionals,and i have been at these tables, to find ourselves sitting there talking about chws without chwsin the room. and it - we can't succeed without the chw voice. so engage chws directly in whatever kind ofpolicy, program and funding development you
do. coordinate your programs within your statehealth departments and to - this is challenging because we often operate in silos within ourstate health departments. and this is an opportunity, because of the wide array of areas in whichchws are effective, to disperse funding and policy throughout our organizations. and socreating some structure to talk about who's doing what, who's already using chws and howto coordinate policy and programs that can be very productive. i think it'll also bevery useful as health departments interact increasingly with healthcare providers inlooking at implementation of healthcare reform. what would be the role, for instance, of chwsworking with hospital in community health needs assessments? and in doing those assessments,adding a community voice and then planning
services. so it's important to collaborate with externalpartners. and be prepared. you're gonna need to commit some resources to do this. someof them may be in kind, using staff that you have, but some of them will involve reallocationof available contract dollars and other funds that you may raise or grants that you mayseek or work with other partners to seek. this is such a productive area of work thati think it bears some creative thinking about how to do it. and finally, i would caution that we avoidthe unintended consequences of professionalization of this workforce. and it's a very robustnational discussion about how to avoid turning
chws into such a professionalized workforcethat they lose that which is the most special about and for them, that deep connection tocommunity, that somewhat intangible sense of trust and connection that is the heartof why they're important. so as we bring them to the table, bring chws to the table, i thinkit behooves those of us who are working for our state health departments to approach thiswhole subject with a great deal of humility and appreciation. and with that, i'm gonna thank you very muchfor the opportunity to participate and thank astho and the office of minority health andturn this over to barbara ginley. great. thanks, geoff. i would like to acknowledgethe previous speakers. i have the good fortune
of following durrell, lisa renee and geoffwho, from my perspective, and i'm sure listeners will agree, really bring so much expertiseand experience to the topic that we're discussing today. and i think as you'll hear from me,as the "somewhat new kid on the block", i have really looked for those opportunitiesto take advantage of the lessons learned by others to really align myself with the workthat's going on regionally because i feel as though what's gone on regionally in somany different ways can help us build a strong system here in maine to support communityhealth workers. i also would like to acknowledge our federalpartners who made this afternoon possible and thank all of you listeners for joiningus on behalf of the region one rhec. my presentation
is gonna be slightly different in that i'mreally going to take parts of each of what durrell, lisa renee and geoff shared and talkabout how, again, the regional collaboration, the work that's gone on at the region onerhec and then the partner states work, how that's really helped inform what we're doinghere in maine. and i feel like it's important to bring thatperspective because it can be somewhat daunting, i know from my personal experience, to thinkabout states like massachusetts and minnesota and texas who've been really engaging communityhealth workers for a number of years and being very thoughtful and purposeful about settingin motion the systems to support the workforce to feel like you may be coming late to thegame. so i'm here [laughs] to tell you that
it is possible to start and to be moving forwardon supporting community health workers in your own state, despite of when you're startingon that venture. the one thing i did want to start with, iknow geoff made mention of the opportunities under aca as it relates to potential reimbursementfor preventive services. the monograph that i reference here also speaks to other opportunitiesand incentives under aca to support community health workers both with the health homesinitiative, which looks at supporting states with enhanced payments for providing carethrough multidisciplinary teams for specific core services. and some states have reallyoperationalized that in a way where they name community health workers as part of thoseteams, and there's plenty of opportunity for
chws to be providing those core services rightin line with the apha definition on issues like family support, making referrals, assistingwith transitions in care, being that bridge. the perspective that i'm gonna bring todayis from a state that was funded by the innovation program within cms to develop a statewideinnovation model to test the development of a model that would transform our healthcaresystem. this graphic gives you a sense of how maine, as a state, set out to do thiswork. as you can see, developing a community health worker initiative appears under ourworkforce development pillar of primary innovation. and that's not to say that we don't touchupon the others as it relates to payment reform, as it relates to engaging patients and/orcommunities or strengthening primary care,
but at the core, we realize that if we wantedto come out at the other end of this project, which is 36 months, that we really had tohave a focus on building a system and infrastructure to support the workforce. the community health worker initiative inmaine is a partnership project. it involves not only the agency that i work for, the mainemigrant health program, but our state health department, the maine cdc, as well as medicalcare development. now, those are just the partners for the community health worker initiativecomponent of sim. under sim, three goals were set out for the community health worker initiative.it's a little bit of a misnomer to say to develop a new healthcare profession. therewere certainly community health workers working
in maine prior to this project launching in2013, but i think the important part of the first goal is the recognition piece, is thepromoting the identity and the role that chws could play in a new healthcare landscape. we are hard at work at getting four pilotprojects up off the ground. our hope is that by expanding capacity, we are, in fact, developingnew community health workers to be out in communities providing care and services perhapsin parts of our state where there was no chw capacity. and certainly, the work that willlead to sustainability are these latter two pieces of making sure that we have a systemin place to train and certify our registered community health workers, which, of course,we will need as it relates to developing any
sort of financial models to support more long-termincorporation or integration of chws into our system of care. now, as i said when i introduced myself, muchof my work has been informed by the work of others. and i thought probably the easiestway for me to speak to that was by sharing with you our timeline for year one. we'reactually coming up on the end of year one this september. and when i was - stepped intothis role and was given the work plan and given the grant narrative for the federalproposal, there were so many places where i saw, again, that the work of others couldreally help us inform what we do here in maine just by way of example, in terms of completingour background information gathering, doing
an environmental scan. one of the first thingsthat i did was to conduct key informant interviews with other states on how they went about buildinga system to support community health workers. and clearly, from my perspective, there werefolks outside of our region to connect with, but i also knew from having attended the summitthat lisa renee spoke about, that it would be really important for me to connect withthe folks in connecticut at their ahec to learn about what role their ahec had playedin helping to support the training and education of community health workers. i knew that under the vermont blueprint forhealth, that chws had been adopted into community care teams to be providing services and bridgingbetween providers and communities. and i certainly
knew that the folks both at machw and withinthe mass. department of health could really help me with recommendations on, "how do youinstitutionalize the integration of chws within public health programming? if you're gonnabegin to do grant making or issue an rfp that promotes use of community health workers,what should that look like as it may relate to training, as it may relate to supervision?"so those are just a handful of examples of where the coalition and those contacts andthose relationships were really key to the work that we've done here in maine. sorry. my computer timed out. and i will alsosay one of those critical learnings for me, personally, and it will be echoing much ofwhat geoff, lisa renee and durrell shared,
is that leadership component, that engagementin a really meaningful and transparent way of community health workers to be involvedin what we were trying to do here in maine. recognizing, as lisa renee said, that youneed to have strong relationships in place when opportunity presents itself. so whenthe project started, initially, the timeline looked as though we wouldn't begin talkingabout making recommendations for sustainability to year - until year three, and that the realwork initially would focus on building up the opportunity to fund these pilot projects.and i really asked our state health agency, as well as our other partner, mcd, that werethink that and that we look to build that capacity, that level of engagement early onin the process.
it's not as though - that we had a mandateto establish an association, but i knew from learning from others that having that networkin place would be critical not only in terms of making sure that what we developed wouldactually not only serve the policymakers well, but actually serve community health workers.but also that we would need to have those relationships in place for after the projectwas completed. so we have convened what we're referring to as our stakeholder group. it'ssomething that we started in october of last year and we did so with - it's an open door,anyone who wishes to be sitting at the table and working with us on developing those, whati call, almost building stones or doing the foundational work, anyone's welcome to joinin doing that.
having said that, i early on have also madesure that we're going the extra mile in terms of figuring out ways to make sure chws canparticipate, and whether that's saying, "we need to secure funding to help pay stipendsor reimburse for transportation" or if it means that i'm taking what we're working onto places where community health workers are already meeting, already working, then thoseare the pieces that we're figuring into how we do this work. so we - i said to the folkswho came to the table and said, "what do we want of this - from this process? how do wewant to move this forward?" - and these are - and thinking back on those first few months,this is generally our roadmap to say, "these are the things that we hope to achieve. thisis what we'd like to see come out of this
36-month project." now, remember, this is one of many piecesof sim, and i am particularly proud that we're able to do this engagement piece and to bemoving this forward in a way that i hope will serve, again, our state well from a very broadperspective. that system-building piece you can clearly see in this slide as it relatesto workforce development, as it relates to discussion and development of reimbursementand payment models, and thinking, too, on future project design and making sure thatwhen we're doing the pilots that the evaluation really helps inform future work here in maineand elsewhere. but it was also important that we developa common language. we realized that when you
say community health worker, that may meana different thing, depending on the audience. we also realized because there's not broadadoption of chws in our state, that there was clear need for doing some education andawareness on professional identity, especially as it related to primary care medical homesor ccts, which are our medicaid health homes. and really looking to engage folks who mighthave overlooked community health workers as a key player to their team. and again, thinkingback on the focus of our discussion on thinking about the role a community health worker couldplay in addressing disparities and also in moving on health equity. i'm actually going to close not with recommendations[laughs], but i'm gonna bring us full circle
because i think it's an example of some workthat - foundational work that we've done, but i think it also hits home how we herein maine have tried to be mindful about the community health worker's role in health equity.and as i said and as you can see from this list of commitments, one of the things thatwe worked on early, early on was to begin to develop common language. and we startedwith developing a community health worker definition to ground our work and have builton that. we've moved from this to developing and adopting core roles and responsibilitiesto developing and adopting a crosswalk of skills and core competencies to inform training.but it really all comes back to our common definition. and this definition, i know if- for those of you who are familiar with the
apha definition, you'll hear bits and piecesof it. we looked at apha's, we looked at the worldhealth organization's, we looked at a number of other states, but we wanted to operationalizeit for ourselves and for it to help guide the work that we were doing not only developmentally,but also as it might relate to policy development. and two - in closing, the two points thati want to make as it relates to thinking about relationship of chws to health equity is thinkingabout the role of chws in terms of focusing their work on reducing disparities, promotinghealth and thinking about that from promoting health for all. and also thinking in the advocacypiece. durrell started us off in terms of thinking about and talking about social determinantsof health. from the work that we're trying
to do, community health workers can play thatcritical role in giving a voice to addressing and/or recognizing barriers to health, togiving voice to naming what social determinants are actually impacting an individual's health,and then also in terms of really helping to build community capacity. and with that, i will close out my time. ifi can get this slide to - and i have provided you with my contact information at the migranthealth program. and i will hand it back over to monica. thank you so much barbara. thank you to durrell,lisa renee, geoff and barbara for those really great presentations. i've been tracking thechat box in the lower left-hand corner. we've
got a lot of questions. so operator, whilewe're queuing up the live q&a, we can go ahead and try to get through some of these chatbox questions. one of the questions that came up was actually a question that i had forthe speakers. and it's whether you have seen examples in the region one states or in yourconversations with other states where health insurance plans, community health centersor other accountable care organizations ______ the ______ of the work are actually receivingreimbursement for the services that they're offering to be part of these integrated healthteams in these different settings. so i will ask that question and if any of the presenterswould like to respond, that would be great. and we'll continue to get folks lined up forthe live q&a.
yeah, i think all of us were probably gonnatalk and then none of us talk. but i know that there are examples and models aroundthe country. when you look at the system that's in place in minnesota that's been referenceda couple of times, you see a direct effort to get chws reimbursed through medicaid. you'veheard about some of the medicaid waivers in other forms, but i also know that there havebeen community coalitions, there was a small model in the western part of massachusettswhere funding was pooled from revenues of multiple health centers. it's out in the springfieldarea. and they were actually able to fund a generalist chw that basically worked withthis coalition of agencies and worked in the community. we also know there are publishedarticles related to folks like premier plus,
health plus, i think christus _____ systemdown in texas, and there's a few other examples where they've actually used operating budgetfrom health plans and others to actually pay for the ftes of chws out of revenues and operatingcosts versus grants. and this is lisa renee, and i'd also liketo add that although there are lots of windows of opportunities right now and we're talkinga lot about reimbursement, many of us feel pretty strongly that reimbursement is a partof the solution to pay for chws and that we need to be very careful about putting allof our eggs in that one basket. thanks for pointing that out, renee. definitely,reimbursement is one of those mechanisms that i think was a theme in your presentation,all four of your presentations in terms of
sustainability, but definitely have to beaware of implications and sort of unintended consequences of just focusing only on thatpath or mechanism. operator, do we have any live questions on the call? ladies and gentlemen, if you would like toregister for a question, please press the one followed by the four on your telephone.you will hear a three-tone prompt to acknowledge your request. if your question has been answeredand you would like to withdraw your registration, please press the one followed by the three.once again, ladies and gentlemen, that is a one-four to register for a question. while we're waiting, there's a question inthe chat box from gene hutchin and i'll read
it for you all. "there's several providers"in gene's state "who have employees that fit the definition of chw, but may have othertitles. case managers, coordinators. are those chws or does it need to be a separate professionand identity?" and i know that there's been a lot of work done on this in terms of howto define a different title set like _______. so i will open that up to the presenters.and then following that response, we'll open up the line for the live q&a. hi. it's geoff wilkinson. i actually postedan answer to gene, but it looks like it was - i was answering geoffrey watty. but theanswer briefly is yes. our 2006 workforce assessment in massachusetts and in subsequentassessments, and this is true around the country,
have documented literally dozens of job titlesthat we understand to be community health workers. so it's an umbrella term. it's abroadly-inclusive job classification, but it really has to do with who's doing the workand how they are relating to community. but you absolutely can have different job titles.and another them that has emerged in the online chat that i want to just also emphasize inthis regard is that chws work outside of the health sector proper. you have chws workingin public safety, in housing and in a variety of different areas so that they - as durrellwas talking about social determinants of health, whether or not they actually work in the directprovision of healthcare or public health services. most of 'em do and all of 'em have valuableimpact on health, but they may not be directly
in the sector. and what you will also notice that many stateswho have adopted chw definitions will sometimes give you the common titles and terms. i thinkwe listed over 55 in our state reports of titles commonly used for chws in our state.and i know others have done that as well. thank you, durrell and geoff. this is lisa renee. our hope is that moreand more employers and funders will embrace the chw term and we'll see more of that inproposals, et cetera as we move forward. thank you. operator, do we have any callerson the line with questions? we have no questions at this time.
well, i'm gonna go back to the chat box becausethis is sort of a link to what you were all saying in terms of community health workersreally going beyond just the public health and the healthcare sector and being able tobridge different sectors. one of the participants asked - or referenced that one of our speakersmentioned that chws are poorly supported. and, "our state health department's tryingto get more businesses involved, particularly health it industry, for example, in termsof additional support to help facilitate chws." and i suppose to provide that sustainabilityto their funding. just curious if any of the presenters have a response to that idea. yes. again, this is geoff. i'm pausing sothat if durrell or lisa renee or barbara want
to jump in here, i'll hold off for a second.but since they're not jumping in, i will say that yes, in a couple of respects. certainly,in the healthcare sector, there are efforts in massachusetts and other states to engagehealth providers as employers, as businesses in looking at compensation and benefits forchws and workforce development opportunities. and i think some of those productive. we'vealso been doing some work more broadly with the workforce development sector. i mentionedworker investment boards, but there's a whole world of employment development and workforcedevelopment outside of health that is quite interested in chws as a workforce and forthe business opportunities they may provide. higher education, similarly, is looking atthis and since there's been a lot of productive
work with community colleges along these linesand some of them see the chw field as a growth field. so there are training, educationalopportunities and employment opportunities for their graduates. they are figuring andmaking investments. and i also think it's important to note that the philanthropic sectorhas been a leader for a number of years and continues to provide critical support, includingstudies and initiatives in this area, but also seed funding. our blue cross blue shieldfoundation in massachusetts has made grants available to community health centers andis now doing some active partnering between providers who work with high-risk, high-carepatients and larger provider systems that are looking at implementation of the affordablecare act.
yeah, i'll also just note that there are alsoopportunities in justice. for instance, the attorney general for massachusetts was ableto get some settlement dollars and essentially, 1,000 of those settlement dollars went directlytowards support chws in the central part of massachusetts. and i also know lisa reneetalked about building relationships and there was a gentleman who used to work for hhs whoactually went to ibm and for several months there were communications, meetings that oncehe got in the door at ibm, he brought his health and public health hat and pulled chwsin to communicate with them. i don't know if there's more workplace wellness discussions,but i think that's another opportunities for chws to get engaged in some of the nontraditionalsettings, particularly related to workplace
wellness, helping people navigate, helpingpeople have less time lost at work, et cetera. and this is barbara. i would say one of thethings that i've done with my work here in maine is, as geoff mentioned, the workforceinvestment board, is really engage folks within our department of labor, folks who are workingon apprenticeship programs, looking at what federal dollars may be flowing in to helplong-term unemployed, and just creating that awareness. i think at least in our state,there's quite a bit of awareness of what workforce needs we'll have as it relates to, say, 2025and ______ productions in number of nurses or/and physicians in our state, but reallytrying to broaden that dialogue so that folks begin to think, "so, yes, chws aren't - i'mnot saying we'll step into the role of being
a nurse or physician, but are there rolesfor community health workers as we begin to look at workforce needs for our state movingforward?" and quite frankly, thinking about career ladder,at least here in our state, one thing that is an active engagement between our communitycolleges and adult ed. and philanthropy is really looking at how we can provide a careerpath potentially for folks who may be foreign-trained physicians or clinicians to help them be ableto be working at their original credential or potentially in some clinical role, butcan they - as they work towards that, is there meaningful work for them as a community healthworker where they may be using their skills and expertises in an interim way? so i dothink it's important to perhaps engage folks
that you may not necessarily consider as "publichealth partners" or a part of the traditional healthcare system. thank you, barbara. and i think that'll haveto be the last word because we've reached the end of our webinar this afternoon. i knowthat - and we can tell from your presentations and your responses that there's a lot of commitmentand passion in terms of the role of the community health workers and their role in this sortof emerging landscape of health and more broadly, using the social determinants framework. one thing i will mention is that participantsand speakers may also want to look at the federal reserve bank in your region becausethere's a lot of work around social impact
bonds, and i believe that some of the examplesthat they've collected have featured the use of community health workers in non-healthsettings. so please visit those websites. i want to thank everyone again for joiningus this afternoon on the webinar. as we mentioned at the top of the call, you'll be directedto an evaluation as soon as we wrap up. it's really important for us to receive feedbackfrom all of you on the webinar so that we can use it for planning future projects andwebinars. i also wanted to put in a quick plug for the new england rhec's website, again,that was on the last slide that barbara shared with us, so that you could get more informationabout how to join region one and their efforts around health equity.
finally, i'd like to thank the office of minorityhealth again for sponsoring this webinar and to our speakers for their great presentations.a recording of the webinar along with the slide decks will be posted on the astho websitein the next few days along with responses to the q&as and the questions that we weren'table to get to this afternoon. the web address should be on your screen now, and we hopethat you'll use this as a resource and share the link with your other colleagues once it'savailable. thanks again to the presenters and to all of our participants. and i hopethat you enjoy the rest of your day. thank thank you. [end of audio]
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