From The Field A U G U S T 2 3 , 2 0 1 0 Building the Community Health Worker Field through Partnership and Innovation MARSHA SHOTLEY President, Blue Cross and Blue Shield of Minnesota Foundation M innesota is home to the country’s largest Somali and nationally, combines classroom learning, field work, and second-largest Hmong populations and has signifi- internships in a standardized CHW curriculum. Next cant numbers of immigrants from Central and steps call for distance learning through I-TV, as well as South America, Asia, Africa, and Europe. It is also home to the on-line training. largest urban population of Native Americans. With many • Provision of CHW training to over 350 students who cultures come many different beliefs on health and illness, and received certificates that make their services eligible for treatment and prevention options. medical assistance payment. Minnesota is one of only two While Minnesota generally ranks as one of the healthiest states to reimburse CHWs under the Medicaid program. states in the nation, people of color, foreign-born individuals, and those living in poverty typically experience poorer health • Development of specialized training in oral and mental than the native-born white population. The causes of these health for CHWs. disparities are complex and intertwined, and include access to • Provision of scholarships to support participation in quality care, language barriers, housing and environmental CHW training. conditions, and individual and collective historical experience • Creation of the first statewide CHW Peer Network to with the health care system. provide opportunities for peer learning and professional Ten years ago the Blue Cross and Blue Shield of Minnesota development. Future plans include expanded outreach, Foundation began to look for community-based approaches to career development, and leadership activities. close the gap on health inequities. We identified support for community health workers (CHWs) and the sustainable ® Workforce Development and Job Creation development of the field as one path to healthier communities. • Formation of the Minnesota CHW Alliance, formerly Since then, we have invested in research, grantmaking, and the Minnesota CHW Policy Council, a workforce partnerships to build the field. development partnership. A DECADE OF PARTNERSHIP AND IMPACT • Creation of new jobs for community health workers. Many partners have contributed to the development of the • Growing understanding among health care providers that CHW field in Minnesota over the last decade. They include CHWs are important members of a multidisciplinary educators and academic institutions, the health care sector, team and can enhance services for diverse clients. health plans, public and private agencies, funders, policymak- ® Research and Legislation for Sustainable Financing ers, researchers, and CHWs themselves. Their contributions have included the creation of partnerships and coalitions, as • Research on outcomes, cost effectiveness, and well as individual efforts. sustainability. The foundation has served as a catalyst, providing funding • Passage of landmark Minnesota legislation authorizing that has resulted in impressive concrete outcomes, including: medical assistance payment for CHWs. ® Training, Curriculum, Peer Learning • A study recently published in Health Affairs examined the policy and systems change initiatives of a number of states • Development of professional standards for CHWs, working to integrate CHWs into service delivery teams defining their role in the health care delivery system. and use CHWs to help eliminate health disparities. The • Development of a standardized curriculum and a 14- study offers recommendations for comprehensive state credit CHW certificate program to educate CHWs in legislation and cites the approaches of Massachusetts and Minnesota. The statewide program, the first of its kind Minnesota as models for other states seeking to eliminate health disparities (Rosenthal et al. 2010). care reform efforts move forward, we will continue to partner with others to promote awareness, understanding, and support ® Awareness and Public Support of the CHW role and to document outcomes, costs, and • Creation and use of tools and strategies to build aware- benefits. ness and support, including a public television program Future goals include increasing the number of curriculum and DVD (in English, Somali, Spanish, and Hmong) sites, enhancing placement services and career counseling, and on CHWs, communications, and convenings. providing opportunities for distance learning. In particular, the foundation will explore opportunities to better integrate • A growing appreciation for the role CHWs play in CHWs into the health care system, sustain CHW models increasing access to health care coverage, improving the based in social service and community settings, and support quality and cost effectiveness of care, enhancing health, next-stage policy work and innovative partnerships that and increasing the diversity of the health care workforce. advance the field. LOOKING AHEAD TAKING ACTION: WHAT FUNDERS CAN DO For those looking to enhance the credibility of the field and • Provide financial support to help health providers, social ensure that CHWs contribute to the health of Minnesota’s service agencies, and other nonprofits serving ethnically and communities to their fullest potential, some challenges lie racially diverse populations incorporate community health ahead. These challenges include full integration of CHWs in workers into their programs. the health care field; clarifying their roles, responsibilities, and competencies; demonstrating the impact of investments in • Support coordinated statewide systems of CHW training, CHWs on patient outcomes; making the case for sustainable including scholarships that reflect lessons from Minnesota funding mechanisms; recruitment; training; ongoing and other states. professional development; and retention. • Understand that funders involved in a variety of issues – Recent promising developments include: early childhood, youth development, seniors, immigrants, • A national conference, supported by Minnesota’s environment, community development, healthy and/or Healthcare Education-Industry Partnership and a supportive housing, workforce development, regional consortium of researchers, funders, and others, proposed a equity, poverty reduction, health, and health care – research agenda and other recommendations to strengthen can support the CHW field. the evidence base for CHWs. • Raise awareness of the CHW role as a career track and • On the national level, a membership organization known as pathway into the health care professions. the American Association for Community Health Workers • Support ongoing rigorous research, demonstration, and was formed. evaluation that identify success factors in clinics and • The U.S. Department of Labor created a classification code outcomes in clinics and community-based settings to for CHWs in 2009. This will enable better collection of provide evidence of impact and cost reduction. workforce data, including the number of existing CHWs. • Focus on policy and systems change for broad impact. • The National Center on Minority Health and Health Disparities, a division of the National Institutes of Health, We are proud of the work that has been done over the past targeted a portion of its American Recovery and 10 years and are pleased to share the report Community Reinvestment Act funds to support research on CHW Health Workers in Minnesota: Bridging Barriers, Expanding training. Access, Improving Health that provides a comprehensive look at the project, and features the partners, additional • The Children’s Health Insurance Program, reauthorized resources, as well as model legislation. It can be accessed at in 2009, recognizes CHWs as providers of outreach, www.bcbsmnfoundation.org. enrollment, and education. • Federal funds support Centers for Medicare and Medicaid CHW demonstrations, and pilots, and now under the 2010 health care reform legislation include grants by the Centers for Disease Control and Prevention to promote healthy behaviors among medically underserved SOURCES populations through the use of CHWs. Rosenthal, E. Lee, J. Nell Brownstein, Carl H. Rush, et al., “Community Health Workers: Part of the Solution,” Health NEXT STEPS FOR THE BLUE CROSS Affairs 29(7):1338-1342, July 2010. FOUNDATION The Blue Cross and Blue Shield of Minnesota Foundation is encouraged by the success of building the CHW field in Views from the Field is offered by GIH as a forum Minnesota. But we know the work is not over. As health for health grantmakers to share insights and experiences. If you are interested in participating, please contact Faith Mitchell at 202.452.8331 or fmitchell@gih.org.