Rural and Community Health

MessengerSummer 2015 Vol.13/No. 2

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eCommunity Health Workers: The FriendNext DoorBy: Debra Flores, Ph.D., Director of West Texas AHEC

In this Issue:

• Community Health Workers: The Friend Next Door

• Executive Vice President’s Corner

• Making Waves in Telehealth

• Rural and Community Health Employees

Recognized

• Three West Texas Hospitals Receive 5-Star HCAHPS Rating

• Community Health Workers and

Community-Based Participatory Research

• Youth Engagement Training Initiative Project

• Community Health

Workers in Texas

• The Changing World of Post-Acute Care:

Reform and Readmission Seminar

• AHEC Update

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A publication of the F. Marie Hall Institute for Rural and Community Health

Community Health Workers (CHWs) are also known in Spanish as “Promotora de Salud.”

In spite of the history of community health workers working among us for many years, many people still do not know who these individuals are and what they do. Community Health Workers have different titles and roles such as community liaison, health educator and patient navigator, just

to name a few. These individuals emerge from the community as natural helpers. They typically live and work in the neighborhood they serve, which makes them culturally sensitive and knowledge-able. Community Health Workers are valuable resources when it comes to creating connections with individuals who reside in the communities they live because they are known and respected by their neighbors.

In addition to their knowledge and connectiv-ity to their community, now many of them are certified. You may wonder what this certification entails and who issues the certification. Through Senate Bill 1051 (77th Texas Legislative Sessions), the Texas Department of State Health Services

created a forum for which certification became possible. This certification lends itself to adding credibility to the work CHWs perform. A basic certification program delivers a minimum of 160 clock hours of course work which consist of eight competencies. These competencies include communication, interpersonal, teaching, orga-nizational skills, service coordination, capacity

building, advocacy and knowledge base. There are several institutions throughout Texas that are certified by the Texas Department of State Health Services to deliver this certification program and the F. Marie Hall Institute for Rural and Commu-nity Health is included. TTUHSC is among these institutions that recruit and hire CHWs. Paid positions that CHWs in Lubbock and surround-ing areas are qualified to apply for include, but are not limited to: patient navigators, health educa-tors, managed care case workers, research assis-tants, and lead specialists. In addition to the 160 hours of course work required by the certification, CHWs must also maintain their certification by obtaining 20 hours of continuing education units every two years.

T E X A S T E C H U N I V E R S I T Y H E A L T H S C I E N C E S C E N T E Rcontinued on page 7...

Executive Vice President’s Corner

Dr. Philips

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Aunt BC was what we called her. Her given name was actually Bernice and she was a one-woman miracle worker. Back in the day when Moms stayed home and raised families, she was the one in our neighborhood that walked the blocks around us to be sure all the other moms, and thus their kids, knew about the polio vaccination clinic down at the school. There was a campaign going to get every kid immunized to stop polio and prevent the horrible disease from claiming kids like our neighbor across the street. Aunt BC was so effective at getting out the word and knowing the answers to every ques-tion that moms might have about this revolutionary new preventive agent, that people began to refer to her as better-than-the-headache powder by the same name. Looking back on those days, I realized that she was the person in our neighborhood that everyone believed and trusted on health matters. She was an advocate for her community and its health, knowing almost everyone, albeit she had no formal training in health and didn’t earn a penny for her good labors.

What Aunt BC would have been called today in South Texas where we lived was a promatora. What many forget is that most of us lived in a blended culture, part American, part Mexican, and all Texan. Most of us spoke Spanish, although not the kind taught in most language courses. Promotoras work today in many neigh-borhoods similar to the one I grew up in. Much like Aunt BC, many are not formally trained and not paid for their good work. Others are community health workers because they have been formally trained for the role and employed to work on a specific project or program. They too, do good work.

Community health workers are bridge people. They interpret and translate services to their community by providing

culturally appropriate health education and assistance to people to help them get the care they need. They may play many roles where they live and work – health promotion and promotion of healthier behaviors, outreach for screening and delivery of health interventions, com-munity health education, social support and informal counseling, and know and advocate for community health needs. They are naturals at communicating inside and beyond their neighborhoods and are often the champions for the underserved individuals and the unpopular health concerns that affect everyday life at home. The simplest way to express why is to rec-ognize that people who do the job bring their gifts and their talents and apply them to their “calling”, usually with the passion of one who lives daily with the needs of their community and the people affected by these needs.

Much has been made about the transfor-mation of health care that is flowing from the national focus on health insurance that stems from the Patient Protection and Affordable Care Act, popularly known as Obamacare. There will be many changes in models of service delivery, reimburse-ment, and new focus on quality metrics and improved patient outcomes. The “big idea” is to move away from fee-for-service towards alternative payment models that reward value, improved outcomes, and re-duced costs. The goal is to have 50 percent of Medicare payments tied to these “big idea” changes by 2018. Even a cursory reading or hearing of the daily news would help most of us in becoming familiar with the names of the new ways to incentive care such as “bundled payment”, “value-based purchasing”, and “accountable care organizations.”

The unstated fact is that all of these will depend on a much greater team-centered care that involves the patient much more

integrally involved in their care and the outcomes of that care, and ultimately in the value received from the dollars spent on it. That can only mean that we will need to train and employ many more communi-ty health workers as we deinstitutionalize care and work to treat and care for people at home. There will be more emphasis on prevention, reducing unnecessary read-missions to hospitals, and more use of new technologies such as telemedicine and social media. All of these new things will require one old thing - a human touch, and that is where community health workers will find their future. Like Aunt BC, some are already living among us and advocating for health needs. Like her, they may not yet be trained but have learned on their own because they are motivated and smart. Like her, they are the ones we must train, must pay, and must promote in new roles on the healthcare team that will shape the future. Something tells me that if she were alive today, Aunt BC would be cheering this new healthcare revolution and she might even be leading the charge. For all I know, she is probably in the place and position now where she can do us the most good. I’ll let that be my hope. Yours in part can be there too, and in those will-ing to pursue the “calling” of becoming a community health worker.

-Billy U. Philips, Jr., Ph.D., M.P.H.

Community Health Workers - New Roles but Not a New ConceptBy: Billy Philips, Ph.D., M.P.H., Executive Vice President & Director

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Making Waves in Telehealth By: Carson Scott, Director, TexLa Telehealth Resource Center

As Telehealth expands around the country, the TexLa Telehealth

Resource Center (TRC) and the Texas Tech University Health Sciences Cen-ter (TTUHSC) Telemedicine Program continue to support the movement and implementation of telehealth programs throughout Texas and Louisiana.

Currently, the TexLa TRC and the Tele-medicine Program are involved in the development of multiple initiatives and legislative efforts to expand the utiliza-tion of telehealth services and bring care closer to our most rural communities. One key area of impact focuses around the creation of the Telehealth Certificate Program to be available later this year.

The TexLa TRC has begun to develop a unique and robust certificate program, to include online modules, simulation

center learning, and objective structured clinical examinations (OSCEs), to pro-vide a knowledge base and telehealth training through a competency-based model focused on the essentials of tele-health business, technology, and clinical procedures.

The certificate program will begin to set the standard for educating and train-ing the telehealth workforce, including telehealth-specific OSCEs, which al-low instructors to accurately evaluate a student’s performance and competency through their completion of each OSCE case. Each OSCE will provide an in-depth and detailed simulated portrayal of specific case-driven patient telemedicine visits to effectively prepare telemedicine presenters and health care providers for all aspects of a telemedicine visit. The telehealth certificate will not only appro-

priately train health care providers, but will have a significant impact on reduc-ing any stigma associated with telehealth technology and prepare health care organizations to successfully implement or increase the utilization of telehealth services.

For patients that may be interested to receive care closer to their own home, please reach out to the Telemedicine Program at 806-743-7960 to learn about specialty care that may be available in your area through the use of telemedicine. In addition, to learn more about the Certificate Program, telehealth related questions, resources, and technical assistance, please contact the TexLa TRC at 806-743-7960, texlatrc@ttuhsc.edu or visit www.texlatrc.org.

Rural and Community Health Employees RecognizedThe F. Marie Hall Institute for Rural

and Community Health is proud to recognize two staff members who were recently chosen as recipients of the 2015 Quality Staff Award at Texas Tech Uni-versity Health Sciences Center.

Cole Johnson, direc-tor for the Office of Contracts, Report-ing, and Data Man-agement with Rural Health, has been with the Institute since 2012, and re-ceived his J.D. from Texas Tech Univer-sity School of Law.

Jimmy Ashley, technology manag-er for Telemedicine, has been with Rural Health since 2013, and is in charge of all telemedicine video conferenc-ing equipment and installations. He graduated from DeVry University as an Electronic Tech-nician.

The Quality Staff Award recognizes employees who have one or more years of service with Texas Tech University Health Sciences Center. These individu-

als have made significant contributions and shared innovative ideas throughout the year to their department and to the HSC. The nominees have demonstrated initiative, a take-charge attitude, and im-provement through collaborative strate-gies. Individuals receiving this award are considered emerging leaders within Texas Tech University Health Sciences Center.

Johnson and Ashley will be recognized at the TTUHSC Distinguished Staff Awards Ceremony this June. Congratulations!

Cole Johnson

Jimmy Ashley

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Three West Texas Hospitals Receive 5-Star HCAHPS RatingBy: Terry Alexander, Managing Director, Rural and Critical Access Hospitals, West Texas HITREC

In April of this year, Centers for Medi-care & Medicaid Services (CMS)

released the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) sur-vey conducted from July, 2013 through June, 2014. There were 3,553 hospitals that were surveyed and we are proud to announce that three West Texas hospi-tals were part of only 251 hospitals that received a 5-Star Rating. They are:

• Mitchell County Hospital District (MCHD) – Colorado City

• Eastland Memorial Hospital – East-land

• Childress Regional Medical Center (CRMC) – Childress

These three hospitals are in the elite seven percent of all hospitals surveyed. There are more than 3,553 hospitals in the U.S., but some did not have enough survey data to statistically qualify for a rating. The HCAHPS survey contains 21 patient perspectives on care and patient rating items that encompass nine key topics: communication with doctors, commu-

nication with nurses, responsiveness of hospital staff, pain management, com-munication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care. The survey also includes four screener ques-tions and seven demographic items, which are used for adjusting the mix of patients across hospitals and for analyti-cal purposes. The survey is 32 questions in length.

Robbie Dewberry, CEO, Mitchell County Hospital states, “MCHD has been and will continue to be diligent in its efforts to improve overall patient experience. We know our patients have a choice when it comes to healthcare and we want to always be that choice. We are honored to have been given a 5-star ranking by CMS, but also know that improvement can’t stop here. We will continue to raise the bar because quality care and patient sat-isfaction matter; our patients matter. Our recipe for success is centered on a simple idea with a big impact: Doing the right thing every time, for every patient.”

John Henderson, CEO, CRMC states, “Our Always Team works on patient ex-perience initiatives, but the 5-star recog-nition from CMS really involves everyone at CRMC. Our crew is caring, thought-ful, consistent, and competent. This is a team accomplishment we’re proud of, because it requires every employee doing everything they can for every patient every day.”

Ted Matthews, CEO, Eastland Memo-rial Hospital states: “Patient satisfaction and quality of care measures are what set Eastland Memorial Hospital apart from other healthcare facilities. We are very pleased with the results of this patient satisfaction survey. I would like to compliment all of the hospital’s em-ployees and local physicians. It takes the entire team to achieve these outstanding results.”

The theme that is common to all three of these hospitals is an atmosphere of “teamwork”. We congratulate them on this outstanding achievement.

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electronically, please send your email address to briana.vela@ttuhsc.edu.

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The YETI Project (Youth Engagement Training Initiative) is an evaluation

study aimed at identifying adolescent risk factors such as mental illness, substance use, and access to care in the following rural counties: Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, and Terry.

As part of the Texas Healthy Adolescent Initiative across the state, YETI serves to give a voice to adolescents where they were previously lacking. YETI joins junior high and high school students who are at risk, along with their parents, with caring, professional adults in a Youth-Adult Council whose primary function is to promote positive youth development and youth engagement, leading to posi-tive outcomes for council members and at-risk youth in the communities.

The YETI project, though facilitated by adults, is student led and solution focused. As the council approaches its fourth month of planning, future activi-

ties include mental health and substance abuse trainings, access to care workshops, and outreach activities to be held in rural West Texas communities. Additionally, YETI is bringing training to the youth-serving community sector with a Positive Action model of engagement and devel-opment. This model enhances social-emotional learning while increasing academic achievement and addressing adolescent risky behaviors.

For more information, contact Jeff Carr at YETI@ttuhsc.edu or (806)787-7930.

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Youth Engagement Training Initiative Project

Community-based participatory research focuses on conducting human health re-

search in the actual settings of where people live their everyday lives. This allows un-derstanding of health as people actually live rather than through contrived studies that screen for inclusion and exclusion. It utilizes a model that equitably involves community members, community leaders, organiza-tional representatives, and researchers in all phases of a research study, starting with the actual health issues to be studied, research design, data to be collected to answer ques-tions, analysis and interpretation of that data, and how the study results are shared with the local and scientific communities. This approach enables remote researchers to study diverse problems and produce results that can directly impact the research participants. Project FRONTIER, sponsored by the F. Ma-rie Hall Institute for Rural and Community Health, is such a research study examining aging processes in rural West Texans.

While this research approach is innovative and exciting, it cannot work effectively with-out community-based health workers who perform all the research “legwork.” We are very fortunate to have four outstanding com-munity health workers who are the life-blood of Project FRONTIER. These workers each cover one of four rural counties involved in the project, a combined area of 3,391 square miles with an average of 4 to 25 people per square mile. In that vast area, they recruit participants; arrange and shepherd partici-pant medical examinations and blood draws; obtain medical, personal health, and family histories; and complete extensive cognitive testing. To do all this, Project FRONTIER community health workers meet people at clinics or their homes, attend and participate in community events, and sometimes work weekends and evenings.

Because the Project FRONTIER workers are members of the communities they work in,

they have the visibility and trust necessary for this research to be successful. Moreover, because of that visibility and trust they have become resources to help all members of their communities to understand and access the healthcare resources available to them. This, combined with information provided as feedback from Project FRONTIER, can encourage healthier people and healthier communities.

It is with great appreciation that the Project FRONTEIR staff salutes Cordelia Aguirre (Bailey County), Lousinda Anguiano (Co-chran County), Rocio Carrasco (Parmer County), and Teresa Huckabee (Hockley County) as our community health workers.

For more information on the Rural Health Research Group, visit www.ttuhsc.edu/ruralhealth/research-group.

Community Health Workers and Commuity-Based Participatory ResearchBy: Matthew E. Lambert, Ph.D., Director of Behavioral Health Innovations and Research

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Community Health Workers in TexasBy: Scott Phillips, Debbie Curti, Cole Johnson and Melanie Teague, Office of Contracting, Reporting and Data Management

Nationally, community health work-ers (CHWs) are known by a variety of

names, including community health advi-sor, outreach worker, community health representative, promotora/promotores de salud (health promoter/promoters), patient navigator, peer counselor, lay health advi-sor, peer health advisor, and peer leader. Put simply, CHWs are frontline public health workers who are trusted members of the communities they serve. CHWs improve the quality of health care delivery by acting as liaisons between providers and community residents. CHWs increase the community’s self-sufficiency through informal counseling, education, and outreach while also educating health care providers about the community’s health needs and the cultural relevancy of interventions.

According to a 2014 report by the Depart-ment of State Health Services (DSHS), the number of certified CHWs in Texas contin-ues to increase steadily. There were 2,687 certified CHWs in Texas as of December 31, 2013; an increase of 28 percent over the pre-vious year. A total of 890 CHWs were newly certified during 2013. The number of Texas counties with at least one certified CHW also

rose in 2013 from 109 counties to 116 coun-ties.

The “Promotor(a) or Community Health Worker Training and Certification Program,” implemented by the State of Texas in 2001, requires certification for CHWs who receive compensation for services provided. CHWs are eligible to be certified in Texas by com-pleting DSHS-certified training of at least 160 hours or based on experience through verification of at least 1,000 hours of commu-nity health work services in the most recent six years. Approximately 60 percent of CHWs newly certified in 2013 were certified based on experience. Certified CHWs must also complete 20 hours of continuing education every two years to renew their certificates, including at least ten DSHS-certified contact hours.

Involvement of CHWs in the prevention and control of chronic disease continues to grow as supported by the following evidence:

• A review that examined CHWs’ effective-ness in providing care for patients with hypertension noted improvements in keeping appointments, compliance with

prescribed regimens, risk reduction and related mortality

• In reviewing studies of CHWs involved in the care of patients with diabetes, researchers found improved lifestyle and self-management behaviors among par-ticipants, as well as decreases in the use of the emergency room

• A colorectal cancer male navigation program designed for Hispanic men showed an increase in life expectancy for participants

• Asthma symptom frequency was re-portedly reduced by 35 percent among adolescents working with CHWs

As the number of CHWs in Texas continues to grow, there will be more opportunities for communities to utilize CHWs as a link be-tween health/social services and the commu-nity, which will ultimately improve access to medical services and the quality and cultural competence of service delivery.

“The Changing World of Post-Acute Care: Reform and Readmission” SeminarKenneth Ottenbacher, Ph.D., traveled to West Texas this summer to present a seminar on

post-acute care findings and changes in the medical field. Dr. Ottenbacher is a professor and director for the Division of Rehabilitation Sciences Center for Recovery, Physical Activity and Nutrition at the University of Texas Medical Branch (UTMB) in Galveston, Texas.

His presentation entitled “The Changing World of Post-Acute Care: Reform and Readmis-sion,” covered topics such as the ongoing reform of our country’s health care and how it might affect the post-acute care of patients. This includes payment methods and opportunities in the future.

Dr. Ottenbacher also described some of the early statistical results behind one of his current studies showing the difference in readmission rates between post-acute care facilities and the different patterns across post-acute care settings.

“The rehabilitation research community has a unique opportunity to impact the future of post-acute care service delivery,” Dr. Ottenbacher stated. He also quoted Abraham Lincoln’s famous saying, “the best way to predict the future is to create it.”

For more information on the UTMB Division of Rehabilitation Sciences, please visit http://rehabsciences.utmb.edu/.

Above: Kenneth Ottenbacher, Ph.D., University of Texas Medical Branch |

Although there is a Texas job code for CHWs, many institutions do not recog-nize the code and are confused about the multifaceted capacities of CHWs. The work that CHWs have been and are currently involved in is evidenced based and has proven many times over to be effective. You will find this evidence-based literature that describes the value of employing CHWs in many facets of healthcare in journals such as Journal of Public Health, Health Promo-tion and Practice, Journal of Community Health, Journal of Cardiovascular Nursing, Health Education & Behavior and Journal of Preventive Medicine, to name a few.

We at The F. Marie Hale Institute for Rural & Community Health look forward to partnering with TTUHSC School of Nurs-

ing, who is also a certified CHW Instruc-tor Institution, in order to deliver the best certification course and continuing educa-tion units that meet the needs of CHW working in different areas of the health care field. We are working to create hybrid class delivery models in order to reach individuals who desire to become certified community health workers in the rural community and have difficulty traveling to urban communities. More information about this endeavor will be disseminated by the fall 2015. We believe that CHWs are integral partners to health care providers, especially as we move to new models of care that require patient involvement, and we look forward to continue to grow this important field.

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For Upcoming Activites, Visit your Regional AHEC’s Website

AHEC of the Plains2417 Yonkers; P.O. Box 1116Plainview, TX 79072806.291.0101www.ahecplains.org

Desert Mountain AHEC440 ReynoldsEl Paso, TX 79905915.783.6211www.desertmountainahec.org

Big Country AHEC3702 Loop 322Abilene, TX 79602325.972.0495www.bigcountryahec.org

Panhandle AHECWTAMU Box 61003Canyon, TX 79016806.651.3480www.panhandleahec.org

Permian Basin AHEC3600 N. GarfieldTechnology Center, RM 140Midland, TX 79705432.685.4794www.permianbasinahec.org

Like us on Facebook! https://www.facebook.com/WestTexasAHEC/

CHWs continued from page 1

Check out our H.O.T. Jobs website for health care opportunities in Texas:http://www.texashotjobs.us

Visit our website to stay up-to-date on AHEC events at:www.westtexasahec.org

Panhandle

Permian Basin

AHEC of the Plains

Big Country

Desert Mountain

Patient navigator, advocate, educator. All names that de-

scribe what a Promotora de Salud means to their community. Elsi Rivera-Colon followed her calling a year ago to become certified by the Texas Tech HSC School of Nursing as a Promotora de Salud.

“This is God’s perfect plan for me. I’ve met wonderful patients, I’ve been exposed to many new things, so many needs that without this calling I wouldn’t be able to help or pray the way I do,” Rivera-Colon stated in a social media post. “I was thanking God and meditating about my time...knowing in my heart that there was more to what God wanted for me.”

Rivera-Colon states now she is able to attend family events and volun-teer her time in the community all while serving others. “I love my ministry at TTUHSC!”

Above: Elsi Rivera-Colon, Promotora de Salud, TTUHSC

Local Promotora de Salud Testimony

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3601 4th Street STOP 6232 Lubbock, TX 79430-6232

ADDRESS SERVICE REQUESTED

HEALTHBeat

Beat the Heat This Summer!• Schedule outdoor, physical activies for

cooler times of the day. This includes working out, running, yard work, or walking around at your summer vaca-tion spot. Take periodic rest breaks in a cool area if the activity you are doing is strenuous.

• Dress in light, loose, cotton clothing. Natural fabrics are much cooler than synthetic clothing and can help keep your body temperature down in the heat. Protective hats also help provide some shade for your face and keeps the sun out of your eyes.

• Use sunscreen! The most effective products are labeled “broad spectrum” or “UVA/UVB protection.” It is rec-ommended to use an SPF 30 or higher for daily use. Remember, you can still get a serious sunburn even on cloudy days! Don’t forget to protect your ears, lips and back of neck.

• Drink, drink, drink your water! It is recommended to drink 3 to 4 quarts of water per day in hot weather. It is important to stay hydrated and stay away from drinks that increase water loss, such as caffeine and alcohol.

• Get plenty of sleep and eat light, nutri-tious, and non-fatty meals. Foods high in water content, such as fruits and vegetables, will keep you going during the summer months.

• Keep cool with fans, air conditioning, and shaded areas. Keep your shades or curtains closed on extra sunny days and avoid using the oven to avoid heating up the inside of the house.

• Take precautions if you are taking medications, as some have certain side-effects that could be enhanced in the heat, such as fatigue, sunburn, or dizziness. Be extra cautious in the heat if you have diabetes or high blood pressure and protect yourself from the sun as much as possible.

• Also, remember to never leave your children or pets inside a car on a hot day, even if the windows are open.

F. Marie Hall Institute forRural and Community Health

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