History of Community Health Workers Programs
Synopsis of New Mexico Community Health Workers Association
A Brief History of Community Health Worker Programs
Community Health Workers/Promotores de Salud (CHWs) has been part of the health
care delivery system for decades, both in the U.S. and other countries. In the
1960s the U.S. Government supported the development of CHW programs as a means
to improve health care to under served communities. The Federal Migrant Health
Act of 1962 and the Economic Opportunity Act of 1964 mandated outreach efforts
in neighborhoods with high poverty levels and migrant labor camps. Since 1968
the Indian Health Service (IHS) has trained “Community Health Representatives”
(CHWs) to serve the Native American population in New Mexico, Alaska, Montana
and many other states. In 1914, The Smith-Lever Act established the County Extension
Service (CES) to foster practical scientific education and outreach in agriculture
and home economics throughout the U.S. As rural communities’ needs changed
so did the community outreach provided by the CHES regarding home canning, water
quality, nutrition & food safety, waste management, pesticide use and immunizations,
taking on a more universal approach to environment, health and social issues.
Much of what is known about community health workers comes from experience throughout
Latin America, Africa, and Asia. CHWs often work in rural areas where the medical
model of health care is limited or non-existent. Over the years CHWs in New
Mexico and other states have been effective health educators and service providers.
They are often involved in community organizing and the development of health
and social service projects and are an important link in the health delivery
model. They serve as interpreters and a direct link in accessing health care.
Many of them are Medicaid On Site Application determiners and have been instrumental
in signing people on to Medicaid.
New Mexico has a number of community health worker programs operating independently
from one another in both rural and urban areas. They are funded in part by state,
federal and private foundation dollars. Some programs have developed a way to
bill for services under Medicaid dollars and SCHIP funding. Many programs began
their efforts targeting maternal and child health outcomes, some have selected
other health risk factors as their target, among them are access to care/Medicaid
enrollment, Substance Use or Smoking Cession, Diabetes, Breast and Cervical
Cancer, HIV/AIDS and traditional medicine; community health workers also serve
as interpreters and doulas. There are 32 counties in New Mexico, 26 of these
have established a Maternal and Child Health Councils to formally address health
and social service needs for childbearing women and their families. Most of
the outreach, prevention, health education needs are being met by community
health worker services in these counties.
As community health worker programs were being formed here in New Mexico, it
became evident that education, funding, and networking were areas of need for
new programs. While training was available for social workers and nurses in
maternal and child health issues, there was no training available for the lay
health worker.
New Mexico Community Health Workers Association (NMCHWA)
The New Mexico Community Health Workers Association was informally developed
under the University of New Mexico Prenatal Care Network in 1993 to provide
a venue for community health workers to gather information regarding health
and social service resources, share info on CHW programs best practices, education,
legislative updates, peer support, political power for the CHW model and networking.
The organization met in different quadrants of the state, with CHW programs
taking turns hosting the meetings. In 1995, a three-year grant from the Robert
Wood Johnson and Henry J. Kaiser Foundations awarded to UNM Health Sciences
Center helped to formalize the organization. Funds provided for a full time
coordinator position and a .5 administrative assistant. The coordinator and
part time administrative assistant were hired in September 1995 and began the
process of formalization. The process for training for NMCHWA members began
from 1995 through 1998 under the existing funding.
NMCHWA Mission:
To bring community health workers together into a cohesive body that promotes
outreach, education, and support for the CHW model, each other as well as their
respective communities. Additionally, the association provides networking opportunities,
information exchange and training for community health workers.
NMCHWA Network Executive Board
An executive board was elected as follows: President, Vice-president, Secretary
and Treasurer. Board orientations are held annually to help define roles and
orient the newly elected board. CHWs. fill the board positions, board training
is provided annually for new officers. Quarterly meetings continued to be held
to address issues of importance for programs, provide training, make decisions
and set goals for NMCHWA, to plan conferences/training and lobbying efforts.
The officers are volunteer, there is no salary attached to the positions. This
board is currently seen as the Network executive board that includes: the president,
vice-president, secretary and treasurer, whenever possible reflects representation
from different parts of the state. There is also a Board of Directors that oversees
the corporation since it received its 501(C)3 status in 2003. Board officers
include Chair, Vice-Chair and Treasurer. Secretary.
NMCHWA Governance and By-laws
By-laws were developed to help guide the association. These have been revised
in applying for their non-profit status in developing the articles of incorporation.
The meeting at the annual conference is used for electing a new Network executive
board. The new officers are installed during the conference graduation and awards
ceremony. The by-laws address components of the organization such as who is
eligible for membership, the executive board, the mission, voting, quorum, definition
of a CHW, meetings, minutes, sub-committees, procedure for complaints, representation
and communication. Operating Policy and Procedures have been developed for the
organization.
The NMCHWA has put on 9 annual training conferences. Attendees have come from
all over the country. The first one was held in September 1996 and the last
one was in October 2004. Funding for the conferences have come from organizations
such as RWJ, UNM Kellogg Community Voices Project, Archdiocese of Santa Fe,
March of Dimes, Department of Health, Cimarron (HMO) and the University of New
Mexico CASAA Program, McCune Foundation, and Health Resources and Services Administration
(HRSA). If funding allows, scholarships for registration fees, travel and board
are provided for Promotores whose programs are unable to fund expenses to attend
the annual training conference.
Evaluation
In April 1996 Robert Wood Johnson and Henry J. Kaiser Family Foundation funded
a companion CHW evaluation project. The two goals of the evaluation project
were: 1) to evaluate CHW programs in New Mexico have a measurable benefit on
the clients they serve, and 2) to provide technical assistance to CHW programs
in New Mexico in developing and implementing appropriate evaluation methods
and data collection. Three national consultants provided technical assistance
during the early development phase, Dr. J. Nell Brownstein, Dr.Terri D. Sterling
and E. Lee Rosenthal. During the first year participants worked together to
develop evaluation methods and questionnaires which were consistent with the
functions of the participating CHW programs and NMCHWA. The second year focused
on collecting data from each of the participating CHW sites and providing technical
assistance on evaluation to other New Mexico CHW programs. Participants in the
evaluation project worked closely with the National Community Health Advisor
Study funded by the Annie E. Casey Foundation. The NCHA study was part of a
national initiative to support and strengthen CHW programs. Copies of the New
Mexico Community Health Worker Program evaluation study are available through
ktollest@unm.edu.
NMCHWA Training Curriculum and Graduation Ceremony
In 1993, a training curriculum was developed though a collaborative effort between
the University of New Mexico Area Health Education Center and the Prenatal Care
Network and focus groups made up of CHW program staff. The New Mexico Department
of Health and the New Mexico Chapter of the March of Dimes Birth Defects Foundation
provided funding for the curriculum. The curriculum, Reaching Out: A Training
Manual For Community Health Workers includes 40 hours of training in topics
such as:
Orientation into the CHW model
Communication Skills (including confidentiality)
Community Resources
Prenatal Care I
Prenatal Care II
Labor and Delivery/Postpartum Care
Breastfeeding and Nutrition
Substance Use/Domestic Violence
Sexuality, Family Planning, STD's
Early Childhood Development
The manual is provided free of charge to all new local CHW programs in New
Mexico. The training is conducted in modules over an extended period for a total
40-hours. It includes role-playing home visits, viewing films, class discussions,
lecture and visits to health care providers. The written material is at a level
that is easy to understand by the lay health worker. Participants are encouraged
to take part in deciding how the training sessions will be conducted. Upon completion,
participants are presented with a Certificate of Completion from the University
of New Mexico Health Sciences Center at the annual statewide training conference.
The curriculum is available for out of state programs for $25 by contacting
the NMCHWA office (505) 255-1227 P.O. Box 81433, Albuquerque, New Mexico 87198
or email nmchwa@yahoo.com
Skills Building
Although the curriculum appears to have an MCH focus, other topics are introduced
as needed by the programs or individuals. NMCHWA members meet on a quarterly
basis and request training on other skills and topics. Among them are: Evaluation;
meeting facilitation & planning; public speaking; group dynamics; communication;
mental health, grant writing & fundraising; board training; use of computers.
Many of these topics are also addressed at annual training conferences or quarterly
meetings.
NMCHWA Non-Profit Status
NMCHWA, in July 02 received 501 (C) 3 from the State of New Mexico, the federal
status was granted in January of 2003, this has enabled the association to apply
for funding to set up a headquarters. It has also enabled NMCHWA to hire an
executive director to oversee the day-to-day activities of the Association;
develop a website, revise the existing curriculum, coordinate quarterly meetings
and the annual training conference, explore an accreditation or certification
process and work on the legislative initiatives to sustain promotora programs.
NMCHWA Funding
NMCHWA received a small capacity building grant in 2003 from Hispanics in Philanthropy.
This enabled the Association to hire a consultant, develop a website and develop
operating procedures. In 2004 and 2005 HIP provided funding for a part time
director. NMCHWA has also started a thrift-store to generate revenue.
2003 Training
On December 3rd & 4th, 2003 the Association held the annual training conference
in Santa Fe, New Mexico at the Museo Cultural de Santa Fe. Workshops included:
Mental Health Practitioners in Indo-Hispanic Culture; La Cultura Cura; Remedios,
Dichos y Canciones del Norte; Obesity and the Built Environment; Stress Relief
Instead of Smoking; Herbal Wellness Tea; Lifelong Happiness; Diabetes, Physical
Assessment; Childhood Diseases and the need for Immunizations; Male Involvement-Young
Father’s Project; Alcohol in Indian Country; and Stages of Change in Mental
Health. In October 2004, NMCHWA coordinated the annual training conference in
Albuquerque, New Mexico
2004 Training
On October 18th through the 20th NMCHWA held the 9 annual training conference.
Sessions included medical interpreter training; Cultural Diversity, Debt and
Money Management; Environmental Health, Immigration, Nutrition, Natural Medicine
During Childbirth, Depression, CHW in diabetes Prevention, Healthful Living,
Resource Management, and Childhood Obesity. Awards were given for the Promotora
of the Year and Model Program of the Year.
Legislative Initiatives
NMCHWA participated in the development of Senate Joint Memorial 076 for the
2003 Legislative Session that will initiated the development of a task force
around a study in that will evaluated the value of CHWs to the health care delivery
system and their impact on public health outcomes; Economic development and
access to health care. SJM 76 was passed. The results of the study, including
legislative recommendations to address economic opportunities for the communities,
were reported to the interim legislative health and human services committee
at its October 2003 meeting. The study has also been accepted by the American
Public Health Association and was presented at the November 2004 conference
in Washington, D.C.
Advocacy on Behalf of CHWs
Collaborated with Senator Linda Lopez to establish “Promotora Day”
during Health Week at the State Legislature in both 1998 and 1999. This gave
programs the avenue to promote the CHW work and the impact it generated in many
communities in New Mexico. NMCHW also successfully lobbied Governor Bill Richardson
to proclaim the month of December 2003 “Community Health Worker Month.”
in the state of New Mexico.
NMCHWA National Initiatives
NMCHWA is a board member of the Lay Health Workers National Network/Red Nacional
De Promotores de Salud. NMCHWA representative serves on the planning committee
for the annual national CHW conference and in the development of CHW training
needs, sustainability of CHW programs, Medicaid reimbursement efforts and certification
initiatives. The NMCHWA member is nominated by their peers to represent the
Association at the national level. Representatives also serve on the advisory
and regional committees. At the Unity 2005 conference in Gulfport, Mississippi
in March 2005, New Mexico was one of 5 states highlighted regarding CHW legislative
initiatives. NMCHWA was part of a panel at that conference. New Mexico has also
been selected to participate in a CHW workforce study being conducted by the
University of Texas in 2005, NMCHWA will conduct focus groups for the national
study. NMCHWA is also participating in the American Public Health Association
SPIG initiative to come up with a CHW definition to add to and revise the Department
of Labor Occupational codes in time for the 2010 Census to include CHWs.
Contact Info:
NMCHWA
P.O. Box 81433
Albuquerque, NM 87198
Telephone (505) 255-1227
Fax (505) 255-1157
nmchwa@yahoo.com
Current Network Officers 2004-2005
President Sylvia Garcia,— Promotora, Presbyterian Family Health Care-
Rio Bravo , 3436 Isleta Blvd. S.W. Albuquerque, NM 87105 (505) 462-7865 fax
462-7774 sygarcia@phs.org
Vice President Greg Lopez—Promotor, La Familia Medical Center 1035 Alto,
Santa Fe, NM 87501 gjlopez69@hotmail.com
Secretary Lovell Lechuga—Secretary, Promotora, Community Action Agency,
320 Wyatt, Las Cruces, NM 88001 (505) 525-2571 lechugal@caasnm.org
Treasurer Amy Ramirez—Promotora, Community Action Agency, P.O. Box 518,
Anthony, NM 88201 (915) 886-4587 ramirez@caasnm.org
Non-Profit Board of Directors
• Chairman of the Board, B.J. Ciesielski— Outreach Education Coordinator,
UNMH Maternity & Infant Care Program, 7525 Zuni S.E. Albuquerque, NM 87108
(505) 272-4741 bciesielski@salud.unm.edu
• Vice-Chair, Sylvia Sapien-- La Clinica de Familia, P.O. Box 3420, Anthony,
NM 88021 (505) 882-7370 ssapien.@lcdfnm.org
• Treasurer, Virginia Alexander—Bernalillo County Extension Service,
NMSU, 1510 Menaul N.W. Albuquerque, NM 87107 valexand@nmsu.edu
• Secretary, Terri Smith—Sierra County MCH Care, 201 E. 4th St.
TorC, New Mexico 87901 tel. 894-0543 fax 894-3478 mchc@zianet.com
• Patricia Anello, RN,BSN, CNN—NMDOH Diabetes Prevention & Control
Program, 1190 St. Francis Dr. P.O. Box 26110, Ste S. 1300, Santa Fe, NM 87502-6110,
tel (505) 827-2333, fax (505) 827-2329, patriciaa@doh.state.nm.us
• Paula DeVitt-- La Familia Medical Center, 1035 Alto, Santa Fe, NM 87501
(505) 982-5460 pdevitte@lfmctr.org
• Sylvia Ornelas, —La Familia Medical Center 1035 Alto, Santa Fe,
New Mexico 87501 (505) 982-5460 fax (505) 982-8440 s_ornelas@lfmctr.org
• Darren Griego, —Project Manager, Rio Arriba Family Care Network,
P.O. Box 778, Espanola, New Mexico 87532 (505) 753-3143, fax (505) 753-1769.
dgriego@rafcn.org
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