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Nayak SS, Scoglio AAJ, Nandi S, Anderson K, Mirand D, Roper K, Méndez-Peñate L, Moulin C, Arty M, Molnar BE. Implementing Integrated Early Childhood Mental Health Services in Primary Care: Relationships, Vision, and Sustainability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:763-772. [PMID: 37273121 PMCID: PMC10359204 DOI: 10.1007/s10488-023-01275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/06/2023]
Abstract
The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.
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Affiliation(s)
- Sameera S Nayak
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Arielle A J Scoglio
- Department of Applied and Natural Sciences, Bentley University, Waltham, MA, USA
| | - Shurobhi Nandi
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kayla Anderson
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Daphney Mirand
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Beth E Molnar
- Institute for Health Equity & Social Justice Research, Northeastern University, 360 Huntington Avenue, Mail Stop INV 314, Boston, MA, 02215, USA.
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Nayak SS, Tobias C, Wolfe J, Roper K, Méndez-Peñate L, Moulin C, Arty M, Scoglio AAJ, Kelleher A, Rue J, Brigham M, Bradshaw T, Byars N, Camacho A, Douglas S, Molnar BE. Engaging and Supporting Young Children and their Families in Early Childhood Mental Health Services: The Role of the Family Partner. Community Ment Health J 2022; 58:87-98. [PMID: 33641064 PMCID: PMC8732897 DOI: 10.1007/s10597-021-00796-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
This study explores the role of family partners, peer professionals with lived experiences of raising a child with behavioral health needs, and their value in primary and community-care based mental health services for young children aged 0-8 years. Interviews and focus groups were conducted with staff, leadership, and caregiver participants (n = 38) from two early childhood mental health programs and analyzed using thematic analysis. Five interdependent themes emerged: (1) the centrality of lived experience to the family partner role; (2) the importance of the family partner in family engagement and relationship building; (3) the value added by the family partner in navigating systems; (4) the ability of the family partner to build skills and empower caregivers; (5) the role of the family partner in alleviating caregiver stress and other mental health concerns. Adapting and expanding the role of family partners will improve effective mental health care for children and their caregivers.
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Affiliation(s)
- Sameera S Nayak
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Carol Tobias
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Jessica Wolfe
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Amy Kelleher
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | | | | | - Tarsha Bradshaw
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | | | - Angelina Camacho
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Sade Douglas
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Beth E Molnar
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA.
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Meiers SJ, Dyce E, Wieland ML, Patten C, Clark MM, Hanza MMK, Bronars C, Nigon JA, Sia IG. Lay health worker as interventionist training: reflective writing in US family health promotion practice. Health Promot Int 2021; 36:1739-1752. [PMID: 33619566 DOI: 10.1093/heapro/daaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Lay health worker-led health promotion interventions are well received within racial and ethnic minority communities. Increasing numbers of trained lay health workers will be needed to meet global health goals. The purpose of this process evaluation was to gain insights about how lay health worker as interventionists used theory-based approaches within a nutrition and physical activity health behavior change intervention in a clinical trial enrolling immigrant and refugee families. Data were comprised of ongoing reflective writing statements from four health workers about their implementation of the intervention. Using content analysis three themes emerged: (i) encouraging setting of small, family focused and relevant goals, (ii) being flexible in content delivery and (iii) being personally transformed (i.e. gained a sense of meaning from their experience). Lay health worker interventionist reflections on practice revealed they delivered the intervention within the primacy of the family partnering relationship by attending to unique family needs, and adjusting educational content and goal setting accordingly. Our results provide guidance for training and process evaluation of lay health worker intervention delivery in ethnically and racially diverse populations. Incorporating real-time reflection upon what was learned about skills of facilitating family motivation and family confidence enhanced affective learning and may be useful in future research studies and health promotion practice. The processes identified including setting small goals, flexibility and personal transformation could be considered in future lay health worker-delivered health promotion interventions.
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Affiliation(s)
- Sonja J Meiers
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA
| | - Evan Dyce
- Department of Graduate Nursing, Winona State University, Rochester, MN 55904, USA.,Department of Family Medicine, CentraCare, Big Lake, MN 55309, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Rochester, MN 55905, USA
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Carrie Bronars
- Department of Mental Health, Minneapolis Veterans Administration Health Care System, Minneapolis, MN 55417, USA
| | - Julie A Nigon
- Hawthorne Education Center, Rochester Public Schools Rochester, Rochester, MN 55902, USA
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA
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Comparative Case Analysis of the Role of Community Health Workers in Rural and Low-Income Populations of West Virginia and the United States. J Ambul Care Manage 2020; 43:205-220. [PMID: 32467434 DOI: 10.1097/jac.0000000000000335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The rural United States, including West Virginia, has decades of experience engaging communities and utilizing community health workers (CHWs). This study aims to inform policy and planning by comparing how 2 county-level CHW programs engage with communities. The analysis is based on in-depth interviews with 19 community representatives and 20 health workers and archival documents and published literature reviews. Results highlight the local contextual determinants for community engagement with CHW programs. Making CHW policies inclusive and adaptable to local realities will enable more community benefits. Making the value of CHW programs for communities explicit should guide resource allocation and policies.
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Building a Framework for Community Health Worker Skills Proficiency Assessment to Support Ongoing Professional Development. J Ambul Care Manage 2019; 41:298-307. [PMID: 29923846 DOI: 10.1097/jac.0000000000000251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although community health workers (CHWs) continue to gain credibility and recognition in the health care and public health sectors, there is still a need to expand workforce identity and development efforts, including identifying best practices for assessing CHW skill proficiencies. During this qualitative study, we interviewed 32 CHWs, trainers, and supervisors to understand current practice, perspectives, and perceived importance in assessing CHW skills and guiding principles for CHW skill assessment. Results from these interviews can be used to inform CHW workforce development to enhance efforts among those who are actively building CHW programs or who are considering improvements in strategies to assess CHW skill proficiencies.
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Gustafson EL, Atkins M, Rusch D. Community Health Workers and Social Proximity: Implementation of a Parenting Program in Urban Poverty. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 62:449-463. [PMID: 30222866 DOI: 10.1002/ajcp.12274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Community health workers (CHWs) offer a potential means through which to mitigate many of the barriers to mental health services faced by minority youth and their families. The primary aim of the present study was to better understand a core feature of CHWs: their shared community membership with the population served, or social proximity. We conducted qualitative semi-structured interviews with 16 CHWs implementing a school-based early intervention program in Latino and African American communities of urban poverty. The program promoted child and parent/caregiver engagement in schooling as a protective factor for children's mental health. Thematic analyses revealed three main themes defining social proximity: (a) experiences of parenthood or caring for children, (b) familiarity with and understanding of culture, and (c) experiences of life hardships and struggles. Additionally, the process of relating with parents/caregivers through shared experiences was the main theme to describe how CHWs leveraged their social proximity. CHWs' accounts illustrated how their experience of social proximity to the population served was central to how they engaged parents/caregivers in services, highlighting the importance of supporting and promoting CHWs' natural traits and lived experiences.
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Affiliation(s)
- Erika L Gustafson
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Marc Atkins
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Dana Rusch
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
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Molnar BE, Lees KE, Roper K, Byars N, Méndez-Peñate L, Moulin C, McMullen W, Wolfe J, Allen D. Enhancing Early Childhood Mental Health Primary Care Services: Evaluation of MA Project LAUNCH. Matern Child Health J 2018; 22:1502-1510. [PMID: 29909431 PMCID: PMC6153762 DOI: 10.1007/s10995-018-2548-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives The purpose of this study was to evaluate the efficacy of an innovative early childhood mental health intervention, Massachusetts Project LAUNCH. Early childhood mental health clinicians and family partners (paraprofessionals with lived experience) were embedded within community pediatric medical homes. Methods A longitudinal study design was used to test the hypotheses that (1) children who received services would experience decreased social, emotional and behavioral problems over time and (2) caregivers' stress and depressive symptoms would decrease over time. Families who were enrolled in services and who consented to participate in the evaluation study were included in analyses (N = 225). Individual growth models were used to test longitudinal effects among MA LAUNCH participants (children and caregivers) over three time points using screening tools. Results Analyses showed that LAUNCH children who scored in age-specific clinically significant ranges of social, emotional and behavioral problems at Time 1 scored in the normal range on average by Time 3. Caregivers' stress and depressive symptoms also declined across the three time points. Results support hypotheses that the LAUNCH intervention improved social and emotional health for children and caregivers. Conclusions for Practice This study led to sustainability efforts, an expansion of the model to three additional communities across the state and development of an online toolkit for other communities interested in implementation.
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Affiliation(s)
- Beth E. Molnar
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
- Bouvé College of Health Sciences, Institute on Urban Health Research, Northeastern University, 360 Huntington Ave, M/S 314 INV, Boston, MA 02115 USA
| | - Kristin E. Lees
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Kate Roper
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Natasha Byars
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, 250 Washington St., Boston, MA 02118 USA
| | - Christy Moulin
- Boston Public Health Commission, 1010 Massachusetts Ave, Boston, MA 02118 USA
| | - William McMullen
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Jessica Wolfe
- Institute on Urban Health Research, Northeastern University, 360 Huntington Ave., Boston, MA 02115 USA
| | - Deborah Allen
- Los Angeles County Department of Public Health, 313 N. Figueroa St., Los Angeles, CA 90012 USA
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9
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Rahman R, Pinto RM, Wall MM. HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030294. [PMID: 28335444 PMCID: PMC5369130 DOI: 10.3390/ijerph14030294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.
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Affiliation(s)
- Rahbel Rahman
- Department of Social Work, Community of College and Public Affairs, Binghamton University, 67 Washington St, Binghamton, NY 13902, USA.
| | - Rogério M Pinto
- School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI 48109, USA.
| | - Melanie M Wall
- Department of Biostatistics, Columbia University, 722 West 168th St. New York, NY 10032, USA.
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Shelton RC, Dunston SK, Leoce N, Jandorf L, Thompson HS, Erwin DO. Advancing Understanding of the Characteristics and Capacity of African American Women Who Serve as Lay Health Advisors in Community-Based Settings. HEALTH EDUCATION & BEHAVIOR 2017; 44:153-164. [PMID: 27206465 PMCID: PMC5350077 DOI: 10.1177/1090198116646365] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lay Health Advisor (LHA) programs hold tremendous promise for reducing health disparities and addressing social determinants of health in medically underserved communities, including African American populations. Very little is understood about the capacity of LHAs in these roles and the broader contributions they make to their communities. This article seeks to address this gap by describing the characteristics and capacity of a sample of 76 female African American LHAs from a nationally disseminated evidence-based LHA program for breast and cervical cancer screening (The National Witness Project), as well as potential differences between cancer survivors and nonsurvivors who serve as LHAs. A conceptual model for understanding LHA capacity and contributions in underserved communities at the individual, social, and organizational levels is presented. We describe LHA experiences and characteristics (e.g., experiences of mistrust and discrimination, racial pride, sociodemographics), capacity at the individual level (e.g., psychological and physical health, health behaviors), capacity at the social level (e.g., social networks, social support), and capacity at the organizational level (e.g., role-related competencies, self-efficacy, leadership, role benefits/challenges). Data were obtained through interview-administered telephone surveys between 2010 and 2011. Findings highlight the critical capacity that LHAs bring to their communities and the importance of supporting LHAs to sustain these programs and to address racial/ethnic health disparities.
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Affiliation(s)
- Rachel C. Shelton
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 168Street, New York, NY 10032
| | - Sheba King Dunston
- Columbia University, Mailman School of Public Health, Department of Sociomedical Sciences, 722 168Street, New York, NY 10032
| | - Nicole Leoce
- Columbia University, Mailman School of Public Health, Department of Biostatistics, 722 168Street, New York, NY 10032
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, Department of Oncological Sciences, 1 Gustave L. Levy Place, Box 1130, New York, NY 10029
| | - Hayley S. Thompson
- Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, Department of Oncology, 4100 John R - MM03CB, Detroit, MI 48201
| | - Deborah O. Erwin
- Roswell Park Cancer Institute, Office of Cancer Health Disparities Research, Cancer Prevention & Population Sciences, Elm & Carlton Streets, Buffalo, NY 14263
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Mayer VL, Young CR, Cannuscio CC, Karpyn A, Kounaves S, Strupp E, McDonough K, Shea JA. Perspectives of Urban Corner Store Owners and Managers on Community Health Problems and Solutions. Prev Chronic Dis 2016; 13:E144. [PMID: 27736054 PMCID: PMC5063606 DOI: 10.5888/pcd13.160172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Urban corner store interventions have been implemented to improve access to and promote purchase of healthy foods. However, the perspectives of store owners and managers, who deliver and shape these interventions in collaboration with nonprofit, government, and academic partners, have been largely overlooked. We sought to explore the views of store owners and managers on the role of their stores in the community and their beliefs about health problems and solutions in the community. METHODS During 2013 and 2014, we conducted semistructured, in-depth interviews in Philadelphia, Pennsylvania, and Camden, New Jersey, with 23 corner store owners/managers who participated in the Healthy Corner Store Initiative spearheaded by The Food Trust, a nonprofit organization focused on food access in low-income communities. We oversampled high-performing store owners. RESULTS Store owners/managers reported that their stores served multiple roles, including providing a convenient source of goods, acting as a community hub, supporting community members, working with neighborhood schools, and improving health. Owners/managers described many challenging aspects of running a small store, including obtaining high-quality produce at a good price and in small quantities. Store owners/managers believed that obesity, diabetes, high cholesterol, and poor diet are major problems in their communities. Some owners/managers engaged with customers to discuss healthy behaviors. CONCLUSION Our findings suggest that store owners and managers are crucial partners for healthy eating interventions. Corner store owners/managers interact with community members daily, are aware of community health issues, and are community providers of access to food. Corner store initiatives can be used to implement innovative programs to further develop the untapped potential of store owners/managers.
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Affiliation(s)
- Victoria L Mayer
- Department of Population Health Science and Policy, Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY 10029.
| | | | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, and Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Allison Karpyn
- The Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware
| | - Sarah Kounaves
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Strupp
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin McDonough
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judy A Shea
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Diabetes Connect: African American Women's Perceptions of the Community Health Worker Model for Diabetes Care. J Community Health 2016; 40:905-11. [PMID: 25773991 DOI: 10.1007/s10900-015-0011-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Community health worker (CHW) interventions have potential to improve diabetes outcomes and reduce health disparities. However, few studies have explored patient perspectives of peer-delivered diabetes programs. The purpose of this qualitative study is to investigate possible benefits as well as risks of CHW-delivered peer support for diabetes from the perspectives of African American women living with type 2 diabetes in Jefferson County, Alabama. Four ninety-minute focus groups were conducted by a trained moderator with a written guide to facilitate discussion on the topic of CHWs and diabetes management. Participants were recruited from the diabetes education database at a safety-net hospital. Two independent reviewers performed content analysis to identify major themes using a combined deductive-inductive approach. There were 25 participants. Mean years with diabetes was 11.2 (range 6 months to 42 years). Participants were knowledgeable about methods for self-management but reported limited resources and stress as major barriers. Preferred CHW roles included liaison to the healthcare system and easily accessible information source. Participants preferred that the CHW be knowledgeable and have personal experience managing their own diabetes or assisting a family member with diabetes. Concerns regarding the CHW-model were possible breaches of confidentiality and privacy. The self-management strategies and barriers to management identified by participants were reflected in their preferred CHW roles and traits. These results suggest that African American women with diabetes in Alabama would support peer-led diabetes education that is community-based and socially and emotionally supportive.
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Community Health Workers: a Resource to Support Antipsychotic Medication Adherence. J Behav Health Serv Res 2016; 44:341-346. [DOI: 10.1007/s11414-016-9515-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Allen CG, Escoffery C, Satsangi A, Brownstein JN. Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: "A Little Fish in a Big Pond". Prev Chronic Dis 2015; 12:E154. [PMID: 26378900 PMCID: PMC4576500 DOI: 10.5888/pcd12.150199] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction The Patient Protection and Affordable Care Act acknowledges the value of community health workers (CHWs) as frontline public health workers. Consequently, growing attention has been placed on promoting CHWs as legitimate partners to provide support to health care teams and patients in the prevention, management, and control of chronic disease, particularly among diverse populations and high-need individuals. Methods Using a mixed-methods research approach, we investigated the integration of CHWs into health care teams from the CHW perspective. We conducted a survey of 265 CHWs and interviews with 23 CHWs to better understand and describe their experience and their perceived opportunities and challenges regarding their integration within the context of health care reform. Results Feelings of organizational support were positively correlated with the number of CHWs in the organization. CHWs reported the following facilitators to integration: having team meetings (73.7%), training inside (70.4%) and outside of the organization (81.6%), access to electronic health records, and ability for CHWs to stay connected to the community. Conclusion The perspectives of CHWs on their positive and negative experiences offer useful and innovative insight into ways of maximizing their impact on the health care team, patients, and their role as key emissaries between clinical services and community resources.
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Affiliation(s)
- Caitlin G Allen
- Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322.
| | - Cam Escoffery
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Anamika Satsangi
- Emory University, Rollins School of Public Health, Atlanta, Georgia
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Allen C, Brownstein JN, Jayapaul-Philip B, Matos S, Mirambeau A. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships. J Ambul Care Manage 2015; 38:254-62. [PMID: 26049655 PMCID: PMC5304911 DOI: 10.1097/jac.0000000000000085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities.
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Affiliation(s)
- Caitlin Allen
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Allen and Drs Brownstein, Jayapaul-Philip, and Mirambeau); and Community Health Worker Network of New York City, New York (Mr Matos)
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Katigbak C, Van Devanter N, Islam N, Trinh-Shevrin C. Partners in health: a conceptual framework for the role of community health workers in facilitating patients' adoption of healthy behaviors. Am J Public Health 2015; 105:872-80. [PMID: 25790405 PMCID: PMC4386525 DOI: 10.2105/ajph.2014.302411] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/04/2022]
Abstract
We formulated a conceptual framework that begins to answer the national call to improve health care access, delivery, and quality by explaining the processes through which community health workers (CHWs) facilitate patients' adoption of healthy behaviors. In September 2011 to January 2012, we conducted a qualitative study that triangulated multiple data sources: 26 in-depth interviews, training documents, and patient charts. CHWs served as partners in health to immigrant Filipinos with hypertension, leveraging their cultural congruence with intervention participants, employing interpersonal communication techniques to build trust and rapport, providing social support, and assisting with health behavior change. To drive the field forward, this work can be expanded with framework testing that may influence future CHW training and interventions.
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Affiliation(s)
- Carina Katigbak
- At the time of the study, Carina Katigbak and Nancy Van Devanter were with the College of Nursing, and Nadia Islam and Chau Trinh-Shevrin were with the Department of Population Health, School of Medicine, New York University, New York, NY
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Balcazar HG, Wise S, Redelfs A, Rosenthal EL, de Heer HD, Burgos X, Duarte-Gardea M. Perceptions of Community Health Workers (CHWs/PS) in the U.S.-Mexico border HEART CVD study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1873-84. [PMID: 24518646 PMCID: PMC3945574 DOI: 10.3390/ijerph110201873] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 11/16/2022]
Abstract
Although prior research has shown that Community Health Workers/Promotores de Salud (CHW/PS) can facilitate access to care, little is known about how CHW/PS are perceived in their community. The current study reports the findings of a randomized telephone survey conducted in a high-risk urban community environment along the U.S.-Mexico border. In preparation for a community-based CHW/PS intervention called the HEART ecological study, the survey aimed to assess perceptions of CHW/PS, availability and utilization of community resources (recreational and nutrition related) and health behaviors and intentions. A total of 7,155 calls were placed to complete 444 surveys in three zip codes in El Paso, Texas. Results showed that participants felt that healthful community resources were available, but utilization was low and variable: 35% reported going to a park, 20% reported having taken a health class, few reported using a gym (12%), recreation center (8%), or YMCA/YWCA (0.9%). Awareness and utilization of CHW/PS services were low: 20% of respondents had heard of CHW/PS, with 8% reporting previous exposure to CHW/PS services. Upon review of a definition of CHW/PS, respondents expressed positive views of CHW/PS and their value in the healthcare system. Respondents who had previous contact with a CHW/PS reported a significantly more positive perception of the usefulness of CHW/PS (p = 0.006), were more likely to see CHW/PS as an important link between providers and patients (p = 0.008), and were more likely to ask a CHW/PS for help (p = 0.009). Participants who utilized CHW/PS services also had significantly healthier intentions to reduce fast food intake. Future research is needed to evaluate if CHW/PS can facilitate utilization of available community resources such as recreational facilities among Hispanic border residents at risk for CVD.
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Affiliation(s)
- Hector G Balcazar
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - Sherrie Wise
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - Alisha Redelfs
- School of Public Health, University of Texas Health Science Center, Houston, El Paso Regional Campus, 1101 N. Campbell CH 410, El Paso, TX 79902, USA.
| | - E Lee Rosenthal
- Project on Community Health Worker Policy and Practice, Institute for Health Policy, University of Texas School of Public Health, c/o El Paso Regional Campus, 1101 N. Campbell, CHS 410, El Paso, TX 79902, USA.
| | - Hendrik D de Heer
- Department of Physical Therapy and Athletic Training, Northern Arizona University, P.O. Box 15105, 208 E Pine Knoll Dr., Flagstaff, AZ 86004, USA.
| | - Ximena Burgos
- Department of Public Health Sciences, The University of Texas at El Paso, 500 W. University Ave., El Paso, TX 79968, USA.
| | - Maria Duarte-Gardea
- Department of Public Health Sciences, The University of Texas at El Paso, 500 W. University Ave., El Paso, TX 79968, USA.
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Lees S, Kielmann K, Cataldo F, Gitau-Mburu D. Understanding the linkages between informal and formal care for people living with HIV in sub-Saharan Africa. Glob Public Health 2012; 7:1109-19. [PMID: 23116123 DOI: 10.1080/17441692.2012.733403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In response to the human resource challenges facing African health systems, there is increasing involvement of informal care providers in HIV care. Through social and institutional interactions that occur in the delivery of HIV care, linkages between formal and informal systems of care often emerge. Based on a review of studies documenting the relationships between formal and informal HIV care in sub-Saharan Africa, we suggest that linkages can be conceptualised as either 'actor-oriented' or 'systems-oriented'. Studies adopting an actor-oriented focus examine hierarchical working relationships and communication practices among health systems actors, while studies focusing on systems-oriented linkages document the presence, absence or impact of formal inter-institutional partnership agreements. For linkages to be effective, the institutional frameworks within which linkages are formalised, as well as the ground-level interactions of those engaged in care, ought to be considered. However, to date, both actor- and system-oriented linkages appear to be poorly utilised by policy makers to improve HIV care. We suggest that linkages between formal and informal systems of care be considered across health systems, including governance, human resources, health information and service delivery in order to improve access to HIV services, enable knowledge transfer and strengthen health systems.
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Affiliation(s)
- Shelley Lees
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Abstract
Drawing from role theory, this study sought to explore the effects of assuming a new role on Latina community health workers (CHW) participating in a cervical cancer prevention program in a new Latino immigrant community located on the East Coast of the United States. Through a series of in-depth, Spanish language interviews with the 4 participants, the researchers explored the process and effects of assuming and enacting the CHW role through a narrative analysis approach. Themes that emerged from the analysis included “Reasons for becoming a promotora,” “Vision and reality of the role,” “Structuring interactions: The hierarchy of knowledge transmission,” and “Transforming identities.” Findings showed that assuming the CHW role had transformative effects on the participants that, in the end, allowed them to reconcile disparate aspects of their own immigrant identities. The findings have multiple implications for designing prevention programs employing CHWs and immigrant community strengthening.
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Affiliation(s)
| | - Matthew J. O’Brien
- Temple University School of Medicine, Philadelphia, PA, USA
- Puentes de Salud Community Clinic, Philadelphia, PA
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Pinto RM, da Silva SB, Soriano R. Community health workers in Brazil's Unified Health System: a framework of their praxis and contributions to patient health behaviors. Soc Sci Med 2012; 74:940-7. [PMID: 22305469 PMCID: PMC3299536 DOI: 10.1016/j.socscimed.2011.12.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 12/02/2011] [Accepted: 12/08/2011] [Indexed: 02/03/2023]
Abstract
Community health workers (CHWs) play a pivotal role in primary care, serving as liaisons between community members and medical providers. However, the growing reliance of health care systems worldwide on CHWs has outpaced research explaining their praxis - how they combine indigenous and technical knowledge, overcome challenges and impact patient outcomes. This paper thus articulates the CHW Praxis and Patient Health Behavior Framework. Such a framework is needed to advance research on CHW impact on patient outcomes and to advance CHW training. The project that originated this framework followed community-based participatory research principles. A team of U.S.-Brazil research partners, including CHWs, worked together from conceptualization of the study to dissemination of its findings. The framework is built on an integrated conceptual foundation including learning/teaching and individual behavior theories. The empirical base of the framework comprises in-depth interviews with 30 CHWs in Brazil's Unified Health System, Mesquita, Rio de Janeiro. Data collection for the project which originated this report occurred in 2008-10. Semi-structured questions examined how CHWs used their knowledge/skills; addressed personal and environmental challenges; and how they promoted patient health behaviors. This study advances an explanation of how CHWs use self-identified strategies--i.e., empathic communication and perseverance--to help patients engage in health behaviors. Grounded in our proposed framework, survey measures can be developed and used in predictive models testing the effects of CHW praxis on health behaviors. Training for CHWs can explicitly integrate indigenous and technical knowledge in order for CHWs to overcome contextual challenges and enhance service delivery.
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Affiliation(s)
- Rogério M Pinto
- Columbia University School of Social Work, 1255 Amsterdam Avenue #806, New York, NY 10027, USA.
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Balcazar H, Rosenthal EL, Brownstein JN, Rush CH, Matos S, Hernandez L. Community health workers can be a public health force for change in the United States: three actions for a new paradigm. Am J Public Health 2011; 101:2199-203. [PMID: 22021280 PMCID: PMC3222447 DOI: 10.2105/ajph.2011.300386] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2011] [Indexed: 11/04/2022]
Abstract
Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the roles of CHWs to enable them to become collaborative leaders in dramatically changing health care from "sickness care" systems to systems that provide comprehensive care for individuals and families and supports community and tribal wellness. We recommend drawing on the full spectrum of CHWs' roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness. We also urge that CHWs be integrated into "community health teams" as part of "medical homes" and that evaluation frameworks be improved to better measure community wellness and systems change.
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Affiliation(s)
- Hector Balcazar
- Health Science Center Houston, El Paso Regional Campus, University of Texas School of Public Health, El Paso, 79968, USA.
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