Latino Community Health Workers Linking Latino Children to

Latino Community Health Workers: Linking Latino Children to Health Services Anel Mercado, Health Educator/Promotor Coordinator Public Health-Seattle & King County, Seattle, WA 98104 Introduction Results In early 2007, King County Executive Ron Sims, the King County Council, and community partners established Children’s Health Initiative (CHI) to identify and enroll children in Medicaid and CHIP. About 15, 000 children were estimated to have no health coverage (4. 4% of all children in the county). The CHI uses culturally-tailored community-based outreach approaches, such as the Promotores de la Salud de los Niños Program, which is composed of volunteer Latino community health workers. The Promotores were trained as health navigators to work within their own Latino communities to enroll uninsured children into public health coverage and assure that they received medical and dental care. The CHI Promotores Program began in May of 2007 and 39 Promotores have been trained since then, 28 of whom continue to actively participate in the program to varying degrees. Though the majority of Promotores are women, there are two men in the CHI Promotores Program. The volunteers receive reasonable reimbursement of expenses they incur while serving as volunteers in the form of gift cards. The Promotores also refer families to other CHI outreach workers, when appropriate, for assistance with other programs, such as, Basic Food, Energy Assistance, and the Breast & Cervical Health Program increasing the visibility of outreach efforts. PROMOTOR PROGRAM DATA: From May 2008 through September 2009: “The training we receive has helped us to improve our skills. I think that even though we may think that we do not know too much because we did not attend school, with all these trainings we are getting the support to keep working and it is helping us to know that we can do many things. ” –CHI Promotora • 304 children applied for publicly-funded health coverage • 249 children enrolled in publicly-funded health coverage. • 595 children connected to medical and/or dental homes. * *A medical home is a regular source of healthcare, rather than the emergency room, and a dental home refers to a regular dentist. . FOCUS GROUP DISCUSSIONS: Successful Strategies § Promotores have success in reaching families who are often on periphery of the health system because they are part of the Latino community in which they volunteer. § Promotores primarily use personal networks to locate eligible children, which include, family, friends, neighbors, schools, churches, neighborhood apartment complexes, and word-of-mouth referrals. § Promotores help families to navigate the complexities of publicly funded agencies that oversee the medical programs and the healthcare system in this country. Figure 2. Promotores receive ongoing training that occurs every two months and they participate in the Washington CHW Network’s quarterly trainings. Personal Benefits for Promotores • "The cornerstone of [Promotor(a)] programs is the recruitment of community members who possess an intimate understanding of the community's social networks as well as its strengths and its special health needs. " -National Community Health Advisor Study Materials and methods We tracked the number of newly enrolled children in Medicaid and SCHIP in 2008 and 2009 by Promotores and those connected to a doctor and/or dentist. Additionally, focus group discussions were conducted with Promotores to ascertain the strategies they employ to successfully connect with families, the intangible benefits that program participation offers to them and the challenges that the community faces. Program evaluation consisted of conducting three focus group discussions with CHI Promotores. Lessons Learned Figure 1. CHI Promotoras and their families, assisting at the Apple Health kick-off event hosted by the CHI on July 31, 2008. Promotores value learning about the health benefits for which they are eligible and helping other in their community to become informed about those benefits. • Promotores, the majority of whom are low-income women with little previous professional work experience, report a new sense of pride and accomplishment and increased self esteem as a result of their participation in the Promotores Program. • Promotores value the opportunity for personal and professional development and opportunities to learn. • Promotores appreciate contributing to the financial health of their own families through the gift cards, which they receive as reasonable reimbursement for expenses they incur while serving as volunteers. “We can help our community and people we know, but it is also helping us in our personal lives. It is helping our kids…It is giving us more confidence, because we are learning how to work better with people, how to deal with many confidential issues that are very personal. People trust us. ” • Promotores find that many families still encounter persistent system wide discrimination while trying to apply for publicly funded benefits and services. • Promotores’ credibility and role is enhanced in their community with agency support, such as formal introductions to community partners and at community events. As well as, equipped with the proper identifiers and materials, such as, badges, flyers, and business cards. • Promotores overwhelmingly concurred that a Program Coordinator has to have certain characteristics and someone who is both fluent in Spanish and Latina is essential to program success. “I think it’s important that she recognizes that we are trying to improve our lives, that she is able to see what each of us has inside, not just the outside, she understands what everyone needs…” “she is also Latina who knows our culture, who knows the difficulties we have…about our experiences of racism, or not being accepted” “she has a lot of education, tells a lot of her, and she always treats us equal…always willing to share her expertise with us” –CHI Promotores Figure 3. Promotores play important roles at Health Fairs that are organized specifically for the Latino community. –CHI Promotora Literature cited Rosenthal, E. L. , Wiggins, N. , Brownstein, J. N. , Rael, R. , Johnson, S. , & Koch, E. et. al. (1998). The final report of the National Community Health Advisor Study: Weaving the future. Tucson, Arizona: University of Arizona, Health Sciences Center. Public Health-Seattle & King County. 2008 and 2009. Children’s Health Initiative Annual Measurement & Evaluation Report. Seattle, WA. Acknowledgments For further information At Public Health-Seattle & King County, I thank Susan Johnson for program leadership, Lisa Podell for program management, Carol Allen for always having a solution, Susan Thompson and Kirsten Wysen for evaluation and presentation help, Penny Lara for her constant support, and Aida Mengistu for general assistance. I thank the CHI Access and Outreach team for their support of the Promotores and the families they help. A special thanks to Lilia Gomez for her assistance with the evaluation of the Promotores Program. Please contact anel. mercado@King. County. gov for more information about the Promotores Program and information about the King County Children’s Health Initiative can be obtained at www. kingcounty. gov/healthservices/health/partnerships/kchap/chi