Meeting with Dr. Wells 7/3/15

We met with Dr. Wells today to discuss how our research is progressing and what we can do to get the most out of this project from an academic standpoint. Dr. Wells has been awesome at encouraging us to make the most of this experience. She obviously wants us to be in line with the overarching goals of the Global Health at Home project, but she also wants us as students to make this a valuable learning experience. Here's some of the things we talked about:

• GSP funding: small amount available to help with publication fees and poster printing
• Other funding: for our project this fall - CGH? Emergency department through Dr. Burt?
• This will be important if we want to travel to do site interviews
• Publishing: Dr. Wells will help with the editing, formatting, and submission processes
• Make a list of journals, we can start by looking at journals we cite frequently
• M&S goal: Methodology and Results by Aug 3, everything else by Aug 31
• What to expect: initial review to see if it's right for the publication, then formal review and either accepted, accepted with revisions, or denied
• Student research: Dr. Wells had a great idea that we should try to share our research methods, especially on topics like medical students working together and with undergraduate students
• Forums to share this: Med-Ed poster presentation every year (will look up date), also Vitals magazine, maybe some others? 
• Maybe present to the GSP students in the spring
• This can also be written up and published, but not sure where?

Next Steps:

- Meet with Dr. Keeley

- Meet with Dr. Burt and Dr. Luna

- Write up 1 page summary of new project background research (tentatively Aug 31)

- Write up Methodology/Results by Aug 3

Scheduling notes:

- Melissa on PICU ACE in July

- Steven on Family Medicine ACE in Aug

Literature Review Support from UVA Health Sciences Library

Today we met with Ms. Karen Knight, our wonderful librarian who shared many insights with us on searching the available literature. We are doing a literature search relating to CHW curriculum development and general implementation of programming.

• Today we reviewed the use of OVID and MeSH terms to make sure that we have been performing an adequate search of the literature.
• Karen also shared a website for us called Web of Science. During our review of literature, if we a few articles that we particularly like, we can type in the information to this site. Once we find these articles in this database, we will be able to see any other papers that have cited it. This will help us dig deeper and potentially find other articles. Web of Science can also be used for general search.
• Karen also walked us through the use of RefWorks. This website allows us to easily document and record the sources that we review. We can use this program to easily create a bibliography. It will also be very helpful when we are typing any write-up or paper as we can use this program with Microsoft Word to easily cite sources.
• Other items that we discussed include the use of interlibrary loan, single cite matcher included with pubmed, and HubMed (which allows us to easily upload previously search sources onto RefWorks).

This meeting will be invaluable as we move forward with further review of the literature regarding CHWs. We will continue our literature review for the next few weeks and plan to summarize what we find in brief write-ups. 

Lit review update

Steven and I have been doing a LOT of reading about CHW training programs. Not going to copy/paste the 20 pages of notes we have, but just wanted to make a note here about some overarching themes that we're seeing repeated.

Search terms: “Community health worker” + “curriculum”, “training” + “United States”

Common themes in curriculum design:

• based on community-identified needs (we have this from 2013!)
• CHW input for where gaps in education are (we have this too - Spencer 2014!)
• core competency for all CHW + specific modules depending on local health needs
• need for constant evaluation and CHW input in courses
• adult learning styles: interactive, role-playing, learning through doing, less emphasis on didactics
• learning resources: training book, but also simpler resources/handouts to use with community members

Identifying paracurricular topics - from past research

COMMON THEMES: coded by color as below

• Language Competency
• Health system navigation (UVA and community): services, documentation issues, payment
• Skills training (ongoing): BP, RR, HR, temp, height, weight, glucometer, motivational interviewing
• Health topics: Dental care, Respiratory problems (asthma, COPD), Gynecologic cancer (cervical), heart disease (HTN, HLD), mental health / addiction , Diabetes
• or colon cancer??
• Career Development

Is it possible to represent all of these themes in each lesson?

Thoughts from Burt meeting

• Importance of English classes

• Career development opportunities - CV, resume, etc
• Retraining, skills practice
• UVA Health System Navigation

Thoughts from Spencer/Natasha’s notes:

• lots of enthusiasm, desire for a more organized and active program
• English classes
• lots of experience in foreign health systems (good bridge??)
• inactive program → lapse in skills over time, need continuing experience and practice
• some need for institutional/financial support
• importance of strong leadership and program structure
• some desire to eventually work in healthcare (ex as CNA), could benefit from English and career development help
• Core competencies (VA CHW Task Force): health promotion/prevention, outreach & advocacy, service coordination, health and data collection knowledge, professionalism
• TJ Health District CHW program: basic health knowledge, health promotion, and navigation of care & services
• Promatores Program
• 3 courses: comprehensive, diabetes (grant), breast cancer (grant)
• Outreach events: education, vital signs (BP), mammography referrals, Tdap vaccinations
• Educational enrichment for CHWs - “challenging program… sense of certification” - Hannah Showalter
• need for CHW “support system,” revitalize and incentivize program without financial compensation
• CHW close connections with physicians and pharmacists can help ease referrals
• how to deal with financial/documentation issues

Thoughts from Steven’s research:

• biggest health problems: dental, mental health, diabetes
• barriers to care: language, transportation, documentation

Thoughts from Melissa’s research:

• biggest health problems: diabetes, respiratory, heart disease, cancer, alcohol
• barriers to care: insurance, documentation, language
• top health care providers: UVA, Free Clinic, WIC/Social Services

Thoughts from 2007 Southwood survey (Linda Hemby):

• Top health problems: dental, chronic pain, GI, respiratory, gynecologic
• >70% use UVA for health services
• 7.5% adults, 56% of children have insurance (Medicaid)
• Asthma is a huge problem in children, so is dental
• Adults: dental, resp problems, CV risk factors (HTN, HLD), DM
• lack of awareness of Medicaid coverage, how to work with translators, how to apply for programs
• useful places for interventions: church, laundromats, Latino grocery stores and restaurants, community spaces (ex in Southwood), home visits
• Churches: Word of Faith, Casa del Padre, Iglesia Canaan, Church of the Incarnation

GHAH Research Proposal

Background/Previous work

In the state of Virginia, the Latino population has grown by 92% in 10 years, earning recognition as one of the “New Latino States” by the Pew Hispanic Center. Locally, the US Census shows that the Latino populations of the City of Charlottesville and Albemarle County have nearly doubled in size from 2000 to 2010. In the summer of 2013, we undertook a project to evaluate the health needs and available resources of the Latino population in Charlottesville. The project was two-pronged, involving 1) structured interviews with local health and social service providers and 2) surveys of Latino residents about health priorities and perceived barriers to care. This project illuminated a number issues related to health care of the Latino population in the Charlottesville area. Firstly, it appears that community members and health care providers have some significant areas of disagreement in terms of perceived priorities and barriers. Secondly, while the study identified many health-associated organizations with specific programs for Latinos, the local health care network was fragmented and demonstrates a lack of inter-organization communication and cooperation. Following presentation of this data to the stakeholders, a working group was convened drawing from UVA and community organizations including the Promotores de Salud. The working group aimed to unite local organizations working on Latino health issues and brainstorm a cohesive plan of action to reduce health disparities in the Charlottesville/Albemarle Latino community. Ultimately, a joint decision was made to revitalize the Promotores program using the combined resources and expertise of all of the working group partners.

Rationale:

The Charlottesville area Promotores program has existed since the 1990’s, although changes in funding and leadership in the last 5 years have rendered the program largely dysfunctional. The Promotores report a strong desire to continue their work as community leaders, although several issues stand in their way such as lack of English skills, lapse in skills and knowledge over time, and unavailability of compensation. As the Thomas Jefferson Health District seeks to re-vitalize the CHW program, UVA would like to play a role in developing a para-curriculum. This would be designed to complement, not replace, the existing Health Department curriculum by focusing on overarching skills such as English language acquisition and healthcare navigation. To ensure the success of this new undertaking, we must ensure that the program has a solid foundation in best practices for both CHW training and university-community program implementation.

Hypothesis/Research Question:

The purpose of this study is to investigate the current best practices in CHW program implementation and training in order to design and implement an effective and culturally-competent para-curriculum for local Promotores.

Our specific aims are as follows:

1. To conduct a thorough search of the literature regarding the philosophy and existing curricula for CHW training.
2. To identify and investigate model university-community partnerships in CHW program implementation.
3. To disseminate the data derived from this study with the para-curriculum working group.

Methodology:

1) Describe the site including mentors and available resources/services.

We will work closely with Dr. David Burt (Emergency Medicine) and Dr. Max Luna (Cardiology)  as our primary coordinating mentors. We will also be working closely with Dr. Kristen Wells (Department of Public Health Sciences). We will be visiting different sites around the country with well established CHW programs. In Charlottesville we will work closely with the Thomas Jefferson Health Department and the CHW working group.

2) Describe the population that you will be working with.

We will work with a diverse group of individuals who are a part of the CHW program at each respective site. This will include program coordinators, program instructors, community health workers, and individuals who have played a role in the development of each program. All of these communities will be representative of a university-community based CHW program. Because we do not plan to interview patients or access HIPAA-protected materials, this study does not require IRB approval.

3) Describe the methodology that you will use to collect data.

Melissa Ogden and Steven Nguyen will work together to conduct this study. During the first 2 weeks, we will conduct our literature review regarding the philosophy and curricula of CHW programs In addition, we will design a survey instrument that will help us to evaluate these programs in regards to program implementation and CHW training. Once we have developed our survey, we will identify programs that will serve as our site of research. The the last two weeks will be spent interviewing individuals from these programs in addition to performing preliminary qualitative analysis.

4) Describe your planned analysis of the data.

This study will generate primarily qualitative data, although some quantitative data about the programs (ex. number of CHWs) may also be collected. Interviews will be recorded and transcribed, and subsequently coded for recurrent themes which can be compared across programs. The results of this study will be analyzed with the help of Dr. Kristen Wells and the Generalist Scholars Program.

5) Briefly discuss alternative strategies to address your hypothesis in the event that your initial plans are untenable.

If it is not possible to schedule and conduct all of the site visits during this limited time period, we plan to conduct phone and video interviews with stakeholders from the various university-community partnerships.

Expected Outcomes:

First, this study will inform the restructuring and formation of the community health worker promotores de salud program at the Thomas Jefferson Health department. We believe that through evaluation of these programs, we will glean information regarding organizational structure, including participant recruitment/retention, training, program evaluation, and funding. Second, this study will provide information regarding best practices involved in the implementation of a community health worker program that is integrated into the wider healthcare system. Ultimately, this study will lead to the development of a revitalized, sustainable promotores program that will empower promotores to advocate for our community.

Dr. Luna Meeting 6.16.15

Meeting notes with Dr. Luna:

• ​​Community health worker (promoters de salud or CHW): General idea is to help develop an advanced training and empower CHWs 
  • Skills that the CHWs need to be advocates for patients: English language, navigation, how to speak with a health care provider etc
  • A defined skill set should be developed. Promotores should not take the place of a physician
  • Curriculum should work backwards from defined skill set to specific learning objectives
• ​​Spencer Moore performed extensive interviews with current and past CHWs. From his final report, UVA-GI started meeting with key organizations and stakeholders like Crescendo Juntos, Sin Barreras, and the Health Department on how to go about restoring the network of CHWs.
  • From this collaboration, the idea of a new para-curriculum that would complement the basic CHW training was proposed
• ​​​​​​Health department: There is currently a committee about the CHW initiative and there is a subcommittee that focuses on latino CHWs
  • Putnam Ivey is now the person who is leading the CHW training at the health department. She is bilingual with a lot of ideas and energy that will be helpful as we begin re-building the network of Latino CHWs.
  • ​​​We hope to invite about 15-20 CHWs past and present (those who recently complete the basic course) to take part in the advanced training.
• ​There are other health systems that have strong CHW programs: University of Pennsylvania, University of Maryland, University of Texas, program in Seattle, program in Chicago
  
  • It would be beneficial to learn from these programs
    
  • Possible project would be to do field work at one of these locations to learn about the programs and to learn best practices
• ​Melissa and Steven will do background research on CHW. 
• All agree that having amazing list where we share new research and articles with stakeholders involved will be helpful.
  
• At the free clinic, Dr. Luna has started a Latino clinic one evening a week. The hope is that eventually latino patients can be part of a  regular clinic with the help of CHWs.
• not just providers, but bilingual front desk staff, nurses, medical students, etc to ensure door-to-door bilingual service
• CHW can follow up with patients after seeing a physician, ex. for HTN check after starting a new medication
• physician-CHW communication and trust is key here!
• Mapping: add to maps designed by Ariel in 2013
• Ideas from 2013: add service providers, bus routes
• Idea from Dr. Luna: add CHW so we can see who lives closest to a particular patient who needs extra supervision

And we're back! Meeting up with Dr. Burt

Hello everyone!

After going through third year of medical school and a few board examinations, we are back to continue our research. After an intensive year of clinical work, the fourth year of medical school gives us more time and opportunities to pick up where we left off.

We wanted to document one of our first meetings with Dr. David Burt, our research mentor. Based on our research from the summer of 2013, we found that it could be beneficial to have highly trained and skilled health promoters who would be able to help individuals navigate the health system at UVA. We discussed the potential development of a para-curriculum that would add to the community health worker training that is already provided through the health department. We plan to perform background research on effective navigators and curricula. From this research, we will develop a survey instrument that would gauge the opinions and thoughts of local organizations and community members. We believe that this will help us create a thoughtful and informed curriculum that will address the specific needs of the Charlottesville community.

We outlined our plan of attack for the next few months.

• June/July: Melissa and I will review our past projects and cap off any loose ends we have from our previous research. We plan to work with our GSP research mentors to refine this data. This will help build a foundation for the next steps of our research. We will also plan to meet with Dr. Max Luna, another mentor who has spent a considerable amount of time working with local Latino communities in Charlottesville.
• July - August: During these months, we will be doing an academic literature review of different curricula to train high quality navigators and promoters.  We hope to enlist the help from one of our librarians at the health system library to make sure we are able to learn from previous programs and attempts. We also plan to informally meet with key individuals who would help guide the creation of our research instruments.
• September - October: Project proposal for M4 elective and IRB application will be sent in ideally on September 1st. We will also begin to develop our survey instruments to distribute to community organizations and members in regards to the potential creation of a para-curriculum.
• November: The month of November is our dedicated research time to implement our surveys. 
• December - Spring 2016: We hope that our data will be helpful as we think about creating a curricula for the development of trained health promoters/navigators. 

Melissa and I are excited for the next steps in the Global Health at Home initiative. Until next time!

-Steven Nguyen