Expanding Access to Care through Community Health Workers Podcast Transcript - [Intro Narrator] Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast. This is where we connect you to public health topics and issues, as well as with colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning in to this episode, which is a collaboration between the Institute for Public Health Practice, Research, and Policy, and the Prevention Research Center for Rural Health at the University of Iowa College of Public Health. Please note that this episode has been reformatted from its original webinar recording. - [Tricia Kitzmann] Welcome to today's webinar, Expanding Access to Care through Community Health Workers, organized by the Institute for Public Health Practice[, Research,] and Policy at the University of Iowa College of Public Health in partnership with the Midwest[ern] Public Health Training Center and the University of Iowa Prevention Research Center for Rural Health. Today's objectives are to examine the role of community health workers in improving healthcare access and quality of care, identify communities that face greatest challenges in accessing care and how community health workers help address these challenges, explore partnerships and strategies to enhance resources to support systems for community health workers and communities they serve. I'm Tricia Kitzmann. I'm faculty here at the University of Iowa College of Public Health. I work with the Institute for Public Health Practice, Research, and Policy at the University of Iowa College of Public Health. I have been doing these webinars now, it feels like forever, so I am excited to be wrapping this one up for this semester. I will pause throughout the webinar today to make sure we get your questions answered. We have two wonderful experts with us today, so I wanna make sure, those of you that are participating, we get your questions answered. I'll have our guests introduce themselves real quick, and then we will get started. - [Kaitlin Emrich] I can go first. My name's Kaitlin Emrich. I'm the public health director at Black Hawk County Public Health out of Waterloo. - [Deb Kazmerzak] Good afternoon, everyone. I'm Deb Kazmerzak, and I work for HealthTeamWorks. - [Tricia] Wonderful. Well, we are both excited to have you on board today and excited to learn about your expertise when it comes to community health workers. Can you share just a little bit more about your background, your current role, what inspired you to work or advocate for community health workers in your community? Kaitlin, you wanna kick us off? - [Kaitlin] I sure can. I've worked in governmental public health most of my public health career, just over 15 years. I've worked in public health at either the local or a brief time at the state level. My current role, as I mentioned, is public health director. I've been in this role for a few years now. I've lost track of my exact anniversary, but it's been a few years, and I've been at Black Hawk County for coming up on four years. It'll be four years this winter, so. What inspired us and me to work with or advocate for community health workers, it was actually an initiative that was already started when I joined Black Hawk County. The former public health director, Dr. Cisse Egbuonye was the one that started our community health worker journey and really advocated for hiring two community health workers during the COVID-19 pandemic. And that was really in response to being able to serve populations that were disproportionately being impacted by COVID at that time. And we can talk a little bit more about that later, but then when I joined Black Hawk County, we've added a third community health worker since then. - [Tricia] Wonderful. Deb, I'll turn it over to you. - [Deb] Yeah, so, you know, my personal interest, I think, in community health workers probably started around 2015. At that time, I was working at the Iowa Primary Care Association, which represents the federally qualified health centers in Iowa. And we also managed a statewide safety net collaborative, which was really a mix of provider types from around Iowa focused on safety net issues. And we brought in a community health worker program from Minnesota. And, you know, it just hooked me, I think, the concept. And I'm a social worker by background, and I've done a lot of work over the years, both on the human services side of things, and then, when I went to the Primary Care Association, on the health or public health side of things. And to me, community health workers are a perfect bridge between those systems and really between all kind of systems. They really become expert in navigating all kinds of services systems and blur those silos and those lines between those systems. And so to me, community health workers just make the most sense in the world as far as making care more accessible and thinking broadly about what healthcare is and what healthcare means. - [Tricia] Wonderful. So tell me a little bit more about your organization and how it supports community health workers or utilizes their services to reach your community partners, or your community members. - [Kaitlin] So what Deb just mentioned is what I have in my talking points as well. We really define community health workers as a bridge from the community to the public health system, whether they're linking to healthcare, to food access, to housing, to employment, to transportation, whatever it is in that community health system that that population needs help with, that's what our community health workers are tasked with doing. We know they're a proven model for improving health among community members and our community health workers are really culturally specific. And so we know that they're a proven model for providing that culturally-appropriate public health services that can work with our community members to build trust and bring the lived experiences that they have to the individuals that they're working with to better connect with care and really focus on those health outcomes long term. - [Deb] And HealthTeamWorks is a small nonprofit, which is actually based in Colorado but has a presence in Colorado and Iowa, Nebraska and Kansas as well, and Missouri. And really, that organization has been around for quite a long time. I don't know exactly, to tell you the truth. 15 years or more. And they, historically, have worked primarily in healthcare and working with healthcare practices around transformation efforts. So they have training programs, they do consulting, they've worked on a number of, good number of CMS initiatives all around transforming healthcare to make it more accessible, more culturally relevant, and just more appropriate and more available to patients from all stripes. We merged with Iowa Chronic Care Consortium, which is where I used to work, the beginning of last year, and the CHW work is primarily what I do. It was really a nice way to blend the two organizations. The community health worker initiatives and training programs that we developed with Iowa Chronic Care Consortium fit beautifully into, really, the mission of HealthTeamWorks. And so my role is mostly around community health worker training and initiatives with HealthTeamWorks, but the organization does work beyond that as well. - [Tricia] Wonderful. I think you both have kind of touched on this, but I wanna make sure if there's anything else you would like to share. What are some of the current projects your organization is involved in to engage the community health workers? Kaitlin, I think I've heard a rumor that Black Hawk County is in the process of maybe creating a video that will be released later on this year. You wanna share a little bit more about that? - [Kaitlin] Yes. One of the things we're currently working on in partnership with the College of Public Health and Iowa Health and Human Services is to highlight community health workers. It's a day in the life of a community health worker video, and it'll help people that aren't familiar with a community health worker, what they do on a day-to-day basis and the kind of impact that they can have in the community. So stay tuned for that video to be coming out soon. - [Tricia] Wonderful. - [Deb] And I would just say we're a little more removed from the day-to-day work with CHWs as a training program, but there is an opportunity that I would love to push out there today, and that is the Iowa Community Health Worker Alliance. That is a loosely-knit group that is co-led between HealthTeamWorks and Iowa Health and Human Services and is quite a large mix of organizational types and community health workers. And we would love, love, love to have more community health workers involved in that. It's more of a policy and informational group. So it's not a group of CHWs for CHWs necessarily, it's more about the policy discussion and what could the state of Iowa do to promote, educate, involve community health workers in meaningful ways, what should the state do as far as developing infrastructure to support CHWs and that kind of thing, so. That's probably the most direct work with and involving community health workers that we're involved in. Although I will say, I'd love to hear about what organizations are doing to support CHWs, and I love to talk to CHWs and hear what they're up to. And so just try to have a good feel for what's going on in the state of Iowa. But there's always more to learn for sure. - [Kaitlin] And I would just add, I talked about the video, but I didn't talk about all the things that our community health workers work on. And so in preparation for today, I started to make a list. And admittedly, there's things that aren't on my list, but some of the things I wanna highlight include probably our most established and ongoing projects that our community workers are leading is a community garden project, working with specifically refugees and immigrants that are looking to establish gardening here in Black Hawk County. And so that's been going on for several years, and we've done a lot of sharing about that over the years. Other things that our community health workers focus on or that have been, you know, either one-time highlighted or ongoing events include doing mental health education. Many individuals in the refugee and immigrant population aren't familiar with the concept of mental health. And so introducing them to that concept and emotional wellbeing and, you know, promoting some resources that are helpful when it comes to that. We do quite a bit of partnering with other organizations for community education on a wide variety of topics, whether that's connection to employment or housing or transportation or whatever that is. We're working with other community partners constantly. Our community health workers also work with our communications team to provide culturally-relevant public health education and public health communication for our population. A lot of times, that's provided over a video or it's provided through our WhatsApp or other social media platforms that are specifically in other languages. Our community health workers also do nutrition education, assist our communicable disease prevention teams, assist our oral health teams or clinic teams. They're working with all of our public health services all the time. - [Tricia] Sounds like they have their hands in a little bit of everything. They really get- - [Kaitlin] That's true. - [Tricia] - the true meaning of public health. That's awesome. What are some of the most pressing challenges and barriers related to accessing healthcare in the communities you work with? - [Deb] I would just quickly say, not working directly in the community, but having talked with some CHWs in recent months, I mean, I would just say immigration fears are front and center right now, and people are avoiding accessing healthcare because of that. So that's a very current one. - [Tricia] Absolutely. - [Kaitlin] Yep. I would agree with Deb on that. We're actually doing some adjusting and pivoting to be able to provide additional resources when it comes to the immigration fears and, you know, withdrawing, I guess, from services due to fears related to that. I would say another, you know, the top reason for community health workers being established with our organization was language barriers. As I mentioned, all three of our community health workers are working with specific populations that oftentimes do not speak English, and so that's really at the top of the list as well, is assistance with, or assisting populations that have language barriers or limited English. And then also, we're local public health. So we do a community health assessment and a community health improvement plan. And the things that came to the top of the list for our community health improvement plan are also the same things that our community health workers are assisting our community members with. And those include transportation barriers, housing, economic stability. You know, as a comprehensive community health improvement plan, those are all captured in that. And then I would just add misinformation and mistrust. This is something that we, you know, are working with, all of our, all of our public health staff are working on misinformation and mistrust, but this is really something that our community health workers focus on as well. - [Tricia] Wonderful. So a lot of programs going on, a lot of concerns with access. We talked a little bit about some of the fear of refugee immigration, those populations, but I'm sure there's more. Which populations are you guys seeing face the highest risk for poor health outcomes and greatest barriers to accessing care in their specific communities where they both intersect? - [Deb] I'll let Kaitlin field that one. - [Kaitlin] Yeah, that's totally fine, Deb. This is a complex question really, because it depends on the health outcome that we were talking about in terms of what population is at risk for poor health outcomes. But I will say our approach for community health worker efforts are focused on the intersection of those two. They're focused on the immigrant and refugee populations because they do experience both barriers to care and disproportionate health outcomes in some areas. Now, depending on, you know, the health outcome, that population of focus may be a little bit different, but like I mentioned at the beginning of the webinar, our community health worker program really started during the COVID pandemic, and that population was experiencing, you know, very well-documented disproportionate health outcomes at that time. And so that's where we started as a community. We do know that we probably could have many more community health workers than we do have because there are a variety of populations in our community that have either barriers to care or poor health outcomes, depending on what we're looking at. But that's where we have focused our efforts and our resources for now. I would say, you know, in other populations that faced risk for poor health outcomes that are on my radar include, you know, those that are experiencing poverty, those with low health literacy, some of the other well-documented risk factors to poor health outcomes that are out there. - [Tricia] Wonderful. Thank you. What strategies have proven effective in reaching underserved populations and improving healthcare access through the community health workers? - [Deb] I can start, if you like. Kaitlin, you have probably a lot of more examples are very relevant in your world, but just things that I hear about, you know? First of all, I would say there's a ton of research about strategies and effectiveness, and a resource that's starting to get a little bit dated but I still use all the time is from ASTHO. They partnered with the National Association of Community Health Workers and put out an evidence summary, which I think is just a really good jumping off point to the tons of research that's out there because it can be, I think, overwhelming if you're just trying to dive in and see what the evidence base is. So that's a really great resource that I like to share. But just some things that I've heard about, both in Iowa and elsewhere, you know, making CHWs available to first responders, you know, emergency, fire, police. You know, you're catching people at their most vulnerable, right, when they are in crisis, and getting them connected right away must be just such a comfort and such a relief to those families. I love the idea of holding office hours in different points throughout the community. Like going to the senior meal sites once a week or once a month, going to the public library on Wednesday afternoons, you know? The CHW is here to serve you, and that becomes a known quantity. So I love those kinds of approaches. You know, all kinds of neighborhood events, whether they're, you know, summer fest kinds of things, farmer's markets, you know, celebrations or more service oriented. I think just being out there and visible in community. Podcasts and radio shows can help reach a very specific audience. And then if you wanted to think really non-traditionally, which I think is, again, part of the beauty of community health workers is you can be really creative, I think, and really think outside the box might be, and this may be a little training focused, might be training barbers and cosmetologists as community health workers. And there are programs like that out there. Interpreters, front desk people, or, you know, reception staff. Because if you think about community health workers really broadly as I like to do, there's an awful lot of people that do some component of what community health workers do every day. And, you know, maybe it's a missed opportunity if you're not taking advantage of that. So I think there's really a lot of opportunities if you just think really broadly and you think about everybody's job in your little local public health department and say, "Who's really helping people?" Maybe it's that first person they talk to when they come in, regardless of what their title is. And then one more thing, then I'll let Kaitlin talk, is I love the idea of cross training similar positions. So doulas in community health workers or peer recovery coaches in community health workers, you know, people that are already in that peer role I think can just be so much more powerful and so much more effective if we think about, you know, broadening the scope just a little bit and maybe broadening the training. I just think those could be just really powerful supports for people. - [Kaitlin] Deb covered it very well. The thing that I would add is that I think the most, the thing that we prioritize at the top for effectively reaching our underserved populations with our community health workers is the lived experience component. So we have seen, through experience, and it's well documented in publications, that community health workers are really most effective when they can bring the lived experience to the population that they're working with. So that, I think, is something that I will continue to share and shout from the rooftops about. You know, if you have a community health worker, for us, that is working with the Congolese population, then, you know, for them to have lived experience as a Congolese individual, that is really, really impactful. If you want a community health worker to work with your rural populations, then having them have, you know, lived experience as someone who's lived in a rural population is really important. It depends on who you're trying to reach, but I think that lived experience is really key. - [Tricia] 100% agree. I think research continuously supports the fact that lived experience is one of the key factors in reaching the most vulnerable populations. I love the idea of cross training. Great conversation, great ideas. What resources currently exist to support community health workers and the individuals that they serve? - [Kaitlin] So resources are limited for supporting community health workers. I wish I could say it's different, but it's not. So we do utilize some grant funds that we have, both our Iowa Health and Human Services grants that allow us to build community health workers' salary into those grants. However, our community health workers are mostly tax supported. Our Black Hawk County Board of Health and our Black Hawk County Board of Supervisors have prioritized supporting community health workers because of the impact that they have in the community. And I know that that is not the case for communities across the state of Iowa, across the nation. We're very blessed to have supportive boards that continue to support this work. We previously did have private foundation funds that supported salaries for community health workers. Those were largely linked to COVID response. They have expired since then, so that's why we've shifted the funding to grant and tax-supported resources. The other thing that I will emphasize is that it would be a lot easier for organizations of all types, including local public health, to support community health workers if we were able to have third-party reimbursement for their services. So if health insurance of whatever type, either public or private or public and private would cover community health worker services, then that would stabilize the funding model for community health workers. And so that's something that we continue to advocate for from our perspective, and I encourage everyone on this call to do the same, to talk to your elected officials about how we can make community health worker services sustainable through that model. - [Deb] Just to jump in a little bit and add to the funding discussion, I would say, in Iowa, there are examples like Black Hawk County has done of, one, for sure, and I think beginning to see it in another health system in Iowa, that they're figuring out how to work it into their budgets without having a specific funding stream, having said that, and there are other organizations beyond the health systems as well, but there are just as many or more that are grant to grant to grant, you know, hoping to continue to fund their CHWs. There are, at least, some, maybe a few practices that are trying out implementation of the CMS Medicare reimbursement for community health workers, which was new as of a year ago, I guess, and not perfect and not the only solution, but it's, you know, part of a solution. And so I'm really interested in how that's going and how that turns out for those to see how realistic that is or how helpful that is in creating, you know, sustainable funding for CHWs. So that's on, since I'm talking, that's on funding other, you know, kinds of resources. I wish I could say there's a long list of resources available to CHWs in Iowa, and that's just not the case. But I can tell you what I think is important and, you know, what's in other states. You know, self-care to help avoid burnout is so important. I see that Tanika, who is our lead instructor in our CHW registered apprenticeship program is on. And she tells me, almost every time I see her, the CHWs are stressed out. When we talk about self-care, they are unburdening themselves, you know, and they need support, so, you know? Networking is so needed, I think, and there are, I just looked at the website this morning, there are 43 states that have some sort of network or association for community health workers. I mean, that's not everything, that's not all support, but it's something. And so would love to see, you know, something like that created in Iowa. There are some. You know, training is one way for CHWs to connect with each other, but it's not enough. It's not near enough, and it's reliant on people maintaining relationships over time. The American Public Health Association does have a community health workers section, and so, you know, that would be a way to get involved and get informed and perhaps get some support. I see Natalie put the National Association of Community Health Workers in the chat. I was gonna mention that as well. There is a national association, it's not very old, less than 10 years old probably, but it's a growing national association. And so, you know, there are some, and I wish there were a lot more resources available to support Iowa CHWs. We're always trying to think of ways to bring them together, you know, just so they can talk with each other and get some support. - [Tricia] Hannah had a question: Please remind me, does Medicaid currently reimburse for community health workers? She's new to this world, exploring the different options for funding for this important role. - [Deb] Not in Iowa. In some states, in, I would say, a growing number of states, there is some Medicaid reimbursement. I did not refresh my memory on the, it's the National Academy for State Health Policy that tracks activity like this from state to state for community health workers. And I looked up the associations, I did not look up the Medicaid reimbursement. But that's a great go-to resource to see what's available in other states. - [Kaitlin] And Hannah's question is exactly what I was speaking to, that we don't have Medicaid reimbursement options or private insurance options for reimbursement as far as I know. Somebody can correct me, but I believe that to be true. - [Tricia] So the importance of reaching out to legislators when we talk about the Medicaid reimbursement is, maybe starting there would be a good avenue. Jennifer put, Molina Health has community connectors, which really do similar work, and they are certifying all of us as community health workers, which is wonderful. So Jennifer, thank you for sharing that. That's fantastic news. - [Deb] Well, and it's a good point and a good reminder that it's an umbrella term, and Natalie mentioned the National Association of Community Health Workers, they have identified nearly a hundred job titles that fall under that umbrella term. So again, you know, I always tell people that are looking for jobs or, you know, don't only look for community health worker, you know, look for navigator, look for patient advocate, you know? There are many, many job titles that fall under that. - [Tricia] Absolutely. Donna put a comment: But there is Medicare reimbursement, is that correct? - [Deb] So CMS authorized or began allowing Medicare reimbursement for community health workers under two umbrellas. I'm not very refreshed on this. Community health integration is one, and the other one has a behavioral health focus as of a year ago, January, I guess, January, 2024. And again, it's not perfect. It's linked to a primary care provider, and it's linked to the patient coming in to access care, not finding the people that are not connected with care and, you know, being able to be reimbursed for those services. So, you know, there are lots of limitations to it, but it's a start. And oftentimes, when CMS does something, it's precedent setting, you know, so hopefully it will grow. - [Tricia] We do have a question in the Q and A. Will Iowa allow community health workers be certified in the future? The HealthTeamsWork training is fantastic training, through it would be professionally appreciated to be certified. Thoughts. - [Deb] Yeah. So, you know, I mentioned the Community Health Worker Alliance earlier, and, you know, that's a place where those conversations are occurring in Iowa. I did refresh myself on that, and there are 33 states, I think, that have state-level certification, either voluntary or mandatory. Iowa is not one of them yet. Whether we go there or not is, you know, undetermined, but I would say that that's a trend, and I think there are more and more states all the time that do offer that. It's not without controversy, I think, and different schools of thoughts on the value of certification, but I certainly get that it's affirming to community health workers doing the work that, you know, their work is important and valued and is, you know, in some ways, officially recognized by the state. So I get the desire for it for sure. - [Tricia] Where do you see some of the biggest gaps in service or infrastructure? I think we've talked a little bit about this so far, obviously funding for sure. But what other gaps exist? - [Kaitlin] One that we've identified in our community, and Deb mentioned a little bit through the self-care emphasis, is that there aren't enough community health workers to serve our community, so. We have three that work specifically with our Congolese French-speaking population, our Hispanic and Latino population, and our Marshallese population. And there are a few other community health workers in other sectors, like in education, K through 12 schools, or in healthcare, or with organizations that serve immigrants and refugees, they're definitely there. But what we found is they might be the only one serving that population on a paid status. There are lots of volunteers that are working as community health workers for their community, but not on a paid status. And so that is definitely a gap in infrastructure that we've identified, you know? To really build the network of community health workers, we're just not there yet with our community. - [Deb] And I don't really have anything to add. I feel like that's a boots-on-the-ground question. So yeah. - [Tricia] Wonderful. In what ways can public health agencies play more active role in supporting and scaling community health worker programs? - [Kaitlin] So I'll take that one as a public health agency. - [Tricia] Wonderful. - [Kaitlin] Community health workers and the work that they do, the impact they have on communities are solidly backed by public health science and in published literature, excuse me. So I think that we need to continue to share that message, that this is something that's already been proven to be effective. It's a very cost-effective way to use our resources wisely to improve health outcomes in our community. The community guide, I'm not quite sure what the community guide is looking like these days, but the community guide, historically, has had very solid evidence from an evidence-based practice perspective on community health workers and how they've been shown to be effective in meeting the needs of communities in a variety of ways. Whether that's through high blood pressure or cholesterol screening or lipid reduction or blood glucose reduction or, you know, all kinds of things related to downstream health outcomes, cancer screenings, medication adherence, there's all kinds of things. And so I think that we as public health agencies need to continue to promote these conversations about the cost effectiveness of using community health workers in our communities. - [Tricia] Deb, do you have anything you would like to add? - [Deb] Just, I guess, restating what I said earlier about thinking creatively and thinking a little differently about existing roles and whether they really are doing community health work, even though they have a completely different job title. And then I think about, you know, involving yourselves in the policy discussion, you know, and using your voice to, you know, create the demand and sustain the demand for, you know, infrastructure support for community health workers. - [Tricia] I would also add probably empowering those that are most impacted, right? Like taking the voice of folks that are already working with community health workers and raising their voices on how it's benefited them and how important it is to have them in their community. Sometimes I feel like others who are most impacted by community health workers have a better voice than some of us maybe and in local public health. Considering I used to be at local public health, I sometimes feel like our community members had more sway than maybe sometimes our organizations did, so. Also encouraging those folks- - [Deb] Great point. - [Tricia] - that are accessing and using and benefiting from community health workers. We never wanna overlook the stories that they can share to policy makers as well. - [Kaitlin] The other thing I'll just add real quick before we move off of this question is, you know, I am very acutely aware, I think many of us are, that resources are really limited right now for scaling up new programs or adding positions or things like that. So to Deb's point about, you know, thinking about it differently, maybe it's a, maybe you go with a couple of different organizations to, you know, share a role, to share in supporting a role or things like that. You know, those are all things that I think have worked for other services in our community. And community health workers are no different. - [Deb] There are certainly some examples about, you know, maybe the CHW's employed by one organization, but they're co-located, you know, in another organization. So I mean, I think those are good partnerships you could work toward. - [Kaitlin] Yep. - [Tricia] Absolutely. So that leads into our next question. What types of partnerships with local, state, or national are the most impactful for strengthening the workforce of the community health workers? - [Deb] Locally, I think again of those non-traditional partnerships, you know, think creatively about where people are that might lack access to services, you know, medical practices and libraries partnering, local public health in schools, low-income housing, emergency services. Going more broadly from local, at the state level, you know, it's the, again, that alliance or looking for that state-level voice and, you know, asking the state to create that infrastructure and support for things like state CHW networks or that kind of thing. And then at the national picture, I would say, again, we talked about the Medicare reimbursement already, which is a great start, but there's a long way to go, right, in terms of, there isn't even a national recognized standard for training or a nationally, an offered definition of community health workers, you know? I mean, there's really no consistent, I guess, message coming from the national level other than states, you should be supporting community health workers, you know? I mean, it's, like, everybody's talking about it, but there's not really concrete guidance coming from the national level. - [Kaitlin] I don't have a lot to add from what Deb has already shared, but the one thing that I identified is, you know, at the state level, we are fortunate enough to have grant funding that supports some of the salaries from our community health workers. I think, I hope that continues forever. We're a larger public health agency, so we do have a lot of grants and contracts from the state. That might not be the case for some of our smaller organizations, so I fully acknowledge that, that, you know, that might not be an option for everyone, but for those that it is an option for, I really encourage them to think about how you can build in community health workers into some of the work that we do already, right? And then I'm just gonna echo the policy, the policy conversations, to continue to have those. - [Tricia] For organizations or individuals looking to get involved supporting the community health worker efforts, what are some of the key steps that they should take? Talking to policy makers, obviously. For sure. - [Kaitlin] Yeah. - [Deb] Yeah. - [Kaitlin] I think collaboration is just really key when it comes to supporting community health worker efforts, building the infrastructure for them. Our nonprofit organizations, our community coalitions, we have a community coalition here in Black Hawk County. It's called Advancing Equity. That Advancing Equity coalition is made up of a lot of different representatives from all kinds of, you know, sectors, and they're really embracing community health workers and working on, particularly working on refugee and immigrants as a focus area to support those populations in our community. So, you know, no one organization can do this alone. It's really working across your community with your partners to talk about and think about how you can support this work as a community. - [Deb] I would just say learn the lay of the CHW land in your state, learn what's out there, learn who's having those discussions, find the coalitions or state associations. I think we still have a ways to go in defining and raising awareness about who we mean, who we're talking about when we're talking about community health workers. We've already talked about this a little bit, but the more we can work toward that definition and raising that awareness about that umbrella nature of that term and then just promoting the role at every level of, you know, what you do, at a community level, organizational level, state level. Keep talking about it. - [Tricia] Are either one of you aware of volunteer programs that engage community health workers to expand healthcare access? And how can people support or participate in these volunteer opportunities? - [Kaitlin] I'm not aware of any volunteer, this one stumped me. I'm not aware of any volunteer programs that exist. We don't do, we don't take a lot of volunteers to be completely honest. We have more, our strength is really in our internship programs, in our AmeriCorps programs, things that have paid stipends and things like that. I do know that our healthcare systems also have community health workers, but I'm not sure if they have volunteer programs either. So I'm gonna have to see if Deb knows any more about this one than I do. - [Deb] Yeah, not a lot, you know? Just in that informal way. I can say, from a training perspective, you know, we've had conversations before with organizations that utilize a lot of volunteers like food banks, you know? But training is important, and, you know, our training is quite extensive, and it would be a lot to ask of a volunteer to go through that extensive training program for volunteer work, you know? So I think that's, you know, maybe somewhat of a barrier around that. However, I think there are volunteers that do that kind of work just out of the goodness of their heart and on their own probably every day in more places than we could even list. - [Tricia] 100%. Absolutely. So for individuals who are excited or are very interested in learning more, where should they be looking to pursue a career as a community health worker? What should they do if they're interested? Is there a particular direction or place that they should start? - [Deb] So I can start maybe, Kaitlin, and you add anything that you'd like. You know, I would say look for training, qualifications usually are high school diploma or equivalent, age 18, and, you know, maybe lived experience, maybe not. Really fairly simple, although individual organizations that are hiring might have their own qualifications beyond that. That's the general. So, you know, look for training, which is not always required. It's not required in Iowa at this time, but it does show initiative and, you know, improves employment chances if you wanted to work in the field. And then I would say involve yourself in the community and volunteer capacity. Employers are looking for CHWs that are well-connected, that are known entities in their communities, and volunteering and becoming that trusted member of your community is a great way to prepare for that role. And then I think this is a challenge as well, and, again, it goes back to that umbrella term of community health worker because if you're looking to get into that role, don't only look for community health worker jobs, look for those other jobs as well. And, you know, think carefully about how you articulate and describe your skillset because it's so much more about being able to engage with people, you know, showing interest, have empathy, understanding the needs in your community. That's what it's about, not educational background. And so learning how to, you know, distill those skills and articulate and communicate those skills on a resume or on a job application or that kind of thing I think is really important. And then, I will just put one plug in, we do have a job board on our grant website. So this would be Iowa specific, and the more it gets used, the better it'll be, you know, so I just try to promote it so people will use it. So employers that are looking to hire can post a position on the job board, job seekers can look there for job opportunities. And I think the IowaWORKS offices are getting more and more tuned in to community health workers as well and helping lead job seekers in that direction as well, so. The website for that is just communityhealthworker.org. And if you looked under Iowa activities, you would see the job board there. So that would be another way to see what was out there job wise. - [Tricia] Wonderful. - [Kaitlin] Yep. I would agree with all those things. I will say from our perspective, our qualifications for community health workers are the high school diploma or equivalent. And we do, you know, we'd love to see that training ahead of time, but that's something that we also offer to our community health workers after they begin as on-the-job training. So if you're not able to do that training ahead of time, you know, don't let that scare you away. I think the most important thing is that you are familiar with the community resources because that's really what, the skills that you're gonna be using as a community health worker is knowing what exists out in the community and connecting people to the resources that are out there. So that's, I think if someone can demonstrate that they have a really good grasp on community resources, then that will give you a definite advantage. And listening. I would add listening to the list of skills that Deb listed because, you know, a lot of times, you need to employ your listening skills in order to build that trust with people before you can help them with connecting to what they need, so. - [Tricia] Deb made a comment that I just wanna share: My 2 cents, be very aware of your local organizations, so your own community, county, your surrounding counties, state, national resources, research, research, research. Yes, I think public health, yes. Our golden standard is evidence-based practices, so. So for sure. Deb, thank you for that. - [Deb] Great point. - [Tricia] In closing, we only have about three minutes left. Is there any last minute words, Kaitlin or Deb, that you would like to share? - [Kaitlin] I think we covered everything. - [Tricia] I was gonna say I think you guys did a great job. - [Kaitlin] I just would, you know, I understand there were a lot of people that registered for today's webinar, and I just think that that's a wonderful indication of the interest that there is around community health workers and utilizing community health workers in our community and as a permanent solution for improving the health of our communities moving forward. So I just wanted to say I'm really energized by that news. - [Deb] We've had some great opportunities in Iowa, you know? The Iowa HHS training grant has really amplified the community health worker discussion in Iowa. We have great momentum growing in Iowa. I worry sometimes that it's just gonna trickle out in the noise of everything else that's going on, but the level of interest remains high, which is, you know, really encouraging. - [Tricia] Wonderful. Deb, Kaitlin, thank you so much for your time. Everyone who participated, thank you for joining us today. Hopefully this was very insightful for you and has inspired you to learn a little bit more and how you can implement community health workers in your community. Again, this is our last webinar for this semester. Please be on the lookout for any future webinars that we will be producing. Again, thank you so much for everything you do, and Kaitlin and Deb, thank you for sharing your expertise with us today. - [Kaitlin] Thank you. - [Deb] Happy to. Thanks to those who joined. - [Tricia] Have a wonderful day. Thanks, everyone. - [Outro Narrator] Thank you for joining us today. Special thanks to Tricia Kitzmann, Erblin Shehu, Tasneem Ali, Mary Kosobucki, Dena Fife, Rima Afifi, Laurie Walkner, Cynthia Maharani, Natalie Peters, Melissa Richlen, and the speakers who have shared their expertise with us. Theme music for the Building Health Equity podcast series was composed and produced by Dave Hoing and Roger Hileman. Funding for the Building Health Equity Initiative is provided by the Iowa Department of Health and Human Services. Please see the podcast notes for an evaluation link and transcript. For additional resources and information, or to view the video webinar recordings, be sure to visit the Building Health Equity website at iphprp.org/services/training/building-health-equity/.