Evaluation of the role of neighborhood health coordinators in a comprehensive neighborhood health services project

Abstract

This study evaluates the role of the Neighborhood Health Coordinators (NHC's) within Kaiser Foundation's Comprehensive Neighborhood Health Services (CNHS) Project. This project was established in September, 1967, under the provisions of the 1966 amendments to the Economic Opportunity Act, to provide and make readily available comprehensive medical care to 1ow-income persons. In compliance with the stipulations of this Act, persons who reside in target areas, designated as depressed neighborhoods, were hired to serve as NRC's. These indigenous non-professionals serve as links or "gatekeepers" between the low-income persons enrolled in this program, and the Kaiser medical care facilities which include the hospital-clinic and three neighborhood health clinics. The NRC's were to enroll these low-income families in the program, and assist them in obtaining appropriate health services. In addition to these primary responsibilities, the NHC’s were to refer their clients to community resources whenever necessary. The impact of the NHC's contact with families enrolled in the program was evaluated on the basis of two major indices: utilization of total medical care services and four specific areas of preventive health care. The findings of this study support the underlying assumption upon which the NRC's were hired and trained; that is, they are effective in increasing the total utilization of out-patient medical services and utilization of specific preventive health services by families with whom they have the most personal contact. In a secondary analysis, characteristics related to several CNRS Project objectives, attitudinal scales and socio-demographic characteristics are examined to determine their relationship to the staff's perception of an "ideal" NHC. This analysis shows that aptitude in interpersonal relationships and personal growth are two characteristics highly associated with rank. Several attitudinal scales, especially powerlessness and dogmatism, are positively associated with rank. Measures of knowledge in the areas of health and medical care programs have a low or negative association with rank. This study does not make an exhaustive investigation of characteristics which may be associated with rank; therefore, other variables considered by the administrative staff in their evaluation of an "ideal” NHC may not have been measured.