Project HEAL: A Community-Based, Learner-Centered Lay Health Worker Program † 636

Abstract

One of the barriers to health care access is the socio-cultural gulf between underserved families and the health care community. We hypothesized that health workers with backgrounds similar to those of community members would be effective links between the health care community and those it serves. A children's health project using Community Health Workers (CHWs) was created to increase families' understanding of and involvement in basic child health issues. A community-based needs assessment was carried out; a community advisory board was formed for ongoing needs identification. A casemanaged “village” approach is used: CHWs enroll families from their own neighborhoods. In a learner-centered model, educational programs were devised by CHWs with technical direction from nurse and physician advisors. This presentation will outline the project and identify the successes and barriers encountered. Specific outcomes will be discussed.Six CHWs have been trained. By August 1997, 56 families (130 children) were participating. 264 home visits and 270 “other contacts” had been made. 155 community agency interactions took place as CHWs linked families with services. 12 health teaching topics have been identified through the community-based needs assessment; 6 have been implemented to date. 64 in-home assessments covering five health areas are completed. In order to understand the project's actual value to families, and to better characterize it, a qualitative ethnographic evaluation was performed. The following features of the program were revealed: The project is “learner centered” (based on knowledge from within the community, on the experiences of the CHWs and client families; learners become teachers, “training the trainer;” the program can adjust directly to the needs of the community). The project is community-based (the CHWs share life experiences with the population they serve; they have unique understanding of cultural systems and categories of the community; they build relationships with the community as a whole and families in particular based on an inherent sense of trust). The CHWs are used by client families for access to medical information, to review the health status of the family, to review acute conditions before using an Emergency Department or clinic, as facilitators when interacting with health or social institutions, as access to information regarding social services and support agencies, and for emotional support. In summary, the CHW is characterized as a “cultural translator” or “bridge” between the health care system and the community it serves.