1. Position Description Job Title: Community Health Coordinator Reports to: Fight Asthma Milwaukee (FAM) Allies Program Manager and Milwaukee Area Health Education Center (Mil AHEC) Director of Community Health Programs Essential Responsibilities and Functions: 1. Work with multiple agencies that collaborate to improve asthma management in the Milwaukee community. 2. Schedule and teach community based asthma education. 1. Deliver school based asthma management education. Teach a minimum of 12 Asthma Smarts sessions (total) in about 6 schools, reaching about 84 students with asthma in 3-5 th grades. 2. Deliver home based asthma management education. Provide a minimum of 10 home based Asthma Smarts education sessions for patients/families with asthma, providing 30 lessons total. Provide a minimum of 10 environmental assessments/ asthma trigger education sessions totaling 30 visits. Attend health fairs and other community events to recruit eligible participants for the home based programming. Connect with Community Health Workers and assist with community outreach to recruit eligible participants for home based programming. 3. Create a partnership between Mil AHEC s WI Community Health Worker Alliance (WICHWA) and FAM Allies Participate in the WICHWA Curriculum and Training working group and contribute toward their work and direction Design and produce 2 online training modules that will support Community Health Workers (CHWs) in continuing education (examples of topics include: general asthma education, asthma trigger management, CHW safety during home visits, CHW communication essentials, etc.) 4. Recruit and train new volunteers to deliver school based asthma management education. Recruit and train a minimum of 8 healthcare professional students to deliver Asthma Smarts in 8 schools (for approximately 112 individual students with asthma). Schedule the training Manage CITI completion Assign students to each school Manage equipment Compile and manage data 3. Maintain and build relationships with schools, community programs and coalitions (i.e., WICHWA: WI Community Health Worker Alliance, MTFC: Milwaukee Tobacco Free Coalition), area businesses and government agencies. 4. Participate in community events on behalf of the organization when appropriate.
5. Conduct community based outreach (e.g., schools, Head Start agencies, housing authority neighborhoods and community centers). 6. Contribute to volunteer recruitment and engagement. (Potential programs, see #2) 7. Assist in training and supervising new volunteers, which may include Community Health Workers (CHW). 8. Write agendas, plan locations, manage RSVPs, and write minutes for community meetings. 9. Prepare monthly status report of activities for Mil AHEC and FAM Allies meetings. Knowledge & Skills: Team player capable of performing in a fast-paced, dynamic environment. Experience working with culturally diverse populations. Self-motivated and detail oriented. Effective public speaker. Excellent written and oral communications skills. Competent in Microsoft Office products (Word, PowerPoint, Publisher, Excel). a. Need: An estimated 25 million Americans suffer from asthma (> 8% of adults, >9% of children) (1), with the prevalence increasing. Ethnic differences in asthma prevalence, morbidity and mortality are highly correlated with poverty, urban air quality, exposure to indoor allergens, lack of education and inadequate medical care (2). In 2011 there were a total of 4,746 asthma hospitalizations in Wisconsin each costing an average of $13,309 (3). Further, in 2011 there were 1,095 more hospitalizations for asthma in minority populations compared to non-hispanic whites (3). This translated into an extra $13 million for asthma care (3). Education: In 2008-2010, Wisconsin adults with the least formal education reported the highest current asthma prevalence (12.4 percent), compared to adults with a college education (8.6 percent), although the difference was not statistically significant (3). Poverty: Milwaukee County has the highest asthma prevalence value for adults and children (10.3 and 10.7 percent, respectively)(3). Nearly a third of the city's residents (29.9%), including four in 10 children (42.6%), lived in poverty in 2012 (4). Milwaukee's poverty rate was in the top 15 among the nation's big cities with populations over 250,000 (4). Adults with the lowest annual household income in 2008-2010 (less than $15,000) reported the highest asthma prevalence (16.6 percent) (3). To reduce hospital use and increase quality of life, Milwaukee s community of asthma patients needs asthma education that is culturally appropriate and written at low health literacy levels. FAM Allies serves Milwaukee County; however the majority of programming is delivered in central city zip codes. Sometimes programming may be focused in smaller areas depending on funding and collaborations. For example, FAM Allies home visiting services are provided in collaboration with City of Milwaukee Health Department Housing and Urban Development grant that targets 53206, 53208, 53209, 53210, 53212, 53216 which are the zip codes with highest asthma hospital use as well as the highest poverty levels on Milwaukee s North side.
b. Evidenced based impact: Asthma Smarts, delivered to students with asthma in 3-5 th grades, can document learning from pre/post testing, and evaluation to show outcomes such as visits to the school nurse and absenteeism is underway. Results from Pre/Post testing in 2015-16 school year: Questions N Mean proportion Mean proportion Difference Std Err p-value* correct (Pre) correct (Post) (Post-Pre) (Diff) Q3 463 0.35 0.54 0.19 0.03 <0.0001 Q4 466 0.59 0.76 0.17 0.03 <0.0001 Q5 459 0.35 0.57 0.22 0.03 <0.0001 Q6 463 0.66 0.80 0.14 0.03 <0.0001 Q7 446 0.51 0.77 0.26 0.03 <0.0001 Q8 462 0.73 0.88 0.15 0.02 <0.0001 * Wilcoxon Signed Rank Test (paired) Environmental assessments (EAs) for asthma triggers. Two, Milwaukee studies have been associated with improvements in asthma control and emergency visits. The most recent study showed the following outcomes: Variable Number of children Baseline 6-month follow-up P value (statistica l test) Mean TRACK asthma control score 119 48 79 <.001 (W) Mean asthma emergency visits in past 6 117 0.66 0.15 visits <.001 (W) months visits Missed childcare and school days in past 6 80 1.5days 0.4 days <.001 (W) months Cigarette butts or ashes in trays 134 39% 20% <.001 (M) Mold, mildew or water damage in home 134 72% 25% <.001 (M) Pillow and mattress encasing s on bed 135 6% 75% <.001(M) Test or Respiratory and Asthma Control in Kids (TRACK) 5-question score: 0-79 = uncontrolled asthma and 80-100 means controlled asthma; changes in score of > 10 represent clinically meaningful changes in respiratory control status (Zeiger) Tests of statistical significance: M=McNemar s; W=Wilcoxon signed rank FAM Allies has developed a protocol for delivering Home Environmental Assessments with Asthma Trigger education. Recruitment began in spring 2015, and similar outcomes are expected. Skilled nursing visits (SNV) for asthma management education. Preliminary data from the Wisconsin Medicaid Program examining de-identified fee-for-service claims on health services utilized before and after FAM orgainzed skilled nursing visits (1/05 7/13) for children with persistent asthma showed a 53% decrease in ER visits, 66% decrease in hospitalizations, 17% decrease in urgent care visits, and 7% increase in primary care visits. i. FAM Allies is moving forward with an outreach and evaluation framework to show that Community Health Workers (CHW) can generate patient outcomes for a lower cost than
skilled nursing. Home based Asthma Smarts education started in spring 2015, and expects to demonstrate learning similar to that seen in children. CHW employment in chronic disease outreach has been associated with improved medication adherence and increased patient involvement in management -a return on investment estimated at >$2 for every dollar invested (5). The Institute of Medicine outlines barriers to CHW participation in healthcare systems including lack of funding, training, and insufficient recognition by other health professionals (6). CHW home interventions improve Asthma Quality of Life (QOL) scores, symptom free days, acute care needs, rescue medication use, missed work/school and home management behaviors. Stronger data exists in pediatric populations, but is limited in adult populations (7). 2. Plan for Volunteer Recruitment: Most FAM Allies programming is delivered by volunteers that are recruited through a member base consisting of 80 organizations that are regularly asked to volunteer. The HealthCorps member will approach coalition members with service opportunities. Milwaukee Area Health Education Center actively seeks volunteer placement opportunities for Community Health Workers (CHWs) through the WICHWA Community Health Worker Peer Network. This is a source of volunteer recruitment for the HealthCorps member, and since most CHW volunteers would require training for their volunteer position, it is also a trainer training opportunity. A training protocol exists for Asthma Smarts volunteer orientation and training. The HealthCorps member will go through this protocol as a trainee, then will co-teach with veteran FAM Allies members, and finally will transition to leading the protocol with new volunteers. The protocol includes: MPS background check CITI: online research ethics training, verified by CHW IRB An orientation program delivered with PowerPoint Skills training on spacers/inhalers and peak flow meters with teach back practice Prezi overview for Asthma Smarts Marketing materials exist for program and volunteer recruitment that can be tailored and updated for the HealthCorps member to utilize when approaching new audiences. 3. Member Training and Development During the first Days: Mil AHEC will provide Welcome Monday orientation that will include key card/identification card and computer login/password information. The member s supervisor will provide a FAM Allies overview and a review of the member s outreach goals. Regular meet times will be negotiated and scheduled. The member will be asked to schedule interviews with key FAM Allies members including several Board members, leaders from priority partner organizations, and dedicated volunteer staff. Background check forms for MPS.
During the first 3 months: Curriculum-specific training and mentoring via FAM Allies. The member will participate in Asthma Smarts trainings that are already scheduled with healthcare professional students. Collaborative Institutional Training Initiative (CITI) certification on ethics in research, required. The member will observe and co-teach programs with veteran FAM Allies volunteers, until the member feels comfortable enough to teach independently. We expect this independence within the first 3 months of service. 100-hour Community Health Worker Training via Mil AHEC depending on the availability of the course. Teach Asthma Management, Basics Seminar via FAM Allies. Generally scheduled in November. Participate in WICHWA Curriculum and Training meetings. Starting in January 2016: If the member has not yet started Asthma Smarts Home visits yet, they should begin in January. The curriculum is identical to the Asthma Smarts program being implemented in schools, so the member should feel comfortable. Member should begin to review the training protocol from the viewpoint of a trainer and prepare to implement with new volunteers. Teach Asthma Management, Plus Seminar via FAM Allies. Generally scheduled in March. Essentials of Healthy Homes Practitioners Course participation depends on the availability of the course. Batzner often hosts an integrated pest management course in early spring. Observation and co-teaching in Home Environmental Assessments will begin and continue until the member can independently provide the outreach. Begin preparing content for online training courses. Literature Cited: 1. Asthma at a Glance, National Center for Environmental Health (NCEH), U.S. CDC, 1999 2. Asthma and Allergy Foundation of America: http://www.aafa.org/display.cfm?id=8&sub=42#_ftnref5 3. Burden of Asthma in Wisconsin 2013 http://www.dhs.wisconsin.gov/publications/p4/p45055.pdf 4. Milwaukee Journal Sentinel http://www.jsonline.com/news/milwaukee/milwaukee-poverty-a-regionalproblem-mayor-tom-barrett-says-b99101258z1-224346311.html 5. Centers for Disease Control and Prevention, A Summary of State Community Health Worker Laws, available at http://www.cdc.gov/dhdsp/pubs/docs/chw_state_laws.pdf. 6. Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002). 7. Effectiveness of Home-Based, Multi-Trigger, Multicomponent Interventions with an Environmental Focus for Reducing Asthma Morbidity A Community Guide Systematic Review. Crocker et al. Am J Prev Med 2011;41(2S1):S5-32