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Center for Rural Health
Agents of Change: Promotoras Transforming Communities
Tuesday, September 22, 2015
Promotoras Transforming Communities
Martha Monroy, MA
REACH Program Director
University of Arizona, Mel and Enid Zuckerman College of Public Health
Floribella Redondo,BS
President
Arizona Community Health Worker Association
Are any of you promotoras?
Have you worked with promotoras?
What roles do promotoras in your community play?
• Provide linkages to culturally relevant providers and care
• Advocate for family, friends, and provider social support for health improvements
• Provide education, training, and support for healthy lifestyles, chronic disease prevention and management
• Assist families and friends with navigation to needed services including health, basic needs (food, shelter, clothing, medication) transportation, social, and government support
• Work with institutions & organizations to provide culturally relevant services.
• Educate about needs and barriers to care and services
• Assist organizations with understanding community history and cultural issues
• Organize services in convenient locations
IndividualKnowledge, Skills, Attitudes
InterpersonalFamily, Friends, Providers,
Social Supports
OrganizationalOrganizations, Institutions
CommunityRelationships among organizations
PSE changeLocal, State, National
Figure 1REACH U.S. Major
Roles for Community Health Workers Cosgrove. et al
• Provide education, training, and support for healthy lifestyles, chronic disease prevention and management
• Assist with navigation to needed services including health, basic needs (food, shelter, clothing, medication) transportation, social, government support
• Address gaps in health literacy, communications, education, employment• Assist with screening for eligible services and completion of applications
• Advocate for local, state, and national health, social and environmental policy changes
• Facilitate\lead PSE change, inrform that change• Communicate community needs to policy makers• Disseminate policy changes to communities
Bridge gap between needs and services in community• Identify and develop
strategies to address the social determinants of health
• Address social and health• Enhance community capacity
and infrastructures to provide culturally relevant services
Juan y la Ficha
Promotoras are uniquely qualified to create PSE change
• Already address social determinants of health through direct services: health education, insurance and other benefit enrollment, etc.
• Are members of the communities they serve and understand the assets, challenges and culture
• Generally Spanish-English bilingual.• Are trusted community members • Successfully engage community members
Promotoras have a deep understanding of social factors that influence health in their
communities
Paseando en Bicicleta
Promotoras successfully engage community members
Local Partner Organization
Location
Urban or Rural
Years prior experience with PSE
Example PSE change instituted under RSC
Campesinos Sin Fronteras Yuma County, Arizona
Rural
10 years
Created environmental change in local supermarkets that highlighted and increased healthy food options
North Country HealthCare
Flagstaff, Arizona
Urban
5 years
Increased access to healthy food options through partnering with Market on the Move and a system of fresh produce distribution in target neighborhoods
Mariposa Community Health Center
Santa Cruz County, Arizona
Rural
24 years
Developed policies that integrated physical activity opportunities into schools.
Sea Mar Community Health Centers
Skagit County, Washington
Rural
None
Expanded the number of Latino-owned stores in Latino neighborhoods offering 10 or more fresh produce items.
Benton County Health Services
Benton County, Oregon
Rural
7 years
Instituted healthy food procurement in government facilities andIncreased SNAP use 19.2% from 2011 to 2012.
The Next Door, Inc.
Hood River, Oregon
Rural
8 years
Expanded the local farmers market to locations where most Latinos reside including culturally appropriate foods/signage/activities.
Pima County REACH Tucson, Arizona
Urban
10 years Created a community cycling centerCreated environmental changes in local grocery storesCreated systems change in clinics
Texas A & M
Hidalgo County, Texas
Rural
None
Established summer healthy meal and physical activity locations for local children.
Gateway to Care
East End, Houston Texas
Urban
None
Increased the number of home daycare providers enrolled in Child and Adult Care Food Program (CACFP) and aligned with national standards for provision of healthy food/beverage.
National Center for Farmworker Health
Buda, Texas
Rural
None
Established a community task force dedicated to increasing safe options for walking and bicycling.
How to Support Promotoras in PSE Change at local level
• Provide ongoing training for promotoras in topics they identify
• Engage the support of policy makers• Stable funding
Opportunities for Engagement • Build awareness of the CHW environment in
your communities/agencies/organizations• CHW input and public health perspective
represented • Strengthening the role of CHWs and improve
successful integration in significant areas such as– Infrastructure– Workforce Development– Financing Mechanisms– Evaluation
How to Support Promotoras/CHWs in PSE Change at a State Level
What contributes to CHWs advocating for themselves and their profession?
• Membership in a CHW association (4 x more likely)
• Job description includes “advocacy”; “working with community leaders” and/or “working with other CHWs” (1.5-2 x more likely).
• Being employed in a state with a statewide professional association, credentialing process or CHW legislation were not more likely to advocate for their profession.
Expressions of CHWs/Promotoras
1. CHW’s want a state certification2. CHW’s want to be recognized as a professional
workforce3. CHW’s recommend that supervisors be trained on
the scope of practice of the workforce4. CHW’s Recognition from other health professions5. CHW’s would like to have opportunities for
professional development within their organization
6. CHW’s recommend that AzCHOW is the official professional organization representing the workforce
“Certification is to have a voice and recognition that we exist, and that our work and delivery is very important so that our community is educated”
Questions?
