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Managed care organizations (MCOs) are increasingly engaging community health workers (CHWs) to support service delivery for their members, particularly in the realm of social determinants of health. Some states now require MCOs to offer CHW services. Although the roles and activities of CHWs working in other contexts (eg, clinics, hospitals, community-based organizations) are well established, there is sparse knowledge about how MCOs are operationalizing CHW roles and whether CHW activities differ based on whether CHWs are employed directly by MCOs or contracted through other organizations. In 2021, 2 CHW professional associations and a university partnered to conduct a national cross-sectional survey of CHWs working with MCOs. Respondents (

In multiple and related forms, violence is a serious public health issue with lasting impacts on health and wellness in the United States. Community health workers (CHWs) are frontline public health workers and trusted members of communities. We aimed to analyze recent examples of CHW activities in violence prevention public health programs with a goal of informing future programs and research. We collected more than 300 documents published between 2010 and 2020 to identify public health programs to prevent violence including CHW activities. We used an iterative process to develop and apply a coding scheme to the CHW activities. We identified 20 public health programs to prevent violence which included CHW activities. CHWs most often addressed community violence, youth violence, and family violence and played an average of 8 of 10 core roles per program. Fewer than a third (i.e., 6 programs) reported community-focused CHW activities to address upstream and structural determinants of health inequities. This first examination, to our knowledge, of the intersection of the CHW and violence prevention literature shows that CHWs have played many of their core roles in public health programs to address multiple forms of violence. (Am J Public Health. 2022;112(8):1191–1201. https://doi.org/10.2105/AJPH.2022.306865 )

BACKGROUND: Over 600,000 people leave US prisons annually. Many are eligible for Medicaid upon release but may need support to enroll. Carceral facilities in nearly half of states have implemented systems to facilitate Medicaid access for those leaving incarceration, but there is limited information on program implementation models or outcomes. OBJECTIVES: To evaluate implementation and initial outcomes of Louisiana’s prison-based Prerelease Medicaid Enrollment Program. METHODS: In this mixed-methods study, we assessed enrollment in Louisiana Medicaid at time of release from prison in the 2 years (2017–2018) after Program implementation, as well as reasons for Medicaid closure (ie, loss of coverage) and health services use 6 months postrelease. In May-June 2019, we conducted interviews statewide with program implementers (n=16) and focus groups in New Orleans, Louisiana with formerly incarcerated Program participants (n=16). RESULTS: A total of 4476 people were included in the quantitative analysis. There was a 34.3 (95% confidence interval: 20.7–47.9) percentage point increase in Medicaid enrollment upon release. Nearly all (98.6%) attended at least 1 outpatient visit and almost half (46.7%) had 1 emergency department visit within 6 months of release. Not responding to information requests was the most common reason for Medicaid closure. Program implementers and formerly incarcerated participants identified Program strengths, barriers, and suggestions for improvement. CONCLUSIONS: The program was successful in rapidly increasing Medicaid enrollment at the time of prison release and facilitating the use of health care services.

Coastal communities in South Louisiana and worldwide are increasingly impacted by climate-related events such as hurricanes, floods, and rising sea levels. In addition, they have recently faced the...

Globally, the rate of incarceration among women is rising, and in the U.S., women's incarceration has grown at twice the rate for men over the last four decades. Louisiana has the second highest rate of incarceration in the U.S. There is evidence that men in Louisiana prisons do not receive adequate healthcare, but little is known about their women counterparts. We aimed to document formerly incarcerated women's experiences with receiving healthcare during incarceration in Louisiana to inform policy and practice change. In partnership with two community-based organisations in New Orleans, Louisiana, between August 2016 and April 2018, we conducted semi-structured 1-hr interviews with 22 formerly incarcerated women who had been incarcerated in the state for at least one consecutive year. A convenience sample of participants was recruited through community-based organisations' re-entry and health programmes. Our interview guide included questions about experiences with accessing care, reproductive health needs, interactions with providers and preventive care during incarceration. We used applied thematic analysis techniques to interpret data. Over 90% of interviewees identified as Black. Their mean age was 50.7. The average length of incarceration was 8.4 years. Participants reported multiple barriers to accessing care including punishment for seeking care, long wait times, costs, lack of respect from providers and health concerns being dismissed. Participants reported limited mental health, preventive and dental services; an insufficient number of providers; and poor health outcomes as a result of delayed care. Overall, women did not have access to adequate, timely care during incarceration. Findings suggest a need for policy changes related to the provision of carceral healthcare services and external oversight of prison conditions and healthcare delivery. Further research into women's experiences of ageing during incarceration and tailored transitional health models is needed.

Background The Resilience Against Depression Disparities (RADD), a community partnered, randomized comparative effectiveness study, aimed to address mental health in Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) racial/ethnic populations in New Orleans and Los Angeles. Objectives To describe engagement methods, lessons learned, and recommendations in engaging LGBTQ individuals and agencies throughout the RADD study. Methods RADD used a community partnered participatory research framework to engage LGBTQ community members and agencies. Observational and quantitative data were collected to describe engagement activities and study adaptations from October 2016 to May 2019. Results Our partnered approach resulted in multiple study adaptations. The principles of cultural humility, coleadership, and addressing health determinants were important to successful engagement with LGBTQ community members and study participants. We recommend maintaining cultural humility as the tenant of all research activities. Conclusions This project's engagement plan demonstrates that community-academic partnerships can be forged to create and modify existing study models for LGBTQ communities.

Community Partnered Participatory Research (CPPR) is grounded in the ethical principle of respect for persons participating in the research enterprise. The critical importance of respect for person...

Introduction This article presents the Louisiana Hepatitis C Elimination Program’s evaluation protocol underway at the Louisiana State University Health Sciences Center–New Orleans. With the availability of direct-acting antiviral (DAA) agents, the elimination of Hepatitis C (HCV) has become a possibility. The HCV Elimination Program was initiated by the Louisiana Department of Health (LDH) Office of Public Health (OPH), LDH Bureau of Health Services Financing (Medicaid), and the Louisiana Department of Public Safety and Corrections (DPSC) to provide HCV treatment through an innovative pricing arrangement with Asegua Therapeutics, whereby a fixed cost is set for a supply of treatment over five years. Materials and methods A cross-sectional study design will be used. Data will be gathered from two sources: 1) an online survey administered via REDCap to a sample of Medicaid members who are receiving HCV treatment, and 2) a de-identified data set that includes both Medicaid claims data and OPH surveillance data procured via a Data Use Agreement between LSUHSC-NO and Louisiana Medicaid. Discussion The evaluation will contribute to an understanding of the scope and reach of this innovative treatment model, and as a result, an understanding of areas for improvement. Further, this evaluation may provide insight for other states considering similar contracting mechanisms and programs.

Objectives. To understand changes in behavioral health services utilization and expenditures before and after natural disaster with an adult Medicaid population affected by the Baton Rouge, Louisiana–area flood (August 2016). Methods. We examined de-identified behavioral health claims data for Medicaid-insured adults in the affected region for 10 months before and after flooding (October 2015–June 2017). This constituted 273 233 provider claims for 22 196 individuals. Claims data included patient gender, behavioral health diagnoses, treatment dates, and costs. We made adjustments for Medicaid expansion by using monthly enrollment data. Results. Overall, most male patient behavioral health care visits were for substance use disorders (33.6%) and most female patient behavioral health care visits were for depression-related disorders (30%). Both diagnostic categories increased after the flood by 66% and 44%, respectively. Expansion accounted for a 4% increase in claims. Postflood claims reflected 8% to 10% higher costs. Conclusions. Greater amounts of behavioral health care services were sought in all 10 months of the postflood study period. We observed gender differences in use of services and diagnoses. Behavioral health care services following natural disasters must be extended longer than traditionally expected, with consideration for specific population needs.

Disparities in chronic disease and life expectancy remain a significant public health problem and are largely attributable to social determinants of health. Community health workers (CHWs) promote health equity through individual- and community-level activities, and leadership and advocacy skills training make CHWs more likely to catalyze structural change. CHWs are increasingly being integrated into clinical practices to support care management, creating a need for new grassroots community-level advocates. We adapted for community residents an existing CHW training curriculum focused on social determinants of health and effecting community change. We offered 36 hours of training at community-based locations in New Orleans, Louisiana. We assessed baseline civic and community participation and pre- and postknowledge for each lesson. Among 43 enrollees, 42 completed the program. The majority were Black (92.7%), female (92.7%), and retired or unemployed (77.5%), with a median age of 61.5 years. In the past year, 85% of participants had volunteered, 57.1% had been involved with a community organization, and 32.4% had contacted the city council. Participants demonstrated statistically significant increases in knowledge in 5 of 6 lessons. Our success in increasing knowledge of advocacy among a civically engaged group suggests that trainees may become community leaders in addressing social determinants of health.

As community health workers (CHWs) have increasingly become recognized as members of health care teams, several states have considered or implemented processes to certify them. Between April and September 2017, we interviewed 41 stakeholders (e.g., CHWs, employers, and state health officials) in seven states that had considered or developed CHW certification to gather information about their processes and lessons learned. Interviewees reported several areas to consider in developing certification such as requiring training and education, deciding whether to certify based on experience, ensuring that CHWs are members of communities served, and avoiding marginalization of some groups of CHWs. Participants highlighted strategies for ensuring active CHW leadership in decision-making about certification. Interviewees identified best practices for supporting CHW workforce development such as using national models and standardized training, supporting CHW leadership, involving CHW professional groups, convening workgroups, and educating stakeholders. Findings are relevant to states seeking to grow their CHW workforce.

Community health workers (CHWs), including promotores de salud and Community Health Representatives, have worked in the United States for over half a century. In this chapter, we summarize the complex history of how and why CHWs across the United States and tribal nations have organized themselves over the last two decades at the local, regional, state, and national levels. We describe some of the major milestones that contributed to conceptualizing CHWs, CHRs, and promotores as a single workforce and a recognized health profession. Next, we describe efforts to establish local and state CHW networks across the country. Finally, we provide a detailed history of over a decade of collective work resulting in the launch of the National Association of Community Health Workers (NACHW) in 2019, including the personal reflection of a founding NACHW board member who is active at the state and national levels.

As of 2017, there were more than three million individuals in the United States infected with Hepatitis C virus (HCV) [1]. Because most cases are asymptomatic, leading to a higher rate of unreported cases, this number is suspected to be much higher. Furthermore, there is a rise of HCV cases, and this increase documented since 2013 is primarily due to injection drug transmission alongside the rise of the opioid epidemic [2]. The Centers for Disease Control and Prevention (CDC) encourages HCV testing for all adults at least once in their lifetime, and those that test positive for HCV should be linked to treatment [3]. In 2013, only 13%-18% of patients with HCV received treatment in that year, indicating that there are barriers to treatment, such as lack of treatment acceptance, co-existing conditions, extensive treatment, side-effects, and access to treatment[4]. Thus, health disparities may ensue and the eradication of HCV as a public health issue becomes even more challenging. Edlin and Winkelstein (2014) suggested that to achieve optimal HCV eradication, social determinants of health, such as homelessness, need to be addressed [5]. Because there is room for improvement in linkage-to-care opportunities, it is important to explore whether linkage-to-care interventions address social determinants of health, and if so, which ones, to obtain a better understanding of what may help improve patient outcomes. References: U.S. Department of Health and Human Services. 2019.Retrieved June 11, 2020, fromhttps://www.hhs.gov/opa/reproductive-health/fact-sheets/sexually-transmitted-diseases/hepatitis-c/index.html Centersfor Disease Control and Prevention(CDC). 2019. Commentary portion of U.S. 2017 Surveillance Data for Viral Hepatitis. Retrieved June 11, 2020, fromhttps://www.cdc.gov/hepatitis/statistics/2017surveillance/index.htm Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A.B. (2020). CDC Recommendations for Hepatitis C Screening Among Adults – United States, 2020. MMWR Recommendations & Reports, 69(2), 1-17.https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm Infectious Disease Society of America. 2019. HCV Testing and Linkage to Care: HCV Guidance. Retrieved June 23, 2020, fromhttps://www.hcvguidelines.org/evaluate/testing-and-linkage Edlin, B. & Winkelstein, E. (2014). “Can Hepatitis C be eradicated in the U.S.?”Antiviral Research.110: 79-93.https://dx.doi.org/10.1016/j.antiviral.2014.07.015

Community health workers (CHWs) are effective in improving public health, and many states are developing policy to support the workforce. In 2019, the Louisiana legislature created the CHW Workforce Study Committee (Committee) of at least half CHWs to study the workforce and provide the state with policy recommendations. The Committee followed national best practices in CHW engagement. A CHW and an academic team identified CHWs and employers statewide, administered a survey in partnership with a CHW professional association, and conducted in-depth interviews with CHWs and employers. Descriptive statistics were used to summarize survey data and applied thematic analysis was used to interpret interview transcripts. Sixty-five CHWs and 37 employers participated in the survey. Twenty-one CHWs and 15 employers completed interviews. Survey data indicated that Louisiana CHW roles and activities are consistent with national research. Interviews revealed a lack of knowledge about CHWs among key stakeholders, CHW workforce challenges including lack of community and professional resources, and differing ideas about the value of common workforce development practices such as standardized training and credentialing. Findings suggest a need for widespread education about CHWs and support for CHW participation in professional associations to address common workforce challenges. CHW co-leadership and partnering with a CHW professional association enabled successful study execution and full participation of CHWs in the formation of Committee recommendations. A subset of Committee members, made up of at least half CHWs, continues to meet to expand and support the workforce.

Community health workers (CHWs) leverage their trusting relationships with underresourced populations to promote health equity and social justice in their communities. Little is known about CHWs roles in addressing COVID-19 or how the pandemic may have affected CHWs' ability to interact with and support communities experiencing disparities. A focus group with CHW leaders from 7 states revealed 8 major themes: CHW identity, CHW resiliency, self-care, unintended positives outcomes of COVID-19, technology, resources, stressors, and consequences of COVID-19. Understanding the pandemic's impact on CHWs has implications for workforce development, training, and health policies.

Intimate partner violence (IPV) is a persistent public health problem in the United States, with an estimated one in three women experiencing rape, physical violence, and/or stalking by an intimate partner within her lifetime. Non-Hispanic Black women disproportionately experience IPV, but there has been limited success in implementing culturally appropriate preven­tion programs and services for members of this population. Community health workers (CHWs) are trusted members of under-resourced communities who provide reliable health information and improve the cultural appropriateness of service delivery and may be a vital resource for developing new IPV interventions. Guided by the prin­ciples of community partnered participatory research, we developed the CHW-led Safe Spaces project, which aimed to establish a strong academic-community partnership to focus on issues related to experiences of IPV and the prevention of IPV in New Orleans. In this article, we describe the development of our partnership including the formation of an advisory board, creation of a broad-based stakeholder coalition, offering a community partnered participatory research training, conducting IPV education and out­reach, and establishing a research agenda. Our processes are replicable and lessons learned may be relevant to other groups seeking to address IPV by leveraging the strengths of community-academic collabora­tions and CHWs.Ethn Dis. 2018;28(Suppl 2):317-324; doi:10.18865/ed.28.S2.317.

The AAMC has called for research exploring causes of health disparities and the value of educating health care providers about population health. Research on best practices for educating medical students about social determinants of health is limited. During academic year 2015–2016, we implemented a required 4-week community health clerkship for all fourth-year medical students at Tulane University not concurrently seeking an MPH. The 15-h classroom component of the course included discussion of reading materials and didactic instruction on social determinants of health, principles of prevention, health disparities, racism, cultural humility, and community health workers’ (CHWs) roles in improving population health. Students also spent 80 h at a community agency doing non-clinical work. In addition to course evaluations, students completed pre-and post-course surveys that included 15 items measuring knowledge and attitudes about patient care and community health on a 4-point Likert scale. Post-course surveys also contained ten open-ended questions. Students were highly satisfied with the course. There were significant changes in 11 of 15 items related to knowledge and attitudes about patient care and community health. Students reported better understanding of chronic disease causes, physicians’ roles in health promotion, and the roles of CHWs. Students expressed intent to improve their communication skills, address health literacy, contextualize care based on social circumstances, and respond to patients’ cultural health beliefs. This required 4-week course resulted in significant changes in fourth-year students’ attitudes and knowledge of community health principles. This course may be a model for other institutions.

IntroductionDepression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement (QI) and delivery of cognitive behavioural therapy (CBT) skills provided by community health workers in reducing depression. Depression QI approaches across healthcare and social/community services in safety-net settings have shown improvements in mental wellness, mental health quality of life and depression over 12 months. Further, a randomised study showed improved depression among low-income racial/ethnic minorities enrolled in a CBT-informed resiliency class (Building Resilience and Increasing Community Hope (B-RICH)). The current protocol describes a comparativeness effectiveness study to evaluate whether predominantly low-income, SGM racial/ethnic minority adults randomised to a CBT-informed resiliency class have improvements in depressive symptoms over and above community-engaged QI resources and training only.Methods and analysisThe study approached three clusters of four to five programs serving predominantly SGM and racial/ethnic minority communities in the USA: two clusters in Los Angeles, California, and one in New Orleans, Louisiana. Clusters are comprised of one primary care, one mental health and two to three community agencies (eg, faith-based, social services/support, advocacy). All programs received depression QI training. The current study employed a community-partnered participatory research model to adapt the CBT-informed resiliency class, B-RICH+, to SGM communities. Study participants were screened and recruited in person from participating programs, and will complete baseline, 6- and 12-month survey follow-ups. Participants were depressed adults (8-item Patient Health Questionnaire ≥10; ≥18 years of age) who provided contact information. Enrolled participants were individually randomised to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms; secondary outcomes are mental health quality of life, mental wellness and physical health quality of life. Data collection for this study is ongoing.Ethics and disseminationThe current study was approved by the UCLA Institutional Review Board. Study findings will be disseminated through scientific publications and community conferences.Trial registration numberhttps://clinicaltrials.gov/ct2/show/NCT02986126

Incarceration poses significant health risks for people involved in the criminal justice system. As the world’s leader in incarceration, the United States incarcerated population is at higher risk for infectious diseases, mental illness, and substance use disorder. Previous studies indicate that the mortality rate for people coming out of prison is almost 13 times higher than that of the general population; opioids contribute to nearly 1 in 8 post-release fatalities overall, and almost half of all overdose deaths. Further, Social Determinants of Health (SDOH) and health care are often interrelated difficulties and conflicting priorities for formerly incarcerated people. Given the interplay of incarceration, opioid use disorder (OUD), and social determinants of health, evidence is urgently needed on intersectional interventions to improve outcomes for this vulnerable group. We will conduct a systematic review of existing peer-reviewed literature published in the last 5 years that describe interventions for justice-involved people with OUD through a social-determinants lens. The purpose of this systematic review is to 1) identify interventions for opioid use disorder that are implemented as part of criminal justice system involvement, 2) determine which interventions also include a social determinants component, and 3) note any common elements between interventions with significant outcomes.

Objectives. To determine how community-based organizations (CBOs) define priorities for bolstering community resilience, challenges in addressing these priorities, and strategies to address challenges. Methods. The Community Resilience Learning Collaborative and Research Network (C-LEARN) is a multiphase study examining opportunities to improve community resilience to the threats of disaster and climate change in South Louisiana. Phase I of C-LEARN involved using the National Health Security Strategy and Implementation Plan for directed content analysis of key informant interviews with CBO representatives from 47 agencies within South Louisiana between February and May 2018. Results. CBO interviewees highlighted the importance of forging relationships and building trust through diverse cross-sector collaborations and partnerships before disasters. Such collaborations and partnerships were shown to tailor disaster response to the needs of particular communities and populations as well as address key challenges such as gaps in information, services, and resources. Conclusions. Our results encourage a culture of community resilience and community preparedness through partnerships and community-engaged strategies. C-LEARN will utilize the results of our interviews in the design of phase II of our agency-level coalition-building intervention.

Background: This year has seen the emergence of two major crises, a significant increase in the frequency and severity of hurricanes and the COVID-19 pandemic. However, little is known as to how each of these two events have impacted the other. A rapid qualitative assessment was conducted to determine the impact of the pandemic on preparedness and response to natural disasters and the impact of past experiences with natural disasters in responding to the pandemic. Methods: Semi-structured interviews were conducted with 26 representatives of 24 different community-based programs in southern Louisiana. Data were analyzed using procedures embedded in the Rapid Assessment Procedure-Informed Community Ethnography methodology, using techniques of immersion and crystallization and focused thematic analysis. Results: The pandemic has impacted the form and function of disaster preparedness, making it harder to plan for evacuations in the event of a hurricane. Specific concerns included being able to see people in person, providing food and other resources to residents who shelter in place, finding volunteers to assist in food distribution and other forms of disaster response, competing for funds to support disaster-related activities, developing new support infrastructures, and focusing on equity in disaster preparedness. However, several strengths based on disaster preparedness experience and capabilities were identified, including providing a framework for how to respond and adapt to COVID and integration of COVID response with their normal disaster preparedness activities. Conclusions: Although prior experience has enabled community-based organizations to respond to the pandemic, the pandemic is also creating new challenges to preparing for and responding to natural disasters.

Community health workers (CHWs) are frontline public health workers who are becoming increasingly integrated into medical settings for the prevention, treatment, and control of chronic disease. In particular, they have demonstrated the ability to improve medication adherence in underserved populations. One overlooked population that could benefit from CHW intervention is individuals with severe mental illnesses such as schizophrenia and bipolar disorder. These conditions are disproportionally weighted to economically disadvantaged communities and people of color, and are typically treated using antipsychotic medications. A number of factors, including social disadvantage, contribute to antipsychotic non-adherence, which is highly prevalent and drastically increases the burden of illness and economic impact of these conditions. This commentary examines the ways in which CHWs may be able to best serve individuals with severe mental illness, and proposes methods for facilitating this expanded scope of work.

School-based health centers (SBHCs) mitigate the long-term effects of poor health on children and adolescents. Although varied in staffing patterns and services provided, SBHCs aim to advance health equity among populations with histories and ongoing experiences of oppression. Reforms in education policy and the growing recognition of the role schools have in social mobility and economic prosperity beg the question of whether SBHCs demonstrably promote educational success alongside improved health outcomes. However, the current literature to elucidate the relationship between SBHCs and educational outcomes is limited. The purpose of this systematic review was to examine the recent evidence linking SBHCs and educational outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, this review explored and summarized studies examining SBHCs and educational outcomes. A total of 16 articles met the criteria for inclusion. School attendance was the most commonly observed academic outcome, while school discipline outcomes were understudied. Each publication included varying amounts and types of information delineating SBHC characteristics. The findings of this systematic review indicate that despite the expansion of SBHCs, there remains limited research studying the relationship between SBHCs and educational outcomes. Future research will benefit from accessing data for a broader array of outcome variables. Given the heterogeneity of SBHCs, it will be important for future studies to describe the delivery model, provider teams, types of service, and funding structures of SBHCs in detail.

Incarceration poses significant health risks for people involved in the criminal justice system. As the world's leader in incarceration, the United States incarcerated population is at higher risk for infectious diseases, mental illness, and substance use disorder. Previous studies indicate that the mortality rate for people coming out of prison is almost 13 times higher than that of the general population; opioids contribute to nearly 1 in 8 post-release fatalities overall, and almost half of all overdose deaths. Given the hazardous intersection of incarceration, opioid use disorder, and social determinants of health, we systematically reviewed recent evidence on interventions for opioid use disorder (OUD) implemented as part of United States criminal justice system involvement, with an emphasis on social determinants of health (SDOH). We searched academic literature to identify eligible studies of an intervention for OUD that was implemented in the context of criminal justice system involvement (e.g., incarceration or parole/probation) for adults ages 19 and older. From 6,604 citations, 13 publications were included in final synthesis. Most interventions were implemented in prisons (n = 6 interventions), used medication interventions (n = 10), and did not include SDOH as part of the study design (n = 8). Interventions that initiated medication treatment early and throughout incarceration had significant, positive effects on opioid use outcomes. Evidence supports medication treatment administered throughout the period of criminal justice involvement as an effective method of improving post-release outcomes in individuals with criminal justice involvement. While few studies included SDOH components, many investigators recognized SDOH needs as competing priorities among justice-involved individuals. This review suggests an evidence gap; evidence-based interventions that address OUD and SDOH in the context of criminal justice involvement are urgently needed.

The Patient Centered Outcomes Research Institute (PCORI) supports patient-centered clinical comparative effectiveness research (CER) including health disparities and engagement portfolios. In 2013, PCORI launched the Pipeline to Proposal (P2P) mechanism to support development of nov­el patient- and stakeholder-centered part­nerships focused on designing clinical CER funding proposals. By providing a tiered structure of successive small contracts and technical assistance, the P2P mechanism encourages development of new research partnerships among diverse stakeholders. As a comparatively new field, patient-centered outcomes research (PCOR) has few well-delineated methods for engaging patients and other non-scientists in effective teams with academics or clinicians to develop and implement rigorous, scientific research pro­posals. Community partnered participatory research (CPPR) provides a useful frame­work for structuring new partnerships.In this article we highlight the origins, de­velopment, and prospects of three current examples of funded P2P initiatives based in New Orleans and Los Angeles. We outline how these projects – Prisoner to Patient, the NOLA Partnership, and Resilience Among African American Men – use CPPR principles. We also describe how they have collaborated with, and contributed to, a two-way learning and knowledge exchange among members of the PCORI-funded Community and Patient Partnered Research Network. Lessons learned may be ap­plicable to other groups planning to create new partnerships focused on implementing PCOR.Ethn Dis. 2018;28(Suppl 2):303- 310; doi:10.18865/ed.28.S2.303.

Objective: We describe the rationale, de­velopment, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Methods: Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Setting: A community-academic partner­ship across Los Angeles County and New Orleans. Design: Descriptive report. Findings: Patient and community stakehold­ers participated in all phases of develop­ment, including local and national activities. Key developments include partnered plan­ning efforts, progress on aggregating a large, de-identified dataset across county agen­cies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion: The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakehold­ers. Ethn Dis. 2018;28(Suppl 2):295-302; doi:10.18865/ed.28.S2.295.

Community health workers (CHWs) are expected to improve patient care and population health while reducing health care costs. Law is a tool states are using to build a supportive infrastructure for the CHW workforce. This study assessed the extent existing state law pertaining to the CHW workforce aligned with best available evidence. We used the previously developed Quality and Impact of Component (QuIC) Evidence Assessment method to identify and prioritize those components that could comprise an evidence-informed CHW policy at the state level. We next assessed the extent codified statutes and regulations in effect as of December 31, 2014 for the 50 states and D.C. included the components identified in the evidence assessment. Fourteen components of an evidence-informed CHW policy were identified; eight had best, three had promising, and three had emerging evidence bases. Codified law in 18 states (35.3 % of 51) pertained to the CHW workforce. Fifteen of these 18 states authorized at least one of the 14 components from the evidence assessment (maximum: nine components, median: 2.5). The most frequently authorized component was a defined scope of practice for CHWs (authorized by eight states) followed by a standard core competency curriculum and inclusion of CHWs in multidisciplinary health care teams (each authorized by six states). States could consider the components presented in this article when developing new or strengthening existing law.

This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.

Community health workers (CHWs) collaborating with health care teams improve health outcomes. The feasibility of employing CHWs to support behavioral health in primary care is unknown. We offered experienced CHWs a 48-hour behavioral health training and placed them at health centers. Supervisors received technical assistance to support integration. We interviewed team members to explore CHW interactions with patients and team members. There was evidence of CHW integration. Major CHW roles included care coordination, outreach, and screening. It may be feasible to integrate behavioral health-focused CHWs into primary care settings. Both CHWs and supervisors need ongoing training and support.

Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N = 1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R 2 statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.

The floods and devastation of Hurricanes Katrina and Rita contributed to socioeconomic instability and psychosocial trauma for the affected communities and populations, significantly for people of limited economic means and persons of color. Though more than 1/3 of the adult population from impacted areas experienced significant psychological distress, few people had access to or received appropriate health or mental health services in the months and years that followed. Community health workers (CHWs)—defined as lay community members whose backgrounds are similar to those for whom they provide such services as culturally relevant health education, individual- and community-level advocacy, and links to the health care system— may represent a particularly promising workforce strategy to increase access to quality mental health services and overcome racial and ethnic disparities in care. In this paper, we briefly review a post-disaster mental health training program for CHWs from the greater New Orleans area. We present preliminary evidence that CHWs remain engaged in addressing post-disaster concerns, and that there is community support for further CHW education. We discuss implications for CHW participation in recovery from future disasters and we highlight the work of Cynthia Carriere, a CHW from the Lower 9th Ward in New Orleans.

This manuscript presents the protocol and participatory planning process for implementing the Community Resilience Learning Collaborative and Research Network (C-LEARN) study. C-LEARN is designed to determine how to build a service program and individual client capacity to improve mental health-related quality of life among individuals at risk for depression, with exposure to social risk factors or concerns about environmental hazards in areas of Southern Louisiana at risk for events such as hurricanes and storms. The study uses a Community Partnered Participatory Research (CPPR) framework to incorporate community priorities into study design and implementation. The first phase of C-LEARN is assessment of community priorities, assets, and opportunities for building resilience through key informant interviews and community agency outreach. Findings from this phase will inform the implementation of a two-level (program-level and individual client level) randomized study in up to four South Louisiana communities. Within communities, health and social-community service programs will be randomized to Community Engagement and Planning (CEP) for multi-sector coalition support or Technical Assistance (TA) for individual program support to implement evidence-based and community-prioritized intervention toolkits, including an expanded version of depression collaborative care and resources (referrals, manuals) to address social risk factors such as financial or housing instability and for a community resilience approach to disaster preparedness and response. Within each arm, the study will randomize individual adult clients to one of two mobile applications that provide informational resources on services for depression, social risk factors, and disaster response or also provide psychoeducation on Cognitive Behavioral Therapy to enhance coping with stress and mood. Planned data collection includes baseline, six-month and brief monthly surveys for clients, and baseline and 12-month surveys for administrators and staff.

There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams.

Academic institutions and community organizations engaged community health workers (CHWs) in creating a community-appropriate CHW workforce capacity-building program in an area without a previously established CHW professional group. From 2009 to 2010, we solicited New Orleans-based CHWs’ opinions about CHW professional development through a survey, a community conference, and workgroup meetings. Throughout 2011 and 2012, we created and implemented a responsive 80-h workforce development program that used popular education techniques. We interviewed CHWs 6 months post-training to assess impressions of the course and application of skills and knowledge to practice. CHWs requested training to develop nationally-recognized core competencies including community advocacy, addresses issues unique to New Orleans, and mitigate common professional challenges. Thirty-five people completed the course. Among 25 interviewees, common themes included positive impressions of the course, application of skills and community-specific information to practice, understanding of CHWs’ historical roles as community advocates, and ongoing professional challenges. Engaging CHW participation in workforce development programs is possible in areas lacking organized CHW groups. CHW insight supports development of training that addresses unique local concerns. Trained CHWs require ongoing professional support.

Total annual costs of stroke-related care and loss of post-stroke productivity are projected to reach $241 billion by 2030, an increase of 129% since 2010. Although comprehensive stroke care programs have contributed to reductions in recurrent strokes, readmissions, and stroke-related complications, this population is vulnerable to non-adherence to the plan of care during the first year. Innovative in-home programs that coordinate team-based care hold promise for positively impacting this public health threat through greater emphasis on effective prevention, adherence, and optimizing outcomes. Purpose: The purpose of this project was to evaluate the implementation of a home-based post-discharge stroke mobile program to existing comprehensive stroke care. Methods: An inter-professional team of stroke specialists (physicians, advanced practice nurses, registered nurses), and administrative and financial specialists collaborated to develop an innovative, family-centered, home-based approach to post-discharge stroke care. The team identified project goals, assessment tools, and 12-month post-discharge outcome metrics. Telemedicine technology enabled a direct link between the mobile team, patient, and an APN or Neurologist to reduce office/emergency visits, and lower costs. Results: Training of the home-based team included stroke specific education, along with training in communication skills and family-based interventions. Home visits were structured to occur once per month for 1 year post stroke. Each visit was designed to impact specific elements related to enhancing physical recovery, preventing readmissions and stroke recurrence, improving medication compliance, risk factor management, and caregiver support. Fifteen of 24 (63%) received all scheduled visits, and all planned visits did not occur in 9/24 (37%) due to patient’s schedule. Only 2/24 (8%) were readmitted for stroke recurrence. Lessons learned include need to validate contact information before discharge; develop a brochure that targets program enrollment; and explore options to visit in other settings. Conclusion: A family centered, home-based, post-discharge system of care is a viable solution to addressing the complex needs of the stroke patient.

To describe participants' experiences with training on, and implementation of, a collaborative care mental health approach for treating depression and anxiety in post-disaster New Orleans.Healthcare providers from three organizations that participated in the Mental Health Infrastructure and Training (MHIT) program underwent semi-structured interviews.The MHIT program provided training and clinical support to community-based agencies.Social workers, care/case managers, primary care providers, and a psychiatrist that participated in trainings.The MHIT project consisted of a series of trainings and clinical support designed in collaboration with specialists from Tulane University, RAND/UCLA, the University of Washington, and local community organizations with the goal of creating local resources to provide screening, diagnosis, triage, and treatment for depression and anxiety.Interview participants were asked to describe the impacts of training on the following areas: delivery of mental health services, ability to implement elements of the collaborative care model, care of clients/patients, and development of networks.Interview transcript analysis identified themes highlighting the opportunities and challenges of implementing a collaborative care model.Implementation of a collaborative care model for treating depression and anxiety was possible in post-Katrina/Rita New Orleans and has potential for implementation in future post-disaster recovery settings.