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 Improving Access to Medical Home Programs for Hispanic Children with Special Health Care Needs by Utilizing Community Health Workers

By Myra Rosen Reynoso, PhD
National Center for Ease of Use of Community-Based Services

Data from the National Survey of Children with Special Health Care Needs (CSHCN) indicates that the reported prevalence rate of Hispanic children with special health care needs has risen from 8 percent to 11 percent over the past few years. In addition, recent parental reports indicate that only 32 percent of Hispanic CSHCN have medical homes, which is the model for delivering the highest quality of primary care that is accessible, comprehensive, family-centered and culturally effective (medicalhomeinfo.org).

For many underserved populations, one key component to increasing access to health care, achieving health equity, and promoting medical home access is community health workers (CHWs). Moving forward, learning from states that have succeeded in implementing successful models of CHWs to increase access to medical homes and reduce disparities for Hispanic CSHCN is imperative to reducing medical home disparity.

In November 2013, a national meeting was convened to address emerging CHW models. The National Center for Ease of Use of Community-Based Services convened the meeting, "High Expectations: Community Health Workers and Hispanic CSHCN." The meeting was held in partnership with the Eunice Kennedy Shriver National Institute of Child Health and Human Development and The HSC Foundation. The HSC Foundation is dedicated to improving access to services for individuals who face social and health care barriers due to disability, chronic illness, or other circumstances that present unique needs. States represented at the meeting included Indiana, New York, North Carolina, Rhode Island and Washington, as well as the District of Columbia.

During the meeting, three key areas regarding CHWs were discussed regarding potential strategies to increase access to medical home programs for Hispanic CSHCN and their families:

1. Core Competencies of CHWs

There was consensus that CHWs assist families in accessing services as part of the medical home. The core competencies needed for this role include a basic understanding of the ways that having a child with a special health care needs affects a family. For CHWs who serve Hispanic populations, a special attention to cultural norms and cultural competency is crucial. The CHW also should have knowledge of insurance coverage, including coverage for CSHCN. Their work should help families build their general advocacy skills and assist in developing family leaders in the community. These professionals should be linked to medical homes and provided a formalized way to document visits and develop benchmarks of success.

2. Knowledge Medical Home Providers Need to Have About CHWs

Within a medical home program, there needs to be a clear definition of the role of the CHW with the recognition that many terms like navigator, promotora, liaison, and health worker are often times used interchangeably but may have different functional roles in each setting. There must be an established understanding of the value added by working closely with CHWs. The "value" may be in the form of reduced rates of cancelled appointments, compliance to treatment protocols, reduced emergency room visits, or increased trust and communication between providers and families.

Additionally, providers should stay informed of the changes provided by the Affordable Care Act and possible funding mechanisms to either establish or expand different models of CHWs. Most importantly, providers should know that CHWs play a paramount role in fortifying linkages to the community and improving families’ access to essential services.

3. Knowledge Medical Home Providers Need to Better Serve Hispanic CSHCN

The Hispanic community has significant historical, political, economic, cultural, educational and linguistic variations. Providers should not assume that all parents want to speak in Spanish during a medical visit; however, qualified medical interpreters should be available for those that do want to interact in Spanish. An ecological approach should be considered when designing effective and sustainable medical home programs for Hispanic families with CSHCN.

For more information, including a video of the panel presentation, Health Insurance Access for Underserved Families, visit communitybasedservices.org.

Speakers at the meeting included:

Robert Hall
Associate Director, Federal Affairs, American Academy of Pediatrics

Kim Horn
Regional President, Mid-Atlantic States, Kaiser Foundation Health Plan

Diane Lewis
Executive Vice President, Alta Consulting Group, Inc.

Donna Cohen Ross
Senior Advisory, Office of External Affairs, Centers for Medicare & Medicare Services

Data source: Data for both 2005- 2006 and 2009-2010 National Survey of Children with Special Health Care Needs. Accessed at the Data Resource Center for Child and Adolescent Health. Available at childhealthdata.org/browse/survey.