00:05- Good afternoon, everybody.
00:06Thank you for your patience
and thank you for your patience
00:09for folks that are joining us online,
00:12taking us a few minutes to
get folks gathered here today
00:15on this Friday afternoon.
00:17My name is Kara Carter.
00:19For those of you I don't know,
00:20I am the Senior Vice President
for Strategy and Programs
00:23at the California Healthcare Foundation,
00:24and I am thrilled to welcome
you all this afternoon.
00:28This is actually only our
second in-person briefing
00:31since COVID-19 restrictions began.
00:34I'm so grateful that we're able
00:36to have the opportunity
to gather like this,
00:38and I'm grateful for you all for coming in
00:41an absolutely gorgeous Friday
afternoon in Sacramento.
00:46The California Healthcare Foundation
00:47is an independent nonprofit philanthropy,
00:50and we work to improve the
healthcare system to make sure
00:52that all Californians have
the care that they need.
00:55We focus particularly on
making sure the system works
00:59for Californians with low incomes
01:00and for communities who
have been historically
01:02to face the biggest barriers to care.
01:06Our headquarters are in Oakland.
01:08We have an office here in Sacramento,
01:10and we have a number
of colleagues that work
01:11in the southern part of the state.
01:15Today's convening is one of
a regular series of briefings
01:18that are in-person and their
virtual that we sponsor here
01:21in Sacramento for Sacramento policy staff
01:23and other folks that are interested.
01:26These briefings have two purposes.
01:27So they're designed first off
to bring you the information
01:30that is relevant to
healthcare issues and trends,
01:33and secondly, to promote
dialogue on potential solutions
01:36to the challenges the state faces.
01:39In addition to the folks in the room,
01:40there are over 450
people on our Zoom today.
01:45We're excited to welcome
both our in-person colleagues
01:48and our remote colleagues.
01:50And for folks who are curious,
01:51we will make a video of today's
briefing available so people
01:54who aren't available today
were able to watch it later.
01:58Our briefing today is about a key part
02:00of the health workforce in California,
02:02our community health
workers and Promotores
02:04and community health representatives.
02:07My colleague Carlina
Hansen will take the stage
02:09in a few minutes and she'll
talk more about that.
02:11But these workers have a long
02:13and incredibly critical history
02:15in supporting our communities.
02:17They often serve as a critical
bridge connecting people
02:20who are not well served by
traditional healthcare system
02:22to the services that they need.
02:25During the COVID-19 pandemic,
02:27they were heroes on the front lines.
02:30They combated misinformation,
they connected people
02:33to the supports they needed to survive,
02:35they promoted vaccinations
and they helped save lives.
02:39The pandemic's disproportionate
effects on people of color,
02:42particularly Latino
and black Californians,
02:44laid bare the structural racism
02:46that has long existed and
permeated our healthcare system.
02:49It is our collective
responsibility to now uproot
02:52and eliminate that racism.
02:58Part of this work is ensuring
03:00that we're building a health workforce
03:01that reflects the rich diversity
03:02of the California population
03:04and is deeply connected to the
communities we all live in.
03:08Community health workers and Promotores
03:10and community health
representatives have a vital role
03:12to play in creating a
modern healthcare workforce.
03:16We were very encouraged by
the commitment to expanding
03:19and supporting this workforce
in last year's state budget.
03:22While California's financial
situation has changed,
03:25the need for community
health workers, Promotores,
03:28and community health representatives
03:29is greater than it has ever been.
03:32They've been serving California
communities for decades,
03:35and now it's time for
us to serve them better.
03:38How do we ensure that this is a workforce
03:40that is well compensated, fully respected,
03:43and given the opportunities
to advance in their careers?
03:47How do we rapidly expand this workforce
03:49without over medicalizing it
03:51or diluting their connection to community?
03:53How can we help new partners
03:55like Medi-Cal managed care plans engage
03:57with community health
workers and Promotores
03:59in a way that is mutually
beneficial and respectful?
04:03How do we ensure that all of this work
04:05is ultimately impactful
for Medi-Cal members
04:07who we put at the center
of everything that we do?
04:10And what is the role and the
responsibility of the state has
04:13in growing and supporting this workforce
04:15through this time of
transition and growth?
04:19I couldn't be more thrilled to
bring together today a series
04:22of distinguished researchers and speakers
04:24to have this conversation on our panel,
04:26and I hope that you'll all enjoy it
04:27as much as I know I will.
04:30Carlina Hansen, a Senior Program Officer
04:31at CHCF leads the foundation's work
04:33around the community connected workforce.
04:35She's going to kick us
off in a few minutes
04:37with a short overview on introductions,
04:39and then she'll serve as a moderator
04:40of the panel discussion.
04:42There'll be plenty of time for
Q and A following the panel.
04:45Before I hand to Carlina, I
have a few housekeeping items
04:48that I've been asked to kind of convey.
04:50The first is around questions.
04:53If you have a question,
04:54and we very much hope
you have many questions,
04:56and you're sitting here
in the room with us,
04:58please save those questions
to ask during Q and A.
05:01We'll have mics circulating
for them at the time.
05:04If you're joining us on Zoom,
05:05please submit a question at any time
05:07by clicking on the Q and A icon.
05:09Use the chat function for
technical issues only.
05:13This session is being recorded,
05:15so the recording will be available
05:16on the CHCF website early next week.
05:19You'll receive an email with
a link once it is available.
05:22And finally, for those of you on Zoom,
05:24we have both captioning
in English and in Spanish,
05:27as well as translation to Spanish.
05:29Please check the Zoom
chat for instructions
05:31on how to access those options.
05:33Now, please join me in welcoming Carlina
05:35to the platform, thank you.
(audience applauding)
05:43- Hi, everyone, thank you so
much for joining us today.
05:47I want to just thank Kara
for the introduction.
05:51I'm very excited to be
here with you in person.
05:54I have to say a teeny
bit anxious to be away
05:56from the safety of my own living room,
05:59but I am definitely sure that my dog
06:02will not bark when the doorbell rings,
06:04so that gives me a
little bit of confidence.
06:08So I am thrilled to be
able to talk to you today
06:12about the community
health worker workforce.
06:15Kara has gone over the housekeeping items.
06:18So just who are community health workers,
06:21Promotores and representatives?
06:23As Kara said, they are community members
06:26who offer a wide array of health
and public health services
06:30and have been doing so since the 1970s,
06:33and some would say long before that.
06:37include providing culturally
competent health services,
06:41health promotion and education,
06:44assistance in accessing
medical and social services,
06:48care coordination, patient
advocacy, and much, much more.
06:53You may also be wondering why
the long acronym, CHW/P/Rs.
06:58It is because there are critical
members of this workforce
07:01who have a unique identities
and a long history
07:05of serving California's
diverse communities.
07:09P stands for Promotores, who
largely work in Latino, Latinx,
07:14and Spanish speaking communities,
07:16and the R stands for community
health representatives
07:19who have long worked in American Indian
07:22and Alaska native communities.
07:26So I want to start by grounding us
07:28and sort of emphasizing some
of the points that Kara made
07:31about why this workforce is important
07:34and what exactly is driving
the increased attention
07:38by healthcare systems and
policy makers in California.
07:42First and foremost, as we know,
07:45there are far too many
people in California
07:48who have been impacted
by racism, xenophobia,
07:52discrimination, and trauma,
all of which of course
07:56can have a negative
impact on their health.
07:59The systems that are designed
to support Californians
08:02have work to do to
dismantle systemic racism.
08:06CHW/P/Rs are part of the solution.
08:10It is however important to be clear
08:12when we talk about the workforce,
08:14that they are not responsible
for solving the woes
08:17of systemic racism in
the healthcare systems.
08:20They are part of a solution,
08:22a solution that all of us
needs to be playing a part in.
08:28So evidence also tells
us that shared identity
08:31can shape people's health
experience and outcomes.
08:35We also know that shared
language is important,
08:38all the more so because so
many Californians choose
08:41to receive access to healthcare
08:43in languages other than English.
08:46Yet the demographics of
California's health workforce
08:49does not match the
population of the state,
08:52let alone the population of Medi-Cal.
08:55The CHW/P/R workforce
is racially, ethnically,
08:59and linguistically diverse,
09:01and they often share other
intersecting identities
09:05with those they serve, an
experience of homelessness
09:10or incarceration or a shared identity
09:13around gender expression
or socioeconomic status.
09:17These kinds of shared
experiences build trust,
09:20which Kara talked about.
09:22CHW/P/Rs are bridge builders
09:25who support people's health and wellbeing.
09:30Additionally, as I think many of you know,
09:32the Department of Healthcare Services
09:33is encouraging health systems
09:36and Medi-Cal managed care plans
09:37to be more community connected,
09:40to reach out into the community,
09:42to meet people where they are,
09:44as opposed to waiting
for them to come to us.
09:48CHW/P/Rs are an important
part of this effort.
09:52Their work often happens in
the community at health fairs,
09:57churches, homeless encampments,
or community centers.
10:00This kind of outreach is important
10:02because it meets people
on their own terms.
10:06Finally, CHW/P/R interventions work
10:09to help people controlling their diabetes
10:12or addressing chronic health conditions.
10:17So with that, I want to
introduce our wonderful Jackie
10:23who is going to be presenting
some of the research
10:25that CHCF has funded to
reinforce some of the evidence
10:29that we know about CHW/P/Rs
in the state of California,
10:34both from their perspective
10:35and their perspective of employers.
10:38Jackie, who's with the
UCSF Health Force Center,
10:43has been a critical partner
of ours in learning more,
10:47and I invite you to the stage, Jackie,
10:49thank you so much for joining us today.
10:52(audience applauding)
11:01- Thanks, Carlina, for the introduction,
11:03and thank you everyone so
much for being here today.
11:06As Carlina has mentioned,
11:07I am here to discuss the
recent research that we at UCSF
11:11have done about community
health workers and Promotores.
11:17So I'll start by providing
some general notes
11:19about our research study as a whole.
11:23First, the research
focused on California only.
11:28Second, the research was
informed by an advisory group,
11:33which represented seven
different organizations,
11:36and these advisors really
aided with survey development
11:40and interview guide development.
11:44Third is that the study
population captured information
11:47about CHW/Ps who are both volunteering
11:51and in paid positions.
11:54So the initial goal of our project
11:56was to measure supply and demand of CHW/Ps
11:59but we experienced barriers
to assessing supply,
12:02which I will discuss in a
little bit more detail soon.
12:05The project comprised
of four main components,
12:08which resulted in four main reports.
12:11First, we surveyed and
interviewed CHW/P training
12:14and education programs across the state.
12:17Second, we surveyed CHW/Ps themselves.
12:20Third, we surveyed CHW/P
employers and healthcare settings.
12:25And fourth, we interviewed CHW/P employers
12:28in a variety of settings.
12:30So today I'll be presenting highlights
12:32from all four reports,
12:33but the full reports can also
be found on CHCF'S website,
12:37with the exception of the
employer interview report,
12:39which will be finished soon.
12:45So first, I'd like to talk a
little bit about CHW/P supply
12:48and why it's so difficult to measure.
12:50One of the reasons that we
set out to measure supply
12:53is because we know that the
national and state sources
12:56that count the workforce,
12:57like the Bureau of Labor Statistics,
13:00vastly undercount the number of CHW/Ps.
13:03Although there is an SOC code
13:05for the community health
worker profession,
13:07the code does not capture all workers
13:09who perform the many different
roles that CHW/Ps can have.
13:13Additionally, there are separate
codes for different roles
13:16that can overlap with CHW/P work,
13:18such as health education specialists
13:21and mental health counselors.
13:25The workforce also lacks a
licensing or certification body
13:28to track the workforce, which
many other professions use
13:31to aid and measuring supply.
13:35Lastly, as many of you know,
13:36there are different job titles
used to capture CHW/P work.
13:40Part of the reasons why there
are many different job titles
13:44is because there are
so many different roles
13:46that CHW/Ps can have.
13:48Oftentimes, they can focus on working
13:50with people with specific
chronic health conditions
13:53such as diabetes or specific populations
13:55such as homeless individuals.
13:58Job title can also be affected
by the type of organizations
14:01that CHW/Ps work for and their HR systems.
14:05And funding streams, especially
if the role is grant funded,
14:08can also affect job title.
14:11Pictured on the right hand side
14:13is a word cloud that shows all
of the different job titles
14:15that were reported on our CHW survey.
14:19And as you can see from the slide,
14:22community health outreach worker
14:24was the title that was most often used.
14:30So although supply was
difficult to measure,
14:32we were able to get a better
sense of CHW/P demand,
14:35and I'd like to start by saying
14:36that there has always
been a need for CHW/Ps
14:39as they care for high need
and vulnerable populations.
14:43However, the COVID-19 pandemic
really highlighted this need
14:47and created additional workforce demand.
14:49Data from the CHW/P survey showed
14:52that one third of CHW/P said
14:54that their employment changed
as a result of COVID-19,
14:58and of those respondents,
nearly two thirds said
15:01that their employment change
resulted in increased hours.
15:05Additionally, some healthcare
employer interviewees
15:08commented on the COVID-19
impact on demand.
15:12For instance, one interviewee said,
15:14"I think COVID actually
amplified the need for Promotores
15:18"because they were flexible
and they took on a lot of roles
15:20"that were there before, and
they have done amazing work."
15:29In addition to creating demand,
15:30the pandemic also changed the CHW/P role
15:33in some organizations.
15:35The chart on the previous slide showed
15:36that nearly one quarter of CHW/Ps
15:39who said that their employment changed
15:41as a result of COVID-19 listed an impact
15:44other than their hours changing.
15:46Examples of other impact
that the workforce reported
15:49included shifting work responsibilities
15:52and taking on new roles.
15:55From the CBO perspective, one
CHW/P interviewee explained
15:59how her role shifted during the pandemic,
16:01stating that, "Misinformation
and myths travel very fast.
16:06"We're definitely seeing that with COVID.
16:08"And so we do a lot of community building,
16:11"a lot of trust building in the community.
16:13"For us, that's definitely our strength,
16:15"that we're able to go
back to our community
16:17"and do a lot of unlearning,
16:19"making sure that we are up
to date with the pandemic.
16:22"The information changes very rapidly."
16:25Some interviewees also noted other changes
16:28in the role as a result of the pandemic,
16:30including the need to provide
COVID vaccination outreach,
16:33and that the pandemic created challenges
16:35with integrating the role
into the clinical care team.
16:41We were able to quantify demand with data
16:43from the CHW/P healthcare employer survey.
16:47The pie chart show the
number of survey respondents
16:49who said that they employed CHW/Ps.
16:53more clinic respondents
employed CHW/Ps compared
16:56to hospital respondents,
16:57with nearly 80% of clinics
saying that they employed them
17:01and 40% of hospitals saying
that they employed them.
17:05It is also worth noting
17:07that CHW/P wages varied
according to employer type.
17:11In general, hospitals paid
higher wages compared to clinics.
17:15For entry level positions,
17:16most clinics paid between
16 and $20 per hour,
17:19while most hospitals paid between 21 to 25
17:23or 26 to $30 per hour.
17:26This trend also continued
for senior level positions.
17:30For senior positions,
17:31most clinics reported paying
between 21 to $25 per hour,
17:35and most hospitals reported paying
17:36at more than $30 per hour.
17:39Also, in some cases,
17:41CHW/P wages increased during the pandemic,
17:43partially as a result of increased demand.
17:51Clinic and hospital
employers also reported
17:53on how many additional CHW/Ps they plan
17:56to hire in the next 12 months,
17:58as well as how many
they would ideally hire
18:00in the next 12 months,
18:03as shown in the bar chart on the left.
18:06both hospitals and clinics
anticipated hiring more CHW/Ps,
18:11but clinics anticipated
hiring more than hospitals.
18:15Additionally, both hospitals
18:16and clinics wanted to hire more CHW/Ps.
18:20This was especially true of hospitals
18:22who would ideally hire more
18:23than 10 times the number of
CHW/Ps than currently planned.
18:27Clinics would ideally hire more
18:29than three times CHW/Ps than planned.
18:35So now I'll discuss a
little bit about educational
18:38and hiring requirements of CHW/Ps.
18:42The pie chart on the right show hospital
18:44and clinic educational
requirements for CHW/Ps.
18:48And as you can see, most hospital
18:50and clinic employers required that CHW/Ps
18:53have a high school education at minimum.
18:55However, hospitals more
often required an associate's
18:58or bachelor's degree,
19:00and sometimes a CHW/P
training certificate.
19:06Clinics and hospitals also
shared similar job requirements.
19:10The bar chart shows job requirement data
19:12as reported from the
health employer survey.
19:16And as you can see, the job
requirement most often reported
19:19for both clinics and
hospitals was work experience.
19:23Other requirements most
important to clinics
19:25were being bilingual
19:26and having a California driver's license.
19:29Other requirements most
important to hospitals
19:31were having a California's
driver's license, being bilingual
19:34and having completed CHW/P training.
19:38In thinking about hiring for this role,
19:40it is important to note that
there are certain challenges
19:42associated with finding qualified CHW/Ps
19:45beyond having the appropriate
level of education
19:48and meeting other job requirements.
19:50Some employer interviewees spoke
19:52about the challenges associated
19:54with finding qualified CHW/Ps.
19:56Specifically one interviewee said,
19:59"You don't just put this
on LinkedIn or whatever,
20:01"or other job sites.
20:02"You have to take a different
approach also in the hiring,
20:05"having community health workers
on your hiring committee,
20:08"and also hire for some of
those intangible qualities,
20:11"like passion and dedication
to the community."
20:18Now, I'll transition to talk more
20:19about the CHW/P training
programs that exist in the state.
20:25For the state with the largest
population in the country,
20:28there are relatively few opportunities
20:30for CHW/P training programs
for training in California.
20:35At the time of our research,
20:36we identified 25 active
training programs in the state.
20:40On the right, you'll see a map
20:41of these training program locations,
20:43and as you can see, most of the programs
20:45are concentrated in the
San Francisco Bay area
20:48or the greater LA area.
20:50This left large parts of the state,
20:52such as the North and Central
Valley, without any programs.
20:56It is also worth noting
20:57that some programs were completely online
21:00or had online components.
21:02However, it is challenging to assess
21:04if these programs had
the presence outside of
21:06or beyond their own communities.
21:11Most active programs offer general
21:13rather than specialized training.
21:15And when I say general training,
21:16I'm referring to programs
that teach core CHW/P content
21:20that all or most CHW/Ps
would or could use.
21:24This contrasts with specialized training,
21:25which I'm using to refer to
programs that teach content
21:29that would be specific
to a particular role,
21:31such as roles that might focus
21:33on a specific chronic
condition or population.
21:38Although having CHW/P
training was rarely listed
21:40as a hiring requirement
among healthcare employers,
21:43all interviewees describe
newly hired CHW/Ps
21:47undergoing training after
they had been hired.
21:50Post-hire training varied
in length significantly
21:53with a range to two hours to 16 months,
21:55the latter of which was
an apprenticeship program.
21:58The structure of post-hire
training also varied.
22:01Some organizations incorporated
module style trainings,
22:05while others had one large
overarching training.
22:08Some organizations created
their trainings in-house,
22:11some contract with other
education or training institutions
22:14and others participated in both.
22:17Many post-hire training courses
22:18also included a job shadow component.
22:24Now I will pivot to discuss some
22:26of the new billing mechanisms
for CHW/P services.
22:30And first, I would like to
discuss the State Plan Amendment
22:32or the SPA, which is often
referred to as the CHW benefit
22:36or the DHCS benefit.
22:38The SPA became effective July 1st, 2022,
22:42and it provides reimbursement
for some CHW/P activities,
22:45such as preventive services delivered
22:47in individual or group
settings for certain issues
22:51and prevention of
chronic health conditions
22:53or mental health conditions.
22:56These CHW/P services can take
the form of health education,
23:00health navigation,
screening, and assessment,
23:04or individual support and advocacy.
23:07More details on the SPA
can also be found online.
23:11So in our study, we gathered data
23:13from employer interviewees
about CHW/P billing,
23:16and I'd like to provide a small disclaimer
23:20At the time of our interviews,
23:22the SPA had not been finalized
and was thus incomplete.
23:25Although most interviewees were aware
23:27that the SPA was in development
and generally understood
23:30that some types of organizations
23:31would soon be able to
bill for CHW/P services,
23:35interviewees did not know
which services would be covered
23:37or necessarily understand
the mechanism for coverage.
23:41As a result, interviewee
perceptions of the SPA,
23:44including who and what
it was designed to cover,
23:47did not always accurately
reflect the version
23:53So our interviewees shared
mixed opinions about the SPA.
23:57Some commented on their
belief that the SPA
23:59could improve access to preventive care
24:01and potentially negate the need
24:02for organizations to demonstrate
return on investment.
24:06Others feared that the SPA
24:07could potentially over
medicalize the profession
24:09by excluding CHW/Ps who do not
work in a clinical setting,
24:13and that the SPA could potentially
24:14require formal CHW/P education,
24:17which could create barriers
for authentic CHW/Ps.
24:21Some interviewees were
also curious to know
24:24if or how the SPA may tie into
certain elements of CalAIM,
24:28such as enhanced care management.
24:34So CalAIM is another opportunity
24:37for more indirect billing
of CHW/P services.
24:41The cost of services may be reimbursed
24:44through two main components,
24:45which are enhanced care
management or community supports.
24:50Interviewees, however,
reported potential challenges
24:52associated with accessing
CalAIM to support CHW/P work.
24:57Some of these challenges included lack
24:59of organizational infrastructure
25:00to take advantage of ECM
or community supports,
25:04ECM being too focused on case management
25:07or care coordination,
25:08which would not include
other aspects of CHW/P work,
25:13and potentially the idea
25:14that there might not be
enough funding in CalAIM
25:17to support the hiring
of additional CHW/Ps,
25:21the fear being that it might only be able
25:23to support the existing workforce.
25:29So the reason why CHW/P billing
25:31is so important to think about right now
25:33is in terms of rural sustainability.
25:36Hospitals and clinics,
25:37but especially clinics were concerned
25:39with funding uncertainty
for the CHW/P role.
25:44Other top concerns included
finding qualified CHW/Ps
25:47or staff turnover,
particularly for clinics.
25:52Almost half of hospitals
indicated no concerns
25:54with sustainability
compared to zero clinics,
25:57which is also an important note.
26:03Another aspect of CHW/P
work that is important
26:06to consider is role
advancement and growth.
26:09Role advancement is really important
26:11in terms of incentivizing CHW/Ps
26:13to enter or remain in the profession.
26:16And the pie chart on the left shows data
26:20from the CHW/P survey,
26:22while the bar chart on
the right shows data
26:24from the CHW/P healthcare employer survey.
26:28As you can see, half of CHW/Ps reported
26:31that they had opportunities to advance.
26:33For the healthcare employer surveys,
26:35only 36% of hospitals reported
26:37that CHW/Ps had an opportunity
to advance compared
26:49So as I begin to wrap up today,
26:51I would like to leave everyone
with a few key takeaways.
26:54First is that the COVID-19
pandemic highlighted the need
26:58and created demand for more CHW/Ps.
27:01Second, employers reported
ideally wanting to hire
27:04between three to 10 times more CHW/Ps
27:06than currently planned.
27:08Third, there were relatively
few training opportunities
27:11given the size of the state,
especially in certain regions
27:15such as the far North and Central Valley.
27:18Fourth, interviewees expressed excitement
27:20about new mechanisms to
bill for CHW/P services,
27:23but also some concern
about implementation.
27:26And fifth, funding
uncertainty was a top concern
27:29for hospital and clinic employers relative
27:32to CHW/P role sustainability.
27:37I would also like to provide everyone
27:39with some recommendations today.
27:41The left-hand column shows
general recommendations
27:44that are applicable to
many different audiences,
27:46the first set of which is
applicable to training programs.
27:51Training programs have the opportunity
27:52to assist the workforce in several ways.
27:55First, they could expand new
27:57or existing training programs
into new geographic areas.
28:01They could also provide subsidies
28:03or stipends for CHW/P trainees.
28:07Training programs also have the ability
28:09to do better follow up on their graduates,
28:12to find out where they're working
28:14or where they get placed with jobs.
28:17And also training programs can provide,
28:20there may be a space for
more specialty training
28:22to assist folks, to assist CHW/Ps
28:26who want to focus on helping
people with specific needs
28:33such as those with
chronic health conditions
28:35or specific populations.
28:38Employers also have the ability to assist
28:41with the CHW/P workforce.
28:45They can provide higher wages
28:46or offer career growth opportunities.
28:49They can also incorporate
sustainable funding practices
28:54which should include
de-emphasizing the concept
28:57of return on investment,
as it is difficult
29:00to attribute specific improvements
to individuals' health
29:05to CHW/Ps when they're working
in a team-based care setting.
29:10There are also opportunities
29:11for better data collection
on the CHW/P workforce.
29:14And state and national
associations have the ability
29:18to take the lead on collecting these data
29:21as they have a unique understanding
29:23and interconnectedness
with the profession.
29:26There are also opportunities
29:27for the state to assist the workforce.
29:30The state can assist the training programs
29:32by providing funding for these programs,
29:34and they can also provide their
own subsidies for trainees.
29:38There's also opportunities
to assist with billing.
29:42The state could help
with SPA implementation,
29:44especially for organizations
29:46that do not already have
billing structures set in place.
29:49They can also ensure that CHW/Ps
29:51are a critical component of CalAIM.
29:54And lastly, the state can also assist
29:56with better collection of CHW/P data.
30:00They can improve the
accuracy of CHW/P supply data
30:03to inform the state workforce planning,
30:06which could include emphasizing the use
30:08of the existing SOC code,
regardless of employee job title.
30:13And lastly, DHCS and
HCAI can work together
30:16to decide on which other
data might be important
30:18to collect about the workforce.
30:22Here are the chart and quote sources
30:25for the presentation today.
30:28And I'd also like to thank
the rest of our study team
30:30as well as the advisory group
for their help with the study
30:35as they were integral to
the success of the project.
30:39Thank you very much, everyone.
30:41(audience applauding)
30:49- Okay, I'm going to ask our
panelists to come up please
30:52and take your seats.
30:56So a little bit of housekeeping
before we get started.
31:01I want to call your attention
to the blue evaluation form
31:04that you all should have received.
31:06Please do take a moment to
fill this out before you leave
31:10because it helps us in planning these,
31:12making sure that we
are being as responsive
31:14to your needs as possible.
31:16For the people that are online,
31:18you'll have an evaluation
pop up towards the end
31:22of the session, so
please do fill that out.
31:26I want to emphasize the slide
that sits behind me just
31:30to share that there are, as
I think many of you know,
31:34a number of policy changes
31:37that are happening in
California right now.
31:41There is the, and much of it was seated
31:44by the California Health
Workforce Commission in 2019,
31:48which recommended scaling the engagement
31:50of community health workers,
Promotores and peer providers
31:54through certification,
training, and reimbursement.
31:59In 2022, as we discussed,
32:01CHW/P/Rs became covered
providers in Medi-Cal
32:05through an approved State
Plan Amendment or SPA.
32:09Many CHW/P/Rs, as you just heard,
32:12are involved in the CalAIM program.
32:15The 2022, '23 state budget included funds
32:20to add 15,000 new CHW/P/Rs
to the state's workforce
32:26in recognition of some of the other things
32:28that were going to stimulate
demand in the state.
32:30And finally, in 2023,
the budget also directed
32:35the Department of Healthcare
Access and Information,
32:38or HCAI to initiate a
certification program for CHW/P/Rs
32:43who are participating
as Medi-Cal providers.
32:46So you'll hear a little bit more
32:48about these things as we
talk on our panel today.
32:53With that, I would like to
introduce our fabulous experts.
32:57Thank you so much for joining us.
32:58First we have Angelica Alvarez,
who's the program director
33:03with El Sol Neighborhood
Educational Center,
33:08Joseph Calderon, Joe Calderon,
33:10Senior Community Health Worker,
Transitions Clinic Network,
33:15Elia Gallardo, who's
the Chief Equity Officer
33:18and Deputy Director of Legislative
and Governmental Affairs
33:23with HCAI, Andrea Mackey,
who is the Policy Manager
33:29for California Pan-Ethnic
Health Network, or CPEHN.
33:34And finally, Dr. Pooja Mittal,
33:37Chief Health Equity
Officer with Health Net.
33:40Thank you all so much for joining us.
33:43Before we get going, I also
want to acknowledge there
33:46are some fabulous
experts in the room today
33:49who have a long history
33:50of doing amazing work
supporting this workforce.
33:54We cannot have all of you up on the panel,
33:56but I want to make sure that we honor
33:59and thank you for all you have done
34:01to advance and support this workforce
34:03in the state of California.
34:05So I'm going to get started
by asking our panelists
34:08to tell us a little bit
about your organizations
34:11and specifically your work
with community health workers,
34:15as well as one or two important things
34:19that you want everybody
to know about the role
34:22that this workforce can
play in improving the health
34:25of the people of California.
34:27So we'll start with you, Angelica.
34:29- First one, so everyone,
can hear me, right?
34:33Good afternoon, everyone,
34:34I'm very glad to be here and pleased.
34:36My name is Angelica Alvarez.
34:38I work for El Sol Neighborhood
Educational Center.
34:41El Sol is a nonprofit.
34:43We do work in San Bernardino
County and Riverside County.
34:48We have been able to, during 35 years,
34:51we have been able to train, to
provide technical assistance
34:55and to work with community
health workers, Promotores, R.
35:00So, I have been working for
El Sol for about 15 years.
35:06And I have the privilege to train,
35:09to work with community
health workers, to supervise,
35:14to deliver programs with them
35:17in San Bernardino
County, Riverside County.
35:19So something that I'm very glad to be here
35:21is because this is a time
to recognize the work
35:24of the CHW/P/R, I'm very glad.
35:27As we know, after COVID-19,
35:30we have seen not only the struggle,
35:32but how our communities
have been resilient
35:35through the work of
community health workers
35:38and how we see the strengths
that we have in our community.
35:42So something that I want to say
35:43and mention is that
CHW/P/R, they're experts.
35:47So we know that they're experts.
35:49They bring a lot of expertise and wisdom
35:52when we bring them in the table.
35:54Also, I wanted to mention
this phrase that I love
35:59from Harold Fleming.
36:00They say, "Because the
wisdom of the community
36:02"always exceeded the
knowledge of the experts."
36:06So that means that
community health worker,
36:08they bring a lot of expertise
36:10and maybe more than some other people
36:14that have expertise other areas.
36:16Because why CHW/P/Rs are very effective?
36:20Because they live in the same communities
36:24and also they have gone
through different struggles
36:26that the community go through.
36:28And also, the beauty part of this
36:30is that they are able to
connect with the community
36:33in a way that they can make changes
36:34in their communities that they live.
36:37They build a strong
relationships, but not only that,
36:39they go very deeper and
they create those spaces
36:43that we can create
dialogue, we can reflect,
36:48and we can really think about
how can we solve whatever
36:51is happening in the community.
36:54The work of the CHW,
they do different things.
36:58I mean, today, they're outreach workers.
37:02They educate, they provide
education information.
37:07in the years that I have
been working for El Sol,
37:09I discovered that the
CHW work is a vocation.
37:15It's something that they need to fill.
37:17It is we believe that we train
brains and we recruit hearts.
37:23In the individual aspect, when
we talk about that vocation,
37:28that vocation is infused with wisdom
37:31and life experience
that they already have.
37:33And thinking about the big picture
37:36in the macro level is about hope.
37:39So how these CHW are bringing
hope to our communities
37:43and how we can carry the
values and the legacy
37:47in regards to the work that they do.
37:49Why we are here, because we want
37:51to transform our communities
37:52because we want to live in
a health equity communities
37:57that can transform the work,
37:59that can transform our families
38:01and the communities that we are serving.
38:04I believe that without
hope we cannot do anything.
38:08But the hope is the fuel
38:11for the struggle towards health equity.
38:13And I believe that we're here
38:15is because we believe in health equity
38:17and we're here because together,
38:18we can do it better and best.
(audience applauding)
38:29Quickly, you know,
Transitions Clinic Network
38:31is a community-based program
38:33that provides primary care services
38:34to returning community members
like myself coming home
38:38from prisons and jails, our
program's patient-centered
38:41or would like to say
person-centered approach
38:43that works closely with
local organizations
38:45and community-based
organizations to look at
38:48and address social services
38:50and the social determinants of health
38:52and acknowledging the competing
priorities of reentry.
38:57And, you know, having walked those yards,
38:59healthcare's not something we speak about.
39:01So going back and teaching
men and women about speak
39:04and the key ingredient to
change being hope, you know,
39:07as my sister over here said, hope,
39:08hope is the key ingredient to change.
39:10And if we get hope out there,
we can change, you know.
39:15Community health workers from
the community they serve,
39:17build relationships that
keep people in care,
39:20continuity of care, right?
39:21And with that continuity of care,
39:23the community health worker
helps bridge the barriers
39:27and biases that hinder the
people from healthcare.
39:30Education is great, a privilege,
39:35but lived experience can't be
bought or taught, it's lived.
39:38And so, you know, let us
acknowledge that as well.
39:41That's one thing I would love you to know
39:43about community health workers.
39:44I would also like you to know
39:45that Transitions Clinic Network's
model is evidence-based.
39:49And in my experience, while
we haven't studied this yet,
39:51but in my personal experience,
39:53has improved the quality of life
39:55while addressing a safe
mistrust of systems.
39:58You know, thinking about, you know,
40:00everything that we've had to go through
40:01to get to where we're at today,
40:02saving tax dollars while creating jobs
40:05and empowering communities
around healthcare.
40:08But we also have to acknowledge
some of those barriers
40:10and biases might live in this
room or might live in policy
40:14when we think about hiring men and women
40:16with histories of incarceration.
40:18But I can say without
a doubt that regardless
40:21of the ECM population that's being served,
40:23when you have community health workers
40:25from the community they serve,
40:26it's almost common sense
if sense was common,
40:30But thank you, you know,
it's a pleasure to be here
40:33and I thank, you know, CHCF
40:35for everything that they're
doing for California.
40:37And I look forward to
striving towards health equity
40:40in California and doing this correctly.
40:42So as California does, the
nation will follow, thank you.
40:45(audience applauding)
Sorry.
40:50That would be help break.
- No problem.
40:53Again, Elia Gallardo with HCAI
40:56with the Healthcare
Access and Information,
40:59Healthcare Information and Access.
41:02We, and at HCAI, we are actually tasked
41:04with creating a certificate program
41:06for community health workers, Promotores,
41:09representatives or CHW/P/Rs,
41:12that based on statewide standards.
41:14We're working to develop
those statewide standards
41:16with a robust stakeholder
engagement process,
41:20including community health
workers, Promotores,
41:21and representatives themselves,
41:23we are really trying to capture that,
41:25that authentic voice of the community.
41:28We are also tasked with
developing standards, again,
41:31in collaboration with
the CHW/P/R stakeholders
41:34for training programs
that provide the training
41:39that basically are based on the standards
41:41that are developed through community.
41:43I think Carlina already
mentioned, we are also tasked
41:46with the expanding the certified
community health worker,
41:50Promotores, representative taskforce
41:52or workforce by 15,000
individuals by the year 2028,
41:58and providing funds as well as stipends
42:00for community health workers, Promotores
42:02in order to make this a reality for us.
42:06The state is investing in this model,
42:08the community health worker, Promotores,
42:10representative model,
because we see the value
42:12of the community health workers,
we understand the outcomes.
42:16It's been shown multiple
over the last decades,
42:21but really did come to the forefront
42:23with the COVID and the pandemic.
42:26In terms of community health workers,
42:28I wanted to talk a little bit
about my personal experience
42:30and background with Promotores
when I was working with
42:33and staffing Lideres
Campesinas in California,
42:37which is a farm worker
woman's leadership project.
42:40And, you know, because of a long history
42:43of many institutional
and structural barriers
42:45that have created inequities
42:48for many low-income populations,
42:49including the Medi-Cal
beneficiary community,
42:55that's resulted in
tremendous health disparities
42:58throughout the Medi-Cal,
throughout California,
43:02throughout low-income communities.
43:04And I just wanted to mention a couple
43:07of these dimensions or these barriers,
43:09the lack of healthcare professionals
43:12that come from the
communities that we care for,
43:14and in particular that come
43:15from Medi-Cal beneficiary communities,
43:18the lack of trust within the
healthcare delivery system.
43:20I think our two previous speakers
43:22spoke very eloquently about that.
43:25And they also did a
wonderful job of talking
43:28about how community health
workers, Promotores,
43:30representatives, how they bridge
43:32these challenging institutional
and structural barriers
43:36that are faced by low-income communities
43:38because they themselves
have faced those barriers.
43:41They themselves have advocated
43:42and figured out how to
circumvent those barriers.
43:45So they're the perfect bridge
for creating that connection
43:49between the healthcare
delivery system, which again,
43:53does not, as everybody have said,
43:55does not absolve the
healthcare delivery system
43:57of its responsibility of
coming to the community.
44:00But it is one of those things
that supports that connection.
44:05Thank you.
(audience applauding)
44:09- Hello, hi, good afternoon.
44:12It's an exciting time to be here.
44:15I'm Andrea Mackey, she,
her, hers, Policy Manager
44:18with the California
Pan-Ethnic Health Network.
44:20And so CPEHN is, you know,
44:22a multicultural statewide
health policy organization,
44:26you know, bridging and bringing together
44:29and mobilizing communities
of color across the state
44:31to advance health equity.
44:32And so in particular,
44:35I help lead the Community Health Workers,
44:37Promotores and Representatives
Coalition along
44:39with Joe over here from
Transitions Clinic,
44:42Vision y Compromiso, the
Children's Partnership,
44:45Latino Coalition for Healthy California,
44:47California Consortium
for Urban Indian Health
44:50and Roots Community Clinic.
44:52So, you know, a bunch of
us along with, you know,
44:54500 CHW/P/Rs, you know,
health plans, you know, HCAI,
44:59most folks in the room, quite honestly,
45:01I think I've been on a Zoom
call at some point with you all,
45:04you know, we've been coming together
45:05to make sure all that these
policies coming down the line
45:08are rooted in CHW/P/R voices, you know,
45:11are financially sustainable,
45:13prioritize workforce diversity, you know,
45:16lead to equitable health outcomes.
45:18And at the end of the day,
45:19really value community
cultural wealth, you know,
45:21the wisdom, the values,
45:23the stories that we have
from our communities.
45:26And so a lot of, you know, this work
45:28and my mission to promote it all
45:30is, you know, rooted in my experience
45:31as a Filipino community
health worker down in LA.
45:35You know, I used to screen
for social determinants
45:37of health, provide diabetes education,
45:40provide resources to housing,
food pantries, some people up
45:44with CalFresh, medication assistance.
45:47And I realized recently, actually,
45:49my mom and my Lola in the Philippines
45:51were Barangay Health Workers.
45:52So I'm guess I'm following a legacy here.
45:57And you know, what was always powerful
46:00is that you see people transform
46:01from really being passengers,
you know, coming, crying,
46:04you know, their foot's
getting amputated to being,
46:07you know, just drivers of their health.
46:09And so they're shifting positions.
46:12And so that energy and that spirit
46:14is what we bring into our coalition
46:15as all these policies come into play.
46:18And so, you know, Carlina,
you mentioned, you know,
46:20the role of the CHW in
California, you know,
46:23what does that look like?
46:24Well, the Children's Partnership
really framed it for me.
46:28You know, we see our workforce
as an anti-racist strategy
46:31because we're shifting power
to folks who most, you know,
46:35directly experience the
inequity, the conditions
46:39that cause the inequities in our health
46:41to being leaders in the field.
46:42So really excited to talk to
you all today about, you know,
46:45shifting power, you know, having CHW/P/Rs
46:47at the forefront of our workforce.
46:49And with that, I'm going to
pass it to you, Pooja, yeah.
46:53- Thank you for framing it.
(audience applauding)
46:58It's a pleasure to be here today
46:59with this incredible group of leaders.
47:01I'm Pooja Mittal, I'm from Health Net.
47:03I'm their Chief Health Equity Officer.
47:05Health Net is a managed care organization.
47:07We serve about three
million people in the state,
47:10two-thirds of whom are on Medi-Cal.
47:12And we have a footprint
that's quite diverse
47:15across the entire state,
so rural and urban,
47:18and in northern and in southern California
47:21as well as Central California.
47:23And I really appreciated what
you just said around agency,
47:28because as a health plan,
the goal of our organization
47:31is to improve the health
of the communities
47:33and the people that we serve.
47:35And when we think about the
difficulties in doing that,
47:39the biggest thing is trust, right?
47:41And progress only moves
at the speed of trust.
47:44And that's what the CHW
workforce and Promotores
47:48and the representatives bring
to the healthcare system.
47:51They help to bridge that
gap between the community
47:54and between providers, county
organizations and health plans
47:59so that people can feel
like they see themselves.
48:02And in doing so, they create
agency in their own health.
48:06And the other piece that we think about
48:08is a real powerful piece
that this workforce brings
48:15is the ability to actually meet people
48:17in the community where they are
48:19and actually reach the people
48:20who are currently unengaged, right?
48:23We have people who are engaged
with the healthcare system
48:25and they don't necessarily
get what they need,
48:27but there are an entire
other group of people
48:28that are fully unengaged
with the healthcare system.
48:31And so how can we use this
culturally congruent workforce
48:35to go out into the community,
meet people where they're at,
48:38and start to build those bridges again,
48:39and create that trust
between the healthcare system
48:44And just to give you a
little bit of background,
48:48I've had the privilege of
working with Promotores
48:50since I was little, I
grew up in Ventura County,
48:53did my residency in Ventura County,
48:55where I worked with Promotores there.
48:57And at San Francisco General,
48:59we had our Promotores
coming into our clinics,
49:00doing oral health screenings for our kids.
49:03And they were often really
successful in doing that work
49:06where we had very little
access to dental care
49:09for our Medi-Cal patients.
49:11So, have a lot of respect for Promotores
49:14and really excited to be here
49:15to be talking to you all today.
49:18- Thank you so much.
(audience applauding)
49:21I feel so far away from all of you.
49:24So there are, as we discussed
in the introduction,
49:27several significant policy changes
49:29that are happening in
the state of California.
49:31A couple of you touched on them
49:33that are happening right now.
49:35What else can you tell
us about these changes
49:38and their potential impact in California?
49:41And this time, I'm going to switch it up
49:44and ask you to start, Dr. Mittal.
49:49- Thank you, we are really excited
49:53about this being a benefit and are excited
49:57to help be part of rolling it out.
50:00One of my concerns around this work
50:03is how do we really make
sure that the benefit
50:06is being stood up equitably
50:08and in a way that's responsive
to the community's needs.
50:12And we recently partnered
with Vision y Compromiso,
50:15they did a survey of leaders
50:17in many of the CBO organizations
50:20that are traditionally doing this work.
50:22And what they found was
that people are unsure
50:25whether they really want to participate
50:26in this work, those CBOs, right?
50:28They're not sure how the
benefit is going to be stood up,
50:33if it's going to be consistent
50:35with the culture of their organizations
50:37and whether they'll be able
to actually participate
50:41in a way that's equitable.
50:42And so I think that that's
a really important flag
50:45for us to pay attention to.
50:47I also see a couple of
other big challenges.
50:51One, as a health plan with a
large footprint, we're required
50:55and wanting to set up a network
across the entire state.
50:59And there are regions where
there are not enough yet people
51:03to staff those regions,
51:05particularly in some of the rural areas.
51:07And so how can we make sure
that we're not taking shortcuts
51:11and bringing in some of
these companies necessarily
51:14that are sort of coming into the space new
51:16and really supporting these
community organizations
51:19that have been doing this
work for many, many years.
51:22And lastly, I think workforce
51:24is a really important
piece of this conversation,
51:28and I think we'll talk about
it a little bit more later,
51:33how we can support standing up a workforce
51:36that then has the opportunity to grow
51:38and also have new opportunities
within the healthcare system
51:41is going to be really important.
51:46- Thank you, yeah, I
definitely want to echo, hello.
51:51Definitely want to echo
all this, you know,
51:53like I said earlier, this is
a really exciting opportunity
51:56where you're getting all these investments
51:58We have the Medi-Cal benefit, you know,
52:01we're getting sustainable
funding for the first time
52:03for our workforce, which
could lead to economic equity,
52:07you know, in our communities
across the board,
52:09we really see a community
transformation model, you know.
52:13But however, you know,
52:14we're still facing some
current challenges.
52:16We were talking, so with
our coalition, you know,
52:18CHW/P/Rs and only 10%
of folks were telling us
52:22that their current salary
covers basic expenses.
52:25So 90% of folks are saying
that, you know, with their job,
52:30you know, they can't make
rent, provide, you know,
52:33pay for gas food, you
know, just the basic.
52:35And so, you know, I've heard, you know,
52:39we do this out of service of the heart
52:40or, you know, the Bayanihan
spirit, the community spirit,
52:42but the Bayanihan spirit
52:44doesn't pay the bills
at the end of the day.
52:46So, you know, for this to really thrive,
52:48how do we ensure that we have
a payment mechanism that,
52:51you know, equitably allows
us to not only meet our,
52:55you know, just basic needs,
52:56but to have a living thriving wage?
52:58And so that's what a lot of the CHW/P/Rs
53:01have been telling us.
53:02And if you look at the benefit, you know,
53:04the fee for service model
is $26 for 30 minutes
53:08for two hour max per beneficiary.
53:12You know, FQHCs cannot
currently bill for this.
53:15And you know, you're not
even building in, you know,
53:18what is the overhead cost,
the administrative burdens
53:20that now clinics and
community-based organizations
53:23have to undergo to have the infrastructure
53:25to be able to bill for Medi-Cal now.
53:27So, you know, if we're
following along, you know,
53:30where we're currently at,
53:30we're going to just
replicate the status quo
53:32that has not worked for our communities.
53:35Navigating, you know, systems
of care that, you know,
53:37means your experience, delayed
care or no care at all.
53:40Folks who don't look like you, you know,
53:42we don't need more of the same, you know.
53:44Joe always talks about we
can't do the status quo.
53:46That's why we need to transform
how we're shifting all this
53:50and really push for economic
equity for our CHW/P/Rs.
53:53So real opportunity, but we
have, you know, this pathway,
53:57you know, how are we
going to move forward?
53:59And with that, I think
I'm going to pass it.
54:08I did want to mention that
we've talked a little bit
54:10about how the commitment
that was made last year
54:13for the health profession's workforce,
54:15the administration actually
made billions of dollars
54:19of commitment to the health workforce,
54:20and the largest amount actually went
54:23to community health workers.
54:24So of that amount, there was
a significant allocation,
54:27the largest of any other.
54:29So that should really reflect
sort of the commitment
54:32that the state has to
lifting up and being part
54:35of the change that we're hoping to see.
54:39And obviously it's a clear
indication of how important the,
54:44and what value the state gives
to this incredible workforce.
54:49In developing what we're
going to be working on,
54:52which is developing a certificate program
54:54for community health workers,
Promotores, representatives,
54:57what we're really looking
at doing is making sure
54:59that we are aligning closely
with our sibling organization
55:02and the Department of Healthcare Services
55:05to ensure that the training
55:07and the education that's
received in any of the resources
55:11that we're able to allocate
55:12or any approved program that we look at,
55:15that those folks are
coming out of that training
55:17and are going to be able to bill Medi-Cal
55:19for community health worker services.
55:21So we are closely aligning all
the efforts that we're doing
55:25to make sure that that happens
55:26'cause for us, that is
the avenue or the pathway
55:29to get reimbursed for these services.
55:31So we are working hard to
make sure that we align
55:34and yet don't create any
kind of unreasonable barrier
55:38to getting that certificate
as a community health worker,
55:41a Promotores and a representative.
55:50- Well, first, you know,
55:53some of the work that we've been doing
55:54and talking about in
California is being rewarded.
55:56And I want to give a shout out to DHCS
55:59because on January 26th, 2023,
56:02California became the
first state in the nation
56:05to approve an offer for a
set of Medicaid services
56:08for youth adults in state
prisons, county jails
56:11and youth and correctional
facilities for 90 days
56:13or three months prior to release.
56:15You know, doing this
work in our sister clinic
56:18in Santa Clara County,
prior to the CHWs going in
56:2230% of the people showed up for services.
56:26After Santa Clara County Jail
56:29allowed the community health workers
56:30from the organization to
actually go in, you know,
56:32roughly 90 days before
to create a relationship
56:35and do a warm handoff, if you will,
56:38from incarceration to the community,
56:39allowing the community
to play a part in it,
56:41that number went up to 70%.
56:44So, you know, thank you.
(audience applauding)
56:46And I'm thinking about as
California moves forward,
56:49and we're thinking about
that 90 day in-reach,
56:52please, you know, everyone
in the room that has a say so
56:54and what that looks like,
community, community, community.
57:00Let that live in the community
and let those resources
57:03and let us be a part of the solution.
57:05Let us play an active part.
57:08CalAIM and the CHW SPA, if done correctly,
57:11will be a step towards
health equity in California,
57:13while empowering
communities, providing jobs,
57:16and I'm hoping providing career pathways
57:18for community health
workers, a living wage,
57:21respecting the profession,
saving lives while saving money,
57:25and policy that can
guarantee the sustainability
57:28of community health workers in California
57:31as California strives for health equity.
57:34- Wow, community, community, community.
57:36Yes, I mean, we're very excited
about what is happening.
57:40This is a great opportunity.
57:42We believe that the community
health workers peers
57:45have so much expertise
that they can provide
57:49and amplify the work of other entities
57:51in regards to their policies,
the system and environment.
57:54However, they have to be open
57:58so the CHW/PRS can provide that expertise,
58:01and also those organizations
58:02that have been working for many years.
58:05We believe that this is
a powerful opportunity.
58:09However, what happen if those
entities do not are flexible
58:15or open to listen to those organizations
58:18that have been working with the CHW?
58:19That's a huge problem.
58:21And the problem is because
we believe that the CHW/P/R
58:25will have to adapt to a new culture.
58:27And what happen is that culture,
58:29if it will be far from the community,
58:32they will be less
embedded in the community
58:34and the original team regards
58:37to be aligned with the community,
58:38work with the community,
that will be far away.
58:40So I think if we do it right,
if we invite those experts
58:46that have been working in
the field for many years.
58:49I think this is a huge opportunity
58:51in regards to provide more
resources for the community
58:56to amplify their voices
and also to create a system
59:00that is held equitable for everyone.
59:05- Wow, thank you all so much,
incredible and amazing work.
59:10So I'm going to ask one
more of my questions
59:11and then I'm going to turn to
some of the audience questions.
59:15And a really important part
of the community health worker
59:17and Promotores workforce is the premise
59:20of nothing about us without us.
59:23The American Public Health Association
59:25encourages engaging CHW, Promotor
59:28and representative perspectives
59:30in policy related to the role.
59:32So several of you are or have been CHWs,
59:37I would love to hear
just a little bit more
59:39about what you're hearing
from the workforce right now.
59:42And why don't we start with
you, Andrea, at the other end?
59:47- Yeah, so we've been
talking to a lot of folks,
59:50training folks on, you know,
59:52who is Department of Healthcare
Services, who's HCAI,
59:55even just walking them
through how to pronounce HCAI.
59:59And so, you know, with our,
you know, these trainings,
01:00:02you know, we've been hearing
four main themes, you know,
01:00:04as we, you know, work towards integration.
01:00:07So folks are saying, you know,
I have a lot of stats today,
01:00:10but you know, 60% of folks
01:00:12of the CHW/P/Rs we've
been working with say,
01:00:14you know, the general public
doesn't know what we do,
01:00:16who we are, and you know,
how effective we are.
01:00:21And so a lot of it is, you know,
01:00:23how are we building up respect?
01:00:25How are we building up value, you know,
01:00:26valuing our workforce and
giving folks decision making,
01:00:30not giving, but making sure we
have decision making powers,
01:00:34being seen and heard, whether
that be on the care team,
01:00:38whether that be in policy,
you know, as we move forward?
01:00:43You know, again, I had mentioned before,
01:00:44economic equity is a key
theme across the board.
01:00:47You know, folks are experiencing
economic insecurity,
01:00:51you know, folks want a thriving
wage, folks want, you know,
01:00:55benefits 'cause, you know,
there's, we're either paying,
01:00:58you know, out of pocket for
some curriculum for trainings,
01:01:03you know, for gas, you know,
01:01:04going back and forth to community members.
01:01:07And folks are saying, you
know, this is a lot of work.
01:01:10Healers need healing too.
01:01:12Where are the mental
health supports for us?
01:01:15And then, you know, in building
up workforce development,
01:01:17you know, when we're talking
01:01:18about all these upcoming policy events,
01:01:21you know, how are we getting
these paid trainings,
01:01:23whether that be for, you
know, doing referral services
01:01:28or navigating, you know,
these different outreach
01:01:30to COVID-19 to technology
and resume support?
01:01:33People want more professional development
01:01:35to grow in their career.
01:01:37And then also just more
development in, you know, policy.
01:01:41You know, all these events
are coming to a forefront,
01:01:44you know, how are people
are just going to be,
01:01:47someone was saying like,
01:01:48if we're not at the
table, we're on the menu.
01:01:50And so, you know, how are
we bringing in CHW/P/Rs
01:01:54to more of these conversations?
01:01:55You know, this is a great
panel and a good example.
01:01:59And then with these benefits
coming down the line, you know,
01:02:03we've been struggling to understand
01:02:04how are community members going to be able
01:02:06to access our services?
01:02:08You know, in particular
folks were saying, you know,
01:02:10there's still a need to
have more black CHW/P/Rs,
01:02:14more CHW/P/Rs in rural
and agricultural areas.
01:02:17We need to really bridge, you know,
01:02:19the connection between hospital providers
01:02:24and folks on the ground and
members to be able to, you know,
01:02:27get access to these services.
01:02:29And then do we have the
materials and the resources
01:02:32for our community members
that are culturally
01:02:34and linguistically tailored
to what folks need?
01:02:37You know, is that ready
there, is housing there?
01:02:38You know, I think we mentioned it.
01:02:40We're bridging the gap, but, you know,
01:02:43there's some structural issues
01:02:45that collectively we need to change.
01:02:47And so, you know, a lot
of folks are in this
01:02:50and we're really excited.
01:02:51But, you know, again, this
is an anti-racist strategy.
01:02:54So how are we pushing CHW/P/Rs
to the forefront of this?
01:02:59- Thank you so much, Andrea.
01:03:01How about you, Joe?
01:03:05- Promise not to start chanting.
01:03:07You guys want to chant?
01:03:10You know, nothing about us without us.
01:03:15Nothing about us without us, you know.
01:03:17CHW/P/Rs want to a part of the process.
01:03:21We want to help define our work.
01:03:23We want to be a part of
the certification process.
01:03:26We want to help, you know, in
creating the career pathways.
01:03:29You know, CHW/P/Rs, you know,
01:03:31I'll try just not to repeat
anything that Andrea said,
01:03:35but, you know, professional
respect is what I hear
01:03:37when 60% of the community health workers
01:03:39of California say people
don't know what we do.
01:03:43Because I've walked those shoes
01:03:45and I've been a community health
worker, I know what we do.
01:03:48And if California and the
nation knew what we do,
01:03:54there would definitely be more
investment and more pathways.
01:03:58You know, more training is
what we heard, you know,
01:04:00not less training.
01:04:01You know, we've had seasoned, you know,
01:04:03Promotores, community
health workers come to us,
01:04:05you know, looking at the different numbers
01:04:07that are being thrown around
and just going like, really?
01:04:09And I agree, you know,
01:04:11they're saying that our
profession needs to be respected
01:04:16And that includes stipend
trainings and such.
01:04:19I'm going to say it
again because, you know,
01:04:21it's just not happening
as much as it should.
01:04:24Healers need healing too.
01:04:27A lot of us with lived
experience, secondary trauma,
01:04:30et cetera, et cetera,
healers need healing too.
01:04:33While we bridge those gaps
and barriers and biases,
01:04:36you know, sometimes those scars
open up, sometimes I bleed.
01:04:41Healers need healing too.
01:04:43You know, when we're talking
about economic equity,
01:04:45you know, we recently
had a policy committee,
01:04:47and I love the way it was defined.
01:04:49And let me read this really quick.
01:04:52"It refers to ability
to be financially secure
01:04:55"and to thrive personally
and professionally.
01:04:59"This is more than just the ability
01:05:00"to meet your basic needs,
01:05:02"but for you and your family
to live your best lives.
01:05:05"An example of this might be the ability
01:05:07"to take your family on a vacation."
01:05:10Self-care, self-care, self-care.
01:05:13Can CHW/P/Rs get paid enough
to live their own life,
01:05:17live their own best life?
01:05:19And you know, I think a lot of that comes
01:05:20from the meetings that we have.
01:05:22And I feel it's really important,
01:05:25blessed and grateful to be sitting here
01:05:27representing community
health workers, P/Rs,
01:05:30and really everyone that
falls under our umbrella
01:05:32when going on with the terms,
01:05:33who falls under those umbrellas today.
01:05:35Thinking about what California needs to do
01:05:38as we strive towards health equity.
01:05:40Without health equity,
01:05:42I question any of the other things
01:05:44that we've been given in the books.
01:05:48- Thank you, Joe.
01:05:50All right, you all, powerful words.
01:05:52Thank you so much.
01:05:54I have a lot of other questions,
01:05:56but I'm going to give some air time
01:05:58to some of our audience questions.
01:06:01So can you speak to your point, Joe,
01:06:05about the importance of
appropriate supervision for CHWs
01:06:09and Promotores in
managing vicarious trauma
01:06:13and boundary issues?
01:06:15I know TCN's done a lot
of work around this,
01:06:18so maybe we'll start with you again, Joe.
01:06:21- I appreciate that.
01:06:22You know, in thinking about,
you know, secondary trauma
01:06:24and what we, got me stuttering,
secondary trauma (laughs),
01:06:30but thinking about the services we need,
01:06:31when I was originally hired
with Transitions Clinic Network,
01:06:34we actually had our own therapist,
01:06:36which I thought was one of
the best parts of the model
01:06:38because not only did the
therapist have a working
01:06:41and we just like we could in our model,
01:06:44just like we can co-sign for
our doctor and say, Hey man,
01:06:47that doctor's all right or
whoever we're talking to,
01:06:49the people we're talking to, you know,
01:06:50regardless of he, she, they,
we would tell them and cosign
01:06:54and that cosign bridges
some of that mistrust.
01:06:58And so when I'm thinking
about secondary trauma
01:07:00and those type of things,
and healers need healing too,
01:07:03it would be lovely to see
a system that's set up
01:07:06with the flow that actually
has therapy involved,
01:07:09where you can actually do a check-in
01:07:10with who's on your caseload first
01:07:13and then how are you doing.
01:07:15With an understanding about
secondary trauma, you know,
01:07:18there's also secondary resilience
01:07:21and teaching secondary resilience
to the CHWs, Promotores
01:07:24and everybody else is out there
01:07:26to remember this work is hard
01:07:28and we're passionate, but it's necessary.
01:07:31I don't know if I
answered, but I hope did.
01:07:32- Yeah, you did, thank you, Joe.
01:07:34And Angelica do you
have anything to share?
01:07:37- Sure, I mean, in regards to supervision,
01:07:38I think the first thing
that when I supervise
01:07:41is really understand the work of the CHW.
01:07:44Many of our supervisors,
they have been Promotores.
01:07:47I mean, they have been
doing the work in the field,
01:07:49they know the work,
01:07:51they know how to talk to the Promotor,
01:07:53they know in regards to boundaries,
01:07:54to safety, to confidentiality.
01:07:56So I think when I think about supervision,
01:07:59it's very important for the person
01:08:00to really understand the work
01:08:02and to really provide that support
01:08:05that the Promotor needs
in that specific moment.
01:08:08- Great, thank you.
01:08:10Okay, so this is a tough one.
01:08:13How do we optimize this workforce
01:08:15without creating a two-tiered system
01:08:18based on immigration status?
01:08:21Some Promotores are hesitant
to pursue new job opportunities
01:08:26because they don't have
work authorization.
01:08:29How do we wrestle with this tension?
01:08:33We've got any brave panelists
that want to take this one on?
01:08:36How about you, Elia?
- I'm going to do a piece of it.
01:08:42I guess the thing that I would say
01:08:43is we've been very intentional
01:08:46in how we're crafting the
training and the certificate
01:08:52as well as, to be honest,
the community, the DHCS
01:08:54has been intentional with the benefit.
01:08:58There's never a request for information
01:09:01on any part of that
for immigration status.
01:09:04So in order to receive a training,
01:09:07that's not going to be
part of the process,
01:09:09in order to receive a certificate,
01:09:11that's not going to be a
question on the application.
01:09:15And from what I understand, to serve,
01:09:21once you get the the CHW certificate,
01:09:23what it says is that you've
been trained and you're eligible
01:09:27to provide services that can
be reimbursed by Medi-Cal.
01:09:31So you know, we don't speak for employers,
01:09:34we can't do anything on the employer side,
01:09:37but we've been very
intentional to make sure
01:09:40that we didn't create barriers on our end
01:09:44and the training end in
terms of this population.
01:09:46So I don't think that's
a satisfactory answer,
01:09:49but that's as far as we are able to go.
01:09:52- Thank you, Elia.
01:09:54And I think, you know, Joe,
01:09:55you mentioned earlier policy
can be infused with bias
01:09:58and I think that it's a great
example of where HCAI, DHCS
01:10:02have been really intentional
01:10:03about thinking about
the potential barriers.
01:10:06We all know that there's a ways to go
01:10:08and there's other things
that we have to circumvent
01:10:11and address, some of the
much bigger picture issues
01:10:15like the one we're talking about now.
01:10:16But just I'm grateful to you
all for the thoughtfulness
01:10:20with which you've gone
through that process
01:10:22and for all the people that
have participated in it.
01:10:28All right, let's see.
01:10:33So is the 15,000 CHWs,
including current CHWs,
01:10:38including current CHWs, or is
it new CHWs additional ones?
01:10:43And are there steps to retain CHWs
01:10:48in addition to bringing on new folks?
01:10:54to have 15,000 new certified
community health workers,
01:10:59Promotores, representatives, so we
01:11:01are including the existing folks
that we are reaching out to
01:11:04and trying to develop what
we call our legacy pathway.
01:11:08Our legacy pathway is actually the place
01:11:10where we've gotten the most feedback
01:11:11because we are talking
to existing Promotores
01:11:14who have been doing the work forever
01:11:16and basically don't need
to go through a training
01:11:19to show that they can do what
they've always been doing
01:11:21and doing very successfully
throughout the years.
01:11:24So we're trying to create that pathway
01:11:26where folks like that
can get the certificate
01:11:29to count for the existing workforce.
01:11:32The other workforce goal that we have,
01:11:33this is an equity goal that we have,
01:11:35not only for ourselves
but for the secretary
01:11:38and the agency has for us,
01:11:39is we're trying to make sure
01:11:41that in developing a certificate program
01:11:44and developing our training
program and pathway
01:11:46and developing our legacy pathway,
01:11:48that we retain the diversity
01:11:50of the existing community
health worker workforce
01:11:54and that we retain the
language concordance
01:11:57with the populations that
they currently serve.
01:12:00So that is one of our goals
is we want to make sure
01:12:02that in creating a, what I'm
going to put in air quotes,
01:12:06a formal process, that that
process does not take away
01:12:09from the equity aspects that
everybody's been talking about
01:12:13on this panel.
- Thank you, Elia.
01:12:17- Can I just add one thing?
01:12:18I think another really
important piece of that,
01:12:21so at Health Net we've had Promotores
01:12:23on staff actually since 2011.
01:12:25And as we think about
broadening this benefit,
01:12:29actually when we look at our members,
01:12:32we estimate that 70% of them are eligible
01:12:35for CHW support, CHW/P/R support.
01:12:39And so as we train more people
01:12:41and bring them into this system,
01:12:45we need to be very clear
01:12:46about that over medicalization piece
01:12:48or like taking something
01:12:50that is actually a social justice movement
01:12:52and not over incorporating
it into healthcare
01:12:55so that we change the essence
of what the movement is about.
01:13:00- Thank you so much, Pooja.
01:13:02And that's powerful
because Health Net's big
01:13:05and so 70% is a lot of
people, so thank you for that.
01:13:10Okay, audience, do you
have any questions for us?
01:13:14And also we have been
asked to slow down the pace
01:13:16of our talk for our wonderful translators.
01:13:21So for the panelists,
01:13:22if you can slow down just
a tad, that would be great.
01:13:26Yeah, I think we have mics.
- Hi, Christina
01:13:33from the California Maternal
Quality Care Collaborative.
01:13:36I'm incredibly interested in
what data we have currently,
01:13:41specifically about hospital utilization
01:13:44of this important role.
01:13:47And I'm wondering if we have the data,
01:13:50have we dug into county
01:13:52or regional differences,
service differences?
01:13:56I'm very interested in pregnancy,
01:13:59maternal birthing person care, so that,
01:14:01and then for-profit institutions
01:14:04versus not-for-profit institutions.
01:14:07And it just, thank you for
your last comment, Pooja,
01:14:11'cause I think that was
a really telling comment,
01:14:14but so I'd like to know
what's up with the data.
01:14:18- Yeah, thank you.
01:14:20I think a lot of the things
01:14:21that you're talking about
specifically in California,
01:14:24I am not aware that we
have some of the deep data
01:14:27that you're looking for on service lines
01:14:29and things like that.
01:14:31But I'm wondering, Jackie,
01:14:32is there anything you want to
add on the hospital perspective
01:14:35based on the survey that
might speak to the question?
01:14:43- Yeah, I think that's a very
good and important question.
01:14:47I would definitely recommend
that you take a look
01:14:49at the report, the healthcare
survey employer report,
01:14:52'cause that does have some data
01:14:54and statistics about employment of CHW/Ps
01:14:58in the hospital setting.
01:14:59But we didn't do a deep dive
into the geographical regions
01:15:03that you mentioned, although
I could definitely see
01:15:06the value add that would be there.
01:15:11- Can I maybe just put in a-_
- Yeah, please, Pooja.
01:15:13- So we just granted
funding to HealthBegins
01:15:16and Joe behind you is
the one that partnered
01:15:19with CPEHN and HCAI to do
a large employer survey
01:15:24of who's employing CHW/Ps
right now in the state.
01:15:27He's collating the data right now,
01:15:29so that's something that we'll release
01:15:30for everyone to be able to see.
01:15:32But he did break it down by region.
01:15:34So we have some data about regions
01:15:37and to your comment about pregnancy,
01:15:40we did ask about population served
01:15:42and I think that there
is going to be a gap
01:15:45in people who are sort of serving
01:15:47that prenatal to five population.
01:15:49And so that's something that
we'll have to think about
01:15:51as we invest in workforce.
01:15:53- Great, thanks, Pooja.
01:15:55- [Robin] Hi, my name is.
- Oh, go ahead.
01:15:58- [Robin] My name is Robin
Barron and I have a question
01:16:01about recruitment of black CHWs
01:16:06and also community health workers,
01:16:08Promotores in rural areas.
01:16:11I'm wondering if there's like
any plan on how to do that
01:16:15and also funding for these programs
01:16:18to exist and continue running.
01:16:21- Yeah, great question.
01:16:23So I'm going to think there's
two ways to look at this,
01:16:25maybe, Pooja, from
Health Net's perspective
01:16:27as a rural provider,
01:16:28but also Elia to talk about
a little bit about the status
01:16:32of the budget right now
and where things are.
01:16:35So why don't we start with Elia this time?
01:16:38- Yeah, I get to do the
status of the budget.
01:16:41So as I mentioned that the administration
01:16:44has made a huge commitment
to community health workers
01:16:47in the amount of over $280 million.
01:16:52A pretty significant part
of that, about 130 million,
01:16:56is still committed to the
community health worker sector.
01:17:01It's being delayed to be issued
out in later fiscal years,
01:17:06next fiscal year and the year after
01:17:07because of the current fiscal
situation that we're in.
01:17:11And that is those exact training dollars
01:17:14that we are looking at to
provide for training programs
01:17:17and stipends for community health workers.
01:17:19And obviously we're going
to be looking very carefully
01:17:21at the disparities that
have been identified
01:17:24through the research and that
other partners are identifying
01:17:28so that we can look at the
distribution of those dollars.
01:17:30We haven't even begun the
stakeholder engagement process
01:17:33on that type of dialogue.
01:17:36For us, it's very important to make sure
01:17:37that we're checking in with stakeholders
01:17:40to have the dialogue to understand
01:17:42how all of this is going
to look and the framework
01:17:46and ultimately how we're going
to issue out those dollars.
01:17:48Because of the delay, we haven't
started that dialogue yet,
01:17:51so we are looking forward
01:17:53to engaging all of you in that discussion.
01:17:56- Great, thank you.
01:17:59- I thank you for the question
01:18:00around the cultural congruence.
01:18:01And it's something that we
are certainly thinking about,
01:18:04and not only for this benefit,
but for the dual benefit,
01:18:07how are we looking at making
sure that we have providers
01:18:11that are culturally congruent
01:18:12to serve everyone that we serve?
01:18:14And so that's something
that we're looking at
01:18:16when we're investing in training programs
01:18:18and we just granted Vision
y Compromiso and El Sol
01:18:25large grants to train
several hundred CHW/Ps.
01:18:30And so that's a place to start.
01:18:33But as we get a better sense
of where there's a need,
01:18:37what types of programs
people are interested in,
01:18:41that'll help us to better understand
01:18:43and we are providing stipends for those
01:18:45because you have to pay
people for their time.
01:18:49- Yeah, and I'll add just one
thing to answer this question.
01:18:52I think one of the things
we've heard anecdotally
01:18:54is that a lot of black CHWs
01:18:57don't necessarily identify as CHWs.
01:19:00They may be doing community work
01:19:02in churches, doing health education.
01:19:05And so I think there's also a question
01:19:07to be asked about like,
01:19:08who's out there already doing the work
01:19:11whose work can be surfaced and lifted up
01:19:14that may be able to benefit
sort of the Californians
01:19:18and Medi-Cal beneficiaries
that we're talking about today?
01:19:21So another question from
the back of the room.
01:19:26- (laughs) Sure, thank you
for letting me go first.
01:19:30Lisa Chanson with Transform Health.
01:19:32It's so great to hear everybody's
comments, experiences,
01:19:37and it's such an exciting time.
01:19:38But I also want to point out
that we've talked about CHWs
01:19:42in support of a lot of
different populations
01:19:45as well as in a lot of different settings.
01:19:49And my question is around, you know,
01:19:53just adding to some of
the questions around data
01:19:55and the different cuts of data.
01:19:58Has anyone done an assessment
of all the different places
01:20:04that CHW/P/Rs, navigators, you know,
01:20:08whoever's out there that's doing this work
01:20:10is already operating, and what
is the demand and the need?
01:20:15When we do our CalAIM work,
we hear often from the field
01:20:18there are not enough CHWs,
01:20:21that providers are
poaching from each other,
01:20:24that it's been a real
challenge and then, you know,
01:20:27we're not always supporting the CHWs
01:20:30in a trauma informed way.
01:20:33And I remember San Diego County
01:20:36did a fairly in-depth assessment
01:20:39where they looked just in San Diego County
01:20:41and assessed how many of
these types of workers
01:20:46are needed over the next 10 years.
01:20:48They currently have a little over 4,000
01:20:51and they estimated they need over 7,000
01:20:55of CHW/P/R navigator type
workers to support public health,
01:21:01hospitals, clinics in community settings.
01:21:04And my question really is around,
01:21:07has anybody drilled down
in terms of the data
01:21:11to look at what is the level
of need in each of these arena
01:21:17and what is the type of
potentially advanced trainings
01:21:21that could be provided?
01:21:22Are there ways to build career ladders
01:21:25and really lift up the individuals
01:21:28who are entering into this
workforce into this space?
01:21:32I remember when we
01:21:33were running Sacramento
Whole Person Care Pilot,
01:21:35CHWs were at the heart of our program
01:21:38and we had to really evolve
01:21:42and think about the
different types of CHWs
01:21:45that we really needed
01:21:46to support the chronically
homeless population
01:21:50We needed some that
were in the aging space,
01:21:53we needed those who were
previously incarcerated, homeless,
01:21:57who had a farm worker lived experience.
01:22:01And that was just in supporting
the one population here
01:22:06So I wanted to lift that up, thank you.
01:22:09- Yeah, great, thank you so much, Lisa,
01:22:11and thanks for reflecting
01:22:12your Whole Person Care experiences.
01:22:15It's important for us to remember
01:22:16that there have been a
lot of CHWs doing work
01:22:19in the Whole Person Care context
01:22:20for some time now prior to CalAIM.
01:22:24So I'll take a quick stab
01:22:27at your question about regionality.
01:22:29I think one of the things we're doing
01:22:31at the California Healthcare Foundation
01:22:33is supporting for regional
collaboratives around the state
01:22:37and are looking to scale the
workforce in those regions.
01:22:43And it's Alameda, San Diego, Riverside,
01:22:47San Bernardino working with El Sol
01:22:50and then the Central Coast.
01:22:51And part of what they're
doing in those regions
01:22:54is looking at supply and demand.
01:22:56It was one of the things that
we were looking at statewide,
01:22:59which we found extremely
difficult to get to at scale.
01:23:03And so I think those
kinds of regional efforts
01:23:05are really, really important.
01:23:07We did a webinar recently
as part of that work
01:23:11to look at how you could
quantify supply and demand
01:23:14in those regions.
01:23:15And so we'll have that
posted on our website
01:23:17and I invite you to check it out.
01:23:21All right, how was our time?
- Wrap time.
01:23:25- Wrap time, oh my God.
01:23:27Okay, so I just talked
and it's our wrap time,
01:23:33so I want to invite each
one of the panelists
01:23:36to just say maybe two words
about your takeaways from today
01:23:42and what you want the audience
01:23:43to think about leaving
this room and make it quick
01:23:46'cause we don't have much time.
01:23:51- Okay, it'll be two words,
01:23:54but I might have to give context.
01:23:55So I'm going to end with
something that, you know,
01:23:58we end community organizing.
01:24:00In Tagalog, it's (speaks
in foreign language).
01:24:02It means one down, one fall onto the next.
01:24:04So when one of us falls, we all fall,
01:24:06but when one of us rises, we all rise.
01:24:08And so looking at this panel,
01:24:09if we're all moving together collectively,
01:24:11we're going to be able
to address health equity,
01:24:14we're going to address disparities.
01:24:15So, you know, if we do this
collectively with CHW/P/Rs
01:24:19at the front, you know,
one down onto the next,
01:24:22you know, we're going together,
we're going to rise together.
01:24:25So (speaks in foreign language).
01:24:28(Carlina speaks in foreign language)
01:24:32- I have like a sentence, maybe one
01:24:34is I think we have a real opportunity
01:24:36around health equity
here with this workforce
01:24:39and also we have the economic
development opportunity
01:24:43for a whole entire new group of people
01:24:45that can build a pipeline
for a BIPOC providers,
01:24:50nurses, MAs, like the whole thing.
01:24:53And part of what we're thinking
01:24:54about is how can we start earlier
01:24:56and really help people upskill
01:24:59and fill out all these other professions
01:25:02where we need more black
and latino providers, so.
01:25:07- You went where I was
going with workforce equity.
01:25:09We're obviously very
interested in making sure
01:25:12that we are are providing a program
01:25:15that really does have that
centered in the work that we do.
01:25:20And we're looking for your
support in helping us make sure
01:25:22that you hold us accountable
to making that happen.
01:25:25So please do participate
01:25:27in our stakeholder engagement process
01:25:28'cause we're still at
the beginning stages.
01:25:30We haven't made any final decisions yet
01:25:33on anything that we're doing.
01:25:34So please do tell us how we're doing,
01:25:37tell us how to do it
01:25:38and ultimately weigh in on what
we come out with, thank you.
01:25:44- Status quo has never helped my community
01:25:47and status quo has never
been a spark of change.
01:25:50So let public health be the spark
01:25:52that addresses policies moving
forward that serve people.
01:25:56Two words, no mas, equity now.
01:26:00- Beautiful, okay, so I will say
01:26:02that this is a great place to start.
01:26:05I think it's very important
to recruit your CHW/P/Rs,
01:26:09to really think about the
training and supervision
01:26:12that is very important to
connect with those experts,
01:26:15that we don't have to embed the will,
01:26:18the will is already existing,
we're doing the work.
01:26:21And also I have to take one phrase
01:26:24that Kara said this morning,
01:26:26that this is the time
to serve them better.
01:26:28And I believe this is our time.
01:26:30- Thank you, so incredibly powerful.
01:26:34So I'll lift up a couple of
things I heard from you all
01:26:36in addition to those magical
words, this is a vocation,
01:26:41but people need to thrive.
01:26:44Remove bias from policy.
01:26:46The importance of CHW/P/R voice workforce
01:26:51is an anti-racist strategy
and shifting power,
01:26:54unprecedented investment,
but we've got work to do.
01:26:59Learn from the long term,
learn from the agencies
01:27:02that have been doing this for a long time.
01:27:05Professional respect, it works.
01:27:09Healers need healing too.
01:27:11And this is about more
than meeting basic needs.
01:27:15So with that, I want to
thank our fabulous panelists
01:27:18for their wonderful words today.
01:27:20(audience applauding)
01:27:26And thank you to all the folks who helped
01:27:27to organize this fabulous event.
01:27:30I want to remind all of you to
fill out your evaluation forms
01:27:35and please do grab a lunch
if you haven't already.
01:27:38Thank you so, so much for
joining us today, take care.
01:27:42(audience applauding)