CHWs are frontline public health workers who have a deep understanding and/or are trusted members of the communities they serve. CHWs create a link between health/social services and the community to improve service access and quality. Research suggests CHWs are likely to reduce health disparities due to their unique ability to serve as change agents in their communities. Their effectiveness is rooted in CHWs’ lived experience with the communities they serve, the trust they build in relationships, and the holistic and multifaceted work they do. 1 CHWs may work autonomously in the community or as part of a multi-disciplinary team in primary or specialty care.
Training can be varied widely and tailored to meet the needs of intended role and location. CHW services are usually provided to low status communities and to individuals at high risk of poor social or health outcomes. CHWs often work with individuals at risk for or suffering from chronic diseases such as diabetes, cancer and cardiovascular disease.
They also work with women at high risk for poor birth outcomes, providing pregnant women and new mothers with emotional and practical support and education on topics such as family planning, pregnancy, childbirth, breastfeeding, and vaccination.
Home visitation programs have long been used as an effective means of intervention among low status populations including chronically ill, impoverished, rural, or homebound individuals. Understanding barriers and best practices to the implementation of home visit programs is essential to inform effective efforts. Home visit programs led by community health workers (CHWs) are becoming more common and pose specific opportunities for better impact. 2
For instance, the California Home Visiting Program (CHVP) is designed for families who are at risk for Adverse Childhood Experiences (ACEs), including child abuse, domestic violence, substance use disorder and mental health related issues. Home visiting provides parents with the tools and knowledge to independently raise their children. It’s a preventive intervention that promotes positive parenting and healthy child development. Decades of research on home visiting shows that home visits by trained and trusted professionals or CHWs during pregnancy and in the first few years of life improves the lives of children and families. This is important: giving children a solid start in their formative years increases the likelihood for healthier and more prosperous futures. 3
Solutions in Action: El Sol Neighborhood Educational Center’s Home Visitation Programs
El Sol’s approach to community health and wellness centers the family unit as the building block to strengthening communities by incorporating home-based interventions targeting family planning, reproductive health and pregnancy, childbirth, breastfeeding, chronic disease prevention, school readiness and success, and vaccination programs
One of our most successful home interventions has been our Nurturing Parenting and Home Visitation Program. Our program effectiveness is rooted in the CHW’s/promotores’s ability to build trusting relationships with parents and caregivers and their families within their homes, and in the efficacy of our training. Through this program, xx promotores engaged 230 families in their homes located in San Bernardino and Riverside counties. Our goal was to foster empathy, resiliency and to prevent neglect and abuse among young parents through the implementation of home-based parenting education, resilience education, Adult Adolescent Parenting Inventory assessments, and resource and referral services. On average, each family received x home visits.
Over 12 months, we achieved the following results:
Ninety-eight percent of participants improved their scores on the Adult Adolescent Parenting Inventory (moving from “high risk” to “low risk”)
Seventy-eight percent of participants improved their parental empathy towards their children’s needs by at least 65%
Ninety-one percent of participants reported a 28% increase in social interactions and home environmental knowledge to improve parent-child bonding
Promotores received 70 hours of training
Promotores enrolled 300 children in insurance plans
Within this intervention, promotores educated parents about how best to take care of their children and what to do in case of any health emergencies. They also provided empathetic education to prevent unhealthy habits like smoking and excessive alcohol consumption.The CHWs/promotores helped families create a healthy physical, social, and psychological environment for themselves and their infants in this 8-session course that used cognitive-behavioral mood management framework. They also focused on safety precautions, accident prevention, developmental milestones, and support resources to ensure health and wellbeing for children ages 0 to 4 years. Research supports the efficacy of interventions such as ours; 35% of the children whose parents participated in similar home-based programs were less likely to visit emergency rooms during their formative years.
El Sol Neighborhood Educational Center’s Asthma Education, Prevention and Treatment Intervention
Fifteen percent of children in urban areas live with undiagnosed asthma. 4 From 2013 – 2016, to combat the effects of poor air quality in Riverside County, El Sol Promotores effectively promoted respiratory health to parents and caregivers through education, screenings, home visitations and referrals to health professionals. We deployed 6 promtores to conduct 1,064 home visits in Riverside County to provide asthma education, prevention, treatment and home surveillance. XXX high-risk community members participated in the intervention with 84% referred by healthcare professionals. We collaborated with 61 organizations, including local hospitals. Promotores trained parents and caregivers in asthma management, distributed home cleaning supplies, kits and educational materials, and provided referrals to medical homes. Over 12 months, we achieved the following results:
- Promotores trained 16,500 parents/caregivers in respiratory health strategies
- Ninety-six percent improvement in asthma management
- Sixty-nine percent reduction in Emergency Room visits
These interventions were instrumental in supporting parents in detecting asthma early on, making it easier for parents to manage the condition long term, and also in teaching parents and caregivers to make home improvements to mitigate environmental conditions that exacerbated respiratory problems in the home. Most parents who participated perceived their children’s asthma-related coughs to be normative, and did not understand how air quality, stress, and home conditions impacted their children’s respiratory issues. After better understanding these factors, parents were also educated on how best to take care of their children to ensure their health conditions did not become worse.
Evidence Based Home Visitation Consulting
El Sol offers consulting in the following home visitation competencies:
- Developing/maintaining training manuals and protocol
- Facilitating the development of referral pathways between home visitation providers, other existing home visitation programs and other community resources.
- Assisting in the development of data management information systems
- Performance monitoring and continuous quality improvement
- Cross-site peer learning exchanges between home visitation programs
- Site specific and cross-site team building and professional development
- Mentoring and coaching for program managers and supervisors on reflective supervision and trauma sensitive services
- Enhanced program communication and messaging.
Conclusion
Home visitation programs are promising, impactful interventions that are likely to reduce health disparities in low status populations. Contact [Name and title] at [email address and phone number] to learn more about El Sol Neighborhood Educational Center’s Home Visitation programs and how they can be integrated as part of a multi-disciplinary team in primary or specialty care.
[1]https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/community-health-workers
[2] https://pubmed.ncbi.nlm.nih.gov/32037337/
[3] https://www.cdph.ca.gov/Programs/CFH/DMCAH/CHVP/
[4]https://www.elsolnec.org/wp-content/uploads/2021/02/School_based_asthma_management.pdf
