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Funding needed for Community Health Worker force

Granite State News Collaborative
Published: 7/30/2020 12:57:06 PM

If New Hampshire is going to win the COVID-19 war, it is going to need an army of Community Health Workers, according to Dr. Trinidad Tellez, director of the Office of Health Equality for the Department of Health and Human Services.

“No matter what kind of culture, having a trusted member of that community is what the Community Health Worker brings,” Tellez said.

New Hampshire’s minority communities were hit hard by the COVID-19 outbreak in the spring, and a second wave anticipated for the fall has Tellez and other public health officials concerned.

“We have a pandemic, we have practically a state of emergency where the burden of illness is impacting some people more than others,” Tellez said.

Community Health Workers could be key to keeping the state safe and healthy, Tellez said. Community Health Workers are considered lay medical workers, meaning they have no medical training. Instead, they are members of the community who help bridge the gap between people and the services they need.

“They offer a huge amount of support to the work that we do,” said Bobbie Bagley, Nashua’s public health director. “I’m hoping we can get quite a few more.”

State data shows that minorities are getting the illness at higher rates than the rest of the population. Latinos make up 3.9 percent of the state’s population, but 719 Latinos have tested positive for the illness making 12.6 percent of all the COVID-19 cases in the state. African Americans, who are 1.4 percent of the state’s population, account for 337 cases, or 6 percent of all COVID-19 cases. More than 6,500 people have tested positive for COVID-19 since testing started earlier this year.

Many of the more diverse communities in New Hampshire right now have a handful of Community Health Workers. Unlike other states where Community Health Workers can be paid through health insurance, New Hampshire leaves municipalities and organizations to fund the Community Health Worker positions through grants, said Paula Smith, director of the Southern New Hampshire Area Health Education Center.

“It’s hard to put a bunch of them out in the street if you don’t know how to pay for them,” Smith said.

Smith said that while the ranks of Community Health Workers has grown since funding changes brought about in the Affordable Care Act, New Hampshire still lacks the infrastructure like education and certification for these workers.

“I think that if not for the reimbursement, people would use more Community Health Workers because they are great cultural brokers, especially in the time of COVID,” Smith said.

The two Community Health Workers in Nashua reach out to minority communities and assist with access to testing, treatment, and education, Bagley said. They also help people get access to food stamps, food banks, and other services as necessary. COVID-19 has been difficult on minority and immigrant communities partially because many cannot afford to take time off work in case of an exposure.

“Right now with COVID, there’s nothing that’s really typical,” Bagley said.

When her department communicates with a family that has to isolate or quarantine because of a positive test or exposure, that means the family is cut off from even grocery shopping. Bagley and her staff will get them food and necessities. She credits the Community Health Workers in Nashua and the whole model for her staff being able to make connections with people who need help.

Nashua is home to Spanish speakers, Portuguese speakers, and people from Indian subcontinent where there are many different languages. Bagley would like to have someone who can relate to the communities they serve to be a trusted voice. She’d like at least a half dozen more Community Health Workers, if she could afford to fund the positions.

“You want to have someone who can speak the language (of the community) as a first language,” Bagley said.

Anna Thomas, Manchester’s public health director, said cities like Manchester are more vulnerable to the pandemic. That increases Community Health Workers who can be trusted by members of minority and immigrant communities.

“Urban centers are getting hit hard,” Thomas said.

It’s not strictly minorities who need the services of Community Health Workers, though. Thomas said the city is working with organizations to reach homeless people in the city. Homeless people tend to have health issues that put them at great risk, Thomas said.

“I’m gravely concerned about them when we get into those extreme cold weather months.”

Manchester has one Community Health Worker in the department, and two who are assigned to the schools. During the school year, the city adds another two Community Health Workers to the school system, and they focus on school in less advantaged neighborhoods, Thomas said.

“They gave us a whole other level of connection to the communities,” Thomas said.

Community Health Workers free up the other social and health care employees, like school nurses. The nurses can focus on delivering care, while the Community Health Workers assist with things like rides to medical appointments, or testing sites. Thomas said the city is adding two more Community Health Workers to help with contact tracing and COVID-19 infection investigations. Smith said many Community Health Workers have helped people get access to internet connected devices to allow them to engage in tele-health appointments with the healthcare providers.

With Manchester employing at most five to seven Community Health Workers during the school year, Thomas knows they could do more.

“In other cities our size, there are some cities even smaller than us and they will have 50 Community Health Workers on the front lines,” Thomas said. “The pandemic really unearthed that for us.”

Thomas said there is an effort to bring together stakeholders to develop Community Health Worker standards for education and some form of certification. This could help communities around the state build up the number of Community Health Workers, according to Smith.

“I would like to have as many as we can get,” Thomas said.

Smith said developing a certification for Community Health Workers likely leads to the positions becoming eligible for reimbursement through insurance companies and state insurance. Any certification program also needs to go along with a public awareness campaign to promote Community Health Workers as a career option, Smith said.

“We have to figure out how we fund these positions,” Smith said.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.
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