AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
DARLEEN SHEARER: You had to say that didn’t you? Thank you. I would like to spend the next few minutes sharing with you a little bit of our experiences and background as to how we developed a training program for home visitors who work primarily with MCH populations. I get to do the boring part and *Lo * Berry will join me with a reality application of how this looks in her own program. I think everyone sitting here in this room would agree that during the past 30 years our country has undergone many social and cultural changes. And that has created even greater challenges to making sure that healthcare is available, that it’s accessible and that it is utilized by some of the populations that we all serve who are typically referred to as marginalized communities. The Lawton and Rhea Chiles Center for Healthy Mothers and Healthy Babies at the University of South Florida is dedicated to studying and supporting community-based approaches to address disparities in healthcare access and utilization in Maternal and Child Health populations.
With funding that we received from the U.S. Department of Labor and the Centers for Disease Control, we have developed an advanced training to increase the skills and expand the roles of workers who are typically community based and visiting homes of families who face the greatest of life challenges and these challenges affect their ability to access and use services. Community health workers is a term that I will use because this group of workers has immerged as effective agents to promote health and increase the use of health services across the country, not only just in maternal and child health but in a variety of other health problem areas. They are typically from the community in which they serve and they bring a particularly important multi cultural competence to empower families that they visit and help these families to identify their own needs and to develop their own solutions for addressing these problems. In maternal and child health we call these individuals family support workers, home visitors, and outreach workers.
Despite the potential advantages that home visitors and family support workers provide the healthcare delivery system, and despite this growing national recognition of the importance of their roles, the amount of support and training and respect and acceptance by professionals and the utilization of their skills is anything but uniform across programs and across geography. And it is to that end that the Maternal and Child Services Workforce Development Program was developed. We have tried to use a University Community College partnership to create a training model for paraprofessional level MCH workers and home visitors. And our intent was to create a credit earning program that is tied to the educational continuum that will allow these individuals to progress at their own pace and to go to levels of education that they personally desire. Because of our Department of Labor funding, it was particularly important that this training facilitate earning capacity and career development among a low income worker group that consists primarily of women with young children and young families of their own.
To help us develop the training, we turned to several sources. One source was using a DACOM process, which is an acronym, I won’t spend very much time describing, but essentially we had facilitators who spent two days in a room with a group of paraprofessionals and home visitors from our federal and our state Healthy Start Programs from Head Start, from Healthy Families, from Even Start, and a variety of other home visiting programs to learn more about their work related duties and tasks. We also conducted a series of focus groups with employers and with workers to learn about what they expected and needed in training. And we learned that there was a considerable difference between what the employers said and what the workers themselves thought was needed. Employers felt that they had invested a lot of resources in training the home visitors and they really weren’t sure that another training program would be very beneficial to these workers and that there was not really very much that we could add to their knowledge.
The workers told us on the other hand, that trainings were not very well geared toward their home visiting processees. And that the content was often irrelevant or beyond their comprehension level and that they had probably most important to me was, how frustrated they were that they had so little choice about what they were able to learn, what trainings they had to attend because all of these things were mandatory as part of their work. In spite of their training, they felt under valued and they also told us that about what they did not get or what they did not hear in their trainings. One of the quotes that, I often like, to use because it had a real impact on me in thinking about the development of this training. One worker said this and I’ve used it often in my presentations, she said I have enough attendance certificates to wallpaper my entire house. And what has all this training gotten me? Absolutely nothing. And I think that as I have talked to other people around the country, particularly workers themselves, I think that this is echoed over and over and it’s not unique to Florida .
After working with an expert panel, we identified, we pulled together all the information that we had collected. We identified nine competency areas that we felt needed to be addressed in the training that we were developing. And essentially the competency areas identified three different *fosi. One was development of communication skills that reflect understanding of cultural differences, recognition of and communication of important observations that need to be reported to professionals, and model practices for supporting, empowering, and educating the parents. And I, you will hear me talk a lot about the empowering of families because this has been an important theme that we have instilled into the training itself. The result was a set of courses, six courses, that produced 21 credit hours that ends up in a, something we call, an applied technical diploma. This is something that Community Colleges are able to provide. It’s a legitimate diploma and those 21 credit hours do apply toward an associate degree. And it is registered on our State Department of Education, on their listing of available credit courses and it is established within Health and Human Service types of programs that exist in Community Colleges.
Essentially the training ended up with three components. The first component was a set of foundational courses that offered, these are traditionally offered in Health and Human Service Programs. They are Introduction to Human Services for families and young children. Basic Communication and Interpersonal Skills and Cultural Diversity and Implications for Practice. Now these are college level courses. Each of them three credit hours. And they build on, provide the foundation for three specific MCH related courses that we created and developed. They focus very heavily on the maternal/child dyad and on the family context. And then a field component was added that is worth three credit hours to enable these students to apply what they were learning within their own agency that they were employed. And to help their employers see what the student was actually learning and what they were trying to apply. The program lasts approximately 15 months with our pilot test group.
And in keeping with our University and research mission, we have made a considerable effort to develop a strong evaluation of this program, both process and outcome oriented evaluation at three different levels. At the individual level, we’re hoping to be able to examine how the home visitors are changing personally, professionally, and academically. At the agency level we are looking at how the employer views the worker before and after the training and what changes occur in relation to what these workers are earning and doing. And at the client family level we are hoping to identify whether or not this training trickles down so to speak to the family in any way at all. We’ve had 42 students in our program thus far and these are spread across three cohorts at three different Community Colleges. In December we graduated the first two cohorts from two of the Community Colleges and we have a third cohort that is, has just completed their first semester on their second semester of course work.