- Need: Rural Appalachian Kentucky residents have deficits in health resources and health status, including high levels of cancer, heart disease, hypertension, asthma, and diabetes.
- Intervention: Kentucky Homeplace was created as a community health worker initiative to address the lifestyle choices, inadequate health insurance, and environmental factors that are believed to contribute to these diseases.
- Results: Well over 110,000 rural residents have been served. Preventative health strategies, screenings, educational services, and referrals are all offered at no charge to clients.
Effective (About evidence-level criteria)
Kentucky Homeplace was created in 1994 by the University of Kentucky Center of Excellence in Rural Health and funded by the Kentucky General Assembly to combat health disparities in rural areas of the state. This community health worker (CHW) initiative was first based in the eastern town of Hazard, KY, and has since connected thousands of rural Kentucky residents with medical, environmental, and social services.
Currently, 27 counties located in the Appalachian region of eastern Kentucky are being served by Kentucky Homeplace. In comparison to the rest of the state and country, eastern Kentucky residents are statistically poorer, less educated, and have inadequate health insurance. In addition, a majority of the counties in Kentucky are designated as Medically Underserved Areas. Rural, poverty-stricken community members lack proper knowledge of their health conditions and run into barriers of social/cultural inhibitors, financial burdens, and transportation.
Kentucky Homeplace trains community health workers, usually individuals who were born and raised within the community, to provide access to numerous health and social services.
A majority of clients served are at 100%-133% of the federal poverty level. Kentucky Homeplace does not charge the clients for services provided. Within their communities, these services include:
- Providing health information and coaching
- Informing clients about available services in the community, state, and nation
- Providing referrals to agencies and providers
- Making appointments and contacting agencies/providers on the community member’s behalf
- Assistance with transportation arrangements
- Assistance with completing eligibility applications for programs and services
- Access to prescription assistance
Kentucky Homeplace puts an emphasis on care coordination and health coaching on the following:
- Chronic disease management
- Healthy lifestyles and eating habits
- The importance of preventative care
- Prenatal care
- The condition
- Eye care
- Foot care
- Physical activity
- Hypertension, cholesterol, and heart disease
- The conditions and appropriate diets
- Preventative screenings
- Mammograms, Pap Smears, colon and prostate exams
- Discontinuing tobacco use
- Education and referrals for cessation classes
- Resources for support groups and aids
Kentucky Homeplace has served well over 110,000 clients since it originated in 1994. Culturally-appropriate immediate and long-term services are provided, predominantly through home visits. The CHWs encourage their clients to develop and implement health prevention strategies.
For specific, recent information on the statewide impact of Kentucky Homeplace, view the latest Quarterly Reports.
Kentucky Homeplace has received numerous awards and recognition over the years, including the National Rural Health Association’s 2008 Outstanding Rural Health Program Award. See a list of more awards.
Kentucky Homeplace was a collaborating partner in C-Change, an organization that assembles key cancer leaders from the three sectors — private, public, and not-for-profit —and from across the cancer continuum —prevention, early detection, treatment and quality of life. More information about Cancer Patient Navigation: Care for Your Community.
In 2014, Congressman Hal Rogers presented a Health Impact Award to Kentucky Homeplace for its Improving Diabetes Outcomes (I DO) Campaign. Funded by a grant from the Anthem Foundation, I DO is a nurse-led outreach initiative coordinated by community health workers to educate diabetics about their disease. This is important because 31 of the 38 Kentucky Homeplace counties that participated in I DO are located in the “National Diabetes Belt.” In that region, 11% or more of adults had been told by a healthcare professional they have diabetes, yet the belt has the lowest number of certified diabetic educators to help individuals live healthy lives.
Kentucky Homeplace has been recognized by the U.S. Department of Health and Human Services’ Healthy People 2020 initiative for their work to improve colorectal cancer screening rates.
Read more on the Sharing Library at Healthy People.gov: Kentucky Homeplace: Improving Colorectal Cancer Screening Rates Through Tailored, Community-Based Approaches
For more detailed program results:
Dignan, M., White, C., Schoenberg, N., Shelton, B., Feltner, F., Slone, S., . . . Ely, G. (2014, January). Effectiveness of an Intervention for Adherence to Follow-up Recommendations for Abnormal Pap Tests in Appalachian Kentucky. Health Behavior and Policy Review, 1(1):6-15(10). Article Abstract
Donaldson, E., Holtgrave, D., Duffin, R., Feltner, F., Funderburk, W., & Freeman, H. (2012, October). Patient Navigation for Breast and Colorectal Cancer in Three Community Hospital Settings: An Economic Evaluation. Cancer, 118(19):4851-4859. Article Abstract. Free Full-text
Ely, G., White, C., Jones, K., Feltner, F., Gomez, M.,
Shelton, B., . . . Dignan, M. (2014). Cervical Cancer
Screening: Exploring Appalachian Patients’ Barriers to
Follow-Up Care. WSHC: Social Work in Health
Care, 53(2):83-95. Article
Feltner, F., Ely, G., Whitler, E., Gross, D., & Dignan, M. (2012). Effectiveness of Community Health Workers in Providing Outreach and Education for Colorectal Screening in Appalachian Kentucky. Social Work in Health Care, 51(5):430-40. Article Abstract
Feltner, F., Wilson, E., Whitler, E., & Asher, L. (2011). UK College of Medicine – Future Role of Community Health Workers for Reducing Health Disparities. Poster presented at the NRHA Annual Rural Health Conference, Austin, Texas. Poster Presentation
Schoenberg, N., Campbell, K., Garrity, J., Snider, L.,
& Main, K. (2001).
The Kentucky Homeplace Project: family health care advisers in underserved rural communities. Journal of Rural Health, 17(3):179-86. Article Abstract
Whitler, E., Feltner, F., Owens, J., & Gross, D. (2005). Kentucky Homeplace Defeat Diabetes Screening Test: an analysis of rural Kentucky's challenge to overcome the growing diabetes epidemic. Journal of the Kentucky Medical Association, 103(7):307-14. Article Abstract
Kentucky Homeplace is featured in RHIhub's Community Health Worker Toolkit Program Clearinghouse.
Challenges for implementing and maintaining the community health worker program include:
- Funding mechanisms for sustainable employment
- Workforce development and training
- Occupational regulations
- Standards and guidelines for publicly-funded CHW program evaluation and research
Kentucky Homeplace has provided CHW training for more than two decades to CHWs within Kentucky as well as numerous other states across the nation. Lessons learned in the Kentucky Homeplace model have enhanced the success of other programs, service delivery, and research projects.
The Kentucky Homeplace model has been recognized by policy makers at the local, state, and national level, including the following:
- Promoting Policy and Systems Change to Expand Employment of Community Health Workers (CHWs), Centers for Disease Control and Prevention (CDC), 2011.
- Community Health Workers: Expanding the Scope of the Health Care Delivery System, National Conference of State Legislatures, April 2008.
Mace Baker, RN, Homeplace Director
606.439.3557, Ext. 83684
Community health workers
Wellness, health promotion, and disease prevention
January 28, 2015
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.