Evidence-level

Effective (About evidence-level criteria)

Description

The Columbia River Gorge encompasses Hood River and Wasco Counties in Oregon, and Klickitat and Skamania Counties in Washington. Famous for its orchards, the Gorge's fruit industry is dependent on its seasonal and migrant farmworkers, a majority of them having Hispanic ancestry. 

One of the Gorge's main health concerns is obesity. Nearly two-thirds of Oregon's population is considered obese, with Hispanics ranking higher in obesity than non-Hispanics. Hood River and Wasco Counties exceed the state's average in heart and cerebrovascular disease, and death rates stemming from stroke are 20% above the national average. Klickitat and Skamania have blood pressure and cholesterol levels that are higher than the rest of the state.

In response to the need for local culturally-relevant healthcare services, One Community Health (OCH) started several wellness services that promote good health through activities like education, screenings, healthy eating, chronic disease management.

The Steps to Wellness/Pasos Hacía Salud course was originally developed with funds from a 2006-2009 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach grant to reduce diabetes and teach weight management among the Gorge's Spanish-speaking and low-income population. Through funds from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant, the program has grown to address hypertension, hypercholesterolemia, and stress management.

Ongoing financial support has been provided through an additional grant from Providence Hood River Medical Hospital and general budgetary funding from One Community Health.

Several organizations helped to shape Steps to Wellness/Pasos Hacía Salud, including:

• The Next Door, Inc. - Nuestra Comunidad Sana
• Providence Hood River Memorial Hospital
• Klickitat County Health Department
• La Clínica del Cariño, dba. One Community Health
• OSU Extension Office
• Hood River Health Department
• Mid-Columbia Medical Center
• Skyline Health
• FISH Food Bank

Services offered

Below are the current services offered by One Community Health:

• A 12-week Steps to Wellness/Pasos Hacía Salud course teaches stress reduction, physical fitness, and healthy nutrition through self-directed action steps. A team of Community Health Workers teach lessons encompassing control and prevention of 4 main chronic diseases: diabetes, hypercholesterolemia, hypertension, hyperlipidemia, and obesity. Partnering with The Next Door, Inc., this course is offered at an affordable price.
• Salud Chronic Disease Management is offered to OCH patients struggling with hypertension, diabetes, and obesity. Providers at OCH refer patients to this program where CHWs and RNs work alongside the patient. Individualized action plans are created to help the patient carry out stress reduction techniques, physical activity recommendations, and healthy nutrition practices.
• CHWs lead an annual Farmworker Outreach program during orchard harvest. Educational presentations on weight management and diabetes prevention are taught in Spanish. Food donated by the community is distributed, and screenings are offered. Participants are referred to OCH if more specific care is needed.
• The Perinatal Program operates within OCH by provider-referral for expectant mothers. Perinatal CHWs provide comprehensive education and support throughout enrolled patients' pregnancies and postpartum periods. The expectant mothers and perinatal CHWs work together to create plans for prenatal education visits, ultrasounds, lab work, doctor's visits, and follow-up care after delivery.
• One Community Health is a distribution site for the Veggie Rx Program. In partnership with the Gorge Grown Food Network, the program offers monthly vouchers for patients who screen positive for food insecurity. A CHW offers one-on-one educational visits and community cooking classes to these patients. The aim of these classes is to empower patients to shop for healthy foods on a limited budget and increase their cooking skills while sharing a healthy meal with other community members.
• Through the Reach out and Read Program, each child visiting for a well-child checkup are given an age-appropriate book to take home. Parents are encouraged by healthcare staff to read it to their children. The purpose of this program is to support reading skills and the interpersonal connection that comes through reading together as a family.
  

Results

Most participants in the programs have maintained or lost weight and saw reductions in their cholesterol levels, blood pressure, and blood sugar levels. Below are some specific results from 2015.

• 104 participants completed the Steps to Wellness/Pasos Hacía Salud program
• Over 1,500 patients had at least 1 care management appointment with the Salud team
• Over 200 pregnant women received care management from the perinatal team
• Several participants have created on-going support groups and walking groups
• More than 2,200 families received vouchers for fresh produce from the Veggie RX Program.

One Community Health is featured in RHIhub's Care Coordination Toolkit Program Clearinghouse.

For more information on the OCH community health worker model:
Castañares, T., Volkmann, K. (2011). Clinical Community Health Workers:  Linchpin of the Medical Home. Journal of Ambulatory Care Management. 34(3), 221-233. Article Abstract

Challenges

Challenges in starting up the Steps to Wellness/Pasos Hacía Salud program:

• There was little familiarity in the community with CHWs, especially from the healthcare community who didn't understand the role or how to work with them.
• Significant education and guidance was needed from clinic staff for the CHWs to be prepared and effective.
• The original 15-week Steps to Wellness/Pasos Hacía Salud curriculum was labor intensive, requiring a great deal of commitment, time, energy, and resources.
• Bilingual CHWs were hard to find.

Challenges in operating wellness programs today:

• It is difficult to keep Steps to Wellness/Pasos Hacía Salud affordable for participants.
• CHWs are stretched thin. Running Steps to Wellness/Pasos Hacía Salud and Farmworker Outreach programs pulls them away from providing care management at OCH for Salud patients.
• Data collection and data analysis is necessary, yet time intensive and costly. Database limitations also make it difficult to report certain results. OCH has been unsuccessful thus far in securing funding to conduct a comprehensive research study of the Pasos curriculum.

Replication

Finding good CHWs is the base on which to build these kinds of programs. A good CHW is one who knows the needs of the community, is seen as a leader, personable, well-respected, and well-known. Carefully assess their characteristics to make the best matches for teaching teams. Once you have strong leaders, the programs can be built around their skills. Here are some additional steps to consider in running your programs:

• Learn the needs of your community by conducting a community needs assessment and taking surveys.
• Create contingency plans, establish processes, and rehearse scenarios to prepare for a potential loss of key program personnel.
• Ensure staff time is budgeted for required meetings to reassess and adjust the program structure when needed.

• Look for local partners (social service agencies, universities) to collaborate on outreach efforts. The collective impact of organizations working together is much greater.

The Popular Education model was used for Steps to Wellness/Pasos Hacía Salud. This teaching concept, originated by Brazilian Paulo Freire, links education and social action.

Contact Information

Jason Bradley, Site Director
One Community Health
541.386.6380
jbradley@onecommunityhealth.org