Survey Results of the Community Health Worker Employer View to Future Workforce Growth, Needed Skills and Participation in a State Apprenticeship Program

Table of Contents Sample Design Employment & Titles in Rhode Island Future Need & Expected Demand Establishments Involvements in Apprenticeship Program Current Training Provided in Rhode Island Importance of Skills Training Survey Instrument Appendices Survey Instrument Cover Letter

1 2 3 3 4 5 6 A B

Sample Design Community Health Worker Apprenticeship Program Sampling Mail Survey 1. Mail survey to representative sample of employers in industries most likely to employ Community Heath Workers. 611 Educational Services 6111 Elementary & Secondary Schools 6112 Junior Colleges 6113 Colleges Universities & Professional Schools 621 Ambulatory Health Care Services 6211 Office of Physicians 6213 Offices of Other Health Practitioners 6214 Outpatient Care 6216 Home Health Care Services 6219 Other Ambulatory Health Care Services 622 Hospitals 6221 General Medical & Surgical Hospitals 6222 Psychiatric & Substance Abuse Hospitals 6223 Specialty Hospitals 623 Nursing & Residential Care Facilities 6231 Nursing Care Facilities 6232 Residential Mental Retardation, Mental Health & Substance Abuse Facilities 6233 Community Care Facilities for the Elderly 6239 Other Residential Care Facilities 624 Social Assistance 6241 Individual & Family Services 6242 Community Food & Housing, and Emergency & Other Relief Services 813 Religious, Grant Making, Civic, Professional & Similar Organization 8131 Religious Organizations 8132 Grantmaking & Giving Services 8133 Social Advisory Organizations 2. Random stratified sample by NAICS code and size of firm. All employers with 250 or more employees were included in the sample. Provided phone number on survey for those who wish to discuss opinions regarding Apprenticeship Program. -1-

Community Health Worker Apprenticeship Program The information in this report was derived from a sample of companies classified in industries most likely to employ Community Health Workers. The Labor Market Information (LMI) unit established there are 3,114 establishments employing 3 or more workers classified in these industries. LMI randomly selected 508 of these establishments to survey and received responses from 244 (48%). Results of the weighted responses follow. Twelve percent of the employers in the industries most likely to employ Community Health Workers reported currently employing Community Health Workers and 87.9 percent of employers reported they currently do not employ Community Health Workers. 87.9%

Employ Community Health Workers

12.1%

Do Not Employ Community Health Workers

Based on the preestablished list in the survey (page 6), respondents were asked the job titles used to refer to Community Health Workers. Results indicate 44 percent of establishment used the Community Health Worker titles. The Outreach Educator title was used by six percent of establishments and Peer Health Promoter was used by one percent of establishments. Other titles reported by respondents included: Case Manager, Certified Nursing Assistants, Childbirth Educator, Clinical Specialist, CNA’s, Counselors, Direct Support Professional, Direct Support Workers, Emergency Medical Technicians, Family Education Specialist, Family Resource Specialist, General Volunteers, Health Educator Counselors, Home Care Worker Counselors, Homemaker, Paramedics, Peer Facilitators for Pain Management, Peer Resource Specialist, Physical Education/Health Faculty, Residential Counselor, School Nurses, and Volunteers.

Community Health Worker Estimated Employment Estimated number of Community Health Workers currently employed in Rhode Island. Volunteers (unpaid) Employed part-time (1 to 34 hours per week) Employed full-time (35 or more hours per week)

217 311 285

Counts include respondents classifying Certified Nursing Assistants, Homemakers, and Direct Support Workers, and Case Managers as Community Health Care Workers.

-2-

Expected Future Need For Community Health Worker The majority of respondents (76.9%) believe the demand for Community Health Workers will increase. No respondents reported an expected decrease in the number of Community Health Workers and 23 percent reported they felt the demand would stay the same.

Remain the Same 23.1%

Increase 76.9%

Expected Demand For Establishments Currently Not Employing CHW Workers Plan to Hire 16.2%

Approximately sixteen percent of employers that do not currently employ Community Health Workers reported they plan to hire Community Health Workers in the future.

No Plans To Hire 83.8 %

Establishments Willing To Be A Hire Site For CHW Workers Nearly 11 percent of establishments indicated they would be willing to be a hiring site for

No Response 63.9%

Community Health Workers as apprentices.

Yes 10.5%

No 25.6%

Establishments Interested In CHW’s Apprenticeship Curriculum Development Yes 10.5% Approximately 11 percent of establishments would be interested in being part of the curriculum development.

No Response 64.0%

-3-

No 25.5%

Types of Training Currently Provided to Community Health Workers Core Skills Communication Interpersonal Knowledge Base Capacity-Building Advocacy Teaching

Topical and Categorical Domestic Violence Substance Use Re-Entry Parent Support Housing Support Homelessness

Disease Specific Diabetes HIV Asthma Lead

Percent Who Provide Training 11.4% 11.2% 11.6% 5.6% 5.8% 5.8%

Other Business Administration & Medical Assistance Facilitator Restraint

Percent Who Provide Training 6.0% 5.7% 0.3% 5.6% 5.5% 0.3%

Other Chronic Disease Pain Patient Care

Percent Who Provide Training

Other

0.5% 0.5% 0.5% 0.5%

Communicable Diseases Infection Prevention Injuries Neuro Muscular & Skeletal

Types of Training Methods and Budgets Twenty-seven percent of establishments reported that current training is provided by coworkers and/or staff.

2.1 % Training Budget

Twenty-four percent of establishments reported that current training is provided by outside training. Ninety-eight percent of employers reported they currently do not have a budget for training. Two percent of respondents reported a training budget for Community Health Workers. -4-

97.9 % No Training Budget

Skills Training For CHW’s Apprenticeship Program Importance of skills training in the Community Health Workers Apprenticeship Program. Very Important Communication Skills use language confidently active listening written communication Interpersonal Skills counseling relationship building Knowledge Base Skills knowledge of community knowledge of health issues knowledge of health system knowledge of social service issues system Advocacy Skills serve as intermediaries between clients and systems Organizational Skills ability to set goals ability to plan ability to manage time Teaching Skills ability to share information ability to lead classes Capacity-Building Skills ability to help clients solve problems themselves ability to empower Safety conflict resolution self defence

Important

Less Important

98.0 % 98.6 % 77.5 %

2.0 % 1.4 % 22.5 %

35.1 % 85.8 %

37.4 % 14.2 %

27.4 %

56.0 % 83.8 % 49.2 % 45.8 %

17.3 % 2.9 % 37.1 % 54.2 %

26.7 % 13.3 % 13.7 %

15.7 %

39.1 %

45.2 %

60.4 % 75.1 % 85.7 %

4.6 % 4.3 % 14.3 %

34.9 % 20.6 %

62.1 % 47.6 %

37.9 % 3.0 %

49.4 %

36.8 %

36.3 %

26.9 %

62.7 %

22.8 %

14.5 %

47.9 % 23.3 %

23.0 % 33.2 %

29.1 % 43.5 %

Additional Core Skills or Specific Skills The following items were provided by respondents when asked “Are there additional Core Skills or Specific Skills you believe should be part of the Apprenticeship Program.” Conducting community needs assessments Confidentiality/boundaries/HIPPAA Integrity, ethics, infection prevention, patient safety Knowledgeable In Holistic & Alternative Healthcare Including Chiropractic Medical skills such as vitals, blood pressure, height, weight, respiration -5-

Appendix STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS

Department of Labor and Training

Lincoln D. Chafee Governor Charles J. Fogarty Director

Center General Complex 1511 Pontiac Avenue Cranston, RI 02920-4407

Telephone: TTY:

(401) 462-8000 Via RI Relay 711

Dear Rhode Island Employer: The Rhode Island Department of Labor and Training (DLT), in conjunction with the Center for Primary Care and Prevention at Brown University, is conducting a survey to determine the current and future demand for workers in the Community Health Worker occupation and to determine employers’ interest in and point of entry for a Community Health Worker apprenticeship program. “Community Health Worker” is an umbrella term inclusive of many job titles, such as community health advisors, lay health advocates, promotoras (de salud), outreach educators, community health representatives, and peer health promoters and educators, among other titles. In July of 2010 the Federal Department of Labor recognized Community Health Worker as an apprenticeshipable occupation. The State of Rhode Island is one of the first states to start an apprenticeship program for the Community Health Worker occupation. To ensure industry input into this process we are using this survey as a vehicle to gather information on the existing training practices for Community Health Workers and potential training programs that employers deem necessary for these workers. Please direct/forward this survey to the manager or human resource professional responsible for hiring at this employment location. The information you provide will be held confidential by the DLT and the Center for Primary Care and Prevention. No information will be published or shared that would allow for the identification of an individual employer. We would greatly appreciate the return of your completed survey within TWO WEEKS of receipt. Please use the enclosed postage-paid envelope for your return. Or if you prefer, you may fax your response to (401) 462-8766. If you have any questions regarding this survey, please call Marilyn Fitzgerald of the Labor Market Information unit at 401-462-8770 or e-mail us at: [email protected]. We sincerely appreciate your assistance with this survey as we realize that you have competing demands for you time and wish to thank you in advance for your help and support. Sincerely,

Donna A. Murray Assistant Director, Labor Market Information Unit

An Equal Opportunity/Employer. Auxiliary aids and services are available upon requests to individuals with disabilities. TTY via RI Relay711

APPENDIX A: Cover Letter

Contact Information Name: _________________________________________________ Phone: _________________________________________________ E-mail _________________________________________________

Schedule Number 0000 Company Name ATTN: Human Resource Manager Street Address City, State & Zip Code

There are plans to create a Rhode Island Community Health Worker (CHW) Apprenticeship Program. This is an “earn while you learn” strategy combining on-the-job learning with related instruction with a mentor, and incremental wage increases. Successful candidates will receive a Certificate of Completion of Apprenticeship that would be portable and recognized by other states with CHW apprenticeships.

Instructions  For accuracy, it is important that you fill out and return this survey even if you do not employ Community Health workers.  Answer questions for R.I. employees only.  If you have any questions call Kathleen Greenwell at (401) 462-8770 or e-mail [email protected]  Please return the completed survey in the postage paid envelope.

COMMUNITY HEALTH WORKER SURVEY 1. Do you currently employ (include volunteers) any Community Health Workers?  Yes (Continue with question 2.)  No (Go to question 5) 2. What job titles do you use to refer to Community Health Workers? Mark all that apply.  Community Health Worker

 Community Health Advisor

 Community Health Representative

 Peer Health Promoter

 Peer Health Educator

 Outreach Educator

 (Lay) Health Advocate

 (Lay) Health Advisor

 Promotores/Promotoras (de salud)

 Other. Please list title(s)________________________________________________________ 3. How many Community Health Workers do you currently employ? Volunteers (unpaid) Employed part-time (1 to 34 hours per week) Employed full-time (35 or more hours per week)

________ ________ ________

4. What do you expect will be your need for Community Health Workers over the next 5 years?  Increase  Decrease  Stay about the same 5. If you currently do not employ any Community Health Workers, does your company/organization plan to hire any Community Health Workers? Yes No If yes, how many employees would you want to add? Full-time ______ Part-time______ Volunteers ______ APPENDIX B: Survey Form

The following questions relate to your training needs for your Community Health Worker employees. 6. If you currently provide training to CHWs, please mark the training you provide.

Core Skills Training communication interpersonal knowledge base capacity-building advocacy teaching other ___________

Topical and Categorical domestic violence substance use re-entry parent support housing support homelessness other ___________

Disease Specific diabetes HIV asthma lead other ___________

7. Is the current training provided by coworkers and/or staff? Yes

No

8. Is the current training provided by outside trainers?

Yes

No

9. Do you have a budget for this training?

Yes

No

Please indicate the need for skills training in the CHW Apprenticeship Program. V

Very Important

10. Communication Skills use language confidently active listening written communication Interpersonal Skills counseling relationship building Knowledge Base Skills knowledge of community knowledge of health issues knowledge of health system knowledge of social service issues system Advocacy Skills serve as intermediaries between clients and systems

Important

I

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

Less Important

Organizational Skills ability to set goals ability to plan ability to manage time Teaching Skills ability to share information ability to lead classes Capacity-Building Skills ability to help clients solve problems themselves ability to empower Safety conflict resolution self defence

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

V

I

L

L

Are there addition Core Skills or Specific Skills you believe should be part of the Apprenticeship Program. _____________________________________________________________________________ 11. Once an Apprenticeship Program is established would your organization be a site to hire CHW as apprentices. Yes No 12. Once a RI Apprenticeship Program is established would you be interested in being part of the curriculum development? Yes No 13. If you would like to discuss your opinions regarding the Apprenticeship Program , please contact Dannie Ritchie, MD, MPH at 401-729-2065 or [email protected].

Thank You. -7-

Dannie Ritchie, MD, MPH Clinical Assistant Professor Family Medicine Lead, Transcultural Community Health Initiative Brown University Center for Primary Care and Prevention Founder, Community Health Innovations of Rhode Island

Bernard E. Treml, III Supervisor of Apprenticeship RI Department of Labor and Training Division of Workforce Regulation and Safety

Kathleen Greenwell LMI Coordinator RI Department of Labor and Training Labor Market Information