Transcription
Nancy G. Brinker promised her dyingsister, Susan G. Komen, she woulddo everything in her power to endbreast cancer forever.In 1982, that promise became SusanG. Komen for the Cure and launchedthe global breast cancer movement.
KOMEN NATIONAL
25%to Research75%to Education,Screening andTreatment Support
Save lives by meeting the mostcritical needs in ourcommunities and investing inbreakthrough research toprevent and cure breastcancer.
The Bold New Goal.
Health s/visualizing-health-equity.html#/download
Mission Program StrategyIncrease Awareness Coordinate with partners to ensure that individuals know about breast health andunderstand how and where to access health care services, including understandingtheir insurance options.Improve Access Ensuring that individuals have access to screening and diagnostic services, treatmentand support services, including availability of quality providers.Ensure Acceptability Providing support for culturally-sensitive health systems and providers to ensure thatindividuals are appropriate trained to meet patient needs.Influence Agenda Work with key partners to support a coordinated movement for the breast cancercommunity through the alignment of key initiatives and consistent voice to ensurebreast cancer remains a priority in communities and at the state level.Enhance Funding New (and current) donors are knowledgeable and engaged in mission-relatedinvestment opportunities and that these relationships are fostered proactively.
Intervention Strategies that Increase CancerScreeningIncrease CommunityAwarenessIncrease CommunityAccessImprove ProviderAcceptability &DeliveryGroup Education*Provider Reminders*One-on-one Education*Interventions to ReduceClient Out-of-PocketCosts*Client Reminders*Interventions to ReduceStructural Barriers*Client IncentivesMass MediaSmall Media* Reducing Administrative Barriers Providing Appointment SchedulingAssistance Using Alternative Screening Sites Using Alternative Screening Hours Providing Transportation Providing Translation Providing Child CareCommunity Preventative Services Task Force. 2016. https://www.thecommunityguide.org/xProvider IncentivesProvider Performance,Assessment andFeedback*
Community Preventive Services Task ForceIncreasing Cancer commendationRecommended% Point Increase inMammographyScreening6.2Client-Oriented InterventionsInsufficient EvidenceClient RemindersRecommended14.0Group EducationRecommended11.5Insufficient EvidenceOne-on-One Education RecommendedReducing Client Out-ofRecommendedPocket CostsReducing StructuralBarriersRecommendedSmall MediaRecommended20.018.016.0Client IncentivesMass MediaPercentage Point Increase in .54.02.00.018.07.0Provider-Oriented InterventionsProvider AssessmentRecommendedand FeedbackProvider IncentivesInsufficient EvidenceProvider Reminder andRecommendedRecall Systems13.0N/A10.0Community Preventative Services Task Force. 2016. https://www.thecommunityguide.org/x
Multi-Component InterventionsWhat are MulticomponentInterventions?Multicomponent interventionsto promote breast, cervical, orcolorectal cancer screeningcombine two or moreintervention approachesreviewed by the CPSTF.The largest screeningincreases were seen amongmulticomponentinterventions that combinedapproaches from each of thethree strategies or thatcombined approaches toincrease communitydemand and access.Percentage Point Increase in Screening706050403020100MulticomponentStrategies toIncludedAll three strategiesIncludedOverallincrease communityapproaches toapproaches todemand and access reduce structuralreduce structuralbarriers: Addressingbarriers: Providingtransportationlanguageneedstranslation servicesCommunity Preventative Services Task Force. 2016. https://www.thecommunityguide.org/x
Multi-Component Interventions AnalyticFramework
Our Investments -- Intervention Strategies that Increase CancerScreeningIncrease CommunityAwarenessIncrease CommunityAccessImprove ProviderAcceptability &DeliveryGroup Education*Provider Reminders*One-on-one Education*Interventions to ReduceClient Out-of-PocketCosts*Client Reminders*Interventions to ReduceStructural Barriers*Client IncentivesMass MediaSmall Media* Reducing Administrative Barriers Providing Appointment SchedulingAssistance Using Alternative Screening Sites Using Alternative Screening Hours Providing Transportation Providing Translation Providing Child CareCommunity Preventative Services Task Force. 2016. https://www.thecommunityguide.org/xProvider IncentivesProvider Performance,Assessment andFeedback*
Community Health Workers.
Navigating the Health System
Navigating the Health System
Promotoras/CHWs can Help Accelerate Access
Barriers to CareHigh uninsuredrate of 19.2%Hispanic/Latina(o)Do not have paperwork in SpanishBillingprocessDelays onfollow up care20.6% live inpovertyDo not acceptBCCHP or AHPDo not tcommunicationLanguagebarriersNot enoughinterpretersExperiencediscriminationNot enoughprovidersFear toimmigrationSystemAfrican AmericanLow healthliteracyCan’t afford tomissed workProviderCan’t afford tomissed workDidn’t receivedletter or callPatient do notprovide rightinformationlanguagebarriersScreening23.1% livein povertyNot enoughprovidersNo follow upbefore screening7.6% areuninsuredDo not acceptapple health planCan’t afford tomissed workExperiencediscriminationCan’t afford tomissed workDo not providerightdocumentationFear ck of detailinformationPositiveresultsBlack andHispanicwomen receiveradiation,hormonetherapy andchemotherapyless often ientcommunicationAftertreatmentPoorer clinicalInadequateoutcomes, includingDelays onprovider-patientfollow up No follow upprovider-patient regimens, lowerafterscreeningcommunication recommended doseLack of detail (regardless of bodymass index) andinformationearly termination ofchemotherapyNegativeresultsFollow up forpreventivemammogramin 1 year
What do CHWs actually do?Promotoras/CHWs improve preventative and treatment outcomes across a range of populations and conditions,leading to increased 5-year survival rates.HelpEnhanceIncreasingaccess toservicesunderstand thehealth and socialservice systemcommunicationbetween clientand healthproviderappropriate ratesof serviceutilizationDecreasingImprovingReducingcosts fororganizations andgovernmentprogramsadherence tothe need foremergency andspecialty eeman, H. Patient Navigation: A Community Centered Approach to Reducing Cancer Mortality. J Cancer Educ; 21(Suppl): S11-S14, 2006).overall communityhealth status
What is Komen Puget Sound doing to support CHWs?Funding (FY2017): 46,500 Lutheran Community Services 63,000 International Community Health Services 55,800 Northwest Leadership Foundation 35,096 Citrine / Women’s Health Outreach 80,000 SPIPACoalition Building: Promotores/CHW’s, Migrant and Refugee Coalition King County Promotores Network (KCPN) State-level advocacy
The Promotores/CHW’s CoalitionCoalitionComponents: Advocacy Program Leadership Program Training Program Networking Program Fundraising Program EVALUTE!
The Promotores/CHW’s CoalitionAdvocacy1. Build Coalition: define mission statement, goals and vision; develop job descriptions; identify and recruitmembers; develop strategy and work plan; and develop a communication process.2. Create Advocacy Strategy: identifying advocacy goals, stakeholders and target audiences, staff andconsultants, risks and proposed solutions.3. Train CHWs on Advocacy Approaches: Developing advocacy messages tailored to target audiences,identifying strategies to convince your targets, implementing the strategies, and monitoring progress.Leadership1. Develop a leadership program: leadership development is an ongoing project. Every person, no matterhow much they knows and how well they already functions as a leader, needs to continue learning andgrowing in order to meet the ever growing challenges around them.2. Community capacity building, should not be about pilot schemes or short-term interventions; it needs toinvolve long-term commitment that will involves local leadership.3. Peer Mentoring Program, relationships between mentors and mentees sometimes develop organically,organizations will reap the greatest benefits from creating structured mentoring programs.
The Promotores/CHW’s CoalitionTraining1. Develop learning objectives, process of training, program and framework2. Develop training materials3. Design training materials4. Implement the training5. EvaluationNetworking1. Identify Regional Committees that offer a structure that brings individual Promotores/CHW’s together2. Host a 1-2 conference training to bring all network together3. Host monthly meeting to build the Network to provide Promotores/CHW’s with workforce developmentand professional training
The Promotores/CHW’s CoalitionEvaluationProcess measures # of health service per month, professionals trained to use anevidence-based curricula, number and level of participationof organizations involved in theprogram, number of preventive proceduresprovided, number of referrals to otherproviders, number of participants whoexpress awareness of theexistence of breast healthprograms in their communities Advocacy wins/losesOutcome measures Frequency Time Preventive ServicesImpact measures Percentage increase in patientsserved Percentage increase in breasthealth exams Amount of additional revenueavailableFundraising Grant writer (Latino CommunityFund) with the HHS assistance Secured a fiscal agency (LCF)
Mission Fundraising.
Collective Impact1Common Agenda Common understanding of the problemShared vision for changeShared Measurement Collecting data and measuring resultsFocus on performance managementShared accountability3 Mutually ReinforcingActivities Differentiated approachesCoordination through join plan of action4 Consistent and open communicationFocus on building trust25ContinuousCommunication Separate organization(s) with staffBackbone SupportResources and skills to convene and coordinateSource: Channeling Change: Making Collective Impact Work, 2012; FSG Interviews andparticipating organizationsAnalysisSource: Channeling Change: Making Collective Impact Work, 2012; FSG Interviews and Analysis
Collective Impact Offers Funders NewOpportunitiesAmplify ImpactIncrease Efficiency ofResourcesDrive AlignmentInvolves multiple partnersworking towards long term,systemic changeAllows more efficient use offunding, especially in times ofscarce resourcesReduces duplication ofservicesOffers a holistic approach bychanneling the energy ofvarious stakeholders towardssolving a problemEnables leveraging of publicand private sources offundingIncreases coordinationProvides opportunities toinfluence the system fromwithin and outside by couplingadvocacy with actionOpens channels fororganizations to accessadditional funding against anissueEmbeds the drive forsustained social change withinthe community, facilitating“order for free”Source: Channeling Change: Making Collective Impact Work, 2012; FSG Interviews and Analysis
Nancy G. Brinker promised her dying sister, Susan G. Komen, she would . their insurance options. Increase Awareness . 63,000 International Community Health Services 55,800 Northwest Leadership Foundation 35,096 Citrine / Women's Health Outreach
