203251 Community Health Workers in Washington, DC Healthy Start Programs: Perceived Barriers to Successful Home Visitation

Sunday, November 8, 2009

Meagan Lyon, MPH, CHES , Research Associate, GW- Department of Health Policy, Washington, DC
Ashley Hockaday Foster, MPH , GW-Department of Health Policy, The George Washington University, Washington, DC
Anne Rossier Markus, JD, PhD, MHS , GW-Department of Health Policy, The George Washington University, Washington, DC
Washington, DC has two federally-funded HS programs serving diverse populations of low-income pregnant women and their children through home visitation services by CHWs and nurses. This study sought to identify the perceptions of CHWs about their work, including perceived barriers to providing services to women in the program. The study design is qualitative semi-structured interviews with all of the HS-employed CHWs and nurses (n= 34).

Program 1 CHWs felt better prepared to serve clients because of personal characteristics and previous experiences but expressed a desire for a larger role and increased skills (i.e., basic clinical duties, education) to assist them in serving clients better, as well as a clearer delineation of expectations with the nurses. Program 2 CHWs expressed greater autonomy and independence in their roles as part of a care delivery team and felt well prepared to serve their clients because of the extensive training and supervisory support provided by their program.

Perceived barriers to serving clients included in Program 1 - complex social issues (i.e., racism, poverty, inadequate housing, lack of transportation) and individual client behaviors (e.g., not being home for a scheduled visit), and - in Program 2 - cultural and language differences (i.e., social isolation, fear about citizenship), and inadequate time (e.g., due to clients' jobs).

Understanding the experience of CHWs, including their perceived strengths as well as their perceived barriers in delivering appropriate services to women and infants, can better inform supervisors, trainings and the design of home visitation programs such as HS.

Learning Objectives:
1) To describe the perceptions of Healthy Start (HS) Community Health Workers (CHW) about providing home visitation services to low income pregnant women 2) To identify the barriers CHWs perceive to successfully providing services

Keywords: Community Health Advisor, Home Visiting

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have presented posters at GW based conferences during my MPH program, I am a current reviewer for APHA abstracts and have been for several years, I review manuscripts for a peer-reviewed journal, and have been engaged in research post-MPH for two years now.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.