Social inequity is a significant problem facing public health, with some groups facing higher health risks and lower access to and quality of health care, leading to poorer health outcomes. These inequities arise from economic, social, and environmental factors and have contributed to a legacy of distrust in the healthcare system among certain groups. Furthermore, it is widely accepted that climate change can increase health risks in the general population, as well as intensify existing social inequalities. By addressing social determinants of health (SDoH), CHWs contribute substantially to health equity in their communities and are well-placed for adapting their existing skills to address climate-related health disparities. This presentation will overview the Climate Change and Health Equity course for CHWs being developed by the Climate Change Impacts Project (CCIP) team at the Michigan Community Health Worker Alliance (MiCHWA). The course builds on CCIP’s previous Climate Change Impacts for CHWs course (disseminated in 2022) by applying a health equity lens to the knowledge gained by CHWs in the previous course. This presentation will describe CCIP’s priorities in the new training, such as recognizing groups most vulnerable to climate-related health impacts, understanding intersectional vulnerabilities, understanding distrust of health and mental health care systems, and suggesting ways CHWs can use their existing skills to address these health inequities within their roles. The presentation will highlight the role of practicing CHWs in the development of this course, such as in content creation and in-module CHW features. Finally, this presentation will suggest implementation strategies for co-created community climate change and health equity education for CHWs. One member of CCIP works part-time as a CHW, and is responsible for abstract drafting and presentation development, including for this submission.

Issues: Research and evaluation is a core competency for community health workers (CHWs), yet there is a lack of available trainings in Washington state to support this critical role. Furthermore, language and cultural barriers often impede CHWs and promotores (CHW/Ps) from accessing trainings, reinforcing inequities within healthcare systems and upholds structures of white supremacy. Offering culturally congruent workshops guided by anti-racism and community-based participatory research (CBPR) principles is crucial to address this disparity.

Description: The UW Center for Anti-Racism and Community Health (ARCH) presented research and evaluation capacity building workshops for CHW/Ps in two forums, in partnership with the WA Department of Health and local organizations. These workshops equipped CHW/Ps with vital skills in research methodologies, community-driven data collection and analysis, and ethics. The ARCH Center partnered with LatinX Outreach and WA Department of Health to center promotores through a Spanish-first, bilingual workshop format. The second workshop, in partnership with CoMagine Health, trained CHW/Ps working with Black communities in WA. Anti-racism, CBPR, and Community Cultural Wealth principles guided all workshops. By centering these frameworks, the workshops aimed to dismantle linguistic and cultural barriers and empower participants to lead research and evaluation activities.

Lessons Learned: The two workshops trained over 100 participants with 58 attendees providing pre-survey data (n=45 in English, n=13 in Spanish) about knowledge related to research and evaluation and 63 attendees providing post-survey data (n=43 in English, n=20 in Spanish). Pre/post analyses evidenced a significant increase in those who understood how to collect data in their community (pre: 72.4%, post: 92.2%, p=0.004). CBPR engagement methods served as effective tools for modeling community assessment and conducting group data analysis.

For 24 years, Sinai Urban Health Institute (SUHI), the community-engaged research arm of Sinai Chicago (Sinai), has developed expertise in community health worker (CHW)-led health interventions. Sinai, the largest private safety net hospital system in Illinois, serves 1.5 million community members living in Chicago’s West and Southwest Side communities facing socioeconomic challenges and extreme health inequities.

In 2020, SUHI began piloting an innovative CHW integration model within Sinai. CHWs on our team began interacting with post-discharge patients in early 2020 and with inpatients, from floors including telemetry, trauma, med-surg, and orthopedics, in mid-2022. In this pilot, CHWs provide personalized patient care by screening patients daily for Social Determinants of Health (SDoH) and, when indicated, linking them to community-based resources. This approach aims to improve connections between clinical settings and community-based resources and reduce costs associated with unnecessary hospital visits.

To date, our CHW colleagues have rounded and screened over 8,434 Sinai patients for needs pertaining to SDoH, identified unmet social needs in 2,212 patients, and connected over 2,072 patients to resources. Since the COVID-19 pandemic began, they noticed a significant rise in the number of primary and co-occurring behavioral health diagnoses and mental/behavioral health related needs among patients. Notably, SUHI identified that 10% of identified needs centered on behavioral health and/or emotional support. This sparked the idea of integrating CHWs into behavioral health work, thus developing this behavioral health specific CHW pathway.

SUHI developed specialized training and support for this new CHW pathway, including mentorship and consultation with Sinai’s clinical behavioral health program, ‘Under the Rainbow’, an innovative partnership and integration model. A novel approach focused on providing emotional and social support for behavioral health inpatients therefore re-building patient’s trust in behavioral healthcare. There are currently three behavioral health specific CHWs on the SUHI team working within the hospital system. These CHWs specialize in patient needs, follow-up appointments, and discharge planning, centered around mental health and substance use disorders. They work alongside mental health providers in Sinai’s inpatient behavioral health unit, aiming to improve health outcomes and address health inequities in this particularly marginalized patient population.

A Senior CHW at SUHI, who was instrumental in developing this program, will discuss this innovative behavioral health model for patient care and its implications on patient experience and health outcomes.

This presentation aims to describe the innovative Community Residency Psychiatry Program in a Federally Qualified Health Center (FQHC) located on the U.S-Mexico border as a response to the shortage of mental health providers in the region. This innovative model differs from traditional clinical residency models since it focuses on a community-based curriculum which integrates clinical training, fosters interdisciplinary collaboration and has a strong emphasis on community mental health.

Community Health Workers (CHWs) are an integral part of the community-based curriculum since they serve as instructors and lead community based rotations for psychiatry residents. CHWs will instruct residents and foster a deeper understanding of social determinants of health (SDoH) and public health. The aim is for residents to incorporate a holistic approach into their practice, addressing not only the symptoms but also the underlying social and environmental factors affecting their patients’ health and well-being.

In addition, CHWs will become indispensable members of the Team-Based Care approach that will be implemented in our community clinics so they can bring their unique perspective of patient’s lives and lived experiences and help providers see patients through a CHW lens. CHW live and are members of their communities and are uniquely positioned to reduce mental health stigma, build trust, increase access and provide a continuum of care by bridging gaps between patients and mental health services. By integrating CHWs into the fabric of mental health care teams, community clinics and FQHCs can ensure a comprehensive and patient-centered approach that addresses the diverse needs of individuals particularly in border communities where access may be limited.

By the end of this presentation, participants will have a better understanding of an innovative model for CHW integration in the training of psychiatry residents who will become future doctors in our communities. This presentation advocates for the continued collaboration and integration of CHWs within community health care systems to optimize patient outcomes and promote health equity within communities.

Social Determinants/Drivers of Health (SDOH) impact everyone’s quality of life. When people are healthy and have access to critical direct services they need, they can have a better quality of life and can thrive in healthier communities overall. Our program’s aim is to help make people healthier and provide access to services. Employers that offer a wide range of benefit programs to support the physical, mental, financial, and social wellbeing to employees and their families can help – but oftentimes, staff that do not work online or with computers daily do not know about the full array of programs offered to them or sometimes simply how to enroll or access them. Specifically, Distribution Center (DC) staff in medium to high social vulnerability index (SVI) areas that have SDOH needs may not have the support they need to access available services through the employer or in the community.

One innovative solution to address this challenge to better support this type of employee base is a novel pilot approach, built by certified Community Health Workers (CHWs), that seeks to address this challenge through an internally shared full-time Community Health Worker (CHW) Employer Liaison role. The pilot’s goals are to improve DC staff’s overall health status by addressing SDOH needs, improving access to care, advancing health literacy knowledge, and to promote all corporate benefits available to them, as well as to build purposeful community-based partnerships with organizations that provide direct services to address SDOH needs. This pilot also seeks to build strong collaboration between multiple departments internally that capitalizes on existing community-based resources and internal programming.

To-date there have been over 2,000 engagements with the DC staff, over 40 health education opportunities provided, over 200 SDOH referrals provided, and over a dozen community partnerships forged to support the staff’s SDOH needs.

In this session, attendees will hear from a CHW (who is also a CHW Supervisor), about the planning of the pilot, first year progress of implementation, key outcomes and observations, challenges navigated, as well as the potential next steps of this program.

In summary, although a complete scientific analysis on the impact of bringing the CHW discipline to this faucet of our health system is still pending, initial data/observations show the positive impact CHWs have had on our DC employees and their communities.

Background
The changing demographics of Utah, evidenced by a diversity index increase from 33.6% to 40.7% within a decade, highlight the urgent need to address public health disparities by integrating Community Health Workers (CHWs) in university extension settings. Despite limited data on the impacts of CHW interventions in extension programs, Utah State University (USU) Extension, in collaboration with the Utah Community Health Worker Association (UCHWA), demonstrates a positive effect on capacity-building through training, workforce development, and evidence-based community education implemented with our innovative Cultural Belonging (CUBE) model.

Methods
The core elements of the CUBE method involve extension CHWs collaborating with faculty to lead in two main areas: (1) inner extension, which includes diversity action-based training, internal program promotion, and facilitation of linguistic and cultural adaptation, and (2) external impact: providing community outcomes, partnership cultivation, development of relevant programs, engagement with community experts, and ensuring inclusive access to USU extension county offices and programs. Implementing the CUBE approach is applied in both central areas' planning, training, integration into programming, and evaluation stages.

Results
In seven months, the CUBE method evidenced: (1) a 300% increase in youth program participation, showing Latinx active enrollment rates in the 4-H youth program. (2) 200 rural Latinx families engaged through culturally adapted outreach initiatives. (3) Training and workforce: 58 CHWs completed the 'Mejore su salud,' Create Better Health- SNAP evidence-based education program curriculum; a total of 43 CHWs from Latinx, refugee, and Native American backgrounds were certified with the USU Extension Host-site State of Utah CHW Core Skills Certificate; 8 Certified CHWs referred and 11 CHWs employed by USU extension. (4) 300 community members introduced to extension programs, enhancing awareness. (5) 11 extension programs interested in CUBE initiatives and 15 faculty and program collaborators involved.

Conclusion
CHWs have demonstrated highly effective outcomes in leading interventions and implementing innovative approaches within extension settings, resulting in rapid progress and system change. These public health professionals have adeptly linked individuals to various social, academic, health, and prevention extension resources through their proactive outreach to underserved communities. The evidence of this intervention highlights the dynamic role of CHWs in promoting community education across diverse university settings, contributing valuable insights to the limited data available on their impact.

Background: Sickle cell disease (SCD) disproportionately affects African American and Hispanic communities in California, highlighting significant health disparities with broader impacts on health outcomes. The challenges faced by individuals with SCD, including mistrust of healthcare systems, require a comprehensive strategy. By integrating Community Health Workers (CHW) into the care team, Networking California for Sickle Cell Care (NCSCC) initiative aims to address the long history of neglect experienced by individuals with SCD, and to deliver comprehensive, patient-centered care.

Methods: In 2019, Sickle Cell Disease Foundation and the Center for Inherited Blood Disorders started a statewide network of adult SCD clinics. CHWs were trained and placed in these clinics across high-burden counties throughout California, equipped to provide patient-centered care management and to serve as liaisons between patients and healthcare providers.

Results: Since 2019, 15 CHWs have been integrated into the care teams of 14 SCD clinics. From January 2023 to August 2023 alone, the NCSCC clinic sites saw an increase in active patients receiving comprehensive care by 17.6% (from 829 to 975 patients).

Between 2019 and 2021, counties with NCSCC clinics experienced a significant decrease in the average length of hospital stays for Medi-Cal eligible individuals with SCD by 27.34% from 1.39 to 1.01 stays. In contrast, counties without NCSCC clinics saw a decrease of 10.22%, from 1.37 to 1.23% stays. Similarly, the average emergency department visits per Medi-Cal eligible person with SCD in counties with NCSCC clinics decreased by 25%, from 2.60 to 1.95 visits, surpassing the outcomes in counties without NCSCC clinics, which showed a decrease of 7.12%, from 2.81 to 2.61 visits.

Conclusion: Through strategic partnerships with healthcare institutions, a community-based organization like the Sickle Cell Disease Foundation, has effectively harnessed the ability of CHWs to address the impacts of SCD and associated social disparities. CHWs provide tailored support, advocacy, and coordination of care for individuals living with SCD, bridging the gap between public health institutions and the communities they serve. Moreover, findings suggest that the comprehensive care provided at the outpatient SCD clinics, which integrate CHWs into the care team, can positively improve healthcare utilization patterns. This has led to reduced hospitalization and emergency visits for individuals with SCD in the counties served by the NCSCC clinics.

Community Health Workers (CHWs) serve as vital bridges between healthcare institutions and communities, playing a pivotal role in fostering trust in public health and science. This abstract, developed in collaboration with CHWs, outlines the development of a clinical community model that integrates CHWs into the healthcare system to address complex health challenges. A CHW will be co-presenting at the conference, using interactive methods such as case studies and group discussions to accommodate diverse learning needs and ensure that the unique perspectives and contributions of CHWs in the project's development are accurately represented.

The Healthy Community Coalition employs a team of CHWs who implement a three-pronged approach to meet the needs of individuals in our communities. This approach includes strategic initiatives such as clinical referrals, patient panels, and community outreach through services delivered on the mobile health clinic.

A cornerstone of our approach is the establishment of trust through proactive community engagement and patient-centered care. The CHW team, employ a Triage Model informed by Maslow's Hierarchy of Needs to prioritize patient care and navigate referrals effectively.

Initially designed to manage chronic disease, the program quickly adapted in response to community needs, specifically addressing Social Determinants of Health (SDOH) in our rural community. This strategic shift underscored the importance of personalized support and community engagement in fostering healthy behaviors, thereby helping to mitigate the impact of social determinants on health outcomes.

As the program evolved, it identified the urgent need for targeted interventions for individuals with substance use disorder (SUD). CHWs expanded their role to include SUD navigation, facilitating access to Integrated Medication Assisted Treatment (IMAT), harm reduction resources and access to recovery services. The CHWs have established communication pathways within the electronic health record with IMAT providers to expedite access to treatment. CHWs also participate in monthly meetings with providers and partners to discuss access points, and case review.

The electronic health record integration allowed for evaluation of the CHW strategy, demonstrating significant return on investment, notably in reducing emergency department utilization and readmissions. Addressing SDOH and offering SUD navigation improved health outcomes and optimized healthcare resource utilization, resulting in substantial cost savings.

In conclusion, this abstract highlights the transformative impact of CHWs in shaping community-based healthcare initiatives. By responding dynamically to evolving community needs and leveraging their unique position as trusted community advocates, CHWs continue to drive meaningful change, promote health equity, and rebuild trust in public health systems.

In response to growing demand across health systems for Community Health Workers (CHWs), a cohesive approach to integration is needed to prepare employer sites to accommodate the unique qualities of the CHW workforce. The Illinois Public Health Association (IPHA) CHW Capacity Building Center has worked over the past year to develop and implement a comprehensive CHW Integration Readiness Assessment tool developed using CHW feedback and administered by CHWs. This session will share pertinent data from IPHA’s initial findings from readiness assessments completed in 15 different systems, ranging from local health departments to major multi-location hospital systems. Findings will highlight specific considerations needed to accommodate a variety of worksite settings, structures, and regional differences.

A Rural Health Clinic employed a community health worker (CHW) team to work on COVID-19 efforts, as well as medical and social needs exacerbated by COVID-19 throughout their community. This CHW team is comprised of a Program Director, Home Visit Nurse, Care Coordinator, and two Community Health Workers. During COVID-19 pandemic, the local Emergency Medical Service (EMS) Transport staff reported at a community event that EMS calls were higher than ever. They shared information about programs they had to assist people who were at risk for falling to prevent emergencies, along with their desire for other collaborators to help people with diabetes manage their conditions to reduce costly, stressful, and preventable EMS calls.

The CHW team stepped up to collaborate with EMS, providing handout information to EMS staff for distribution to patients and established a referral system to connect patients with their CHW team for education and support in managing their health. The CHW team facilitated connections for patients to primary care providers and assisted patients in medication management. EMS permitted the use of their centrally located building for CHWs to deliver Diabetes Prevention Program classes and chronic disease management classes.

Additionally, the CHW team worked with EMS to help patients who would not have been able to complete the File of Life, a red folder that is normally posted in people’s homes that includes essential health information (their conditions, medications, contact information) equipping EMS staff to best respond to emergencies. EMS and the CHW team have developed a bi-directional referral system with their service model to not only save costs for emergency room visits, but overall healthcare costs as well. Hearing the needs of the EMS teams, the CHW team stepped up to help these clients with medical and social needs when receiving the referral from EMS. Moreover, this CHW team conducts outreach across to various community organizations including coffee shops, the local senior center, the barber shop, other community-based organizations, faith-based groups, and other entities. Their outreach efforts aim to educate the community on a range of services, health education topics, guidelines for contacting emergency services, and various other appropriate matters. The goal of this collaboration is to decrease the number of unnecessary EMS calls and improve the overall wellbeing of the community. The CHW team assisted with providing information for this abstract, will assist with developing the presentation, and be available to present.