NACHW Choosing Wisely

About

The NACHW Choosing Wisely Project engages CHW leaders in partnership with the American Board of Internal Medicine, health care providers and allies to advance Choosing Wisely materials, resources and learnings among community health workers (CHWs include promotoras de salud and community health representatives) professionals who are at the front-line of supporting communities to achieve health, equity and social justice.

The goal of this project is to improve CHWs’ access to Choosing Wisely materials, resources and training, and increases opportunities for CHW engagement in national dialogue on CHWs role in building trust and communication between patients and providers, and avoiding unnecessary medical tests, treatments and procedures. This project is funded by the CT Choosing Wisely Collaborative.

Choosing Wisely develops evidence-based recommendations and disseminates training, materials and best practice approaches to promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. 

Our Process and Participants

In order to promote the national professional identity and capacity of CHWs as a critical part of health infrastructure, materials must reflect the unique role and approaches of CHWs in addressing access to and navigation of health services, and integrate CHW leadership in the conceptualization, design, and process of research to co-develop materials and processes that impact them and/or the communities they serve.

Our project collaborated with culturally and linguistically diverse CHW leaders from NACHW’s membership across the country who serve in a variety of roles, including members of health system care teams, trainers in statewide certification programs, health advocates, outreach workers, survivors of cancer and those living with chronic disease among other expertise.

CHW Leaders:

Delores “Miss Dee” Collins: Miss Dee earned her Associates of Science Degree in Interdisciplinary studies- Early Childhood Development from Kaplan University. She is the Founder and Executive Director of A Vision of Change, Inc. (AVOC), which offers prevention, intervention, and academic services throughout Ohio. She is a graduate of Cleveland State University’s Community Health Worker (CHW) Program and is a certified CHW through the Ohio Board of Nursing, and the Ambassador for the state of Ohio to the National Association of CHWs (NACHW). She is the founder of The Greater Cleveland Community Health Workers Association. She is also a Community Health Ambassador for the Glenville neighborhood and a Master Trainer through the Stanford University Chronic Disease Self-Management Program. She is Crossed trained in the Chronic Pain and the Diabetes self-Management Programs. Ms. Dee’s vision is to embrace, empower, motivate communities to help them overcome Social Determinants of Health.


Lisa Freeman: Lisa Freeman is the Executive Director of the Connecticut Center for Patient Safety. In 1991, her husband experienced serious medical harm during “routine surgery” that left him paralyzed, with a MRSA surgical site infection and with hypoxic brain damage. He died when he was 56 years old as a complication of his surgery. That began Lisa’s passion fueled journey in healthcare quality and patient safety.


Cheryl Garfield: Cheryl is a lead community health worker for the Penn Center for Community Health Workers. She has directly served over 700 high-risk patients during her eight years with the organization. She has 35 years of experience in social service. Cheryl has held leadership roles in several community organizations, including Together West Philadelphia. She has helped develop the training requirements for community health workers in Pennsylvania as part of a statewide steering committee on community health worker certification. She is a preceptor for a nationally-recognized training program focused on teaching health professional students to recognize and address the social determinants of health that’s a joint effort with the Perelman School of Medicine and the center. Her work has been featured by U.S. News, Health Affairs, Kaiser Health News and a book by Dr. Zeke Emanuel.


Luis Lagos: Luis is the Community Outreach Program Director for the Family Medicine Residency of Idaho (FMRI). He was born in Honduras, Central America and holds a bachelor’s degree in Industrial Engineering. He has been a Community Health Worker/Promotor for more than 15 years and has extensive experience working with the CHW/Promotores model. In 2019 he was selected as a National Association of Community Health Workers (NACHW) Ambassador, representing CHWs in the State of  Idaho. While working for FMRI he has developed a screening tool for Social Determinants of Health (SDOH), successfully tracking and referring patients to existing programs in the community, especially patients who are suffering from lack of access to healthcare. More recently, since 2016 he has been teaching the cohorts for Idaho State University (ISU), CHW training program, training close to 200 CHWs in the whole state. He is a co-founder and currently serving as Board Member for the Idaho Community Health Worker Association, established in 2020.


Adrianne Serrano Proeller: Adrianne is a Community Health Worker (CHW) with Morehouse School of Medicine Prevention Research Center (PRC) and Community Engagement Coordinator for The Center for Translational Research in Health Disparities at MSM. She also works on capacity-building projects for CHWs across the state for the Georgia Clinical and Translational Science Alliance.  Adrianne currently serves as the Georgia Ambassador to the National Association of Community Health Workers (NACHW).  She is a graduate of Loyola University of New Orleans and is actively involved in many community-based organizations in SW Atlanta, where she has lived for 10 years.  


Milagrosa Seguinot: Millie is Certified Community Health Worker and the president and a founding member of the Community Health Workers Association of Connecticut. Last year, she was selected Ambassador for the National Association of Community Health Workers for Connecticut. In May of 2019 Millie joined Gateway Community College as an Instructor for the Community Health Worker Core Competency Course. In the recent past, she has served as a Navigator Key Staff for Access Health CT, providing outreach and support to help enroll Connecticut residents in insurance plans as required by the Affordable Care Act. In this role she was responsible for coordinating and supporting 48 In-person Assisters for Access Health CT – Navigator and In-Person Assister program. She has extensive experience working with multicultural and diverse population in Connecticut in the areas of mutual housing, education, parenting and parent leadership, and as a Notary Public, a Justice of the Peace and a Chaplain. In her longer career as a Community Health Worker, Millie has received many certificates: Medical Interpretation, FAST Team Member and Facilitator, Facilitator of the Strengthening Families Program, and a Facilitator for the Courage to Speak Foundation, CERT Volunteer (Community Emergency Response Team), First Aid Mental Health, Community Messenger and the Live Well Program. Also, she is an alumni of PLTI (Parent Leadership Training Institute) class of 2006 and an alumni of Parent SEE (Supporting Educational Excellence) class of 2014. She graduated the University of Puerto Rico with a Cum Laude, an A.S. degree in Secretarial Science, and attended Goodwin College for business applications. Millie is a proud mother of a daughter, a son and a granddaughter (Sofia) and two grandsons (Caleb and Mason).  


Treva Smith: Treva serves as the Co-Executive Director of the Kansas Breastfeeding Coalition. Treva is also the Prenatal Care Coordinator at KC Care Health Center serving the Kansas City Metro area. She received her B.S. degree from Northwest Missouri State University. Treva has worked in the field of community health for nearly 20 years. She has worked for WIC, Healthy Start as well as done volunteer work in the locate church. She was recognized in 2018 by the United States Breastfeeding Committee as an Emerging Leader. Treva was one of the first ambassadors to the National Association Community Health workers, and she is actively involved in health promotion through Peer and Community Health workforces in Kansas and Missouri. She resides in Kansas City with her husband and four of their five children. Treva is also the proud grandmother of 3 beautiful, breastfed babies.


Quisha Umemba: Quisha is a Bachelors prepared Registered Nurse with a Masters degree in Public Health. She is a Certified Diabetes Care and Education Specialist, a Certified Lifestyle Coach, and a Certified Community Health Worker Instructor.  Having had gestational diabetes, and now living with prediabetes, Quisha’s passion for helping individuals impacted by chronic disease stems from both a patient and provider perspective. An advocate for health equity; her life’s mission is to empower, educate, and promote optimal health and wellness for all.  To this effort, she founded Umemba Health, LLC; a consulting agency devoted to the education and training of the public health workforce.


Additional key collaborators in the project included Kelly Rand, Program Officer of the American Board of Internal Medicine, who leads the Choosing Wisely Learning Network and Susan Perez, researcher and advisor to Consumer Reports on discussions on cost of care and advancing/integrating patient values into healthcare systems. NACHW staff included Bernadine Mavhungu, Sr. Communications Associate and Denise Octavia Smith, Executive Director of NACHW. Project management support was provided by Maddie Allen as part of her Tufts Public Health internship program

Project Process

In our initial meeting, case examples and rich, often deeply personal stories were shared about health systems barriers and interactions with medical providers. This led to a more nuanced understanding of the scope of work CHWs do and how the CHW role can vary depending on client need, community, program structure, policy, and funding.

Our initial meeting with the CHWs informed our approach to conducting an informal literature review. In this review, we sought to identify key themes, processes, pathways, and theories around the role of trust in CHWs’ and other providers’ interactions with those they serve. Although the existing literature often included boilerplate language around CHWs as “trusted members of the community,” tangible measures or observations of how CHWs build trust were largely absent. Additionally, CHW voices were notably missing from articles about their own competencies and best practices in trust and relationship building. In order to ensure CHW voices and experiences guided our exploration of the literature review and eventual development of a focus group guide, we designed and facilitated an exploratory mind-mapping exercise with the CHWs in order to delve deeper into the role of trust in their work with clients. The mind-mapping exercise generated a deeper exploration of key concepts and ideas around trust and trust-building from the CHW perspective.

Over the course of several months, we discussed their unique roles in building trust among their clients and patients in healthcare settings and explored the environments where CHWs have discussions about health services. Our partners, Kelly Rand, Susan Perez and Kate Carmondy provided an orientation of Choosing Wisely materials. After an initial filtering from the NACHW staff using the mind map and other discussions, CHW leaders worked in pairs to review and rate the readiness of these materials for inclusion in the project. This subset of Choosing Wisely content and materials that the CHWs deemed relevant to the roles and approaches of CHWs and the environments where they work is included below.

Google JamBoard of CHW leaders’ ideas on characteristics of an effective CHW

“Being a person of your word. Actions match up with your word.”

“Someone who has best interests at heart and will represent them well.”

“Shared life experience with the community”

– CHW Leaders

Resources for CHWs

Choosing Wisely” PSA (30 sec): This Public Service Announcement about the Choosing Wisely campaign helps orient the viewer to the idea of medication overuse and helps patients understand how to engage in conversations with their providers about their care.

FORMAT: YouTube video (00:30)
APPLICABLE SETTING: Small groups, one-on-one settings and outreach


Getting the Right Care to Keep your Children Healthy: This resource guides parents/care-takers through which tests and treatments kids need and don’t need according to Choosing Wisely medical experts.

FORMAT: Printable PDF
APPLICABLE SETTING: Clinical settings, home visits, outreach, group education, print pamphlets and website and social media posts


Do You Really Need That Medical Test or Treatment? The Answer Might be No: This resource provides guidance for patients on how to talk to their doctor about which tests, treatments, and procedures they need and don’t need. Available in rack card form.

FORMAT: Printable PDF
APPLICABLE SETTING: Clinical settings, home visits, outreach, group education, print pamphlets and website and social media posts


Learning Network Webinar- Empowering Patients to Ask Questions: Webinar on patient engagement that includes tools and methods to engage patients in conversations about CW.

FORMAT: Webinar Recording via YouTube (57:37)
APPLICABLE SETTING: Healthcare team working in clinics, hospitals, outpatient centers, urgent care centers


Choosing Wisely® Implementation Toolkit for Clinicians And Practice Teams: (PAGE 3 ONLY) CCWC’s Sample Scripts for Patient Engagement with Choosing Wisely

FORMAT: Printable PDF
APPLICABLE SETTING: Healthcare team working in clinics, hospitals, outpatient centers, urgent care centers


“Do I Really Need Antibiotics?” PSA (30 sec): This Public Service Announcement helps orient patients to the idea that antibiotics are not always needed or positive. This PSA encourages patients to ask more questions and communicate with their provider when antibiotics are being considered as a treatment option.

RECOMMENDATION: Pair with CDC awareness campaign https://www.cdc.gov/antibiotic-use/week/toolkit.html

FORMAT: YouTube video (00:30)
APPLICABLE SETTING: Healthcare team working in clinics, hospitals, outpatient centers, urgent care centers, community setting


Lessons Learned from Patient Engagement: A report sharing insights from project directors of grantee organizations about engaging patients, families, and Caregivers in Choosing Wisely conversations.

FORMAT: Printable PDF
APPLICABLE SETTING: Small groups, providers, CHW networks leadership, workshops online


Getting the Right Care to Stay Healthy as You Age: This resource guides older adults through which tests and treatments they need and don’t need according to Choosing Wisely medical experts.

FORMAT: Printable PDF
APPLICABLE SETTING: Clinics, hospitals, health fairs, home visits, social media, traditional media, outreach


“Don’t Be Silent” PSA (30 sec): This Public Service Announcement about the Choosing Wisely campaign helps patients understand the importance of asking questions in during encounters with their provider and shows patients how to engage in conversations with their providers about their care.

FORMAT: YouTube video (00:30)
APPLICABLE SETTING: Clinics, hospitals, health fairs, home visits, social media, traditional media, outreach