Community Outreach Potential
Written by Hayley Timmons
Program Overview + Future Possibilities
According to the Community Health Workers Association of Rochester, NY, a Community Health Worker (CHW) is “a frontline person who works in the community assisting families and individuals to move towards interdependency to achieve their goals and obtain a healthier lifestyle”. Organizations may refer to individuals performing these duties by a number of different titles, including health advocates; community outreach workers; family health promoters; community advocates; lay health workers; neighborhood representatives; allied health professionals; health project counselors; para-professionals; outreach workers; etc.
An essential component of the relationship between a CHW and their client is trust. CHW’s interact with their clients before they enter the formal healthcare or criminal justice setting, and develop a rapport with them that allows them to build a relationship that will lead to formal service provision. After developing a relationship, CHW's can help their clients access preventive services and care, such as emergency food, clothing, shelter, child care, domestic violence, HIV testing, physical and sexual abuse. While CHWs provide an essential service to the community, they do not work alone to provide health and social services. CHW's provide referrals to community resources, healthcare and social services to provide a better quality of life for those they serve. Since they move around the community and interact with people on the streets, they can also locate and provide outreach to the isolated and unidentified population of the community to bring resources to those in need, as well as refer and get them to social and medical care in their area.
The development of the Community Outreach Worker (COW) program in Ithaca has led to a number of improvements for the local community. Because of the work done by Tammy Baker, Ithaca’s homeless and vulnerable populations have been able to access more social services, get treatment for mental health and substance use disorders, and get connected to health care providers. However, there is still work that can be done in order to expand the COW program and provide these benefits to a larger population. The need for an expanded program clearly exists in Ithaca, as data shows that requests for behavioral intervention doubled between Quarter 2 and Quarter 3 of 2018, a year in which total client encounters exceed 1,700. This is an extremely large workload for one person to take on, and even when an additional position is added the per-worker caseload will likely still exceed the recommended averages of 10-30 consistently monitored service users. In order to accommodate the number of people requiring repeat services and interventions from the COW program, at least an additional two community outreach workers should be hired by the city of Ithaca or Tompkins County as soon as the budget allows. Hiring additional community outreach workers will decrease the individual caseloads and allow for more individualized attention.
As the program expands, a training program will need to be developed in order to bring new employees up to speed on what the job entails and what their responsibilities are. While there is no clear precedent for training outreach workers who are non-clinical and focused mainly on diversion from criminal justice, a training program should include education on trauma-based care and ACE histories, mental health issues and how to support people with them, and the types of services that may benefit people from different backgrounds and situations. Since the issue of criminal justice and police involvement is heavily based in racial inequality, a training for a community outreach worker should ideally include anti-racism and anti-bias training so that the outreach worker is prepared to work with marginalized populations and confront the issues that these populations face.
Usage of Community Outreach Workers in Risk Assessment
“When we can intervene in a timely, skillful manner, which is the majority of the time, we are generally able to de-escalate situations before law enforcement or emergency services need to be engaged. This intervention assists with lower rates of arrests, fewer emergency department visits, less business disruption, and less legal, medical, and social consequences for clients”
COW Quarterly Report
The quote above, from a recent report on the effectiveness of the COW program, shows the importance of the program as a whole and also connects to the idea of introducing an RNR model designed to keep people out of the criminal justice system. Community outreach workers can help with the implementation of RNR by vouching for a person’s past behaviors, any improvements noticed, and any serious health concerns that may be of importance in their case. While community outreach workers are not necessarily licensed mental health professionals, they have personal interactions with their clients and in some cases my develop a rapport with them that can lead to a client divulging their mental health histories. This can aid in determining the client’s level of risk, and which kind of diversion programs may best suit them. Combining a community outreach worker’s account of a client’s behaviors and mental health with the use of the ACE scorecard will help put health at the forefront of the criminal justice system. The outreach worker’s role in determining risk will be influenced by which risk assessment tool the city of Ithaca chooses to implement, which is discussed more in the second section of this report.
Effectiveness + Awareness
An outreach program is only effective if community members and local businesses are aware of the services that the program provides. Many towns and cities that have developed a COW program have struggled to communicate the benefits and services that the workers can supply, and have embarked on marketing and communications campaigns. Providing a handout or brochure to businesses in areas with a large number of COW clients can lead to widespread knowledge of the services and increased usage by people in need. While local businesses in Ithaca seem to appreciate and utilize the community outreach worker program, increased awareness is needed in order to realize the full potential. Creating an updated business card or brochure detailing the services provided and the situations in which a business can call the COW could increase awareness, and having someone affiliated with the program available to go door-to-door to talk to business owners could help as well. Holding focus groups or meetings with local business owners can improve communication on both sides and identify weaknesses in the program which may not have been apparent before.