By Dominica Rehbein and Nancy Combs, with Nada Dickinson
“Serving as a community health worker is being a resource to help ease some of the stressors in people’s lives. We are a bridge of support that brings our clients to the road of their success.” — Nada Dickinson, Community Health Worker, Detroit
Nada Dickinson, a community health worker (CHW) since 2011, is on a team with four other CHWs, all of whom have key roles within the Women-Inspired Neighborhood Network: Detroit. The WIN Network is a collaboration among four Detroit health systems, public health agencies, universities and more than 40 community partners to reduce Detroit’s high infant mortality rate. Nada also serves as a health insurance navigator at Henry Ford Health Medical Center-Hamtramck, in a culturally diverse, largely underserved neighborhood north of downtown Detroit. You will see the clock icon to mark a moment in Nada’s average day—although she assures us that no day is “average” in the life of a CHW!
8 am. Coffee in hand, Nada arrives at her office and sits down to check email. Over the weekend, she’s received contact info for 73 community members who have reached out to the CHWs for help getting enrolled in Michigan’s expanded Medicaid program. “Many of these callbacks will be brief,” Nada says, “but you never know when someone will have more complex health needs that will require a longer conversation. My team members and I will divide up the calls to address everyone’s concerns.” Collecting the information, she heads off to her weekly CHW Team huddle.
9:40 am. Nada is gathering up materials for the group prenatal care class she will help lead later this morning when the phone rings. It’s a fellow CHW who’s active in the Michigan Community Health Worker Alliance, (MiCHWA), the statewide CHW advocacy organization. Next week, Nada will join her colleague and other CHWs from across the state, along with health plan and health system decision makers and representatives of the Michigan Department of Health & Human Services. This ad hoc group is working to develop a payment model so that CHWs can be funded through Medicaid. Nada and her colleague check in on details for the summit, then Nada heads to the clinic classroom to set up for the prenatal group visit.
10 am. Twelve women at similar stages in their pregnancies have arrived for this group prenatal care session with a certified nurse midwife, medical assistant and Nada. The women receive their prenatal care together and learn about important practices for their prenatal health. Nada, who is making home visits to each participant, co-facilitates the session, and shares resources. “I really enjoy spending time with these women,” says Nada. “We have some common experience, and I can guide them toward services near where they live. It’s also great to work in partnership with the clinical team,” she adds. Having this connection to a trained health professional who is familiar with their circumstances puts the group members at ease.
11:30 am. Nada arrives at Kayla’s address in Detroit’s Osborn neighborhood, on a street where half the houses are boarded up. Kayla, 26 and in her first trimester, has recently signed up for group prenatal care. She and her energetic toddler are currently are staying with Kayla’s older sister until they can afford their own place. “We call this situation ‘couch-homeless,’” Nada says quietly as we wait for Kayla to answer the door. It’s the first time Nada has met with Kayla so she walks through the standard first-visit protocol. “Kayla, it’s so great to meet you, and I look forward to our getting to know each other better,” Nada says. “What are your major concerns today?”
“I’m really worried about how we can pay the heating bill,” Kayla responds. “What if we get a shutoff notice?” Right there, Nada dials United Way 2-1-1 and puts Kayla on the phone to talk to one of their trained counselors who assures her they can work out a payment plan.
Immediate crisis averted, Nada reminds Kayla about her group prenatal care visit coming up next week. She then arranges for free transportation through Kayla’s Medicaid health plan. She shares helpful tools: a brightly illustrated book on having a healthy pregnancy, a directory of community resources, and last but not least, links to the WIN Network: Detroit website and Facebook page, replete with resources and upcoming events. Together they look at opportunities to connect with other WIN Network: Detroit members. Nada hands Kayla her cell number and contact info for the WIN Network. Lastly, they work out action steps that Kayla agrees to accomplish in the next week, and set a time for Nada’s next check-in.
“Developing a trusting relationship with Kayla is first and foremost,” says Nada upon leaving. “My assistance to her is guided by her priorities for her and her family. Kayla also is worried about getting her own place. We’ll work on affordable housing options next.”
1:30 pm. Nada arrives back at the office with a sandwich she’s grabbed in route. She ensures Kayla’s pregnancy info file is up to date. Additionally, she sets an alert for the day she will follow up with Kayla to see how she is progressing. “Planning and organization are key in a job like mine,” she reflects.
Now, Nada will start working on a phone call queue of community members who have recently connected with the WIN Network. Among these contacts is a young woman who is interested in joining the Co-Captains Club. The Co-Captains Club is a way to expand the WIN Network and empower the young women who have worked with the program in the past. Co-Captains are trained in groups by WIN Network CHWs to host informational meetings where they talk to their friends and family about physical and mental health, family planning and other issues impacting the community. This training empowers the Co- Captain to be a resource for her network of friends and family and supports her along the way. Nada enrolls the new caller in the upcoming Co-Captains training the following week.
The next message is from Tara. Nada explains that Tara has gestational diabetes and was having trouble affording the foods that will help keep her blood sugar in check. “We connected with Detroit’s Food Assistance Program which, so far, has helped Tara stay out of the ED,” Nada said. But today, Tara was calling because her local grocery doesn’t consistently stock the foods approved by the assistance program. Nada helps Tara find the name and contact information for the grocery store manager to ask about the inconsistent food stock. “Please call me back after you talk with him,” Nada says. “We’ll figure this out.”
2:37 pm. Nada makes it through most of her planned phone calls for the day when the clinic’s front desk rings her. A patient who had just walked into the clinic needs to talk about health insurance enrollment as they do not have a health plan in place. Nada grabs her laptop and goes to meet with the patient in the office conference room. She confirms with the patient that he does not already have an application for Medicaid filed with the state and then proceeds to help complete his application. After informing him what to expect next in the application process, Nada learns the patient has not activated his online patient health portal, or MyChart, account. Nada helps the patient activate his account and learn how to utilize it.
4 pm. Nada updates the office records for each of the phone calls she has made and starts a teleconference with a community agency, Matrix Human Services, to learn more about their youth programs. “It’s important that we CHWs develop and maintain good working relationships with the organizations that serve members of our community,” she explains. “When an organization offers a new service or a new director is hired, I call to connect and to be sure they are providing the most up-to-date information about WIN Network, as well.”
4:45 pm. Nada adds to her team’s “asset map,” with its list and location of services and key contacts available to community members. “People sometimes think that poor communities only have needs,” Nada says, ‘but there are a lot of assets here, too. You just have to get to know the neighborhoods and the people in them.”
Nada ends her day sharing with her supervisor the progress she has made on the phone call queue. She responds to e-mails and checks her calendar for tomorrow. “Serving as a community health worker is being a resource to help ease some of the stressors in people’s lives. We are a bridge of support,” Nada says, “that brings our clients to the road of their success.”
This article is from Stakeholder Health: Insights from New Systems of Health. Find more about the book HERE.
CHW Related Links
Community Health Workers & Health Systems: Emerging Trends, a conversation with Kevin Barnett, Grace Damio and Carl Rush