Community Health Workers in WNC: An Interview with Honey Yang Estrada - WNC Health Policy Podcast Ep. 8

Photo by Kampus Production

Facing a dramatically shrinking healthcare workforce, Western North Carolina has identified innovative ways to support and expand the influence of a key role for increasing access among those most vulnerable and most often left behind - Community Health Workers.

In this month’s installment of the WNC HPI Podcast, host Andrew Rainey speaks with the President of the NCCHWA, Honey Yang Estrada, to learn more about this healthcare workforce opportunity in WNC, including strengths, challenges, and potential policy or strategy areas to continue community health work.

Transcript

HYE: Honey Yang Estrada (NCCHWA)

AR: Andrew Rainey (Host)

Introduction

HYE: In rural communities, like many of those in Western North Carolina (WNC), where resources are already thin, where access is tough already enough as it is, who best to get those resources out into the hands of those communities than Community Health Workers, who already have those trusting relationships?

AR: You're listening to the Western North Carolina Health Policy Initiative podcast. I'm Andrew Rainey. In each installment we’ll speak about different public health strategies for improving health and well-being in Western North Carolina (WNC).

Recorded on the flickering internet waves of mountainous Appalachia, in this installment: Community Health Workers (CHWs).

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AR: One of our big focus points for health and healthcare in WNC is our workforce shortage. As the region, state, and country think about this issue, WNC has been exploring the potential to expand our workforce with a motivated and high impact role that has not fully been integrated into our health systems, the CHW.

Our regular listeners may remember hearing excerpts of CHWs’ impact in the language access series, but in this installment, we’ll be digging in a little deeper on how CHWs offer potential to strengthen our healthcare workforce.

 In the fall of 2023, I had the privilege to speak with CHW and president of the NC CHW Association (NCCHWA), Honey Yang Estrada about CHWs, strengths and challenges unique to WNC for CHW, and some potential policy and strategy areas looking ahead.

 Honey, thanks for being here!

HYE: Thank you, Andrew, thank you so much for having me. I am so pumped to be here! So yes, I am Honey, and I'm the president of the NCCHWA..

AR:  So just to help orient listeners a little bit, could you define who CHW’s are and what is the NCCHWA?

HYE: So the  American Public Health Association, APHA, defines CHWs as frontline public health workers who are trusted members of and or have an unusually close understanding of the communities we serve, and this trusting relationship enables CHWs to serve as a link as a liaison as a bridge between health and social services and the communities to facilitate access to services and improve the quality and cultural competence of service delivery. The NCCHWA is the professional home for CHWs across our state.

AR: As you are a CHW, and have this big picture sense of the role, I wonder if you could tell us about how you became a CHW?

HYE: I think I've been a CHW all my life. I really love telling the story about my mom and how she was such a big influence, and really modeled who CHWs are my entire life. So just a little bit about that: My parents were refugees during the Vietnam war. I am Hmong-American, and a lot of the Hmong people, our community, we came to the States during the secret and Vietnam War we fought alongside of the Americans. . .  and it was tough. My mom was 13 at that time she came to the States and knew no English other than “Yes and no,” and my grandmother growing up, has always lived with us, and my mom had to learn how to navigate the system to support my grandmother. . . . and she got pretty good at it, you know, and I remember when I was little, she was a head start teacher, and on the weekends we would go to Hmong family homes, and she would sit with him, and and I play with the kids. But I would remember her talking with the adults, and I would hear words like Medicaid and food stamps and resources and doctors’ appointments, and medicine, right? And all of these I like, I remember those words very vividly, and I didn't know it at the time, but she is a CHW. She was doing CHW work without the title of a CHW, and she would often ask you, “do you need me to go with you to the doctor? Do you need me to help you look at this?” And it was because she looked like the community, she spoke the language, she understood all of those cultural nuances. . .  And when I got my first big girl job at the local health system, I found myself in that very similar role, where I would get calls from Hmong community members because I worked at the health system, people from the community, people from my church, people from with my family, friends, who would call and say, “Honey, you work at the hospital, so you know who the doctors are, you know where the resources are, can you connect me?” So I feel like we've been doing this, you know, for a lot of CHWs, we've been doing this work all of our lives without the title of CHW.

AR: Yeah, that informality of this role out of need really hits hard- coming out of the communities yall are apart of and rise to fill in the gaps that healthcare systems leave behind, and often without the support from the organizations they are creating bridges between.

But now  there’s this NCCHWA which sounds like is offering some more organized support to folks in these roles, and you’ve stepped into a leadership role there. . . you tell us a little more about the association?

HYE: For North Carolina specifically, our initiative started in 2014 and in 2019, there was a small committee, The North Carolina CHW Advisory committee, that was formed, and I was asked to chair that committee. . .  and over time that committee became the association, and I was so honored to be the association’s first employee. So that is my journey and how I have landed here, so it's an honor to get to do this work alongside of so many champions who are really leading health equity and across the State.

AR: You had mentioned that personal lived experience with things Medicaid, food stamps, language, and cultural nuances were key to this workfoce. Could you speak more on how this lived experience plays into this role?

HYE: Yeah, I think you know, just because for us, for CHWs and CHW culture, it is the value of lived experience, right? And so I mean II can use myself as an example here. I know what it's like to be on Medicaid. You know. I know what it's like to have to navigate that system. I know what it's like to take my WIC vouchers into a grocery store and feel shame and embarrassment because the cashier is looking at me kinda in, you know, in in some kind of way, you know, I know what it feels like to be struggling. I know what it feels like to feel like I'm not enough and it's because of that lived experience, it allows me to connect with the people from my community because I know the struggle.

So when we think about the fact that there is intersection across so many different areas, that's exactly right, because that lived experience that we have as CHWs, you're not gonna get that anywhere else. So when I'm talking with a CHW, I get it. And I know that as a CHW who's talking to me. I see myself in that CHW, and I know that that CHW sees me. I feel valued, I feel seen, I feel represented, because this person understands me, and all of my different struggles. All of the experiences that I've had this person identifies with me and sees me, and knows how to speak my language so that they can then take this information and bridge it to the different systems that they're working with.

So yes, there's a lot of bleed over. There's a lot of intersection in lots of different areas. Which is why CHWs are so important because we really can intersect so many of the different areas of our systems.

AR: Could you speak more to that? What range of roles are CHWs taking on?

HYE: CHWs is an umbrella term and encompasses over 90 different titles from community health liaison to patient advocate, to community health outreach specialists. There are so many different titles that fall under the CHW umbrella- understanding also that CHWs work in a variety of spaces.

We have CHWs who are working in maternal child health. We have CHWs who are working to address diabetes. We have CHW's who are working with re entry and returning citizens. We have CHWs who are working in the mental health and behavioral health space. So we have CHWs who are doing work in a lot of different areas.

AR: In our language access series, we heard how CHWs are interpreters too- sometimes in spoken language, but often culturally!

I’m hearing from your description of the role as a sort of umbrella that includes a lot of different kinds of tasks, that for our workforce shortage, CHWs are really picking up the pieces in all areas of need and could be a way to strengthen what we already have. .

For clinicians, how would you describe the way CHWs can work alongside other care providers as part of a healthcare team?

HYE:  Yeah, that’s such a good question. When we look at at an interdisciplinary team, a multidisciplinary team, it's really critical that we value CHWs in this space. And I would be remiss if I didn't say this. I say this in my circles quite a bit, and that is that when we think about CHWs, because we have the trust of the communities we serve, we get the invitations to the dinner table. We get the invitations to the birthday parties. Because we have that experience to really provide empathy and compassion for those community members that we work with everyday.

There are things that CHWs are going to see that the clinical team will never see within the 4 clinic walls, right? So when we walk into a person's home, we're gonna see whether or not there is mold growing on the walls. If the family has enough food. Where this family lives- is this family in a safe neighborhood? Does this family have access to clean running water? Does this family have any other needs that are going to impact how health is addressed for this particular patient or this particular family? Because the part of this, too, a lot of times is, we tend to individualize patients, But what CHWs see is yes, we see this patient, but ultimately we see the whole family unit.

I, personally, and I've heard this from other CHWs is when we go into a person's home. We might be there for Mom right? We might be there for Mom, but we actually also touch on Dad, Grandma, uncle, aunt, right? So all of these other different family members that impact this one patient's life, this one community members life. We get to see the impact of that. And how that really drives what we consider health in our communities. Because there again, really addressing those social drivers of health. So as CHWs, we get to see all of these different structures and all of these different factors that really impact and shape one person's life.So, for example, if we're looking at a treatment plan and we are concerned that this patient is not adhering to his or her treatment plan. That CHW can speak up as part of as a valued member of the healthcare team. This CHW can speak up and say “this is why this patient is not taking her medicines,” or “this is why this patient can't come to her appointment. This is why this patient is experiencing financial hardship and can't make his copay.” I mean, there are all of these different factors that CHWs can see. That's really gonna impact what health is going to look like. So, yes, I really encourage our systems to be thinking about how how CHWs add value to the healthcare team and really should be brought in as the subject matter expert. Because again, that CHW is going to see things that the clinical team may never see. . . 

AR: Yeah! So CHWs are adding value to healthcare teams when they’re brought into the picture because they have trust with patients and, because in the fee-for-service model, clinicians are only spending 15 minutes with their patients in a clinic, the CHWs then can offer perspective on what the patient is needing which is often invisible to the clinician. And then, depending on the situation, they’re likely impacting the whole household vs just individuals and that also has a positive impact on the health of the patient and the community from what we know about SDOH.

HYE:  Yeah, yeah, I mean, there's so many stories that I could tell about this, but yeah, absolutely. I mean, I know one that comes to mind: We had a CHW, this is in another part of the State, and this CHW works inside of a a pretty large health system, and saw just this where the patient was really struggling because she was doing everything she knew to do with her diabetes, but her numbers weren't matching up, Her numbers weren't right. So the CHW went and visited with this with this patient, and as it turns out. she was doing her math wrong. The patient was doing her math wrong on her insulin. And that's why the numbers weren't adding up. But there's no way that that clinical team would have known that because that patient thought she was doing everything right. And it wasn't until the CHW went and sat with her and said, “Show me how you do this. Let's take a look at this,” they were able to say, “Ah, this is it right here,” so then that was a quick phone call to the nurse to say, “I got it. Let's talk through this.” And you know they were able to really think through. “Okay, how can we remedy this and get this patient up to to doing this math correctly?” and doing some education with her, so that we can get those numbers to where we want to see them. So yes, we see stories like this every single day with CHWs.

AR: Thinking about what’s on the mind of many policy makers and hospital systems, could you speak to the cost of bringing in CHWs?  For example, does the upfront cost to integrate, pay, and offer continued training for CHWs have a noticeable impact on the downstream cost for a healthcare system?

HYE:  Yeah, yeah, absolutely, I'm so glad you said that because there have been a number of return on investment studies. And I actually prefer the term “value-on-investment,” as we consider the impact that CHWs have on communities. In almost all of the studies the numbers are very favorable. The results are very favorable. We see a reduction in healthcare costs. We see an increase in adherence of medications we see an increase in health savings. So all of the numbers, All of the metrics, are very favorable. And so there are so many studies that really have cemented the value that CHWs have in these spaces with healthcare and with public health.

AR: We’ve been talking about the health and healthcare workforce with Honey Yang Estrada. After a break, we’ll hear more about what’s been working well and particular challenges for CHWs in WNC!

BREAK

(Saro Lynch-Thomason hums Lady Margeret) 

Hi everyone, Andrew here on the WNC HPI Podcast, the show that looks at public health strategies to improve health in WNC. We’ve been talking about CHWs with CHW and president of the NCCHWA, Honey Yang Estrada.

Be sure to check our website at www.wnchealthpolicy.org for the transcript or listen again on Apple Podcasts or Spotify. Coming up, we’ll be hearing about strengths and challenges for CHWs in WNC.

That was Asheville-based Appalachian ballad singer Saro Lynch-Thomason humming the old shape note styled ballad Lady Margaret. You can learn more about her work and regional music traditions at sarosings.com. And now back to the show:

WNC

AR: Bringing the CHW conversation more directly to WNC, could you speak to what you’ve seen that has been working well in our region?

HYE: So many great things. And I think that one of the best things about WNC is it's people. We have such great leaders across various organizations who are so committed to this work. . .  like HPI, right? We've got all of these wonderful partners, all of these really strong leaders who have come together to form coalition, to build community, and to say, “these are the gaps we're seeing, we need to address these things, we need to make sure that the people who live in our communities are well cared for, that they have access to resources, that they can get all of the things that they need to live a healthy life.” So I think, really, as we look at the landscape of all of that, the different partnerships and the coalitions that have been built under those partnerships have been absolutely tremendous. 

Of course, thinking about Western North Carolina specifically, the CHW Coalition within WNC is really strong-. I think it's one of the most active regions across the State that continues to meet and network. And they've done a lot of really tremendous work already. . . again, lots of really strong leaders from across different sectors from the public to the private sector spanning not just health and public health organizations, but also organizations who are providing social support, also organizations who are in the housing space. So, we've got lots of different leaders and partners who are coming together to address the needs. I love love love, seeing that. And I love the fact that because there is this really strong coalition, there is value that the community sees in really continuing to support this work. So love that. . .there’s so many great things that's happening within WNC, but definitely the people, my friend, the people are what make it that fantastic.

AR: So strengths include how all of these organizations and leaders have collaborated around CHWs. . .  and partnered  together. We’ve heard this as a strength across so many areas of health action in WNC! 

Along those same lines, I know there’s many shared challenges across the health landscape for our region, but could you paint some broad strokes of how they look from your perspective for building our workforce with CHWs?

HYE: I think one of the biggest challenges we face and again, this is not just isolated into WNC, but we see this with across the state and nationally, is the fact that we still have not yet identified what sustainable funding is gonna look like for CHWs, right? And so we know it makes sense. We know it's the right thing to do. We have seen the outcomes. The financing piece continues to get lost.. And it's really tricky. And I totally get that.

AR: Ok, so while there’s sometimes funding pockets for CHWs here, sustainable funding is one big challenge. Another we’ve heard in almost all episodes of the HPI podcast are the SDOH. Could you talk about how that intersects with CHW?

HYE:  Yes. another challenge a is the geography itself, right? There's lots of mountainous regions. There's lots of little pockets of rural communities. So, when we look at the work that CHWs are already doing. You know, I know that there are CHWs who are working very specifically with these vulnerable and rural populations. . . rural communities who don't have a lot of access to resources period, right where it's it's totally normal for them to drive an hour, or more to get to a physician, and then you add on top of that. Well, my goodness, what if they don't have a vehicle?  What if they don't have money for gas? So especially looking at those social determinants of health. . .

AR: And I guess CHWs effectiveness at supporting folks through these challenges heightened with the geography and absence of reliable transportation is part of what got CHWs attention from the state and other funders when COVID hit, right?

HYE: You know, I can't move forward without saying that while there was a lot of of attention to our workforce during the pandemic, we've been doing this work long before the pandemic. And we're gonna continue to do this work long after the pandemic.

CHWs are already addressing all of those needs within these communities. You know, there's so many stories that we can highlight. For example, during the pandemic, there were families who couldn't get to who couldn't get to their physician offices. So CHWs leveraged their own resources to facilitate telehealth visits. You know, we had CHWs who provided services to deliver medicines to make sure that community members didn't have a lapse in their medicine, especially those who have chronic diseases like diabetes. Oh, my gosh! Like, what if this patient didn't have access to their insulin or their hypertensive medicines? So CHWs, of course, quickly fell into position and made sure that these community members had access to all of these different resources so that they could continue their care in order to really get to those healthy outcomes that we're looking for. So CHWs are a bridge. We are those trusted messengers. So, I spoke a little bit ago about how CHWs, we get the invitations to the the birthday parties and a seat at the dinner table, because we have that lived experience to really provide empathy and compassion for those community members that we work with every day.

AR: That leads me to a question for you about a potential challenge and maybe strategy area surrounding CHWs. I hear that with the umbrella of roles CHWs may take, it could be difficult for organizations to understand what exactly the position is that they’re hiring for. I’ve heard CHWs then referenced as a sort of catch-all worker to account for all the broken parts of our healthcare systems. That makes me worry about the potential for folks hiring CHWs to not give a clear job description or appropriate compensation. Particularly because CHWs might feel more social pressure to show up beyond their capacity than a clinician because they’re present in community spaces.

HYE: Yeah. Oh, my goodness, absolutely, yes, and you know. And I hear this. Thank you so much for recognizing that, Andrew, because we see that a lot in a lot of different spaces where we hear just that right? Well, the CHW can do it or the CHW can do this. Yes. And we also need to be thinking about, yeah, what does that job description look like? What does that compensation look like? When we talk about pay equity, CHWs are very much impacted by this.

Because, what I continue to see and hear are that CHWs can be Band-aids for lots of different challenges within communities. And I want to tread very carefully here. So when we talk about that umbrella term, there is, there is actually right now, not just in North Carolina, but nationally, a movement to really unify the profession. So when we're looking at job description, we're encouraging employers to use CHW as the title for that specific position to bill uniformity and consistency for the workforce.

And we do need to be very specific about what CHWs do, and to very much think through intentionally what that job description is gonna look like. And of course, pay equity. I know in North Carolina we champion at least $20 an hour. That is the base rate that we advocate for and we actually saw this during the pandemic, when our friends at DHHS through the COVID project put that into the requirements of the contracts with the vendors that CHWs needed to be paid at least $20 an hour. So we were so excited to see that, because that really was an opportunity to create the stage for CHWs across our state.

AR: So CHWs are this current, motivated, effective, and almost invisible part of the healthcare workforce that our health systems would do well to bring in and support, both to make their care more effective, and also open the door for more folks to enter the healthcare field and address our workforce shortage. That leads me to retention beyond pay equity,

As we’ve heard from different parts of the healthcare workforce, like nurses, burnout can be a big contributor to folks leaving the field. When CHWs are coming from communities that are already facing inequities, it seems like this workforce would also be facing a higher potential for workplace stress and burnout, not just from unclear roles, but maybe training on navigating complicated workplace role conflict. I wonder if you could continue with that point to talk about the kinds of training and supports that the workforce is needing. . . .

 HYE:  All great excellent points here, Andrew, I think there’s so much to unpack because CHWs experience a lot of secondary trauma from working with vulnerable communities.

And we have heard specifically from CHWs, the need for trauma informed care. And really, you know, self-care comes up a lot for our workforce. because when we are caring for those in need or caring for those who are in crisis. There's a lot of bleed over that happens. . .  So much so that we often internalize that into ourselves, we question, did we do enough? Did we provide all of the resources? You know, how much of this am I taking back with me and internalizing? And how much of this is impacting my own personal mental health, right? We see that a lot. So there's a lot of training that we provide for CHWs. I know that we talk about it in the training that is offered through the community college systems.

You know, we've partnered with North Carolina AHEC who is an anchor partner for the North Carolina CHW Initiative to really think about how we can build trainings and deliver trainings that are gonna be conducive to CHWs in addressing trauma, secondary trauma, trauma-informed care, all of those things, because you're absolutely right, we see this show up a lot within our communities.

And it's really teaching CHWs to say, to your point exactly: “These are my healthy boundaries, because this is the protection I need to put in place to protect myself.” So, one of the things that that is a true telltale sign of CHW is when you're a CHW, everybody's got your phone number, right? Everybody's got your phone number and you get calls in the middle of night, first thing in the morning, after everybody's gone to bed. . .  so, as a CHW really understanding that, yes, while there are needs, I also have to take care of myself. So what do those healthy boundaries look like? When do I need to not answer my phone? And when do I need to say, “Okay, I have done everything I can for this person or this family member or this community member, and I need to now put a stop on it so that I can make sure that my cup continues to be full.” So yeah, I mean, we talk about this quite a lot. 

One of the things that we have for the workforce we call it ‘Round table discussions.’ And really, for the workforce, it's a safe space where they can come and just talk. . .and that in and of itself, understanding that ‘I am not alone, that there are other, CHWs just like me, who are experiencing these challenges in their communities just like me. Just that alone has provided so much support for the CHWs.

So, yes, absolutely such an important conversation, one that we have to always keep top of mind to make sure that our CHWs are in the best shape, because this is really tricky and really hard work sometimes. Yes.

AR: You mentioned a little earlier that sustainable funding is a big challenge area for this workforce issue: presumably having HSOs, healthcare systems, or government agencies who can support CHWs for more than 1 grant cycle. Are there any actions being explored or ones you’d like to see to address this?

HYE: I will say that for the first time CMS, the Center for Medicare and Medicaid has identified, and just launched very recently, a new proposed fee schedule, that for the first time would provide reimbursement through Medicare for CHW services. We are so pumped to see that super jazzed to see that, because this is one step in really building sustainability for the workforce. So I think one of the greatest challenges again, not just in WNC, but what we continue to see nationally is how we really do not have sustainable payment models to support the workforce, and that makes it really tricky on our public health and healthcare systems- it really requires us to be innovative.

 I know that there are some organizations who have made a direct investment into CHWs, but for others, especially the small, the small community based organizations with the small hospitals who don't have all of the resources, who don't have the profit margins. It's really tough to make that investment, even though that's what we want, it's really requiring us to get innovative and think through how we can really provide support, not just for CHWs, but for the community as a whole.

AR: Yeah thinking about direct investments to CHWs here, I know some funding has gone towards CHWs through organizations like MAHEC and the Dogwood Health Trust have provided some funding, and then the evaluations like that done by the NCCHW which offers a tool for HSOs to demonstrate the value of that investment, but that funding stability like that with the CMS continues to be an area needing attention. . . Are there other specific policy areas that could aid CHW in WNC?

HYE:  Absolutely. I think. You know, there, we've got a lot of different, a lot of different opportunities. I know that if we look at for example, the training and certification of CHWs, right? Right now, we have very proud to say that we have over 800 CHWs who have been certified through the Association and there are a lot of certified CHWs inside of WNC. I think, really looking at providing legislation to really cement that piece and really support CHWs, as we look at training and certification, that is something that we could definitely provide support for. I think also, looking at again, things like our Medicaid strategies, right? I know earlier this year DHHS released a Medicaid strategy specifically for CHWs, and that that kind of had to take a backseat, rightfully so, because of Medicaid expansion, but if we look at how we can get that implemented and really build some momentum around that. What that would mean, again, not just for the workforce, but for the community at large. Oh, my goodness! It would change people's lives. It would mean that we could then really build support again, not just for the workforce, but for our communities. So really, looking at supporting policies like that.

Last year the American Public Health Association (APHA) released a new strategy to address racism and violence as public health priorities. And this is really naming the fact that CHWs are the workforce to address advancing equity and violence prevention in communities. I believe Buncombe County has already pushed forward with our friends at CHASM to support the work within communities, especially addressing violence.

AR: CHASM is a NC Community-based organization whose acronym stands for Community Healing through Activism and Strategic Mobilization. Their CHW Initiative works with national, state, and local agencies and community-based organizations across the country to advance the profession of CHWs. You can learn more at their website: chasmnetwork.org

HYE: I think this is also an opportunity for us to think through how we can address this, a lot of our communities experience violence, and so really bringing that to the forefront of policies to really provide support for I think that's also really important.

AR: For listeners interested in learning more on violence prevention and action in WNC, we also talk some about this intersection of violence in the region in Episode 3 with OurVoice and 6 with the Healthy Opportunities Pilot, you can find those at wnchealthpolicy.org or wherever you get your podcasts. . .

HYE:  And then also, I think we need to consider the different sources of funding, and how we can really build that into policies for, again, sustainable payment models for our workforce, thinking through the fact that in North Carolina we have our different prepaid health plans. So how do we bring all of these different organizations together to think about how we can really support, not just the workforce, but the health of our communities.

AR: As you’ve pointed out that CHWs are really impactful at improving health equity where they’re supported, I’d love to bring another potential policy related topic up.

On the HPI Podcast, we had a mini-series on the intersection of language access and healthcare in WNC and one notable part of that workforce was CHWs, who might step into an interpreter role, whether formally or not, and in that context, we learned that language access improves healthcare immensely and that it also saves money for the state and other parts of the healthcare system.

Needing interpreters and CHWs, and because fear is a huge barrier for many immigrant communities these days, I’m curious if non-citizen CHWs with a CHW certificate could have the opportunity to qualify for Employment-Based Immigration VISAs as skilled workers. There seems to be an opportunity here for employers to strengthen our healthcare system by filing that I-140 form for those folks to gain that security. Do you see a policy opportunity in creating that access point for CHWs?

HYE: I think that is such a wonderful opportunity, Andrew. I know specifically for us at the Association, we have championed, especially as we look at our curriculum that's being taught and delivered through the community colleges. . . . the way it works is our curriculum is delivered through the workforce and continuing education side of the colleges, and we've worked really hard with the community college system to make sure that there are no barriers to accessing that curriculum, right? So, to your point exactly, we have a lot of CHWs from undocumented communities, and we don't want them to not be able to access these offerings, which is why we've not made that a requirement, right? We're not going to ask about those things that are gonna make people feel a little bit nervous. So and we've gotten questions about that. We also have 2 colleges, Ab-Tech and Durham Tech, who have bilingual curriculums, specifically for Spanish speaking individuals. So yes, absolutely, and we hope to expand upon that, but understanding that, you know we have a lot of monolingual CHWs- That was our first step at really addressing language equity. I think if we could put some protections in place for these community members who are doing such tremendous work in our communities. . . 

I think about my mom. She's not a citizen. You know. I shared earlier, my parents were refugees during the war, but, my goodness, she knows the community like the back of her hand, and she can add, she advocates for people within the community every single day. So I think, absolutel,y we have opportunities here to explore how we can put some protections in place for these people who are doing such good work and leading initiatives and leading change that lead to healthy outcomes in our communities.

AR: And, as you mentioned, saving health systems money and expanding our workforce statewide. . . .

Moving from policy, are there resources you could offer folks who want to learn more about CHWs? Whether it's how care teams like primary care physicians, hospitals, behavioral health groups, or other nonprofits might hire or work with a CHW to improve their systems’ efficiency, health outcomes, workforce, and cost. Whether its how community members connect with CHWs to have better health experiences. . . Or how someone could become a CHW and enter our healthcare workforce in this way, maybe as a new job opportunity for work that maybe they had previously been doing without support. . .

HYE: Absolutely. So this is a shameless plug for us at the Association. So if you visit our website and nchwa.org that will take you directly to our website to connect with us, we have lots of resources and information there. And specifically for CHWs, all of the information on training, on certification, how to become a CHW, all of that information is on our website. Specifically for organizations who are looking to hire CHWs, we really, wanna we really wanna partner, we welcome your partnership with that, and I would love to have a conversation with systems and employers who are are interested in hiring or onboarding CHWs. It's important that we have a conversation, because communities are so different, one to the next, and the needs of those communities are gonna be very different. So really, understanding the needs of those communities and how we can come alongside to provide partnership is gonna be really critical, because again, you know what one community has this certain resource, doesn’t mean that this other community has it, so really understanding how we can leverage the existing resources to build a model that is gonna be sustainable for your community is gonna be really critical. So we would welcome your partnerships to talk a little bit more about the needs and how we can come alongside of you and provide some subject matter, expertise around CHWs.

AR: Yeah, so building on our existing strengths of networking and partnerships. . and what about folks who may want to work with a CHW to support their own healthcare?

HYE: Absolutely, absolutely. So let me just be very clear on this, and that is that there are CHWs already existing in every single community. And while we have not identified them yet, they are there, I promise you they are there. If you think about a neighborhood, there's always that one person that everybody goes to when they have questions, when they need something. When they want to find out what's really going on, they go to that one person, right? That person is your CHW. And while that person may not have that title of a CHW. That person is your CHW.

AR: (although they could receive that title with a certificate, get paid, and enter the healthcare workforce! )

HYE: Right? And so I really want people to be thinking about who those champions already are within their communities, and reach out to those individuals because those individuals are CHWs within those pockets. Specifically for us, at the Association, we're currently building a platform right now, that's really going to allow us to provide a public facing directory of all of the CHWs across the state so pretty excited about that that's gonna be launched. So this will give people an opportunity to find out who the CHWs are within their counties.

AR: In this installment of the HPI podcast, we’ve been speaking about opportunities for the health and healthcare workforce in WNC with The President of the North Carolina CHW Association, Honey Yang Estrada. Thanks so much for talking with me!

HYE: Awesome. Thank you so much for the time, Andrew. I appreciate you.

OUTRO

AR: You've been listening to the WNC Health Policy Initiative Podcast through the NC Center for Health and Wellness at UNCA. To listen again or learn more about public health issues in WNC, check out the website @ wnchealthpolicy.org or listen to other shows on Apple Podcasts or Spotify.

If there’s a WNC health issue that you’d like to hear more about, speak about, or comments about anything you’ve heard on an HPI podcast, feel free to send us an email at info@wnchealthpolicy.org, or write a comment on wherever you listen to podcasts.

To find more information about CHWs, theres a number of places you can look: First, of course, is the NCCHWA website. You can also find results of the 2023 CHW Evaluation completed by the North Carolina Center for Health & Wellness alongside MAHEC with funding from the Dogwood Health Trust. This includes videos and an infographic about CHW in WNC.

The NC DHHS also has a list of contacts affiliated with the CHW COVID-19 Initiative across the state.

For folks interested in becoming certified to be a CHW, Blue Ridge Community College in Henderson County and AB Tech in Buncombe County are two schools offering training in WNC.

Another big thanks to Asheville-based Appalachian ballad singer Saro Lynch-Thomason for humming the old shape note styled ballad Lady Margaret in the mid show break. You can learn more about her work and regional music traditions at sarosings.com.

Other music included in the podcast includes old ballad, Little Margaret, performed on banjo by Cath and Phil Tyler. Found on the FreeMusicArchive, it is licensed under an Attribution- Noncommercial-Share Alike 3.0 United States License.

Additional music includes the tracks Some Nights End, Lover’s Hollow, Blister Creek & Night Watch by the Blue Dot Sessions; These tracks are found on the FreeMusicArchive under license attribution international CC BY 4.0.

Be sure to check the website for more HPI podcast episodes and other resources @ wnchealthpolicy.org. Thanks for listening.