Being a community health center can be more than a designation—it can mean contributing to a community in ways that go beyond health. Asian Americans for Community Involvement, a health and social services organization in Santa Clara County, has formed an innovative workforce development partnership with local community colleges to train low-income youth to be culturally competent patient navigators.
The Need for a Friendly Guide
From its roots as a social advocacy organization, Asian Americans for Community Involvement has grown into a healthcare provider for a diverse community in Santa Clara County—taking an integrative approach to social services at their clinic. A large number of AACI’s patients are of low socio-economic status, speak little English, and lack knowledge of health institutions and resources. For these patients the health system can be a maze of disorienting encounters and confusing instructions. Simply finding one’s way around an unfamiliar hospital to visit a specialist can be an intimidating challenge that turns patients away from necessary primary care.
To better reach out to these patients and improve their access and experience, AACI decided to develop a new staff role: a non-clinical, culturally competent patient navigator who could guide patients through doctor visits and connect them to social resources. The patient navigator program professionalizes what many grown children of immigrants already do for older family members, and in doing so provides an entry-level job that can launch a healthcare career.
“A New and Different Way”
In designing their patient navigator program, AACI turned to a very specific definition of innovation: “Innovation combines existing practices in a new and different way.” In this case they looked to bring together four elements: the practice transformation ideas of Dr. Tom Bodenheimer, of UCSF’s Center for Excellence in Primary Care; a smartphone app to organize the navigators and connect them with patient visits; the entrepreneurial environment of community colleges; and the career advancement academy education model, which has been successful at empowering and building opportunities for former foster youth.
Partnerships to Build a Workforce
AACI chose to work with community colleges because, as Chief Operating Officer Pancho Chang put it, “community colleges are the most entrepreneurial segment of higher education.” Because they usually offer both technical education and degree-seeking programs, these institutions are well positioned to house unique and specialized training regimens. AACI has now formed partnerships with four community college campuses in two districts: San Jose City College, Evergreen Valley Community College, Skyline College and Cañada College.
Each of these schools now offers a specialized patient navigator program, a free, one-year, credit-bearing certificate. Students that earn this certificate will be given opportunities to work as a patient navigator while taking further classes. The program was launched with a starting cohort of eight. Now it is going into its third year with 100 total students entering the program across four campuses.
Health Center as Community Development Corporation
AACI is a community owned organization, with funding that requires its board to be composed of at least 51% community members. With this in mind, AACI believes it has an imperative to act as more than just a healthcare provider: community health centers should be community development corporations.
“If you hire folks, give them their first or second job, you keep folks in the community. We see this as community development,” Chang says. “We are designing this to not be the last job you’ll ever have, but a job to do to figure out what your job is going to be…We aren’t taking kids out of poor communities and turning them into neurosurgeons. We are building a ladder for kids to explore health careers and pick one. A step to the middle class—an indoor job with benefits.”
A Learning Community
The career advancement academy model focuses on creating learning communities, tight-knit cohorts of students that go through the classes together, learning from each other and growing as a group. In some cases the group support of this model has succeeded in increasing community college matriculation rates of former foster youth—one of the most troubled demographics coming out of high school—from 2% to 40%. In its first two cohorts, the patient navigator program had a completion rate well above the state and community college average.
Most patient navigator students are 19-26 and already speak a second language, coming from low-income families in the Vietnamese- and Spanish-speaking communities of East San Jose (though some students are older, and come from a variety of backgrounds). Many of these students are accustomed to helping their older relatives communicate with their doctors—the certificate program seeks to formalize an activity that already goes on in immigrant communities.
“They already have the skills they need,” says Elisa Orona, the project administrator at AACI.
The goal of the program is not to train medical translators. Instead the program focuses on teaching “cultural competency,” the skill of acting with empathy and awareness towards people of different ethnic, religious, economic, regional, and generational backgrounds. Thus while navigators are often paired with patients based on a shared language, the students are trained to be able to assist patients from any culture.
“I was surprised how much I was ignorant about other cultures and other people, and how beautiful it was to learn about other people and be able to communicate with them,” says Sayed Ahmed, who moved here from Egypt in 2008 and joined the patient navigator program while pursuing a higher degree in physical therapy. He now works as a patient navigator at AACI’s clinic.
How Navigators Work
- When scheduling a visit, patients are asked if they would like a patient navigator.
- Patients can select a specific navigator based on when they are available, but also based on characteristics like languages they speak.
- The navigator gives the patient a friendly reminder of their appointment and the documents they need to bring.
- Navigators can accompany patients to their visits, helping them find their way through hospitals, health centers and specialist offices, helping them communicate with their doctor, and making sure they understand their diagnosis and care plan.
- Navigators also help patients connect to social services, community resources (such as food, clothing and transportation), and sign up for Covered California.
- Following the visit, navigators follow-up with patients to make sure their treatment plan is going well and schedule follow-ups.
AACI currently has three full-time patient navigators, and the third year of the community college program has begun classes with four cohorts of 25. AACI plans to expand their navigator staff, and graduates from the certificate program are going on, with AACI’s assistance, work as patient navigators at other area clinics. Others are pursuing further health training, such as EMT certification. With a number of other community colleges clambering for the opportunity to offer the patient navigator program, AACI is looking for ways to continue expanding the program as their Centers for Medicare and Medicaid Services innovation award—instrumental in covering the start-up costs of the program—comes to an end.
AACI also has plans to build on the capabilities of the smartphone app used to dispatch their patient navigators. They hope to eventually include features that allow patients to rate their navigator and fill out a survey via text, with bonus payments provided to navigators based on these ratings.
- Asian Americans for Community Involvement is a social services organization with facilities near San Jose. Visit their website: aaci.org
- AACI developed their patient navigator system with support from the Centers for Medicare and Medicaid Services.
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