Authors :
Presenting Author: Laura De Muro, MS, CHW – Dartmouth Health
Trina Dawson, BA – Dartmouth Health
Lisa Sackett, PhD – Dartmouth Health
Sarah Kaden, BA – Dartmouth Health
Meredith Olenec, BA, CHW – Dartmouth Health
Jessica DeNaples, MPH – Dartmouth Health
Kathryn Giordano, MPH – Dartmouth Health
Ambereen Burhanuddin, MA – Dartmouth Health
Maggie Ellison, BA – Dartmouth Health
Doreen Guilette, – Dartmouth Health
Maureen Quigley, RN – Dartmouth Health
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth Health
Rationale:
Community Health Workers (CHWs) are specifically skilled at closing access to care gaps that drive health inequities. While the CHW workforce has been recognized for their contributions as resource connectors and advocates, they are increasingly being viewed as an integral and distinct segment of the healthcare workforce. CHWs are now employed in diverse clinical and community settings including hospitals, outpatient clinics, health plans, public health departments and social services organizations. This pragmatic study shares the results of integrating epilepsy trained CHWs in an academic hospital setting to grow a trained workforce for delivery of standardized epilepsy self-management (ESM) to people with epilepsy (PWE), and outcomes following CHW ESM delivery. Methods:
CHWs (n=9) were recruited, trained and certified to telehealth deliver the HOBSCOTCH (HOme Based Self-Management and COgnitive Training CHanges Lives) ESM program. Each CHW completed accredited 4 hour virtual interactive community training (“Overview of Epilepsy & Self-Management”) followed by accredited 8-hour virtual HOBSCOTCH Cognitive Coach training. As follow up to the training, CHWs participated in shadowing sessions with a Master Cognitive Coach trainer to refine their intervention delivery skills. Pre- and post-program assessments of quality of life (QOLIE-10) and perceived memory ability (EMQ-R), as well as post-program satisfaction, were collected. Results:
PWE (n=123; age M=43.99, SD=16.02; male=29%, female=70%, prefer not to answer=1%; Table 1) who received HOBSCOTCH via a CHW reported that they strongly/mostly agreed HOBSCOTCH provided useful tools and strategies for everyday life (91%), enjoyed working with a Cognitive Coach (98%), found Problem-Solving process helpful (89%), felt heard/validated (98%), felt better able to manage cognitive problems (85%), and intended continued use of learned skills/strategies (94%). Wilcoxon Signed Rank nonparametric tests revealed statistically significant improvements in the QOLIE-10 (n=119, pre= M3.32, SD .65; post=M 3.05, SD.71, p< .001) and EMQ-R (n=77, pre=31.3, SD 12.49; post=M 24.3, SD 12.52, p< .001; Figure 1). Conclusions:
Pragmatic delivery data at Dartmouth Health’s HOBSCOTCH Institute reveals CHWs integrated into epilepsy center teams can deliver HOBSCOTCH with fidelity, resulting in significant improvements in QOL and subjective cognition, and that PWE endorse high satisfaction post program. This model for CHW training and integration onto clinical teams to provide adjunct self-management programming to PWE is scalable, and would allow for growing the skilled epilepsy workforce to enable improved adjunct support, quality of comprehensive care and patient outcomes.
Funding:
Centers for Disease Control and Prevention 1NU58DP007541-01-00