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The Community Health Access Project
Contact: Mark Redding

Ocie Hill Neighborhood Center
445 Bowman Street
Mansfield, Ohio 44903
Phone (419) 525-2555
reddingz@att.net   

WHO WE ARE

The Community Health Access Project (CHAP) is a not-for-profit organization located in Richland County Ohio.

CHAP employs trains and supports Community Health Workers in three Ohio Counties.

CHAP utilizes a system called Pathways, and has been able to document and better focus on specific outcomes for clients served.

Pathways serve as a framework to integrate the services of CHWs into a collaborative network of community service providers with a focus on producing positive health and social outcomes.

CHAP’s goal is to help improve outcomes through the CHW model utilizing higher standards of accountability defined through Pathways.

HOW WE BEGAN

CHAP is modeled after the 35 year-old Alaska Community Health Aide Program, which is credited with reversing that state’s poor social and health statistics. With over 500 aides serving isolated areas, Alaska now has one of the lowest low birth weight rates in the United States. 

Drs. Mark and Sarah Redding, CHAP physicians, bring more than 15 years of experience working with advisors in rural Alaska and Baltimore, Maryland to the Ohio project.

The Community Health Access Project began in Mansfield in 1999 to overcome barriers to health care. The CHAP program expanded to rural Knox County in February 2000 and to inner city Columbus in 2001.

WHAT WE DO

CHAP uses geomapping of outcomes to identify areas with the greatest need. For example, in Richland County, Ohio birth certificates were reviewed over a five-year period to identify areas most at risk. Two small census tracts were found to have the highest concentration of low birth weight in the county. Pregnant women from these census tracts had a 24% rate of low birth weight (more than three times the overall county average). CHAP went to the churches and other local organizations to identify community members who were willing and capable of reaching out to this at-risk community. College level training was provided and the CHWs were sent out to find and assist pregnant women. Transportation, cultural differences, insurance and other barriers were identified and eliminated for expectant mothers. (For example, it was discovered that prenatal and pediatric physicians were located only a few miles away, but transportation by bus was more than 4 hours round trip, due to transfers, delays, etc.)

Pathways - developed by CHAP - is a standardized methodology for improving health outcomes and was developed and implemented in collaboration with medical, social and community-based providers. The system of Pathways assists in identifying those who need the help the most and then serves as a guide though social and medical service steps with a complete focus on achieving the positive outcome. For example, in the Immunization Pathway, if a child is identified in the community as being behind on immunizations, there may be a lack of insurance, no medical provider, no transportation and a lack of understanding as to why immunizations are important for the child’s health. Each of these steps and the agencies involved with these steps are linked together in a common outcome production tool - Pathway - which will not be credited as completed until the child has had the immunizations and they are confirmed to be up-to-date. In this methodology, critical social services as well as medical services are linked together in a common accountable outcome production tool.

Pathways, allows health and social services to utilize outcome production methodology to increase accountability, and overall production of positive health and social outcomes.

The Pathways approach can be integrated county-wide and across multiple agencies, allowing outcome production accountability at the county level.

County-wide implementation in Richland County has lead to improved collaboration among agencies, reduced duplication of services and an overall county level focus on accountable outcome production.

The Pathways model proposes that reimbursement should be directly linked to achieved outcomes. CHAP has contracted with Jobs and Family Services at the county level to increase specific outcomes – and full payment is not received until the outcomes are produced.

CHAP has been working with The Ohio Department of Health as a partner in the HCAP (spell out) grant. CHAP developed college level CHW training that has now been used to train over 200 individuals across the state. The CHAP program based this beginning CHW curriculum on experience with a similar program in Alaska, which had a tremendous impact on infant mortality and birth outcomes, particularly in economically disadvantaged communities. Integrated with the training and outcome focus is the outcome production model of "Pathways". Through the HCAP grant, four programs, representing twelve community based outreach sites, have adopted the Pathways approach to outcome production.

OUR RESULTS

• Utilizing Pathways and the care coordination services of CHWs, CHAP has demonstrated an 83% reduction in low birth weight for enrolled high risk women identified within the high risk census tracts of Richland County.
• CHAP has demonstrated the production of more than 7000 positive outcomes/Pathways for immunization, lead, truancy, chemical dependency, employment, etc.
• CHAP is working with the Ohio Department of Jobs and Family Services to show the cost savings potential of this model.
• We are comparing birth outcomes and infant medical costs during the first year of life for economically disadvantaged women who have received preventive based Pathways interventions versus those who have not.
• Increased focus on achieved outcomes holds potential for the removal of disparities and significant cost savings though prevention.
• Public funds are used to buy specific health, social, educational, and employment services with measurable results.
• The model of Pathways demonstrates focus of allocations precisely on target populations and their needs as identified by census tract: constituents get the exact services they need with results.
• Pathways tracks service barriers for quick analysis and disparity elimination.
• The Community Health Worker model provides a welfare-to-work approach supplying jobs within low-income communities.
• The Community Health Worker model was signed into law as a new profession in the state of Ohio as part of Ohio’s budget bill July 2003. Through this landmark legislation CHWs will credentialed under the Ohio Board of Nursing.

Previous Celebrated Communities

• July, 2003
  COMMUNITY HEALTH WORKS OF GEORGIA
   
• August 2003
  Project Access, Central Plains Regional Health Care Foundation. Wichita, KS

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