MANSFIELD — Sarah and Mark Redding witnessed something remarkable during a five-day training week in March. The local doctors witnessed 17 eager-to-help care coordinators train to be part of a solution the couple endeavored to solve starting in the late ‘90s.
The problem was a big one. In the late 1990s and early 2000s, Richland County had a high rate of women giving birth to underweight babies, a factor that led to a high infant mortality rate.
According to Sarah, the rate of women giving birth to underweight babies reached 22 percent in parts of Mansfield in 1998 — almost three times the rate of the county.
Since the couple moved here in 1997, they decided to develop a program in Mansfield — the Community Health Access Project — that would address the issue.The premise was simple, find the right people willing to become community health workers and turn them loose in the community.
“We really thought that would fix everything,” Redding said with a smile. “But it didn’t.”
The Reddings and the community health workers visited homes and pregnant women to discuss nutrition and pre-natal care to curb those high infant mortality rates. But their data reflected no significant impact. They went back to the drawing board in 2004. That’s when they struck gold, so to speak.
The Pathways Model
“We started looking at all the risk factors that go in to low birth weight. Each risk factor, became a ‘pathway’,” Redding said.
The Pathway model was designed to solve the problem of delivering underweight babies.
It essentially takes risk factors of infant mortality — lack of health insurance, unsafe living conditions, etc. — and turns them into achievable goals that community health workers help their clients work toward accomplishing. Once those goals were met, the community health workers received monetary compensation.
“So if they needed health insurance, there was the health insurance pathway," Sarah Redding said. "That is completed when we see an insurance card that has their number on it and they use that for their health care.”
Redding said that the new model added an element of accountability. But that’s not all. As part of the Pathway model, the Reddings started the Pathways Community HUB, a centralized entity used to coordinate care and costs associated within various agencies. It's essentially a congregation of health and social workers from different agencies.
And it worked.
In the 2006 and 2007 census track, those women participating in CHAP’s services saw the low-birthweight rates drop to 6 percent. The women who were not CHAP clients experienced low birthweight rates of 13 percent. The data showed the Pathway model was working.
So, it was replicated in Toledo and Cincinnati.
It was so successful the Ohio Commission of Minority Health took notice and granted them $4 million to replicate the model all throughout Ohio. Now, after 11 years of success, the Reddings have plans to build three more Pathways Community HUBs; Akron, Youngstown and Columbus.
Community Health Workers: their role in solving health problems
The 17 care coordinators finished the five-day training on March 18 with notebooks full of new information — information to continue on the path to becoming a certified community health worker in Ohio.
According to Anne Seifert, Care Coordination Systems Director of Education, Ohio is one of nine states in the country that allows care coordinators to become certified community health workers.
“They’re (community health workers) basically the bridge between health and social needs because they actually go out to the homes and see what their clients needs are,” Seifert said.
The Reddings believe community health workers are the solution to solving society’s biggest health problems. The couple moved to Alaska shortly after graduating and getting married. It was in Alaska where Sarah began to see the impact of the community health worker.
“What community health workers seem to have a better grasp of is all of those other issues like safe housing, food security,” she explained. “I don’t know if it’s because they're closer or community based, but they tend to be more holistic; and how they kind of see all the needs that person has instead of just focusing on insurance and access to care.”
Community health workers see their clients every day, as opposed to short visits to doctors.
“Every day I’m going out to homes,” said Arethea Dalton-Austin, a care coordinator from Ohio Infant Mortality Reduction Initiative in Elyria.
Dalton-Austin was one of the 17 care coordinators who participated in the Care Coordination Systems, NECIC and UMADAOP training program to become a community health worker.
“I run into a lot of poverty, a lot of smokers — I see it all,” Dalton-Austin said.
She said she joined the training to help better meet OIMR’s mission: to get every infant to meet their first birthday.
According to the Ohio Department of Health, African-American babies are more than twice as likely to have a low birth weight than white babies, 14 percent vs. 6 percent per 1,000 live births in Ohio in 2012.
Jess Price was one of three care coordinators from Mansfield’s CHAP to undergo the training. She felt the week was “very informational.”
The week-long training, 130 hours of practicum, additional training coming up in May and the application process to receive her community health worker certificate will ultimately help Price better manage her case load.
She said CHAP care coordinators and community health workers each have 25 to 40 clients in the Mansfield area. CHAP has six total; three care coordinators and three community health workers.
“So yeah, it’s something that this community needs,” she said.
“At this point, we’re really encouraging community collaboration,” Sarah Redding said.
According to the March of Dimes Foundation, 1 in 10 babies in the United States are born prematurely. In 2007, the Institute of Medicine reported that premature births cost the nation $26.2 billion each year.
Because of the gravity of the problem, health officials and policy makers alike have taken notice of the Pathways model.
Rockville Institute, a non-profit in Maryland, has started offering certification for cities that want to start a HUB.
“We all want do the right thing," Sarah Redding said. "We really do want to help people but to be effective were just going to have to work better together and this is one way to do it.”