Project Echo; Echo CHN Disk #4

But I do want to go over that the next time around when we when we do meeting We'll have plenty of time to go over the specific recommendations on diet and and then what I would suggest is Kind of make a list of all those questions you're gonna have about what foods you can eat what foods you can eat You know everything else can come up and with big list and that way The next time when we meet and we go over all those strategies. You have those questions in mind about the food and I can answer all of those for you What I do want to do though before we leave is to come up with a kind of a little bit more concrete plan about what we're gonna Do from this point for and so the a great way to do that is to set some goals for yourself about What type of thing what type of things you're gonna be doing or changes you want to make with things So we talked about a lot of stuff today in terms of checking your sugar So I wonder if you what what Chris talked about checking the sugars and then you can see if that's something you're willing to Wanting to deal with the sugars because we don't we don't want to force you to do something you don't want to go We hope that we hope that's something that you will So we did talk about the before breakfast and Chris additionally recommended checking after one meal, okay? So that could be your choice either after lunch

or after dinner Okay, either one either one and remember we talked about two hours after the meal Okay, so does that sound like something that you wanted to try to set a goal doing that every day and in that way You know next time you come in we'll have a good record of all the sugars So that so that's one goal. So what I want to do is we're gonna actually write these down I'm gonna get out my toolbox here And I'll pull out a nice little sheet so we can write down keep track of your goals here So So good thing you're you're editing this So this is a good way that people Make changes with their house as they set some really Specific goals. So the first one is that we're gonna check your you're gonna check your blood sugars

Each day And so the first time Is when you wake up right so does that make sense when you wake up? Yes, right when you wait it should be between 10 and 15 minutes when you wake up Okay, number two would be after either Lunch or dinner And how long after lunch or dinner do we want to do that? Two hours after So this is two hours after Okay, and you can write those right in the book Now Chris, additionally recommended that you check your blood sugar. I'm sorry your blood pressure A little bit more often. So that's you can actually write that right in the book here Then then we can see it really easily So I mean might since we're not doing the medication here. This might be your blood pressure Okay, so you can write that right in when you check on your home monitor Oh, okay, and we can kind of monitor how that's how that's going

Not necessarily every day, but I would say whenever you think about it Does that sound like something you you'd be able to check your blood pressure? I check that these three times. Oh, you already do that. Okay, so if you if you want to continue with that I would continue with checking the three times a day if that makes you more comfortable. Yeah, so just go ahead and record those readings Right here in the book as well. Okay, so that would be number two As you're gonna you want to check your blood pressure Three times a day, right? You're doing it three times a day. Okay, so let's continue with that Now we haven't talked a lot as I said about the dietary stuff We did talk a little bit about the effect of exercise and how that can improve the the higher blood sugar readings that you have Is that something you're willing to try with the with the exercise? Well, I exercise, but I can do a lot because I get dizzy because you get dizzy I remember that was a problem before so what are you doing right now? I walk around four times a lap four laps four laps. So you do a mile a day A little bit less than a mile and then I sit down because I'm dizzy and you do that every day or once a day or twice a week Twice a week.

How would it sound to do a little bit more maybe three or four times a week? Does that sound like something you might be willing to do you could do it more often if you thought you could But let's start with a little bit of a small increase maybe well What do you think you could do with that? What do you think is doable? You could you could do that if you want to do that There's many different ways to do this So what do you think would be easier for you to do to do morning and afternoon a few days a week or just to start with One time a day Just in the morning. Okay, I can get adjusted to get adjusted Okay, so do you want to try to do every day of the week in the morning a few days of the week? What do you think would be good? Well, we could start with the four laps maybe But it would be it would be good to do Well, the best the recommendation would be to do almost every day of the week. So six days of the week Or at least five or six, but we want to kind of gradually increase this to Something you feel confident that you can do Oh,

when you walk over there, okay, so and you said you're doing that once or twice a week, right? So how in the mornings you do that Now Yeah, you're gonna make the shot For the clinic You

You You You Ready So providing

informal counseling and social support providing direct services such as patient assessment history taking foot exams vital signs and health screen tests And building individual and community capacity Although there's not this is the much room now. So just the little memory stuff doesn't work. So providing informed counseling and social support uh Providing direct services such as patient assessment history taking foot exams vital signs and health screen tests And building individual and community capacity We're counseling and social support providing informed counseling and social support

and Providing Informal counseling Providing informal counseling and social support Okay providing direct services such as patient assessment History taking foot exams Vital signs and health screen test Get ahead So Providing direct services such as patient assessment history taking foot exams vital signs and health screen testing Okay, now sell it to the camera Try Ready Providing direct services such as patient assessment history taking foot exams vital signs and health screen tests That's pretty good And then the next one is building

individual and community capacity There we go. I mean, I just don't want to admit that So preparing a family or community health has to give you something good. Yeah Building individual and community capacity Building individual and community capacity You want to try? Building individual and community capacity Good. I'm here and your feet Building individual and community capacity Um Um Well, basically every every visit with our health educator If any issues come up that he thinks Should involve another part of the other provider team

such as medications abnormal vital signs Uh or abnormal blood sugar blood pressure log He will after taking a real thorough history and and getting all of the information Will come and find me And after giving me a real condensed report of what he has found over the course of a 30 -minute interview Take me in and with his background information I'll be able to kind of address all of those concerns with the patient before they leave the visit with them Great Is okay, okay. That's right. No worries. Say incorporate the question. Yeah, no worries So so the warm handoff Model is is Basically to start over the warm handoff model is where our health educator Uh after spending 30 to 45 minutes with a patient obtaining a very thorough history and idea of what has been happening over the past several

weeks After doing that if they have found that there are problems or issues with Medications with blood pressure with blood sugar or if the patient seems to have some more as their concerns The health educator will come and find me and bring me into see the patient so we can address all those before the patient leaves the visit How does the role of the CHW and the health educator benefit the patient? The The role of the CHW the ability to the CHW to be part of the team benefits of patient For many reasons the first of which is they have the time To spend an extensive period with the patient where the patient can really Be relaxed Not be rushed and and have a sense that they're being you know, they're taking up someone's time And really be able to give a lot of very valuable information

to them um and because of that uh We are able to get all that information If nothing else is a clinic where data collectors and the more information we get about patients the better off We are and the better off the patient is because we can deal With a lot more of the patient's problems tonight coming from a A position knowledge of what's going on How does that help you as a as a doctor in in in seeing So it helps me as a provider in that I believe strongly in the team concept of health care and There are patients out there with chronic problems that do not need health educators They have they totally understand the situation and they can in a 10 -minute provider visit Walkaway feeling they have everything they

need But for many many of our patients They need A lot more time to be able to explain what's going on and And I need Without spending all that time to to be able to get all that information So the CHW Gets me the information I need and So I can really do do a better job in treating the patient And clinic as a whole How how this program benefits a clinic as a whole is it reinforces On a daily basis that we really are a team That are working together to really provide health care. It's it's not a provider. It's not a nurse It's not a doctor. It really is a group of people With with one purpose and that is

to help each individual patient as much as we can And so the clinic itself As people see that all different levels of the organization are really involved in patient care I think people buy in more they feel more valuable as a as a member of the organization Financially how is it how does it help financially to the clinic for How it affects the clinic financially Is that one we're we're able to involve an other member of the community in a paid position here at the clinic But also when patients come in and see the CHW And there are medical concerns rather than that person leaving and have to come back And pay for a visit or be built for

a visit We can while they're here Basically kind of capture that patient and it's good for both them and us one. They don't have to come back But two because of the fact that we can involve a provider in dealing with the issues that that person has that day We then can you can bill for a visit Long -term visit and time for the patient and for our medical facility Yeah, I mean, I think there's obvious long -term benefits for both patient and facility soon Which I've already talked about but I believe strongly that really the team approach For special populations is really the only efficient way to to deliver health care I don't know how you do it otherwise with people with multiple chronic diagnosis And so long -term yes, I think it's going to improve their health if

there's any chance This is this is the chance that that will exist and Again for the community for the clinic This This approach I think is the most holistic way to deliver care And I think it's obvious that people involved with it so people doing it here at the clinic we feel better That when the people walk out we've done something Good we've done something special for the patient And hopefully many of the patients feel that they've really gotten their needs addressed at the same time It's like you know This health educator speaks with the patient they've addressed that needs and I come in is In a more brief way just to explain that model sure So kind of a brief explanation of the model of the of the warm handoff of the health educator is that a The patient comes to a scheduled visit with a health educator the health educator Really has a format of getting a

history of what has happened since the last visit usually asking for Logs that we've asked the patient to keep blood pressure logs blood sugar logs Food logs where they've looked at their diet They'll do vital signs get a weight And kind of compare all of those with the prior visits and and see if we have some trends At the end of that 30 to 45 minute time period The health educator would then come find me in the clinic And pull me out and we'll sit for five minutes and he'll give me in in a five minute Uh Condensed version what he's he's been able to obtain in a 45 minute visit and then based on that I'll Take the time to go in and address the different concerns that came up When you mentioned just I mean to me the echo connection is is kind of an important thing

not only The CHW part but the other part is I'm involved in echo and both diabetes and hep C so We look at the CHW as an extender And at the same way. I'm kind of an extender of Specialists at the project echo on albacurkey. So I feel that the CHW Is directly linked to the patient But can kind of reach out to the next level of care easily and smoothly and and access at resource and at the same time I can Reach to the next level of care which are the specialists at down at albacurkey And get just instant great professional advice on I want to do in certain situations um As far as the CHW Tell me again I guess it's um If there was anything that you thought that um we had missed or they wanted to talk about a

CHW as their role If there was anything other important that we didn't cover that you thought it was important to know about them So So one thing is I mean I believe that CHW's or spinal part of the team is anybody else on the team and My own experiences show me that patients oftentimes have a comfort level with CHW's that they do not have with providers and We'll find patients have reported or disclosed to CHW's Things that providers haven't heard Over a period of 20 visits and we're very surprised that that that's happening. So um, I think and I think every member of the comfort team gets a different Story in the sense that people feel comfortable talking about different things to the different professionals whether they're CHW's

or Or front front office personnel or providers. So I just think they're just one more kind of valuable link You know and in the team approach Yeah A CHW provides culturally appropriate health education outreach to high risk communities Ready okay A CHW provides culturally appropriate health education and outreach to high risk communities Yeah a CHW provides culturally appropriate health education and outreach to high -risk communities. Okay, we'll move on to the next one. A CHW supports health providers as a valuable member of a health care delivery team. I'm going to have it here so I can follow along.

Okay, great. A CHW supports health providers. A CHW supports health providers. A valuable member of a health care delivery team. It's a hard thing to say. A support health providers is a valuable member of a health care delivery team. A CHW supports health providers as a valuable member of a health care delivery team. When you're done, just hold that camera. As awkward as it may seem. A CHW supports health providers as a valuable member of the health care delivery team. Excellent. A CHW functions as a force multiplier, expanding the capacity of a clinic to manage and treat chronic

disease. Did you really just get those? A CHW works to promote wellness in both individuals and communities. Great. A CHW speaks the language of the community in which they serve. Great. And I'm a CHW at Ascentral Family Health in Las Vegas. And I worked there for the past three years. Perfect. Okay. Talk to me. My name is Adam McCaff. I'm a CHW and I work at Ascentral Family Health in Las Vegas, New Mexico. And I've been doing this for about three years. Now this gets to hurry and how

it works. So the warm handoff is a way that we can add value to the service for the patients. And we actually advertise it as a team approach to health care. So not only is the patient getting the in -depth work on their diet, exercise, and other health concerns. But they can also get the knowledge and expertise of the provider during that visit. Okay. The first thing we had was how much we want to emphasize on the billing aspect of it. Do you want me to talk about that? That's important. We'll get to that later. But we're just trying to start with some simple stuff. So, Beijing comes in. I see them for 30 minutes. I do all this stuff. And then I bring in the doctor for a brief moment. He's able to do that, which allows us to bill. Okay. So in the reverse warm handoff, a patient is scheduled with me, referred for a particular reason concern that the provider would have

about their health. And when the patient meets with me, I'll vitalize them as well. I've been trained as an MA, which sets us up for the possibility that if we need to pull the provider in for a specific reason, say there needs to be a medication adjustment, there needs to be a provider checking in on their blood pressure readings or their blood sugar readings, that we're able to pull the provider in near the end of the visit, which may be about an hour visit. And the provider can address that specific concern and also bill for the provider's time. And maybe just say something like, the warm handoff model allows me to spend more time with the patient, bringing the provider for a smaller amount of time. So the warm handoff model, I believe, allows us to have some more in -depth follow -up with the patient, but still keeping in mind that the provider's time is limited and allowing them to come in at just the end of the visit

and keep the visit billable. Let's just hit that one again because you said so, the warm handoff. The warm handoff allows us to have a more in -depth follow -up with the patient, spending 40 or 50 minutes, and then pulling the provider in just at the end of the visit to address the specific concern and still make the visit billable. Are you personally going into the field of becoming a CHW? Okay, this is a brief one, didn't it? Yeah, a brief, but still meaningful. Okay, just a voice. I think it was a nice brief way to say. So being a CHW, to me, I'm not going to say so. Being

a CHW, to me, is important because this is the community I live in and I see the impact that we have every day working with patients and the rewards that they get from working with us. Nice. I have to do what you do. Okay. When I see a patient in the community and they come up to me and thank me so much for the knowledge that I've helped them gain and the improvement in their health, that's when I know I've done a great job because it's somebody coming up to me outside of the clinic. When I see somebody outside of the clinic and they come up to me and are very appreciative for the services we provided, that's what gives me the reward for the day and day out of this job.

CHW has the benefit for the patient of being able to spend a little bit more time with them on specific concerns that they may have so we can problem solve issues they may be having with their diet or barriers to them getting more exercise. Whereas the provider may not have as much time to talk about those issues specifically. How does a CH benefit the clinic as a whole? Can you tell me a little bit about how your role benefits the clinic? Well, so there's a few different aspects to that I could think of as the financial aspect bringing more, actually recruiting patients to the clinic but also as the added benefit that they receive from receiving the services as well. I would

say there's several benefits of having the CHW and the clinic. The first as we see it is sort of as a promotional tool for the services that we provide the clinic. Bringing more, I think I'd better say that. I believe that a CHW enhances the value of the clinic when patients can see all the services that they can get under one roof. It becomes a very valuable service to those people whereas if they visited another clinic or another provider they might not get those wraparound services. So primary benefit can also be financial in that more patients are going to be coming to the clinic. The second benefit is just in the services that we're able to provide to people we're able to follow closely on their weight management. We're able to give them more information when there might not be access to a certified diabetes educator. We can give them a lot of the same

information close to home and someone that they know and trust in the community. CHW has several benefits I believe financially for both the patient and for the clinic. The primary benefit for the patient is that they don't have to pay for the services. So they are able to get many more visits out of their care especially if they're uninsured for no cost at all to the patient. So they've automatically multiplied how many visits they get with the healthcare team. For the clinic we're able to keep the patient in sort of the healthcare loop so that we don't lose them three months down the road. We're able to do outreach maybe with our current population or outreach to the community so that we keep people coming back that need to be treated for their chronic diseases. For the reverse handoff

model to work really well there has to be a close interaction between the provider and the CHW. So that when the CHW is meeting with the patient they can be on the lookout for things that do need to be addressed by the provider and have that close relationship so that they could come to the provider. Tell them what's going on and the provider will be able to step in with a minimal amount of time spent and address by the issue. So I guess the only other thing that if there's anything off now is there anything that you really feel that we haven't touched on that CHW brands or helps or brings to the community or brings out in the patients or anything that really stands out to you. Chris and I talked about this earlier how it sometimes feel more comfortable talking with someone who's not as intimidating as a medical provider. I

think another benefit of the CHW is that typically we're less intimidating than a lot of the providers can be to someone who's coming into the clinic. And a lot of times patients will feel more comfortable talking about their health concerns or their inability to take their medication with the CHW and then we can kind of be supportive of those concerns and also be a mediator between the patient and the provider to get those concerns addressed so that we can move the patient on to better health. Okay, you're ready to roll into me. Yeah, let's go ahead and try one. We'll run through this a few times, Dr. Aurora. And again, I think trying to keep it as conversational as possible. And that's the hardest part about reading a script is you don't want to do that, but try and be kind of conversational and go through all three paragraphs as fluidly as you can. Okay, so no gap between paragraphs? No, nothing at all. Okay, the reason you don't write it as one just to make it

easier to read basically. Okay, so I was doing a gap. I was doing a little gap in between. A little gap isn't going to hurt, but it's not necessary. I would rather just be fluid and as natural as possible, conversational as possible. Okay, be right. Project Echo's mission is to develop the capacity to safely and effectively treat chronic, common and complex diseases in rural and underserved areas. Project Echo utilizes technology to bridge the gap between urban health care specialists and primary care clinicians in rural and underserved settings. The Echo Community Health Worker Training Initiative bears the success of the Echo model with the potential and power of CHW's to improve public health. Wow, that was great. So we've got a good one. I mean, if the tone was just what we were looking for, it was comfortable, it was conversational. So I guess you'd like to telepromp you then. It works for you. It works for me, yeah. And it's there, it doesn't work well for me. That's what they do here when they're trying to, they don't have this. How much does this thing cost? A

few thousand dollars. Yeah, that's bad. I think it's probably two, three thousand total. And that's for the software. That's not including a laptop, but it'll run on any laptop. It's a nice thing to have. Yeah, it's very nice. It's very helpful. Okay, you still rolling speed? Okay, anytime, sir. Project Echo's mission is to develop the capacity to safely and effectively treat chronic, common and complex diseases. In rural and underserved areas. Project Echo utilizes technology to bridge the gap between urban healthcare specialists and primary care clinicians. In rural and underserved settings. The Echo community health worker training bears the success of the Echo model, but the potential and power of CHWs to improve public health. Is there a reason you took out training initiative? No. Okay, we want to make sure we have two good versions of it. Okay, good. Just in case. Still rolling speed? Okay. Project Echo's mission. Sorry, I'm starting again. Oh, just a

second. Is there a fan or something? Yeah, it has. Just that. Is it just the... Hands, right? Yes. Oh, okay. It's not bad. Is it boiling? I think it's coming from here. Yeah, just pull that out. I think if you unplug this machine. Oh, okay. Let's stop. Okay. That's not bad. I just started. Okay, ready when you are. Project Echo's mission is to develop the capacity to safely and effectively treat chronic, common, complex diseases in rural and underserved areas. Project Echo utilizes technology to bridge the gap between urban healthcare specialists and primary care clinicians in rural and underserved settings. The Echo Community Health Worker Training Initiative bears the success of the Echo model with the potential and power of CHWs to improve public health. I think I missed an end in there.

See? Ready. Project Echo's mission is to develop the capacity to safely and effectively treat chronic, common, and complex diseases in rural and underserved areas. Project Echo utilizes technology to bridge the gap between urban healthcare specialists and primary care clinicians in rural and underserved settings. The Echo Community Health Worker Training Initiative bears the success of the Echo model with the potential and power of CHWs to improve public health. Nailed it. Okay. Was it good? Oh, we get to practice. Oh, or this is as many times as you want. Well, no. Up to the point where the kick is out of here. Yeah. It's love told. Okay, so are you going to tell me to go? Well, I could. Yeah. Whenever you're speeding, Anthony, just sit down. I'm rolling. Okay. Project Echo can enhance the quality of healthcare through telecommunication and strengthen and expand the role of CHW statewide. Very nice. Okay. This

time when you do it, that was great. I am going to do it again. Yeah. One more time. We always do two. Yeah. Okay. Okay. Project Echo can enhance the quality of healthcare through telecommunication and strengthen and expand the role of CHW statewide. That was a little weird. All right. We got to slow down. A little bit wouldn't hurt making more conversational. I remember we got one good one. We're good. Everything we do from here on out is just fluff. Well, it's it. Can we do it better? You know, we got a good one. So you're saying. Can we go? Ready. Okay. Project Echo can enhance the quality of healthcare through telecommunication and strengthen and expand the role of CHW statewide. That's pretty good. That's the one I want. Yeah. That's the one I want. Go. Ready when you are. Hold on one second. Okay. So read through it. And then if we want to change anything,

we'll stop and edit it. Okay. So this isn't these aren't bulleted, right? I mean, well, each each. I mean, there's the first first line and then each of these will appear as a bullet. But I don't have them bulleted in this. Right. So, but they'll keep going up and you want me to just keep reading as they come up. You got it. Okay. The objectives of the Echo Community Worker stop. Okay. The objectives of the Echo Community Health Worker Training Initiatives are to provide community health workers with experience and skills to become force multipliers as part of the chronic care team. To empower trainees with extensive training to assist in the management of chronic diseases, to teach practical applications of clinical skills, to develop and improve communication teaching and advocacy skills. That's it. So that's the last one. Okay. So there should be an end between those two,

shouldn't there? No, that well, no, there shouldn't. Because the way you want to say. I usually do the end before my... It's okay. The objectives of the Community Health Worker Training Initiatives are to provide community health workers with the experience. I did that wrong. I could have said experience. I stopped. You could. You can go right through it. Okay. From the top. The objectives of the Community Health Worker Training Initiatives are to provide community health workers with the expertise and skills to become force multipliers as part of the chronic care team. To empower trainees with extensive training to assist in the management of chronic diseases, to teach practical application of clinical skills, and to develop and improve communication teaching and advocacy skills. That's good. Yeah. Okay. The objectives of the Echo Community Health Worker Training Initiatives are to provide community health workers

with the expertise and skills to become force multipliers as part of the chronic care team. To empower trainees with extensive training to assist in the management of chronic diseases, to teach practical application of clinical skills, and to develop and improve communication teaching and advocacy skills. You did that. I know. That was perfect. I need to do it just that way again. That was good. Good. Ready when you are. Okay. The objectives of the Echo Community Health Worker Training Initiatives are to provide community health workers with the expertise and skills to become force multipliers as part of the chronic care team. To empower trainees with extensive training to assist in the management of chronic diseases, to teach practical application of clinical skills, and to improve and develop communication teaching and advocacy skills. I like it. That was great. Pretty good.

Pretty good. Okay. Stick the land here. Just look into the camera. Uncomfortablely long for you, and it will probably be perfect. Okay. What is it when you are? The objectives of the... I forgot Echo. Go back. We're good. Delete. The objectives of the Echo Community Health Worker Training Initiatives are to provide community health workers with the experience and skills to become force multipliers. Yeah. I mean, if you kept going, but you kind of second guessed yourself. Yeah. Yeah. Yeah. Experience instead of expertise. Would you rather say experience? No, it's probably the expertise, isn't it? To provide expertise. Yeah. Okay. The objectives of the Echo Community Health Worker Training Initiatives are to provide community health workers with the expertise and skills to become force multipliers as part of the chronic care team. To empower trainees with extensive training to assist in the management of chronic

diseases. To teach and practice application of clinical skills. And to develop and improve communication teaching and advocacy skills. All right. Good job. Okay. That was great. The Echo Community Health Worker Training Initiative is built on the core competencies CHW's need in order to work as part of the healthcare team. Including bridging the disconnect between communities in the healthcare system. Providing culturally appropriate and accessible health education and information. Advocating for individuals and communities within the health and social services system. Assisting people in getting the services they need. Providing informal counseling and social support. Providing direct services such as patient assessment, history taking, foot exam, vital signs, healthcare screening tests. Building on individual and community

capacity. That's where a place where I should put an end. And yeah. After health. You ready? Ready? Okay. Echo Community Health Worker Training Initiative is built on the core competencies CHW's need in order to work as part of the healthcare team. Including bridging the disconnect between communities in the healthcare system. Providing culturally appropriate and accessible health education and information. Advocating for individuals and communities within the health and social services systems. Assisting people in getting the services they need. Providing informal counseling and social support. Providing direct services such as patient assessment, history taking, foot exams, vital signs, health screen tests, and building individual and community capacity. That was good. It could be better. And you will be happier because you will look better on camera.

Are you drawing? Right in the middle. Echo's Community Health Worker Training Initiative is built on the core competencies. The story of it is a big bang when we're working on it. You're right. Wait a second. Tell the fights over. Okay. That's right. Echo's Community Health Worker Training Initiative is built on the core competencies CHW's need in order. Let me go. Ready. Echo's Community Health Worker Training Initiative is built on the core competencies CHW's need in order to work as part of the healthcare team. Including bridging the disconnect between communities and the healthcare system. Providing culturally appropriate and accessible health education and information. Advocating for individuals and communities within the health and social services

systems. Assisting people in getting the services they need. Providing informal counseling and social support. Providing direct services such as patient assessment, history taking, foot exams, vital signs, health screen tests, and building individual and community capacity. That was very good. I think it was the way it was. I mean, that's one to where, I mean, worst case if we looked at it and said, and we had no other options, we'd go full screen with the bullet points and we'd be fine. Oh, so it's clean. Does it matter that health. Just a moment and ready. Echo's Community Health Worker Training Initiative is built on the core competencies CHW's need in order to work as part of the healthcare team. Including bridging the disconnect between communities and the healthcare system. Providing culturally appropriate and accessible health education and information. Advocating for individuals and communities within the health and social services systems.

Assisting people in getting the services they need. Providing informal counseling and social support. Providing direct services such as patient assessment, history taking, foot exams, vital signs, health care screening tests, and building individual and community capacity. That's really good. That's great. I said screening tests, but that's okay.