By Scott Kearnan - There is no shortage of vital responsibilities entrusted to community health workers, but foremost among them is providing patients with the tools they need to care for their health. Sometimes, it’s surprising how simple those tools may seem can be.

“You don’t know what it is that might make the difference,” says Sandy Reichel, a community health worker at Community Health Center of Cape Cod (CHC of Cape Cod).

Using the Foundation’s three-year Closing the Gap on Health Care Disparities grant, CHC of Cape Cod hired and retained community health workers like Reichel through the efforts of the Cape and Island Diabetes Disparities Collaborative (CIDDC), an initiative created to address disparities around diabetes rates and treatment for the region's Brazilian, Latino, Native American, and black populations. Though the issues responsible for these disparities are complex, Reichel recalls one instance that proved how providing even simple tools can make a big impact.

“I was doing nutrition education, and talking in cups and half cups,” says Reichel, who often works with clients around issues of portion control, especially as they relate to cultural diets of rice, beans, and other starchy foods that can compound diabetes with weight gain. But in this class, she soon realized that one of the clients in attendance simply wasn’t able to understand the units of measurement. “At the end of our meeting, I said, ‘I would like you to take these with you,’” recalls Reichel of handing over a set of measuring cups. “He was thrilled … He said that he was moving back to Brazil, and now he would be able to measure.”

Implementing a community health worker model has been extremely important to the work of CHC of Cape Cod and CIDDC in addressing disparities among minority populations, many of whom are low-income, work multiple jobs, and have difficulty accessing the Cape’s limited public transportation resources. For these reasons, actual face time with clinicians is often at a premium. Community health workers at each of the five health center locations are able to go out into the community—at grocery stores, for example—to conduct screenings and book subsequent appointments at the health center for diagnostic exams. During the grant period, CHC of Cape Cod also streamlined its operations so that community health workers would be notified whenever diabetic patients are coming in for an appointment; that way, they can take the opportunity to check in, evaluate progress, set new self-management goals, and, of course, follow up again later.

Day and evening support groups have also been helpful in reaching members of the affected populations, and encouraging social bonds that help reinforce the systems of care. “The social connections are really powerful,” says Reichel. For example, she knows of insulin-dependent patients who have formed carpools to help each other attend support groups. According to Melonie Kelly, director of clinical services at CHC of Cape Cod, support groups and staff trainings in cultural competency have also been particularly helpful in reaching out to Native American patients. “They are one of our most difficult populations to get into the health center,” says Kelly. “There is a huge issue of trust for the tribal populations.”

Trust also continues to be a barrier to accessing populations of undocumented immigrants. “Immigration [status] has been a number-one issue,” says Kelly. “People were afraid that when [Massachusetts health care reform] went into effect, they would have to apply for coverage and that would require they have IDs and Social Security numbers.”

On the other hand, health care reform has also helped community health workers do some parts of their job more easily. “[Massachusetts health care reform] generally brought to the forefront some of the work we were doing,” says Karen Gardner, CHC of Cape Cod’s CEO. “It helped things happen a little more naturally, because when people are in a rush to sign up for health insurance we can say, ‘Why don’t you screen for diabetes while you’re at it!’”

To guide future work, CIDDC has prepared a manual so that each health center site can hire and train new community health workers, and gather data on the disparity of diabetes, depression, and eye and dental health between minority and white populations.

“I think that with many more years and more controlled studies, we will be able to see what works with the communities and what their outcomes are,” adds Lee Wotherspoon, CIDDC program coordinator. “But anecdotally, we definitely feel like progress is being made.”