Last month, Roshaun Hoggard had stomach problems and such severe loss of appetite that he ended up in the emergency room for three days. The ER doctor diagnosed her with diverticulitis, an infection of the digestive tract, and told her to follow up with her primary care provider.
After his discharge, Hoggard contacted Monya Sanders, the community health worker at Transitions Clinic Network in New Haven. Her doctor was booked that Friday, but Sanders told her to come anyway and that she would make sure he was seen.
“She will basically do everything but hold your hand at the door when the doctor is done with you,” Hoggard said with a laugh as he listed all the ways Sanders supported him, from renewing prescriptions to reminding doctors. come back to him when he asks questions.
Transitions Clinic Network provides primary care for ex-convicts with chronic illnesses. The clinic has three locations in Connecticut – New Haven, Hartford and Bridgeport – with the goal of adding more in other cities with high incarceration rates, such as Waterbury, New London and New Britain. Each location employs a community health worker with a history of incarceration.
Sanders said she wanted community health workers present when she left prison nearly two decades ago. Her mother supported her as much as she could, but there was so much about her experience that her parents couldn’t understand.
“They were preachers and pastors,” said Sanders, who openly discusses his past experiences with mental health issues, substance use and domestic violence. “They couldn’t really relate to the things I was going through and didn’t even know how to deal with it.”
Sanders said people coming out of incarceration face different pressures, like being denied jobs and restoring relationships with children, that only someone who’s also been through the experience can understand. “Who better to support them and sail for them than someone who’s been through this before?”
Community health workers, also known as outreach workers, health coaches, patient navigators and health promoters, helping people navigate health care and social services. They have an encyclopedic knowledge of all the resources available to residents in need and are experts at navigating the endless obstacles that can arise when trying to access them.
Two bills currently before the legislature — Senate Bill 10 and Senate Bill 991 — seek to make it easier for organizations to hire community health workers by making their services reimbursable by Medicaid. Currently, funding for their roles is piecemeal and largely supported by grants, which can be insufficient and unreliable.
Puglisi said the change would allow Transitions to hire more community health workers. The New Haven clinic currently sees about 240 new patients a year, but the need is far greater.
“We need a lot more. Monya is a person in New Haven. We have 900 people returning home every year, 80% of whom probably have a chronic health condition, as far as we can tell,” she said.
Community health workers can work in a variety of organizations, including federally qualified health centers, hospitals, community organizations, and foundations, often serving as connectors between health care systems and underserved communities.
And building trust between the medical system and the people it has historically ignored is no small feat, said Lisa Puglisi, physician and director of Transitions in Connecticut.
“To help build that trust is a full-time effort. It’s hard work,” Puglisi said. “And that’s a lot of what CSA helps us do.”
Women of color are the backbone of the workforce. According to a survey, 85% of community health workers in Connecticut identify as female. Forty-four percent and 27% identify as Latino and Black, respectively.
At Transitions, Sanders helps people with traditional medical needs like refilling prescriptions, scheduling doctor visits and arranging transportation to the clinic. She actively participates in appointments, serving as a spokesperson and making sure the doctor understands a person’s needs. There is even a patient who refuses to be vaccinated without Sanders by her side.
But she also supports people in all the ways they seek to rebuild the foundations of their broader health and well-being, which often starts with getting them ID cards and connecting them to pantries, job opportunities and housing.
“Sometimes primary care is at the bottom of the list,” Sanders said. “And I understand because if (someone) has nowhere to stay, how is she going to get to the doctor?”
At Transitions, Sanders is especially passionate about working with the women who come through the clinic’s doors. She runs a weekly support group where women can get together to hang out over pizza and snacks.
The meetings start with everyone sharing “why they are happy” and “why they are sad” – a highlight and a weak moment from the past week. The conversation touches on a lot of serious topics, like preparing for pending court dates or parenting under DCF mandates, but often bursts into laughter.
“These women are amazing,” Sanders said. “I love them so much.”
One week, a regular attendee walked in with a black eye and bruises from an abusive partner. Everyone in the room offered her hugs and words of solidarity. Sanders encouraged her to see a doctor at the clinic, then immediately got to work finding her a safe place to stay.
With help from Sanders, the woman contacted 211, the state’s hotline for essential services and crisis response. She managed to get in touch with someone, but after a few days they still hadn’t found her where to go. At the time, the woman’s attacker was harassing her, Sanders said, so she stepped in, calling 211 herself and asking to speak to the rep’s supervisor.
“I wasn’t taking no for an answer,” Sanders said. “It’s domestic violence. We’re trying to prevent one death.
Within hours, the supervisor found the woman a bed at a domestic violence shelter. Sanders, along with a colleague, traveled with her and helped her get settled.
Much research shows that community health workers improve patient outcomes. A California study showed that community health workers increased treatment acceptance by 79% among Latino adults with depression and diabetes or heart disease. Another in Florida showed they increased the likelihood of a follow-up appointment after an ER visit by 14% among a group of chronically ill older adults.
“You think about the chronic health condition, and there’s usually strong evidence for a community health worker,” Puglisi said. “And we are still failing to fund this very effective, evidence-based intervention.”
Medicaid reimbursement
The two bills proposing Medicaid reimbursement for community health workers passed the 14-7 Human Services Committee, with members voting along party lines.
Rep. Jay Case, R-Winsted, a prominent member of the Social Services Committee, said he did not vote against Senate Bill 991 due to particular concerns about the proposal itself, but more by fear that the measure will be included in two separate bills.
“You have a shot at the apple, and that was in Senate Bill 10,” he said.
Senate Bill 10 is currently in the appropriations and Senate Bill 991 is on the Senate calendar.
Fifteen states nationwide, including Massachusetts, offer Medicaid reimbursement for CHW services. In 10 other states, managed care organizations — health systems that treat the vast majority of Medicaid patients in many other states — reimburse for the services of CHWs or employ them directly.
Sen. Matt Lesser, D-Middletown, co-chair of the Social Services Committee, said the proposal theoretically allows Medicaid reimbursement for strictly medical services provided by CHWs, but also for navigating social services, such as finding a job. or ask for accommodation. Good.
“These would be allowed in theory but ultimately (it) depends on the implementation of DSS,” he confirmed in a text message. “Defenders hope (the) answer is yes.”
In the meantime, Sanders will continue his work in the community.
“It’s the little, little gestures that make you feel like someone really cares,” she explained.
She keeps spare shirts in her trunk in case someone needs clean clothes and texts “I’m thinking of you” when she knows someone is struggling. Although she has a work phone, she also gives the women in the weekly group her personal number, so they know they can reach her day or night.
“It’s just to be (a) support. And not just on their good days, but on their bad days, their days of frustration, their days of wanting to give up,” Sanders said. “It’s who I am. That’s what I want to do.
