Partners in Integration: Addressing Need by Supporting NYC Workers

In today’s evolving healthcare system, there is a growing need for an integrated healthcare workforce to better address the needs of patients with complex and interrelated medical and behavioral health conditions. However, workforce development supporting skills enhancement around integrated practice are imperative to meaningful collaboration across systems. The home health care workforce in New York City provides essential services, and is in need of additional training and certification in order to meet the demands of a changing system. According to District Council 1707 (DC 1707), there are currently thousands of employed home attendants in New York City who are at risk of losing their jobs or not being able to secure new employment with home health care agencies unless they receive 35 hours of additional training to become certified as Home Health Aides (HHAs). Training opportunities that fail to meet workers’ personal and professional demands puts them at risk of job loss. This would significantly impact the quality and availability of services to individuals with chronic health and behavioral health conditions. To address this need within the New York City healthcare workforce, ICL has recently secured funding from the New York State Departments of Health and Labor as part of the Healthcare Workforce Retraining Initiative to work with DC 1707 and the City University of New York (CUNY) to provide the 35-hour Home Health Aide (HHA) upgrade training to 500 or more DC 1707 members currently working as Home Attendants (HAs).

Through collaboration with CUNY’s continuing education and workforce programs department and Lehman College, ICL will incorporate its expertise on Trauma Informed Care to develop a trauma-infused framework into the 35-hour course. A Curriculum Committee consisting of representatives from CUNY, DC 1707, and ICL will be established to address this focus and to add an optional enrichment section that provides basic training on racial, ethnic and culturally-based health disparities, as well as simple but effective tools for helping patients self-manage chronic disorders such as diabetes. Finally, we will work with CUNY to embed a trauma-informed framework into the existing curriculum – reflecting ICL’s leadership and expertise in Trauma Informed Care. We have made a steadfast commitment to the implementation of Trauma-Informed Care in all of our programs. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional approaches to care may ignore, so that these services and programs can be more supportive and avoid re-traumatization. Further, trauma has a profound impact on overall health outcomes and health-related behaviors, and enhancing the existing curriculum will provide prospective HHAs an opportunity to take a more holistic approach to their work. Though the curriculum for HHA upgrade is standardized, CUNY instructors will be encouraged to emphasize how trauma impacts health. By informing Instructors to address a trauma lens to care, HHA’s will better grasp how to provide sensitive care that addresses the whole person’s past and present experiences.

Each year, there are approximately 240,000 registrations in CUNY’s Adult and Continuing Education (ACE) programs, which are an important focus of workforce development activity at CUNY. ACE programs encompass literacy, GED preparation, English for Speakers of Other Languages (ESOL), and a large number of short-term training programs in areas such as health care, technology, business and office administration, buildings and construction, education and others.

District Council 1707 organizes New York City workers, and is a bargaining agent for NYC home attendants in need of the HHA upgrade training. ICL, through its own direct support personnel, has a growing relationship with DC 1707. DC 1707 will work collaboratively with ICL and CUNY to identify members who need and want the upgrade training, assist members in enrollment preparation, and facilitate enrollment at CUNY. The Healthcare Workforce Retraining Initiative grant has allowed this partnership to be established.

Through this collaboration, ICL, CUNY and DC 1707 will work to enhance the New York City healthcare workforce and ensure that a sizable group of individuals can continue working in a field where there is a great need for committed, caring individuals. In addition, the incorporation of an integrated, trauma-informed framework into the current curriculum will support the meaningful acknowledgement of the inextricable link between physical and mental health, and the importance of integrating this framework into all health care settings. Further, research continually highlights the detrimental impact of trauma on mental health and on many health-related behaviors. This is in line with the tenets of the Affordable Care Act (ACA), which stresses the importance of increasing provider competency in the provision of integrated care. Integrated care “enhances usual care and decision-making for people with medical and behavioral health conditions and is a critical factor in quality, patient experience, and cost” (Croft and Parish, 2012). The elements of the ACA that may lead to greater integration between provider systems “are organized into three domains: increasing access, financing and reimbursement changes, and infrastructure enhancements (Croft and Parish, 2012). This project seeks to support infrastructure enhancements through workforce development. Indeed, building a knowledgeable workforce that is attuned to the value of integrated care will help build bridges across providers. Through the addition of an integrated and Trauma Informed Care component to the existing curriculum, prospective HHAs will be positioned to provide high-quality, person-centered, integrated care to New Yorkers in need of these essential services.

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