A Community Bridge
Sylvia Guilliam furiously takes notes as photographs of babies, families and pregnant women flash in front of her. The images are part of a PowerPoint presentation by Michelle Catalano, director of library services for the health sciences at the University of Houston.
Catalano asks the group of about 10, which includes Guilliam, if the photos are accurate portrayals of health situations that could be used in marketing materials.
At first, Guilliam thinks the photo of a thin woman in exercise clothing, stretching on the ground, would be a good image to convey “exercising while pregnant.” But when she sees the second photo of a woman with a defined baby bump, she changes her mind.
“You can definitely tell that second woman is pregnant,” she said.
Guilliam is halfway through a 14-week Community Health Worker Training and Certification Program conducted by the University of Houston Honors College. So far, she and her neighbors at Cuney Homes, where classes are held, have learned how to spot possible allergens in a home, how to identify health care needs, what community health workers do, and where jobs for health workers are available.
Community health workers often live in the neighborhoods they serve. They help disseminate health care information, motivate patients to manage chronic health issues and connect patients to available resources. Cuney Homes, in Houston’s Third Ward near Texas Southern University, is the city’s oldest public housing complex.
Opened by the Houston Housing Authority in 1938, the complex has undergone extensive renovation and holds more than 500 apartments for residents who, as Guilliam puts it, “have a lot of stressors in their life.”
That includes her. She said at times she felt powerless when dealing with the health care system, especially during the loss of her mother at an early age due to heart problems. Guilliam also lost her husband. Four years ago, she decided to seek advice from people who could help her sort through those feelings, even studying with a Buddhist monk.
“I wanted to connect with my internal health and address the anxiety of losing my mom and husband,” Guilliam said.
When she moved to Cuney Homes two years ago, she could sense that same feeling of powerlessness in her neighbors, who were fighting anxiety and financial pressures, as well. Having found her own inner peace, Guilliam wanted to share that with the people around her. She started to work with the YMCA, integrating health education with programs that teach science, technology, engineering and mathematics (STEM) to children.
“Bringing awareness to health in a STEM way allows the kids to get that hands-on training about their health early on,” she said.
And then she joined the Community Health Worker Training and Certification Program.
This is the first year of the UH program, launched by Dan Price, Ph.D., who directs a number of interdisciplinary projects on community health and data at UH Honors College; and Erica Fletcher, Ph.D., a visiting scholar at the Honors College and program director for honors in community health. They believe the program can help change the way health care is perceived, by reducing cultural and socioeconomic obstacles and becoming a bridge between doctors and patients. UH students and residents of the community take the classes side-by-side.
“The health care system is too topdown, which is why some programs have done so poorly,” Price explained. “People don’t feel ownership. When you have a project-based program, like this one, there is collaborative learning from the end users, so people feel engaged and are able to find the information they need.”
Training to be a community health worker takes 160 hours. There is flexibility for those who need to work other jobs, be caregivers to family, or fit the training into their UH class schedule. UH students don’t receive course credit for completing the program, but they do receive community health certifications from the state.
Nour Haikal, a freshman pre-law student, says the certification will help her continue her work with Syrian refugees in Houston. A Syrian-American, Haikal acts as an advocate for the families already here, helping them navigate the complex web of Houston’s health care system.
“There are a lot of mental health issues as a result of them coming from a war-torn country,” Haikal said. “The things they tell you about their struggle to cross the border are heartbreaking. I want to help them figure out the resources that can help them.”
In some cases, community health workers can pick up the slack where a clinic or school nurse leaves off. For example, a community health worker could go to the home of a child with asthma to determine if the asthma is triggered by something in the home.
Communication between the different groups involved in the program has had its challenges. Not everyone in the class has ready access to a computer or the Internet, and not everyone is digitally literate. As a result, homework assignments had to be coordinated differently so that everyone could participate, and UH students were paired with residents who needed help, Fletcher said. In addition, schedules had to be tweaked so participants had time for classes, jobs and caring for children.
“Ultimately, the groups figured out how to use their strengths to work together on projects,” Fletcher said.
The classes at Cuney Homes are part of a bigger program at The University of Texas Health Science Center at Houston (UTHealth) School of Public Health’s Texas Public Health Training Center. Other Texas Medical Center institutions—including Harris Health System, Houston Community College, Texas Southern University and Texas A&M University Health Science Center—have similar programs.
UTHealth started these community efforts nearly 20 years ago to help keep people out of emergency rooms and educate them about preventative care, said Rosalia Guerrero-Luera, program manager for the Community Health Worker Training Program at UTHealth School of Public Health.
“We found the best way to do that is through a peer who can build a bridge between them and the health care system,” she said. “We call them ‘friends with benefits’ because they have empathy for the person they are working with. They’ve been in their shoes—they take the bus, they get the kids to school, they may not have the best type of insurance, but they help them know there is a place for them. They don’t have to do this alone.”
Guilliam is looking forward to getting her certification from the UH program.
“This gives us an outlet to give direction to people, so they can do things like get to the store and know which food to buy to be healthy, or deal with the stressors in their life so they can grow.”