Balancing the Push and the Pull: NYC Community

Transcript:Balancing the Push and the Pull: NYC Community:
Balancing the Push and the Pull: NYC Community Health Workers’ Lived Experience on the Interdisciplinary HIV team Lori Hurley, PhD Fordham University Graduate School of Social Service NACHW Conference Chronic Disparities in HIV Prevention/Care Black/African American= 13% of the US population; 42% new HIV diagnoses Black, Latinx, Indigenous more likely to be uninsured Retention in care disparities non-Hispanic Blacks/African Americans MSM and IDUs Individuals born outside of the United States. U.S. Department of Health and Human Services. 2021. HIV National Strategic Plan for the United States: A Roadmap to End the Epidemic 2021–2025. Washington, DC. Social and Structural Issues Impact HIV Prevention/Care Housing instability/Homelessness Lack of insurance Language barriers Inability to take time off from work Racism/Discrimination Lack of trust in health care providers Culturally Congruent CHWs on HIV Team Shared power gradient facilitates trust building Evidence of Role Conflict issues Power dynamics may influence CHW voice within the team More than “physician extenders” ? CHWs on HIV Medical Team Tackle Disparities in HIV Care & Social Determinants of Health Yet… How do CHWs experience teamwork with other disciplines? How effective do they feel in tackling SDOH? How did COVID-related events of 2020 impact CHW role? Individual interviews: 10 NYC HIV CHWs How well do CHWs believe they are integrated onto interdisciplinary team? What do CHWs perceive as barriers/facilitators of team integration? How do CHWs balance role conflicts? Do CHWs experience their contributions as influencing team decisions? How do CHWs understand their role in addressing social determinants of health? Themes Inspired by Mutual Reliance Vulnerable to Disappointment Documentation demands distort PT. focus Communication Failures Grounded by Strong Supervision Deep Pt. Understanding → Voice Inspired by Mutual Reliance “We have a great balance, and we have overcome a lot. Our team, we need each other so much.” “I felt better leaving that room, as well, so I really thanked my supervisor and the program manager. They all contributed very well. And I was happy that day.” Communication Failures “I try to advocate for them during the session when I do go with them, but what about the times that I don't go with them? They don't get the services that they feel they need, because there's lack of communication.” Communication Failures “It was kind of sad for the frontline, because we can only do so much. We are asking for help and [the medical provider] is really not giving us the