Table 2.

Examples of Patient Navigation and/or Community Health Worker Activities in Action Plans

PN/CHW activity or area	Action plan examples
Addressing barriers	[To reduce the need for palliative care patients to travel long distances], the Cancer Program [will] pilot…our long-distance palliative care appointment system. The oncologist will work with community health workers [who will be at the patient's home and] order necessary tests, [talk] with family members about daily care, and respond to the cares and concerns of the patient.
	Utilizing the promotora model, staff provides education on the importance of breast and cervical cancer screenings throughout the community and help women in underserved populations access free or low-cost services…Patient navigators helped women access screening programs by helping them complete necessary paperwork, finding transportation to screening appointments (including carpools), and providing translation services when needed. They also provided reminder phone calls to women with screening appointments…and provided culturally sensitive breast health education and navigation services.
Cultural competence	This activity is focused on outreach implemented by the Cancer Program Outreach Worker to [name of community] women through Circle Of Life: American Cancer Society's Cancer Education Program developed specifically for American Indians…The Circle of Life program provides education and program promotion materials that are culturally appropriated for the service population…The new program is web-based and has the capacity to make it culturally specific to an individual tribal community through artwork and other graphic images and Tribal Health Services information.
	Increase the number of Community Health Workers trained in end-of-life issues. The end-of-life training is intended to increase the skills of community health workers and allied health workers to discuss advance care planning, hospice care, palliative care, and other end-of-life issues with their clients. A culturally sensitive end-of-life training curriculum has been developed, and we are communicating with our community partner about hosting at least one training before [the end of the funding period].
Disparities	Conducting targeted outreach to increase the rate of mammography screening among groups that experience high mortality rates from breast cancer will ensure screenings are provided to those who are disproportionately impacted by the disease…[We will] conduct “Cancer in Your Community” training for community health workers and allied health workers on cancer early detection…Through lecture and interactive teaching strategies, participants learn about cancer and cancer screening, develop skills to teach others about cancer and screening, and learn about cancer resources in their communities.
	[The Health Department] contracted with four local communities already implementing chronic disease prevention through policy and systems change to integrate primary cancer prevention into their current efforts…grantees are in four, low-income, diverse cities in [our area]…all four grantees incorporated information about the link between obesity and cancer into their training for Community Health Workers (CHW), patient navigators, and Volunteer Health Advisors (VHA). [The Health Department also] funds 3 community-based organizations in high-need areas of the state to provide education, patient navigation and linkages to clinical and social support services with the goal of decreasing colorectal, breast, and cervical cancer screening disparities.
PSE	Increase the percent of subject matter expert staff time designated for implementation of PSE efforts in survivorship for tribal health systems improvement…In addition to PSE involving an increased role for village Behavioral Health Aides in caring for cancer survivors, the Cancer Program has also been involved with a statewide effort to increase the presence of patient navigators in facilities and as champions in communities.
	Increase the number of funding models proposed to PN/CHW Collaborative…To that end [the health department] co-sponsored a Patient Navigation and Community Health Work Sustainability Summit….The intent of this gathering was to engage in critical dialog with key stakeholders, health systems representatives, and policy-makers. Participants evaluated successful [state] and national models and developed recommendations for [the state's] sustainable model for patient navigators and community health workers…Based on analysis, develop and share a funding model proposal with the CHW/PN Collaborative.
Workforce	Training: Increase the number of Community Health Workers (CHWs) trained in standard core competencies to increase use of clinical screenings and link community clinical preventive services. Support development of a statewide system to train CHWs in core competences.
	Building capacity: Increase the number of patient navigation systems…to improve quality of life among cancer survivors…hire and train a part-time HOPE cancer navigator to staff the HOPE Center Resource Room…The HOPE cancer navigator will be available to assist anyone affected by cancer, including family and caregivers.

CHW, community health worker; PN, patient navigation; PSE, policy, systems, and environmental change.