Women’s Health Leadership Institute (WHLI)
***Community Health Worker (CHW) Workshop Application***
OVERVIEW
What is the Women’s Health Leadership Institute (WHLI)?
The WHLI is a new three-year national initiative of the Department of Health and Human Services Office on Women’s Health (DHHS-OWH). The purpose of the WHLI is to train and support experienced Community Health Workers (CHWs) across the country in leadership development to enhance their capacity to influence change in their communities to address women’s health disparities.
What is the Theoretical Framework of the WHLI?
The WHLI curriculum is based on the Paolo Freire educational methodology. It embraces education as a participatory process that encourages reflection and interaction in order to apply personal and collective experience to problem solving and social change. Unlike most CHW curricula, the WHLI curriculum builds on the natural leadership experience of seasoned CHWs to maximize their effectiveness as community change agents. The Institute draws on the collective knowledge and experience of participants in a dynamic way that is adaptable for culturally diverse communities.
What is in the WHLI curriculum?
The WHLI curriculum consists of five modules:
I.Systemic Thinking: Participants will be able to recognize the interrelatedness and complexity of a society where change is needed.
II.Challenging the Process and Mastering Change: Participants will be able to use their reflection, critical analysis and creative thinking skills to contribute to change.
III.Shared Vision and Collective Action: Participants will be able to involve and organize groups to build a shared vision through collective action.
IV.Strengthening Collective Capacity for Action: Participants will be able to engage in an analytical planning process to undertake advocacy that generates action.
V.Values and Culture - Encouraging the Heart: Participants will be able to implement strategies that identify, build and strengthen personal commitment to social change.
When and where will the WHLI CHW Workshop be held?
There are two opportunities to attend the workshop in Michigan:
July 26-27, 2012
Grand Rapids, MI
September 13-14, 2012
Detroit, MI
The workshop will be held from 8:00 AM – 5:00 PM each day, and applicants must attend both days of the workshop.
How much will it cost to attend the WHLI CHW Workshop?
The workshop and resource materials are free. A light breakfast and lunch will be provided for each day of the workshop; however, travel, lodging, and other meals will be the responsibility of the participants.
What will be expected of applicants for the WHLI CHW Workshop?
All participants must complete both days of the WHLI CHW Workshop and participate actively in all sessions and activities to receive the Certificate of Completion.
How do I apply to be a participant in the WHLI CHW Workshop?
Interested individuals must submit a completed CommunityHealth Worker (CHW) Workshop Application no later than July 2, 2012. Please email or mail the application to:
Anne Lee
Migrant Health Promotion
2111 Golfside Drive, Ste. 2B
Ypsilanti, MI 48197
If you have any questions regarding this application, please contactAnne Lee at800-461-8394, Ext. 1021 .
Note to Applicant: The term Community Health Worker (CHW) includes other terms, such as: Community Health Representative, Lay Health Worker, Patient Navigator, Promotor(a), Doula, Outreach Worker, Peer Counselor, Peer Leader and Community Health Advocate.
Workshop Preference1. Which workshop location/dates would you like to attend?
Grand Rapids, MI (July 26-27, 2012)
Detroit, MI (September 13-14, 2012)
2. If your preferred workshop location/date is filled, are you willing and able to attend the other workshop location/date? Yes ____ No____
Personal Information
3. Name: Last: First: Middle:
4. Address:
City: State: Zip Code:
5. Home Phone: ( )
6. Cell Phone: ( )
7. Work Phone: ( ) Ext:
8. Email Address:
9. Race/Ethnicity (Check all that apply): American Indian / Alaska Native Asian / Pacific Islander
Black / African American
Hispanic / Latino(a)
Non Hispanic White
Other (please specify):
10. What cultural group do you most identify with?
11. Highest level of education completed: Less than High School
High School or Equivalent
Some College
College Degree
Graduate Degree
Other (please specify):
Language Information
12. Can you speak, read, and write English? Yes ____ No____
Organization/Agency Information
13. Organization Name:
14. Address:
City: State: Zip Code:
15. Job title or position:
16. How many hours a week do you work at the agency? Paid Hours: _____ Volunteer Hours: _____
17. How long have you worked for this agency?
18. Approximately how many Community Health Workers work in your agency?
19. Which best describes the organization you work for? (Choose one - your primary worksite)
Community-Based Organization
Community Health Center
Other type of clinic
Hospital
Indian Health Service
Tribal Health Department
Local or County Health Department
Other (please specify):
CHW Occupational Information
20. CHWs get their skills and education in many ways.Which of the following best describes your experiences? (Check all that apply)
I have received on-the-job CHW training
I have “shadowed” a CHW
I have been mentored by another CHW
I have attended a conference for CHWs
I have taken a CHW class offered at a community college
I have completed a CHW Certificate Program
I have taken leadership training
I have taken advocacy training
I have obtained skills/education in other ways (please specify):
CHW Occupational Information (continued)
21. In which settings do you mostly work or do outreach? (Check all that apply)
Homes
Neighborhood/ Community-based
Migrant Labor Camps
Religious Organizations / Churches
Schools
Community Centers
Shelters
Clinics / Hospitals
Worksites
Other (please specify):
22. Please check the top three health issues that you work on:
Accessing Health Services
Adolescent Health
Alcohol / Substance / Tobacco Use
Asthma
Behavioral or Mental Health
Chronic Disease (Diabetes, Cancer, High Blood Pressure, Cardiovascular Disease)
Communicable disease other than HIV / AIDS
Dental Health
Elder Health
Environmental Health
HIV / AIDS
Injury Prevention
Maternal and Child Health
Occupational Health
Prevention (Nutrition and/or Physical Activity)
Women’s Health
Other (please specify):
23. Please check the primary activities you do in your work as a Community Health Worker (Check all that apply):
Provide social/ personal support
Provide culturally appropriate health education and information
Advocate for individuals and communities
Assist people to get the servicesthey need
Provide direct services, such as glucosescreening or insurance enrollment
Provide skill-building workshops
Act as a cultural bridge between individuals/ communities and the health and human services they receive
Other (please specify):
CHW Occupational Information (continued)
24. What is (are) the primary languages(s) of the people you serve?
25. How would you describe the populations that you primarily serve? (Check all that apply)
Ethnicity
Black / African American
American Indian / Alaska Native
Hispanic / Latino(a)
Non Hispanic White
Asian / Pacific Islander
Locale
Rural
Urban
Suburban
Income
Low Income
Middle Income
Upper Income
Gender
Women
Men
Age
Adults
Adolescents
Children
Migration
Non-immigrants
Immigrants
Refugees
Other (please specify):
Additional Questions
26. How many years have you served as a Community Health Worker?
27. Why are you interested in participating in the Women’s Health Leadership Institute?
Applicant Statement of Commitment
Please read and sign the following:
I understand that the WHLI may select only a specific number of participants. If I am selected, I will complete the following items:
- I will attend the two-day CHW Workshop.
- I will participate actively in the CHW Workshop, including all sessions and subsequent activities that are required. I understand that I must attend all sessions in order to receive a Certificate of Completion.
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Funding for contract #HHSP233201100049A has been provided by the DHHS Office on Women’s Health