Advocating for Community Health and Well-being in Seattle

Today I visited my first American Community Health Centre. The International Community Health Services (ICHS) is a non-profit community health centre that offers affordable health care services to Seattle and King County's Asian, Native Hawaiian, and Pacific Islander communities, as well as other communities in need. ICHS delivers and advocates for health interventions that are comprehensive and culturally competent, empowering community members to improve their health and well-being.

Sounded the kind of place I needed to learn more about….

Over the past 35 years, ICHS has grown from a small storefront clinic in Seattle’s International District into the largest Asian, Native Hawaiian, and Pacific Islander community health centre in Washington State. It offers a full range of primary medical and dental care, preventive health education services, as well as Chinese Traditional Medicine.  ICHS charges patients a fee based on their family size and household income. Those without insurance are helped to identify if they qualify for any free or low-cost insurance programs.

ICHS has 7 Community Advocates who act as para-professional health educators, teaching ICHS patients and other community members about a variety of health issues, such as cancer screening and diabetes. They represent ICHS at community events, sharing their knowledge of ICHS services with prospective and current patients. They also provide interpretation and translation for ICHS. Community Advocates are paid staff members of the ICHS. Each community advocate works with a different community (Chinese, Filipino, Korean, Mien, Pacific Islander and Vietnamese).  

The role of Community Advocates is to:

·         Link patients and community members to appropriate resources

·         Advocate for patient / community needs

·         Provide basic health education and support

·         Identify patient needs

·         Provide follow up and guidance to patients

·         Empower patients to advocate for their own health

·         Know when to refer patients and where to

I met with one of the ICHS Community Advocates, Irene Chen, who works with the Chinese community. Irene (also known as 'the lady with purple hair' as some of her clients have trouble pronouncing her name!) came to Seattle in 1963 from Hong Kong and has worked as a community advocate for the past 16 years.



Community Advocate, Irene Chen (2nd from right)
and CISC Colleagues at the Advocacy Info Stand.



We met at the Chinese Information Service Center (CISC) in the International District of Seattle where Irene runs a drop in session every week to provide advocacy support to people new to the city from China or Vietnam.  Irene explained, “when people arrive in the city...they often have no health insurance, no job, no income”. Irene’s role is to help people identify what they need, provide support and refer them onto to relevant agencies.

Irene is employed for 30 hours a week – but in reality, she says she is on call 24/7, “people recognise me and approach me in restaurants and when I’m out and about…you can’t tell people to go away because you’re busy…my phone is always ringing”. Irene also does a lots of translation support work, as many of the people she works with do not have English as a first language. She provides an essential bridge between communities and services and enables people to make choices.

In addition to the drop in at the CISC, Irene also runs a diabetes training course– a 6 week programme based loosely on the Stanford model – and also has a role in encouraging the uptake of cancer screening (breast and cervical) by recruiting and enrolling people onto screening programmes.

Whilst at CISC (after being force fed home made green tea jelly by Irene!) I also met Andes Kong who co-ordinates the Sunshine Garden Seniors Day Care Center. The Sunshine Center opened in 1987 and runs a wide variety of activities for seniors living in the community. Their impressive calendar of events included Tai Chi, fall prevention exercises, a singing group, meditation, game playing…and of course – that old favourite - bingo! The Sunshine Centre also provide health checks and information – whilst I was there, a group of people were waiting to have their blood pressure checked, they also have health professionals come and do talks on different health topics on a regular basis.

But it’s not just about bringing in expertise from outside, the group members themselves also contribute to the activities. Andes told me how the seniors within the group share their skills with each other - so someone might do a cookery demonstration, or show people how to do a new craft or art technique. It’s a way of people sharing their skills and knowledge (their assets), encouraging participation and enabling others to learn something new.

Later in the day, I had a useful discussion with Abbie Zahler and Michael McKee at the ICHS who manage the Community Advocates scheme. They explained the origins of the Community Advocates and how they were initially the ‘visible presence’ of the ICHS in the community. The role has developed into more of a health education role over the years as the skills of the advocates developed and different funding streams became available (e.g. funding to increase cancer screening or hep B testing) and the ICHS saw a role for the Advocates in achieving these outcomes. The Community Advocate role also developed out of recognition of the numerous barriers to accessing the US health care system for new arrivals.
Community Advocates have received training on a range of different health issues to enable them to respond to the wide range of queries and requests they receive (e.g. diabetes, cancer screening, smoking, Hepatitis B).



Exchanging materials & ideas about
 Community Health Advocacy
 with Abbie and Michael at ICHS, Seattle.

I asked about the criteria for recruiting and selecting Community Advocates. Michael explained how they key qualities they needed were to be:

 i) bi-lingual

ii) bi—cultural

iii) a trusted leader in their communities.

Abbie explained how a ‘cookie cutter’ approach to selecting Community Advocates is not appropriate as the needs of different communities vary so much.



Other key skills Community Advocates have include:

·        Networking with patients and community members

·         Health disparities

·         Effective patient education

·        Motivational interviewing / self-management

·         Public speaking / group facilitation

·         Health education

·         Building community leadership

·         Multitasking

·         Computer skills

·         Immigrant laws and benefits

Some of which sounds familiar hey…?

Read more about ICHS Community Advocates and view a short film here.