Missoula's Community Health Workers

In 2021, the Centers for Disease Control awarded a $1.8 million grant to Partnership Health Center to set up a community health worker program in partnership with Missoula Public Health and All Nations Health Center. Since then, this team of seven has helped more than 500 clients. But what exactly does a community health worker do?

This week, the Missoula County Commissioners spoke with Eileen Lamble, a community health worker, and McKenzie Javorka, program evaluator from the University of Montana, about how this program helps marginalized individuals re-connect to healthcare services. 

Links mentioned in this episode:

• Community Health Worker StoryMap
• Training program at the University of Montana

Thank you to Missoula's Community Media Resource for podcast recording support!

Transcript

Josh Slotnick: [00:00:10] Welcome back to the agenda with the Missoula County Commissioners. I'm Josh Slotnick and I'm here with my fellow commissioners and friends, Dave Strohmaier and Juanita Vero. And today we have two, not just one, but two special guests. We're joined by two members of the Community Health Worker program. Could you guys introduce yourselves?

Eileen Lamble: [00:00:27] Sure. My name is Eileen. I'm a community health worker and I work at Partnership Health Center and.

McKenzie Javorka: [00:00:32] My name is McKenzie Javorka. I am a researcher and program evaluator at the University of Montana at the Rural Institute for Inclusive Communities, and I am a external program evaluator for the Community Health Worker program. And we can get into what that means a little bit later on, or I can do it now.

Dave Strohmaier: [00:00:50] Launch right now.

Juanita Vero: [00:00:51] No time like the present.

Josh Slotnick: [00:00:53] Absolutely.

Juanita Vero: [00:00:53] What is a community health worker?

Eileen Lamble: [00:00:55] So, like everyone in health care, we're trying to improve health outcomes. But how do we do that? As we might know, health care is more than just in the doctor's office. And there's a lot that goes into your health outcomes that's outside of that physical office. But people do fall through gaps outside of their medical appointments, and that's where a chw comes in to fill in the gaps. So to paint a picture for you picture someone Someone went to partnership and then got a referral to an outside clinic, maybe a PT, maybe some other referral. And to get from point A to point B, there are a lot of steps in between there. You need to have a phone to be able to call to set up that appointment. You need to have transportation to get yourself there. You need to have insurance to be able to pay for that appointment. And maybe you have all those things, but you actually don't have childcare. And so you can't go to that appointment because who's going to be home with your kids? Or maybe you can't focus on that appointment because you don't have food in the house, actually. And so that's where a community health worker comes in. We're not clinicians, we're not nurses. We're outside of the clinic. But I can help you make that phone call to that appointment. I can help you learn how to ride the bus to get to that appointment. I can make sure you're enrolled in Medicaid. I can connect you to childcare resources.

Dave Strohmaier: [00:01:55] So is this a pretty common thing? And what sort of health care settings are there? Community health workers?

Eileen Lamble: [00:02:01] Community health workers are not a new concept. They're very common across the globe. And they're kind of just making the resurgence here in the United States kind of post Covid, actually. And Missoula, we have community health workers at Partnership Health Center, at Missoula Public Health, and at All Nations Health Center. Those are all housed under one grant. And there's also a community health worker at Providence under a different funding source.

Juanita Vero: [00:02:21] So as a patient like how do you know how to access one? How do you even know yourself as a, as a patient that there is help out there? You're worthy of getting that help.

Eileen Lamble: [00:02:29] I would argue almost everybody has a community health worker in your life, your partner, your friend, your family member. They often act like a community health worker. They help get you from point A to point B, but not everyone actually has that. And so if you're in your appointment with your provider and you keep no showing this follow up appointment, it's not that you don't care about that, it's that there's barriers to getting you there. And so that's when the provider will reach out to me and say, hi, can you talk to this patient? I will introduce myself. And how community health workers are different from social workers is we actually have lived experience addressing some of these barriers. These barriers are called social determinants of health kind of the academic word, but just barriers to health care. And so why do I know how to access Medicaid, how to access Snap because I was a recipient of those. How do we have community health workers who know how to navigate the health system with English as a second language? We have community health workers with that lived experience, so that's how we can really create that connection.

Josh Slotnick: [00:03:16] Wow. So what is a third party evaluator do?

McKenzie Javorka: [00:03:19] Yes. So that is a great question. So myself and my colleague Doctor Kaitlin Fertaly, who's also at the Rural Institute, were brought on as external evaluators for this grant program when it was funded by the CDC back in I think fall of 2021 is when it officially started. And the role of an external program evaluator is really to use, you know, rigorous research methods, but apply them to a local specific program to learn about what's working and how it's working, and to essentially kind of do that check of, well, we think that community health workers are great. We've seen them as a wonderful model across the country and across the world. But will they work here in Missoula and in what ways do they work? Who are they helping? That kind of thing.

Josh Slotnick: [00:04:07] So what are some of the metrics? What are the things you're measuring?

McKenzie Javorka: [00:04:09] Yeah, so we measure a lot of different things. Some of them were actually set by the CDC as kind of across the board. Any organization who received this particular grant funding had to report on certain metrics. So those look like the number of clients served by community health workers, the number of messages that are being delivered in the community about things like health information, health, education, because community health workers might work one on one with clients, but they also might attend community events and provide information on things like preventive screenings or other aspects of health and well-being. So those are a couple of the metrics. We also track things like the demographics of the clients that community health workers are working with to make sure that they are working with who they set out to at the beginning of the grant.

Dave Strohmaier: [00:05:00] So is this time limited sort of evaluation, or is it ongoing? As long as there will be community health workers in Missoula?

McKenzie Javorka: [00:05:10] So for now, the evaluation is time limited to the grant period from the CDC, which was a three year grant period that will probably extend for about another year. And so right now we are just doing the evaluation for that portion. And then, you know, hopefully we have laid some of the groundwork for the community health workers themselves, their supervisors and the three organizations that partnered on this grant to track outcomes and some of those metrics on an ongoing basis. But really, this evaluation was kind of focused on this is going they knew that this was going to be a brand new program in the Missoula area. And so they wanted to really understand the impact that community health workers were having, as well as some of the challenges to standing up a brand new program where we hadn't necessarily had these roles at these three organizations before.

Josh Slotnick: [00:06:03] So what did you learn so far?

McKenzie Javorka: [00:06:04] So we have learned some great things. We like to combine quantitative metrics and those performance measures that I talked about with collecting a lot of qualitative data, which is basically stories. So we've collected a lot of data that shows that, you know, community health workers, for example, have worked with over 500 unique clients since about fall of 2022. So they are hustling. I do not know how community health workers keep up their busy schedule, but they are really working with a lot of different clients. And this is, mind you, with only seven funded community health worker positions under this current grant. So across the seven of these community health workers, they have worked directly with over 500 clients. We've also learned a lot about the needs of those clients. So this is, you know, somewhat preliminary data. This isn't the final evaluation report, but of the clients that they've worked with so far, about half have been unhoused and about another 20% are worried about losing their housing. So we know that community health workers are working with some of Missoula's most marginalized populations.

Dave Strohmaier: [00:07:15] And with the unhoused. Would their point of entry to coming into contact with with you, Eileen, still be through their health care provider, in your case at PHC. Yes.

Eileen Lamble: [00:07:27] Most likely. We have a satellite clinic at the Poverello center, and we also have a clinic at the food bank. And so within those centers, that's where you can also find some folks who might need some extra support. And then when I meet people at the Poverello, for example, and I have my name badge on, sometimes people will just come up, hey, are you a nurse? Can you help me with this? Clarify? No, I'm not a medical provider. I'm not a nurse. But what can I help you with? And see if we can connect. And if I can't connect you? Maybe you're just looking for a doctor's appointment. You don't really need social supports. Great. I can do that too.

Juanita Vero: [00:07:52] So what's a successful interaction look like? Keep. Keep going. Great. Tell us a great story or a frustrating story.

Dave Strohmaier: [00:07:59] Yeah. Um. Names changed to protect. Yeah. Of course, of course.

Eileen Lamble: [00:08:02] I have an example of a patient who had a referral into physical therapy but kept no showing. And again, kind of that same example. You really wanted to do this. And when I actually got to meet the patient, he had two major barriers. He was actually afraid that the procedure would cost too much money. And so that was a major barrier. And he also didn't know where he was going and he didn't know how to work the bus. And so I was able to meet with him, enroll him in Medicaid, and then go with him on the bus to his appointment, go with him, not for him, so that he could do this on his own in the future. And then he was able to have that follow up appointment. And then the benefit of being within a health center is I was able to communicate that back to the care team and say, hey, this was the barrier. This was why he was missing these appointments and this is how we addressed it going forward.

Juanita Vero: [00:08:42] How often did you have to. How many kind of points of contact, if you will, or interactions did you have to have before he trusted you enough to say, okay, I trust you to show me how the bus system works, or I trust you enough that you're going to help walk me through.

Eileen Lamble: [00:08:55] Yeah, definitely multiple. I would say again, getting from point A to point B is not that easy. So there is probably five different interactions in there. Often a warm handoff with the provider. It's like, hi, I'm your provider. You trust me, I trust Eileen. How about you two have a conversation? And then how about I actually can meet you in your home? Because getting to partnership is kind of tricky. So how about I meet you in your home and then a I'm not actually free today. Can you come back later? No problem. I'll come back a different day. So a lot of a lot of back and forth. But that's how relationships kind of develop and that's how you gain that sort of trust.

Josh Slotnick: [00:09:25] Are there other specific tools or things you employ to build rapport with folks who have a sense of mistrust of people in systems?

Eileen Lamble: [00:09:33] Definitely. I think that's where the lived experience comes in. And I've kind of mentioned mine, and but we have community health workers of all different backgrounds. So we have peer support specialists in recovery. We have single parents, we have a refugee, we have indigenous folks. And so kind of knowing who to pair, where to kind of elevate that lived experience, to really leverage that, to build that connection. Maybe we see eye to eye on a lot of things we maybe didn't know about. Or maybe I say, hey, I know someone who really you two could get along. And that's what's great about having seven of us. Yeah.

Juanita Vero: [00:10:00] Tell us about, um, yeah. Explain the connection between. Or tell us what Blue Heron Place is or what we hope it to be. And and. Yeah, the connection there. Great.

Eileen Lamble: [00:10:09] Yeah. Blue Heron Place is currently open and opened in September. Its permanent supportive housing, a collaboration between MHA homeward and partnership staffs there during the MHA.

Juanita Vero: [00:10:18] Means.

Eileen Lamble: [00:10:18] Missoula Housing Authority. Thank you and partnership health center staff. During the day, the Poverello staffs at night and its 30 individual apartments that house formerly unhoused Missoula residents. And so I'm a community health worker there 20 hours a week. I'm there in the morning and provide the same services I do in the community to folks at Blue Heron. And so the privilege I've been able to have is really see some great successes of what addressing one of those barriers, that's one of those social determinants of health can do, because I've really seen an increased appointment retention. And that follow through leads to better health outcomes. If I know where you are every day, if I'm not walking every bridge, walking under everywhere to try to find you, we can way more likely get to this Missoula bone and joint appointment, for example. Address that and when you have that medical appointment taken care of, when you have that housing stress taken care of, you can really get broader. You can have bigger goals. Maybe my goal isn't just to make it to Missoula bone and joint. Maybe my goal is to actually increase my physical movement all the time. Maybe my goal is to enroll in some Missoula college classes. Maybe my goal is to learn how to cook better. And when you can address these smaller barriers, you can really zoom out and see the whole person, the whole health.

Dave Strohmaier: [00:11:23] So everything you're describing sounds fantastic. And also our listeners and probably us are recognizing this is currently being supported by grant funding. When we look at sustainability of this sort of offering for the community. Any thoughts? Are the services that you deliver Medicaid reimbursable or not? And if not, how might we need to start thinking right now for what the next chapter in community health worker activity in Missoula might look like?

Eileen Lamble: [00:11:56] So we are grant funded right now and some other states. Community health worker services are billable, but they're not currently billable in Montana. So one plug is for Medicaid expansion. We love it. We want to keep it. And then going on from there, we would love for community health workers to be billable in the future. Right now, we're kind of looking at different funding sources to maybe loop into some other already billable clinic services.

Juanita Vero: [00:12:19] What's a what's a percentage that's realistic to that? That would be billable or reimbursable, because if.

Dave Strohmaier: [00:12:25] State law or regulations were changed to allow that to happen in.

Juanita Vero: [00:12:29] Montana because 100% it's not reimbursed. So so great question.

Eileen Lamble: [00:12:33] That's a little out of my wheelhouse. I do not know.

Juanita Vero: [00:12:36] The gap is huge, I guess is what I'm getting at is that Medicaid never covers what it really costs for you to do your work. Yes.

Josh Slotnick: [00:12:43] So given that you guys are work with folks who have been living outside refugees, people who have been external to the mainstream health care system, have you learned things that would be of a surprise to people who don't have your experience, that are living entirely in the the mainstream system, where there's some stereotypes, I'm sure some uninformed beliefs about people who live on the margins.

McKenzie Javorka: [00:13:06] Absolutely.

Eileen Lamble: [00:13:06] I think one thing that would be surprising is the simplicity of asks I receive. No one is asking, hi, can you pay my rent for the next 30 years? That's not the ask. It's like, hey, can you help me make a phone call? Because I don't have a cell phone and I don't have income. And I've been waiting on Social Security to get back for me for a full year. Or. Hi, can you show me how to use the bus? I can't, I'm not literate and I can't read the bus map. This is very confusing to me. And so I think the surprise has been these these barriers, these gaps, they're not insurmountable. I can address them. If I only had way more of me. And there's so much other community support. It is not community health workers. We work in conjunction with community partners, with other people at our clinics all the time. It is not just me, but these asks are not insurmountable. They're just compounding.

Dave Strohmaier: [00:13:48] So a couple of the things that seem to be coming up in your comments are transportation and communication. Yes. Have you seen the opportunity to to make any more systemic changes related to, say, transportation? Because take the example you just gave, as far as the difficulty one might have in navigating our mountain line bus system, if you have difficulty reading the signage, is there an opportunity there or in other ways to to make broader changes that would not minimize the importance of the support that you're providing, but might kind of head it off at the pass a little if we made those other changes.

Eileen Lamble: [00:14:28] Mountain Line is awesome and they have awesome services. I think just having a pair to show you goes a really long way. And so as I mentioned, maybe you or I have that pair in our personal life, but some other folks don't. And so that's where I step in. But a lot of people in the community do have that pair. A lot of people, whether they have housing, whether they are financially stable, they have that pair.

Dave Strohmaier: [00:14:48] So relationships.

Eileen Lamble: [00:14:49] Relationships, it all comes back to relationships. I know that's too simplistic. I don't have a great policy answer for you.

Dave Strohmaier: [00:14:55] No, that's that's okay.

Josh Slotnick: [00:14:56] That's a good.

Dave Strohmaier: [00:14:57] That hits the heart of it.

Josh Slotnick: [00:14:58] So McKenzie, how are things different or similar in Missoula to other places where you said this sort of program exists not just in the United States, but other parts of the globe as well? How are we the same? How are we.

McKenzie Javorka: [00:15:09] Different? I think one of the really interesting things, and I actually coming into this, one of the great things about being a program evaluator is that we might work on a lot of different topic areas. We're kind of generalists rather than specialists. We have our tools, our research methodologies that we might use in a lot of different topics and areas. So coming into this evaluation, I actually was brand new to the work of community health workers, and that was something that I wasn't familiar with. So, you know, in my doing my due diligence of learning about what this program was going to be and what the role entailed, I, you know, did a lot of reading along with my colleagues at the Rural Institute about what this has looked like other places. And it really varies community to community. I think one of the really interesting things about this role is that in a lot of places, it was a very kind of grassroots development where people in the community saw a need to help address these barriers and gaps that Eileen has been talking about, and they just sort of stepped up and started doing it. It wasn't really a professionalized workforce at first. And community health workers are known by a lot of different names.

McKenzie Javorka: [00:16:21] They can be called community health representatives in things like the Indian Health Service. They can be known as promotoras in Spanish speaking communities. And so really, they have looked different in every kind of community that they've sprung up. And and I think one of the interesting things about this grant in particular, is the CDC was kind of looking around and saying, gosh, so many people following Covid have lost so many of their essential services, have lost their connection to health care. What can we do to, you know, help reconnect folks with those services that they need? And so they have funded, I don't know the exact number of grantees across the country, but a ton of different communities through this grant program to start community health worker programs. So they kind of took this grassroots initiative that, you know, a lot of different communities had going with community health worker programs and said, we're going to scale this up across the country. We're going to build up the community health worker workforce. So this is a little bit of a long winded answer to your question, but basically, it can look really different depending on what the community needs are. And one of the things in Missoula that we've seen as evaluators that kind of surprised us is that is has been really focused on some of those basic needs like housing, like food, like transportation.

McKenzie Javorka: [00:17:39] I mean, those are the top three referral categories for community health workers. So when community health workers are referring out to services or resources in the community, those have been the top three, you know, in other places that we've looked at, community health workers might be doing things like helping patients navigate their diabetes care or, you know, enrolling them into smoking cessation programs or things like that. And it's not that the community health workers never do those kinds of things, but it's sort of been a situation of first, we have to get you stabilized enough, enough Enough of those basic needs met so that you can attend these medical appointments so that you can think about things like smoking cessation or preventive services. So I think that's been a little bit interesting and kind of surprising for both us as evaluators and the the program supervisors at the different organizations is that the community health workers are doing a lot more of connecting to those, those basic social services and a little bit less on the kind of, you know, helping somebody manage their chronic condition over time kind of thing.

Dave Strohmaier: [00:18:47] McKenzie, this might be tough to answer, since what you're describing seems to be largely a function of as you look across other communities here in the United States, for instance, what you're describing is largely a function of the unique aspects of a community, so that not necessarily every community, health worker, program or community would be identical. But having said all of that, is there any generalities you can draw from if we're wanting to rightsize this program for Missoula? Mhm. Uh, and maybe this would also be a question for Eileen, just in terms of your experience, what might we want to be looking at into the future. Right. Uh, to, to make sure that our, our programing is matching what this community needs. 

Juanita Vero: [00:19:33] Besides housing, that's 70% of them,

McKenzie Javorka: [00:19:36] Right?

McKenzie Javorka: [00:19:36] Yeah. Yeah, I mean, there is that. Yeah.

Dave Strohmaier: [00:19:39] It sounds like you can structure the work of a community health worker in different ways such that some of what you're describing in terms of diabetes and, and other more traditionally, um, uh, public health sorts of tasks might currently fall within our public health department with someone else's responsibility.

McKenzie Javorka: [00:20:00] So exactly. Yeah, I think that's a really good question. Again, I think at a at a sort of community level or policy level, the more that our whole community can do to address those basic social determinants of health, like housing, like food availability, transportation, things like that. I think that goes a long way. And there are, as Eileen said, so many different organizations and people doing that work in Missoula. So as much as we have needs there, we also have a lot of wonderful folks working on that. I think that it it just is going to look a bit different in every community. And the the sort of thing that ties that together, which I think Eileen has done a good job of describing, is that community health workers have that lived experience navigating these complex systems. And so I think part of, you know, hopefully growing the community health worker workforce here in Missoula, if that becomes possible, you know, if we get some of these things like state Medicaid reimbursement for services or things like that is looking around and saying, okay, here's who we have represented right now among our community health workers. What populations are we maybe missing? Or, you know, what specific niches can a community health worker help to fill? And then providing, you know, those robust kind of training and professional development opportunities for community health workers, which we are starting to see a lot of cool initiatives around different statewide training curricula and that kind of thing.

Juanita Vero: [00:21:31] What's an example?

McKenzie Javorka: [00:21:32] So the I may not get all the details exactly right on this, but at the University of Montana, there's another center, the center for children, Families and Workforce Development, who received a grant, I believe, from HRSa. The Health Resources and Services Administration is a federal funder to develop a statewide community health worker training curriculum. And so they have developed that curriculum, and I believe they provide a stipend. I think Eileen has taken that training and so can maybe speak to it a little bit more, but just having that available at a state level so that across Montana, anyone who might be interested in becoming a community health worker can get kind of a standardized training that then hopefully down the road will can lead to things like certification and just generally professionalizing of the workforce.

Josh Slotnick: [00:22:24] So could definitely see how this program would really be of great benefit to specific people. How is it a benefit to the entirety of the community? Why is it in our best interest as a community to have this program?

McKenzie Javorka: [00:22:37] I'll start and then I'll pass it over to Eileen for her thoughts from my perspective. You know, in addition to kind of the one on one supports and services that community health workers are providing, community health workers also are just great health ambassadors in the community. And so, for example, at all Nations Health Center, they do a lot of health promotion events. And the community health workers there are actually part of their health promotion department. And so they'll do things like this Spring Wellness Fair, which is a really wonderful event that all Nations puts on in the spring. That's kind of a one stop shop for preventive services of all different kinds. So folks who attend the wellness fair can get, you know, preventive screenings right there. They can set up primary care. If they don't have that, they can learn about things like, oh, gosh, last year, I think they had things on, oh, sleep hygiene, you know, a really broad array of services. That and it's usually, I believe, held on the, um, campus. And so clients can come and kind of get all those services in one day. And the community health workers who work at all nations were instrumental to putting on a big event like that. So helping, you know, register clients doing a lot of outreach and setup and logistics for that event. So, you know, things like that are examples of events that the whole Missoula community, or at least a portion of them, can really benefit from. And community health workers have also done things like, you know, tabling at the farmer's market and being present at these other community events to be able to kind of share information about health care, preventive screenings, all those kinds of things, and then also, you know, connect people to services as needed. From my lens, I think those things really benefit the entire community. And also just a healthier community is better for everybody. I think that's kind of the bottom line for me. Thanks.

Eileen Lamble: [00:24:35] Just to piggyback off of what McKenzie said, I think we're all our best selves when we're our healthiest selves. And when you're your best self, you're contribute best to your community. You are your best neighbor. You're your best friend. You're your best coworker. You're your best colleague. So that's just like the top down, 100 foot view. Whatever they say. That's how community health workers benefit. The whole community is when you're lifting up everybody, especially those most marginalized in our community.

Josh Slotnick: [00:24:58] Thank you.

Juanita Vero: [00:24:58] Practice your sleep hygiene.

Josh Slotnick: [00:25:00] Practice sleep hygiene.

Dave Strohmaier: [00:25:02] McKenzie, what is the Rural Institute?

McKenzie Javorka: [00:25:05] Yes. So the Rural Institute for Inclusive Communities is an institute that's housed at the University of Montana, and it is a organization that focuses particularly on people with disabilities and providing research, service and training related to those populations. So, you know, we take kind of a broad view on what disability means. And so that can include things like, you know, we have Montech, which is our assistive technology provider. They're housed within the Rural Institute. Oh, really? Yeah.

Juanita Vero: [00:25:39] Yeah. Not know that. Yeah.

McKenzie Javorka: [00:25:40] They do amazing work. I don't do a lot directly related to them, but they do fantastic work. And then we have our evaluation unit, which is what I'm a part of. And we focus on a lot of kind of health systems research and evaluation. So things like the community health worker program are an example of something that both, you know, directly. Many of the clients that Eileen and the other community health workers work with may have disabilities, physical or mental, but also, again, just sort of taking that broad view of, you know, prevention and trying to prevent disabling circumstances from occurring. So yeah, that's a little bit about about the Rural Institute. We do a really wide array of work and I'm just kind of one little slice of it. But it's a it's been a really good fit for evaluating programs like this.

Dave Strohmaier: [00:26:34] Are there community health worker programs elsewhere in the state of Montana?

Eileen Lamble: [00:26:39] Yes there are. There's a program under this different grantee, but under the same CDC grant in eastern Montana. And I think they're the Riverstone health. And there are some other other community health workers. Not everyone is under the same CDC funding, but there are a few other community health workers in Montana. But I was recently at a conference in Spokane of nationally, and it also had people from US territories as well. And there are some other states that have thousands. They're very robust. So it's across the gamut of where a where newer program. And then there are other states who are really cranking out. When you said.

Juanita Vero: [00:27:11] We're newer, how you probably saw this, I'm forgetting how new are we?

Eileen Lamble: [00:27:14] 2021 is when this grant. Yep.

Juanita Vero: [00:27:17] Started. So before we close. Yeah. Tell us we're looking for nuggets of wisdom. Is there a good book, poem, podcast, film, song, what have you.

Josh Slotnick: [00:27:26] Something you ran across recently that was worth talking about?

Eileen Lamble: [00:27:29] Yes. Well, I read this book in college by Greg Boyle that really changed my perspective on relationship and service work. And one of his quotes that guides what I do is that compassion is to stand in awe of how much people have to carry, rather than stand in judgment of how they carry it.

Juanita Vero: [00:27:43] Oh, that's a good one.

Josh Slotnick: [00:27:44] Well done. From.

McKenzie Javorka: [00:27:45] From me, i have a couple of plugs to make, so I know that this is something that might be able to be shared as a way to kind of learn more about community health workers. We recently, as part of the evaluation, completed this really cool project. It's called a story map. I don't know if any of you are familiar with those, but so it's a really interactive kind of web based story. It's a it's a website that you can go to, and I think it'll be linked in the show notes. And that is based on some of the data that we've collected from community health workers themselves, who completed daily diaries for a period of time, as well as we had a research assistant who went around and shadowed the community health workers for a few days to really get a sense of, you know, what is a day in the life of a community health worker? Like, since this is a newer role to our community, and we really wanted to illustrate that. So if you'd like to read more about the day in the life of a community health worker, you can check out that story map. And it's really fun and interactive and, um, has a lot of great quotes and things like that from the community health workers. So I just wanted to give that a little plug. It'll be linked in the link in.

Josh Slotnick: [00:28:52] The show notes.

McKenzie Javorka: [00:28:53] Show notes. Yes. Excellent. Um, yeah. And then a little nugget of wisdom to leave. One of my favorite quotes that I think really applies when we're talking about doing anything that is requires kind of resilience or is an uphill battle or anything like that is hope is a discipline. And that's by Mariame Kaba. And so I always keep that in in the back of my mind.

Josh Slotnick: [00:29:18] Thanks so much for coming. Yeah, thanks for the great work.

Dave Strohmaier: [00:29:21] Thanks for joining us. Yeah.

McKenzie Javorka: [00:29:22] Thank you for having us.

Josh Slotnick: [00:29:24] Thanks for listening to the agenda. If you enjoy these conversations, it would mean a lot if you would rate and review the show on whichever podcast app you use.

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Dave Strohmaier: [00:29:38] The agenda with the Missoula County Commissioners is made possible with support from Missoula Community Access Television, better known as MCAT, and our staff in the Missoula County Communications Division.

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Dave Strohmaier: [00:30:05] Thanks for listening.