Health care organizations across the United States are increasingly partnering with local faith leaders to strengthen community connections and bridge care gaps for health conditions, including serious illness. Faith leaders, as trusted members of their communities, are well positioned to engage with parishioners and residents who may distrust the health care system or feel uncomfortable accessing care. In Black communities specifically, people are diagnosed with serious illness at higher rates, are less likely to have discussions on advance care planning, and report fewer encounters with palliative care services than individuals of other races.
The Coalition to Transform Advanced Care (C-TAC) launched the Louisville Community Model of Care Project in August 2020 to support residents of Louisville, Kentucky’s 40203 zip code. The goal of this project is to improve the quality of life for Black community members facing serious illness by providing access to care and investing in trusted partners to address disparities in access to serious illness care. Central to this approach is engaging with faith leaders to better support community members involved in places of worship.
The Better Care Playbook spoke with Elder Angela Overton, Senior Advisor and Director of Faith Community Partnerships at C-TAC, to learn more about the project. In her role at C-TAC, she assists faith leader engagement community partnerships across the country. She is also a Louisville resident and the director of pastoral care at her local church, which has a congregation of about 4,000.
Q: Can you describe how the Louisville Community Care Project was first conceived?
A: When COVID-19 began in 2020, I asked what we could do to check in on residents in the West End of Louisville and provide care to Black and Brown residents who were experiencing serious illness and inadequate care in the community. C-TAC, in partnership with other groups, connected with two faith leaders in these neighborhoods who were very interested in asking residents their opinion on impediments to health care for people who are dealing with serious illness. This was the beginning of the pilot project needs assessment.
The needs assessment found that the faith leaders of participating churches would benefit from training on different topics, including community advance care planning and caregiver support. With the results of the needs assessment, C-TAC created a strategic plan to address the lack of access to resources in the community. The faith leaders helped create the operational plan for the model of care and received a stipend for their contributions.
Q: What does collaboration look like with faith leaders, payers, and other stakeholders involved in this project?
A: After developing the plan, we began to find partners that could resolve the stated issues and invited them to forums. Our partners include behavioral and physical health providers, as well as a palliative and hospice care organization and patient assistance agency. Our memorandum of understanding with partners identifies what each organization can do to be a part of the solution. C-TAC can leverage its position to hold them accountable and include the faith leaders and community-based organizations in these discussions.
Our partners host or participate in food and essentials drives, educational workshops, events, and information sessions on various wellness and serious illness topics. In these spaces, people in the community share what’s going on with them and receive support. A few examples of events we’ve hosted include game nights to work on advanced care planning and a gala for caregivers where we provide respite and entertainment. Marisette Hasan, Vice President of Community Action & Policy for C-TAC, attended an annual event we support at The Christ Cathedral of Praise Church and wrote a blog post on her experience. The project recently hired a community health worker (CHW) who is a resident of the community and will help navigate individual health challenges and basic needs by using the Flourish Index Assessment.
In the beginning, this project was funded by grants and in-kind support. To sustain this work, we had to build a business case that this model of care can be replicated in other cities and states. We had to have the community’s support. We moved beyond the food and essentials drives to seek systemic, lasting change. We’ve connected with the mayor's office, the state Secretary of the Treasury, and the Governor of Kentucky to discuss funding and opportunities to make meaningful strides toward access to services as it pertains to Black and Brown populations as well as rural populations.
Q: Why has it been important for Louisville health care organizations to partner with faith-based organizations to reach community members?
A: The experts in the community are the faith leaders and the community-based organizations on the ground doing the work. They understand the issues in the community, such as insurance status and access to hospice, palliative care, and cancer services. For example, we know Black and Brown people do not go for hospice or palliative care because for many years hospice was introduced in the last week of their lives, and so they didn’t get the full benefit of it. We have liaisons where the messaging is different and the community can receive the information that is shared with them.
Q: What motivated the inclusion of a CHW in the project?
A: The faith leaders and I realized that we did not have capacity internally to address all of the community needs that arose. In Louisville, we have CHWs that are already working on the ground. CHWs can help another person navigate whatever it was that they needed, like broadband access, transportation, healthy nutrition, securing a primary physician, or Medicare and Medicaid benefits. We just received funding for a CHW this year with support from the University of Louisville’s Trager Institute. They’ll meet at places of worship, and in secular spaces to be as inclusive as possible.
Q: What have you learned about the needs and strengths of this community?
A: An alarming number of community members deal with social needs, and we helped address their major needs by providing food and other essentials. You cannot support those that are dealing with serious illness if you do not address their social needs. We also learned that we needed to build trust with the community, but those that provide services also had to begin to trust the community. There are many organizations that mean well and have wonderful programs. The community, in a sense, sometimes denies those services because of a lack of trust. Because of this, events that we hosted, like essentials drives and health screening fairs, were organized on the community’s terms.
Q: What do you anticipate is next for this project?
A: We’ve been invited to apply for a grant to support additional CHWs as they can only work with 100 community members at a time. With more CHWs, we can ensure that all individuals receive quality care when dealing with serious illness. The evaluation component of this project is being led by the University of Louisville and includes monitoring metrics on health care access and effective partnerships. The data we are collecting will provide us with lessons, such as what worked well and what didn’t.
The cost of running one of these programs annually is an incredibly low lift because the partners are already doing what their organization is out to do. Some of our partners have identified funding internally to continue supporting this work. It’s just the practice of being accessible to communities that are not receiving your services and putting them in situations to receive good quality health care. This leads to an improved quality of life that alleviates some of the pressures placed on other systems.
Q: Do you have any advice for other faith leaders looking to implement similar programs in their community?
A: You need to build a sustainable model and create a business case for your work. When initiatives start and organizations share that they are there to help and then that help is gone once a grant or funding period ends, that is harm done to the community.
