ST-AHEC Archive

CDC/Texas DSHS Funded CHW Programs (2020–2025)

The ST-AHEC Program completed the Texas Department of State Health Services (DSHS) and Centers for Disease Control and Prevention (CDC) funded health promotion grant to address COVID-19 in South Texas and to build community capacity within each of the ST-AHEC centers. In addition to implementing the Community Health Worker (CHW) COVID-19 ECHO program, ST-AHEC worked to increase capacity, workforce development, recognition, and value among CHWs in South Texas, while also participating in cross-collaborative health education events between AHEC Centers and community partners.

COVID-19 & Beyond Project ECHO
During the project period, ST-AHEC led a broad set of initiatives to promote health, grow the CHW workforce, and address COVID-19 in South Texas. Key efforts included five bilingual (English and Spanish) cohorts of the 14-week COVID-19 & Beyond Project ECHO for CHWs, with three groups developing community Health Improvement Projects. ST-AHEC also hosted seven RED de Promotoras del Sur de Tejas Spanish-language support groups, delivered CHW certification and continuing education, and provided employment training to two CHW cohorts. Additional activities included “Training of Trainers” workshops on the COVID-19 IPV/DV curriculum (in partnership with Next Door Solutions) and regional health education events in collaboration with AHEC centers and community partners.

CHW-COVID-19 Health Equity Project ECHO
One of the grant’s first major activities was the CHW-COVID-19 Health Equity Project ECHO, initially launched with a supplemental HRSA award. Based on the University of New Mexico’s Project ECHO model, this 12-week program trained CHWs in South Texas on COVID-19 prevention and preparedness. A total of five cohorts—four in English and two in Spanish—were completed, reaching 177 participants. Each session offered 2.0 hours of DSHS-approved continuing education credit. While pre- and post-tests showed no significant increase in knowledge, there was a 42.2% increase in reported preparedness for practice. Weekly evaluations were overwhelmingly positive, with nearly all participants indicating they would apply what they learned in their work settings.

CHW Health Improvement Workgroup
The CHW Health Improvement Workgroup project followed up with CHWs from each of the COVID-19 Project ECHO programs and invited their group to collaboratively develop a COVID-19/Health Equity Improvement project for their neighborhood community. The project incorporated Sara Haskie-Mendoza’s Xinachtli program, a healing initiative based on indigenous teachings. The intention in incorporating the Xinachtli Program was to develop connections, share personal stories, and dismantle false histories by discovering the authentic stories of participants’ ancestors’ strengths and wisdom. A total of 25 CHWs in 3 cohorts attended the Health Improvement Workgroup, which presented their project to 67 community members.

Red de Promotoras del Sur de Tejas Project
Similar to the CHW Health Equity Workgroups, this Spanish-language-only Red de Promotoras del Sur de Tejas Project provided DSHS CHWs with continuing education, support, and networking opportunities. Seven series were completed, with nearly 200 Spanish-speaking CHWs participating. This initiative benefited the community by focusing on health promotion and leveraging the role of CHWs to improve health outcomes in underserved areas. Given the historical success of CHWs in reducing disease rates and bridging healthcare gaps, this program continued to provide support to CHWs, ensuring that community members received culturally competent and high-quality health education and resources.

CHW Training Institute
The Community Health Worker (CHW) Training Institute continued to provide certification and continuing education, supporting a skilled workforce equipped to meet local health needs. In doing so, the Institute played a vital role in expanding healthcare access and strengthening community capacity. By developing a well-trained CHW workforce, the Institute advanced ST-AHEC’s mission to improve health outcomes and promote a sustainable, community-based approach to public health in South Texas.

Employment Skills Training for CHWs Project
The Employment Skills Training for CHWs Project aimed to increase the number of trained and certified CHWs obtaining employment post-certification. ST-AHEC provided resources for employment (including networking, resume writing, and cover letter writing support) via skill-building workshops to CHWs in each of the ST-AHEC Centers. This program also incorporated Sara Haskie-Mendoza’s Xinachtli program. The 10-week CHW Employment Skills Building program contained five sessions covering: 1) how to prepare for the job I want, 2) networking, 3) preparing for an interview, 4) negotiation and understanding benefits, and 5) resume writing. In addition, five sessions of Xinachtli were included. Five of the sessions (not Xinachtli) were approved for 2 hours each (10 hours total) of DSHS-certified CEUs for CHWs. All 31 participants in 2 cohorts completed a post-test identical to the pre-test. The ST-AHEC Program Office finalized the analysis and ascertained a 33% increase in preparedness for practice among participating CHWs. Although knowledge scores increased, the changes were not statistically significant. Weekly evaluation feedback and metrics were favorably high, with nearly 100% of participants indicating they would apply the information learned. A 60-day post-program follow-up was conducted to assess employment status.

Intimate Partner Violence (IPV) Project
The IPV Project began with training CHWs on IPV and COVID-19 in collaboration with Next Door Solutions. The project also aimed to map local resources and host events to connect community members with IPV services. The first phase included training, which 30 CHWs completed. The second phase focused on resource mapping, with 7 CHWs participating. The third phase centered on community events, which engaged 169 community members.

Cross-Collaborative & Health Education Events
Lastly, ST-AHEC successfully launched multiple “Cross-Collaborative and Health Education” classes as part of its outreach initiatives. Over the course of the grant cycle, a total of 1,132 educational events were conducted, attracting a cumulative attendance of 100,526 community members, averaging approximately 89 participants per event. To strengthen impact and reach, AHEC Centers partnered with 1,188 community organizations and institutional partners, fostering a wide network of collaboration and support across the region.

Project Milestones and Impact
During the project period, ST-AHEC achieved several key milestones that enhanced health outcomes, built community trust, and strengthened the public health workforce across South Texas. Highlights included expanding the CHW workforce through the CHW Training Institute, co-developing a community-driven CHW Health Workgroup plan focused on COVID-19 response, and deepening cross-sector partnerships. The project also improved health outreach, increased community capacity, and delivered tangible, on-the-ground impact. Collectively, these accomplishments reinforced ST-AHEC’s role as a leader in advancing health equity, workforce development, and community-based public health in the region.

World Cafe Linking Interprofessional Networks for Collaboration (LINC) (2021)

The Mental Health World Cafe was co-developed to promote understanding of mental health recovery through the lived experiences of individuals with serious mental illness. The program emphasized the importance of holistic, culturally responsive care and encouraged students to engage directly with individuals beyond their diagnoses. Through storytelling and dialogue, students gained insights into the values, beliefs, and hopes of those receiving mental health services, reinforcing the principles of recovery-oriented care and collaborative treatment planning. The initiative aimed to foster empathy, challenge stigma, and prepare future healthcare professionals to deliver compassionate, person-centered mental health support. An article titled “The Co-Development and Implementation of a Mental Health World Cafe” by Recto et al. (2022), published in Issues in Mental Health Nursing, describes the creation and execution of an innovative educational model designed to teach health profession students about person-centered mental health care.

COVID-19 ECHO (2020)

ST-AHEC staff created and evaluated a 13-part “COVID-19: CHWs’ New Role” Project ECHO for CHWs and promotoras in rural and medically underserved areas of South Texas. Outcomes included increased knowledge and practice readiness in fundamental COVID-19 education, remote client care, and use of teleconferencing technology for accessing resources and services. Two CHW cohorts (60 participants) completed the series. Both cohorts demonstrated a marked increase in COVID-19 knowledge and practice readiness from pre- to post-test. Evaluation scores were high. After requests from participating CHWs, a Spanish-language COVID-19 ECHO program was launched in March 2022. Dr. Recto first-authored an article on the development and implementation of the program in August 2021.

Opioid Use Disorder ECHO (2018–2019)

ST-AHEC used supplemental HRSA funds to focus on: 1) behavioral health integration with an emphasis on opioid misuse and abuse, and 2) CHW training on substance use disorders, including strategies to address prescription opioid misuse and addiction in rural and underserved communities of South Texas (including colonias along the Texas-Mexico border). The objective was to modify, implement, and evaluate the University of New Mexico’s “Opioid Addiction Treatment ECHO” for CHWs. The program targeted CHW knowledge and practice readiness in opioid addiction, harm reduction, and recovery services via teleconferencing. CHWs seeking no-cost Texas DSHS CE credits were required to complete post-session evaluations. ST-AHEC conducted several cohorts of the CHW-OUD Project ECHO programs, including Spanish-language sessions. Attendance was high, and post-test scores exceeded pre-test scores for both knowledge and practice readiness. Mr. Zapata was the first author of a paper describing the program. The Spanish CHW-OUD ECHO program, first-authored by Dr. Eduardo Gandara of the ST-AHEC Program Office, was published in February 2022. Mr. Zapata also authored a paper on participants’ perceptions of opioid use disorder service delivery and communication during the pandemic, published in January 2022.

Mobile Health SBIRT (2017-2018)

Access to diabetes education and resources for diabetes self-management is limited in rural communities, despite higher rates of diabetes in rural populations compared with urban populations. Technology and mobile health (mHealth) interventions can reduce barriers and improve access to diabetes education in rural communities. Screening, Brief Intervention, and Referral to Treatment (SBIRT) and financial incentives can be used with mHealth interventions to increase the uptake of diabetes education; however, studies have not examined their combined use for diabetes self-management in rural settings. This two-phase Stage 1 feasibility study aimed to use a mixed methods design to examine the feasibility and acceptability of an mHealth diabetes education program combining SBIRT and financial incentives to engage rural individuals. In Phase 1, we aimed to develop, adapt, and refine the intervention protocol. In Phase 2, a 3-month quasi-experimental study was conducted with individuals from 2 rural communities in South Texas. Study participants were individuals who attended free diabetes screening events in their community. Those with low or medium risk received health education material, whereas those with high risk or those with a previous diagnosis of diabetes participated in motivational interviewing and enrolled in the 6-week mHealth Diabetes Self-Management Education Program under either an unconditional or aversion incentive contract. The participants returned for a 3-month follow-up. Feasibility and acceptability of the intervention were determined by the rate of participant recruitment and retention, the fidelity of program delivery and compliance, and the participants’ satisfaction with the intervention program. Of the 98 screened rural community members in South Texas, 72 individuals met the study eligibility and 62 individuals agreed to enroll in the study. The sample was predominantly female and Hispanic, with an average age of 52.6 years. The feedback from study participants indicated high levels of satisfaction with the mHealth diabetes education program. In the post-study survey, the participants reported high levels of confidence to continue lifestyle modifications, that is, weight loss, physical activity, and diet. The retention rate was 50% at the 3-month follow-up. Participation in the intervention was high at the beginning and dissipated in the later weeks, regardless of the incentive contract type. Positive changes were observed in weight (mean -2.64, SD 6.01; P<.05) and glycemic control index (-.30; P<.05) in all participants from baseline to follow-up. The finding showed strong feasibility and acceptability of study recruitment and enrollment. The participants’ participation and retention were reasonable given the unforeseen events that impacted the study communities during the study period. Combining mHealth with SBIRT has the potential to reach individuals with a need to participate in diabetes education in rural communities.