Calif. County Pairs Chronic Patients with Health Coaches

Aug. 27--Shante Robinson met Jimmy Jordan in April on one of Robinson's many visits to Highland Hospital's emergency room.

Robinson has been struggling to manage his diabetes and control his debilitating gout, and the pain and symptoms of those diseases have taken the 52-year-old patient to the Oakland hospital more times than he'd care to remember.

The 24-year-old Jordan asked Robinson if he'd like more help managing his health problems, and the older man quickly agreed.

Jordan, a certified emergency medical technician exploring different careers in the medical field, is one of eight young "health coaches" Alameda County has employed to approach emergency-room patients with chronic high blood pressure or diabetes. The coaches' role is to make sure their patients get the care they need and guide them to healthier lifestyles.

Jordan regularly checks up on Robinson by telephone, visits his home so he better understands his environment, helps him manage his diet and medications, answers health questions, and connects him with social services for medical care, food, housing, jobs and other needs.

"We've been talking on the phone every week, keeping up with each other," said Jordan, who recently visited Robinson at his studio apartment to help him make healthy food choices on a limited income. "We can talk about what's going on in his life, not just about his health,"

Jordan might seem an unlikely candidate for the job. He grew up in the foster care system and, at one point, became homeless. But, in fact, Jordan said, his background is an asset in understanding patients like Robinson who are struggling with social and economic issues that make it tough to manage their health.

"I've been homeless. I've been at the bottom, so I can't judge another person who's going through a rough time," Jordan said.

Health coaching is a growing profession, used increasingly by hospitals, health insurers and employers to keep people healthy and rein in costs. The coaches are typically people with a background in the health field -- nurses, social workers, fitness trainers, dietitians -- who use their expertise to help people get healthier or manage a chronic illness. Alameda County took a different approach.

The county decided to select young people -- over 18 with at least a high school degree -- and put them through an intensive, five-month training program that concentrated on helping patients manage diabetes or high blood pressure.

The county's first group of eight health coaches, selected from a pool of more than 150 applicants, began working in March at Alameda Health System's Highland Hospital in East Oakland. They were assigned to frequent emergency department patients who were willing to work with a coach.

The two-year pilot program, funded with a $200,000 grant from the Robert Wood Johnson Foundation, is an offshoot of the county's successful Emergency Medical Services Corps program, which started about four years ago and trains young people to be emergency medical professionals. About half the health coaches, including Jordan, are graduates of Alameda Health's EMS Corps.

"The health coach program was created as another career track for EMS Corps graduates as well as other students in the health pipeline to gain entry-level skills in health care, as well as get exposed to a variety of health careers," said Dr. Jocelyn Freeman Garrick, who directs emergency services at Alameda Health System and runs the health coaching project.

The coaching project is similar to programs that have been successful around the country such as the Promotora Model or Madres a Madres, Garrick said. These programs rely largely on Spanish-speaking community members to talk with their neighbors at supermarkets and other places about health and social issues such as breast cancer screenings and parenting issues.

Alameda County's health coaches come from various ethic and racial backgrounds, speak a variety of languages, including Spanish and Cantonese, and may have been at risk at some point in their lives of dropping out of school, Garrick said. "We were very focused on them representing the community they serve at Highland," she said.

The coaches are required to have at least a high school diploma or equivalent, but two of them are college graduates.

The program currently addresses just the two conditions -- diabetes and hypertension -- but Garrick said she hopes additional common chronic conditions such as asthma will be added.

While the health coaches learn a lot about the diseases of their patients, they are also trained to help motivate their patients to help themselves.

"They train to learn how to interview, to listen and ask questions, and then empower patients to be able to ask their own questions," Garrick said. "After six months, we're hoping the patient will be able to graduate and fly on their own. We hope they have those tools now to navigate the system and stay in control of their disease."

In Highland Hospital's emergency department last month, health coach Julieta Murillo, 28, spoke in Spanish with Yesenia Iribe about her ongoing issue with high blood pressure.

She explained how hypertension affects the body and why salt is particularly bad for people with high blood pressure. "The chemicals in salt take out water from the arteries," she told Iribe. "You can have salt, but very limited amounts -- much less than a normal person."

Iribe, a 39-year-old Fremont mother of four, was experiencing fatigue and other symptoms and didn't have health insurance. When Murillo asked if she'd like to participate in the health coach program, she quickly agreed, for herself as well as for her kids, who she said didn't always eat right. She hoped they would listen to Murillo.

For Murillo, who grew up in San Jose, her work is personal. "I grew up being uninsured, coming to the emergency department to get medical care and translating for my family," she said.

She became her family's first college graduate, getting her degree in biology from UC Berkeley in 2009, and will continue her education this fall, pursing a career as a physician's assistant.

Robinson's coach, Jordan, went from couch-surfing at friends' places to having his own apartment in Oakland in less than two years. He plans to finish college and pursue a career as a psychologist or a medical doctor.

"I was never exposed to those ideas of being a paramedic or working in a hospital. I thought it would just be too much," he said.

Since starting the EMT training program and becoming a health coach, he said his confidence has gone from "0 to 90."

During his recent visit with Robinson, Jordan discussed signing up his patient for free meals delivered by the nonprofit Project Open Hand. The two men also talked about the "gout diet," what kind of work Robinson thinks he could physically be able to do and an upcoming move out of his apartment because of rent problems.

Robinson, who has had three strokes and two heart attacks in the past 10 years and struggles with making healthy choices on $189 a month in food stamps, said he appreciated Jordan's help and was determined to stay healthy.

"If I can get help with anything in my life, I'm going to run with it," he said.

Jordan said patients are sometimes surprised to meet a young black man with a tough upbringing working as a health professional in the hospital.

"It's kind of a flip, where you're getting someone from a rough background that can relate to the patient in a better way than someone who's never been in that situation," he said. "They know where I come from and I know where they come from. We can just talk, instead of me being a teacher and doing the instructing. It's more like a conversation."

Victoria Colliver is a San Francisco Chronicle staff writer. E-mail: vcolliver@sfchronicle.com Twitter: @vcolliver

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