Summit County Pathways HUB Project
The Pathways Community Hub Model
The Pathways HUB model was first developed by the Community Health Access Project (CHAP) in Mansfield, Ohio, with leadership from Drs. Sarah and Mark Redding. The model involves working with a team of organizations to reach at-risk individuals and connect them to health and social services. The model is now part of a national network of community-based initiatives working under a common set of national standards and certification developed by the Pathways Community HUB Institute.
The HUB is a community care coordination approach focused on reducing risk factors for high-risk individuals and populations. The HUB relies on community health workers (CHWs) who reach out to at-risk individuals through home visits and community-based work. Once an at-risk individual is engaged, the CHW completes a comprehensive assessment of health, social, behavioral health, economic, and other issues that may place the individual at increased risk.
Each identified risk factor is tracked as a standardized Pathway that confirms the risk is addressed through connection to evidence-based and best practice interventions. The Pathway is a tool for confirming that each risk factor is addressed and that outcomes have improved. The Pathway also serves as the quality assurance and payment tool. When this model is deployed across multiple agencies within a community, the centralized HUB helps agencies and CHWs avoid duplication of effort. The HUB serves as a community-wide networking strategy that helps isolated programs become a quality-focused team to identify those at risk and connect them to care.
We fully understand what they're going through. We've walked the same walk...We all have kids, we've all been through things...What we're doing basically is sharing with them what we already did in order for us to get to the position we're in now.
— Brandee West, Community Health Worker
With funding from the Ohio Commission on Minority Health, Akron Summit Community Action (ASCA) and its partners launched the Summit County Pathways Hub project in April 2016. Since then, the Hub has established an operational structure and engaged key community stakeholders who are committed to addressing the infant mortality problem in Summit County. Four contracts have been established with partner organizations and three more are in process.
The Hub has partnered with the Department of Job and Family Services to train, certify and hire 10 community health workers. The Hub CHWs are women who are embedded in the neighborhoods with highest risk for infant mortality. Because of this, they have experienced many of the same barriers to a healthy, successful pregnancy that their clients may be experiencing. This shared experience helps to foster a relationship based on support and trust while navigating a complex system of healthcare and social services.