Project: Neighbor Health Initiative
Organization: Central Iowa Hospital Corporation
Des Moines, IA
Story written by Rachel Lewis, Outreach Coordinator, and submitted by Mary Martin, Project Director, of the Neighborhood Health Initiative in Des Moines, Iowa.

Adriene’s Amazing Transformation

I’m sure you’ve come across her: we’ll call her Adriene. She lives in federally subsidized housing, she did not finish high school and, like many of her friends, she anxiously awaits the first of the month, so she can stock up on diapers and get her gas bill paid before it gets turned off. She sports a host of tattoos and body piercings to celebrate her four children, her man and her lifestyle. Intuitively, she knows that there is more to life than what she sees. As she says: “I want my kids to have something better than what I had.”

Eighteen months ago, we hired this young woman to be a Community Health Advisor to reach the black residents in our community. It was after we had interviewed a number of people who brought loads of traditional qualifications but no real links to the community – and thus, no credibility with the residents we were trying to serve. After our project director stumbled into Adriene in the community and encouraged her to apply, it was mostly intuition that led us to choose her.

Because our program is administered by a large health care organization with a very sophisticated infrastructure, we have lots of policies and procedures… and ….. rigidity! Even after we told our HR “business partner” that we wanted to hire Adriene, she continued to call us about candidates she felt were more qualified, and to provide “coaching” about how to effectively evaluate applicants. “Do you really think it’s a good idea to hire someone without at least a GED?” and, after meeting Adriene, “I really don’t think we can hire her because of our dress code.” But we insisted that a grassroots outreach program could only be successful if we honored the peer-to-peer, resident-to-resident approach.

A few compromises were still necessary. Like, when Adriene attended the health system’s mandatory “Entry Education,” she was asked to wear a turtleneck, scarf and long sleeves to “hide” her piercings and tattoos from view of those who might be critical. I guess she wanted the job badly enough that she acquiesced…. trusting us when we said we were working on changing the “system” but had to be strategic about which battles to fight and when. Adriene took it upon herself to have the marijuana tattoo on her arm covered with a cross.

Employment in a large health care organization brought the immediate benefit of health and dental insurance for herself and her children and allowed her to transition off Medicaid. We knew Adriene was grateful and pleased for this opportunity but after about 6 weeks on the job we saw a distinct change in her enthusiasm: It was as if she was trying to be invisible. She sat with her back to the world, slumped in her chair, reading the paper and sucking her thumb. This was really apparent on Monday mornings when we had team meeting, and she later told me how much she hated Monday mornings because that was when her fears about her ability to do the job really overwhelmed her. She said she was afraid of everything from managing her morning with her children to getting to work on time to using the computer.

Based on her performance and a traditional approach, she would have been “let go” within the 90-day probationary period. But instead of being disappointed or excessively questioning our wisdom in hiring her, we relied on an underlying belief and program philosophy – that each of us has innate health and wisdom, but we sometimes need a little help reconnecting with it. We understood that it was up to us to help Adriene discover her innate potential and to look for ways to engage her in the work.

Since high blood pressure is one of the leading health issues in the black population, we gave Adriene a blood pressure cuff and supplemented her Certified Nursing Assistant training in using it. This was really empowering for her because suddenly she saw herself as having unique value to the program, and putting that stethoscope around her neck gave her the confidence to walk up to someone and start a conversation about their health. As simple as it may sound, having that one skill propelled her into a new identity as a health advisor, and then she began to build upon her new skills and knowledge.

One of the first things she did was to challenge her own choice to smoke cigarettes. She began to understand the serious long-term effects smoking had on her and her children. She asked if she could participate in a smoking cessation class to both help her quit and to better understand the process so she could help others. She is now 15 months smoke-free and has been trained to facilitate smoking cessation classes. After a 19-month-old she knew died in a car accident she started a campaign to educate families on car seat safety and to provide car seats to families who couldn’t afford them. And keep in mind: these were families that were not responding to mainstream information about buckling up.

It was only after some of these successes that Adriene finally had the confidence to complete her GED. And now, after 18 months on the job, she is even comfortable developing partnerships with other community groups and planning events to improve residents’ health. She is a role model and an inspiration in her community. She now comes to work excited and often times giggling about her accomplishments. She has even accompanied her supervisor on a trip to Washington, DC for a meeting about resident engagement … her first flight, first time in our nation’s capitol, first time away from her family, and definitely an occasion for her to experience herself as a skilled, effective and valued professional! And back at home, Adriene has started a college savings plan for her children, is applying for admission to a Medical Assistant program, and just last week closed on a new home for her family.

So from our perspective, finding a way to create the space to allow the Adrienes in your community to emerge as leaders is well worth the investment – and the risk.

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