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Older adult community service worker program for Riverside County: community-based solutions for social service delivery

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Older adult community service worker program for Riverside County: community-based solutions for social service delivery

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Content OLDER ADULT COMMUNITY SERVICE WORKER PROGRAM FOR RIVERSIDE
COUNTY: COMMUNITY-BASED SOLUTIONS FOR SOCIAL SERVICE DELIVERY

A DISSERTATION
Presented to the Sol Price School of Public Policy
University of Southern California

In Partial Fulfillment
of the Requirements for the Degree
Doctor of Policy Planning and Development

Committee Members:
Peter Robertson, PhD
LaVonna Lewis, PhD, MPH
Maria Aranda, PhD, MSW, MPA, LCSW

By Jamiko R. Bell
M.L., 2010, University of Southern California
B.S., 2000, California State University, Los Angeles
August 2017
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ABSTRACT
The purpose of this project is to develop a community-based pilot program – the Older
Adult Community Service Worker Program for the Riverside County Office on Aging – in order
to supplement the efforts of social service professionals who are tasked with providing services
and support to the growing number of people over the age of fifty-five. The pilot proposes that
older adults be trained and employed to provide an array of services staring with outreach,
evidence-based health promotion interventions, and other services for programs that need
additional support, which will place critical services in the community, rather than in traditional
settings, where older adults need them to be. The study reviews the demographic trends of the
older adult population; a brief history of eldercare in the United States; a review of supportive
policies, legislation, program initiatives, and funding streams that will allow for the integration
of a community service worker (CSW) program with the Senior Community Service
Employment Program (SCSEP) operating within the Office on Aging; and an evaluation of the
best practices of various types of CSW programs to determine the elements needed for a
successful CSW program. The study determines that by using the best practices from other CSW
programs and research, and using the Office on Aging’s SCSEP program as a case study, a pilot
program can be used to recruit and retain 20 CSWs for a period of 18 months.

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ACKNOWLEDGEMENTS

Deep and loving gratitude goes to my parents, the late Dr. James R. Bell and Mrs. Sylvia C. Bell,
who knew all along that I could do it. Although they are no longer with me, their love and
confidence in my ability to “do anything I set my mind to”, resonates with me today. Thank you
to my siblings Mr. Joel G. Bell and Ms. Sarah E. Bell, who always provide moral support for my
crazy adventures. I also want to thank all of my extended family, friends, colleagues, and
“guardian angels” who offered guidance and moral support throughout this endeavor.

Special thanks to my loving husband Todd Woodson, who refused to let me give up on my goal
and supported me throughout all of aspects of this process.

I would like to thank Dr. Maria Aranda and the practitioners who asked the questions in 2013
that formed the basis for my research; Ms. Michele Haddock and Ms. Anna L. Martinez, the
former and current Directors of the Riverside County Office on Aging respectively, for allowing
me to study their organization for this paper; and my Committee Chair, Dr. Peter Robertson and
my committee members for their time and assistance with this project.

Finally, I dedicate this project to my children, Rachael Eleanor & Ernest James Potts.
Thank you for letting me study. I am finally on my way home from the coffee shop.

To all of you, I am forever grateful.

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TABLE OF CONTENTS
CHAPTER I. INTRODUCTION
A. Introduction………………………………………………………………………………. 8
B. Background of the Problem……………………………………………………………… 9
C. Purpose of the Study……………………………………………………………………..10
D. Research Questions……………………………………………………………………....11
E. Background and Origins of the Research………………………………………………..11
F. Significance of Study…………………………………………………………………… 15
G. Definition of Terms……………………………………………………………………... 16
H. Assumptions and Limitations…………………………………………………………....18
I. Conclusion……………………………………………………………………………… 18
CHAPTER II. POPULATION CHARACTERISTICS
A. Introduction…………………………………………………………………………….. 20
B. Overview of Demographic Trends……………………………………………………... 21
C. Older Adult Health and Socioeconomic Issues………………………………………… 34
D. Policies Addressing Older Adult Care…………………………………………………. 43
E. The Future of Older Adult Care………………………………………………………... 47
F. Summary……………………………………………………………………………….. 51
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CHAPTER III. COMMUNITY SERVICE PROGRAM GOOD, BETTER AND BEST
PRACTICES
A. Introduction……………………………………………………………………………. 53
B. Role of the Community Service Worker…………...………………………………….. 54
C. Recruitment and Retention…………………………………………………………….. 65
D. Training and Education………………………………………………………………… 70
E. Measuring Outcomes…………………………………………………………………… 77
F. Program Challenges…………………………………………………………………….. 86
G. Summary………………………………………………………………………………... 90
CHAPTER IV. SCSEP IN RIVERSIDE COUNTY
A. Introduction……………………………………………………………………………... 91
B. National SCSEP Program………………………………………………………………. 92
C. Riverside County SCSEP Program Project……………………………………………. 100
D. Data Collection………………………………………………………………………... 101
E. Data Analysis………………………………………………………………………….. 103
F. Discussion……………………………………………………………………………... 109
G. Summary………………………………………………………………………………. 111

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CHAPTER V. COMMUNITY SERVICE WORKER PILOT PROGRAM
A. Introduction……………………………………………………………………………. 113
B. Need for the CSW Pilot Program in Riverside County……………………………….. 114
C. Program Design and Implementation…………………………………………………. 131
D. Opportunities and Challenges to Implementation ……………………………………. 145
E. Advance in Practice………………………………………………………………….... 148
F. Areas of Future Study…………………………………………………………………. 151
G. Conclusion…………………………………………………………………………….. 153

APPENDIX…………………………………………………………………………………… 155
REFERENCES………………………………………………………………………………... 158

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FIGURES AND TABLES
FIGURES
Figure 1: Riverside County, California…………………………………………………………. 28
Figure 2: 2014 Riverside County Population by Ethnicity……………………………………... 30
Figure 3: Riverside County Population Projections by Ethnicity (2010-2060)………………… 30
Figure 4: Estimated LGBTQ Population of Riverside County by Age Group, 2011…………... 32
Figure 5: World Health Organization Age Friendly Topic Areas……………………………… 40
Figure 6: Riverside County Office on Aging Planning and
Community Services Operational Unit…………………………………………………………129
TABLES
Table 1: Riverside County Population Projections……………………………………………... 28
Table 2: Riverside County Cities Ranked by Same-Sex Couples per 1,000 Households, Cities
with 50+Same-Sex Couples (2010 Census)…………………………………………………….. 31
Table 3: Number and Percent Change in People 55+with Alzheimer’s Disease (2008, 2015, 2030
– Riverside County)…………………………………………………………………………….. 36
Table 4: Percent of Riverside County Older Adults Living Below 100% of Poverty, Per FPL and
Elder Index (2011)……………………………………………………………………………… 38
Table 5: CSW Role Options……………………………………………………………………. 63
Table 6: CSW Recruitment and Retention Best Practices……………………………………… 70
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Table 7: CSW Training and Education Best Practices………………………………………… 77
Table 8: SCSEP Quick Screen Major Skill Categories (Self-Reported)……………………… 107
Table 9: Additional SCSEP Quick Screen Data Categories…………………………………... 109
Table 10: Overview of Office on Aging Programs and Services……………………………... 115
Table 11: Riverside County 65+ Population by Zip Code……………………………………. 132
Table 12: Riverside County Total Disabled Population and Disabled Population Over 65…...136

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CHAPTER I. INTRODUCTION
A. Introduction
The older adult population in the United States is exploding. To date, older adults or
people over the age of 65 years old, represent one in eight people in the United States.
Between 2010 and 2030, the older adult population will increase more rapidly as compared
to generations before the Baby Boomer generation - the largest generational cohort in history
(Eggenbeen & Sturgeon, 2006). Boomers began turning 60 in 2006 and will continue to
advance into older adulthood at the rate of 330 people per hour, or approximately 10,000 per
day until 2024 when the last of the Boomers reach age 60. The Boomers alone will increase
the older adult population by 22% within by 2024 (Uhlenberg, 2013).
As a result of the projected growth in the aging population, practitioners for the aged
must address a multitude of issues including increased longevity, growing diversity, health
and wellness, long-term care, and reduced funding for services. Aging generational needs
will require aging services agencies to develop creative programs and initiatives that go
beyond traditional social service programs. This study seeks to develop one concrete and
specific way to harness the power of the community to help practitioners address the needs of
a growing and aging population, by training and mobilizing older adults to serve their
generation as partners with, rather than be a burden to, service providers. Working as
community service workers, older adults may be trained to offer social services that are
otherwise offered by government employees.

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B. Background of the Problem
Across the nation, Baby Boomers (people born between 1946 and 1964) began
turning 60 in 2006, and will continue to enter older adulthood (at the rate of approximately
330 persons per hour) until December 31, 2024 (Frank, et al., 2014). Today, due to advances
in the fields of medicine, public health, and epidemiological science, the average life
expectancy for a 60 year old is approximately 83 years old. As science continues to make
advances in these areas, life expectancy will only increase. Of the original 78 million
Boomers born in the United States, 57.8 million are projected to live past the age of 90 and
younger age cohorts may live even longer.
The sheer number of older adults and the economic impact of the Great Recession on
retirement savings have already forced a small change in the cultural attitude about old age.
Older adults are delaying retirement, or continuing to work beyond retirement, either out of
economic need or because retirement savings are not enough to sustain them for another 30
years. However, the significant cultural shift in the way that American society views older
adulthood is coming from the Boomer Generation. In 2014, the California Department of
Finance reclassified “older adulthood” by dividing the broad category of adults over the age
of 55 into subcategories consisting of “working age” adults (up to age 64 years old), “young
retirees” (aged 65 to 74 years old), “mature retirees” (age 75 to 84 years old) and “seniors”
(those over 85 years old). This seemingly subtle change codifies the shift in the national
conversation about old age and what it will mean to be an older adult in the 21st century.
Retirement, health care services, community services, and even community-based
infrastructure development will all eventually have to be modeled around the needs and
desires of the nation’s older adult population. Older adults, who are still active, in good
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health, and looking for ways to contribute to their communities after retirement, can be called
upon to supplement the work of social service practitioners by assisting with some of the
functions of community-based care (such as basic health screening and in home care for
those with high medical and functional needs in the older adult population) and by
conducting peer-led health and wellness workshops such as physical activity and chronic
disease self-management.
C. Purpose of the Study
The purpose of this project is to develop a pilot community service worker program
for Riverside County that will train and employ older adults to work on the front lines of
social service delivery and to assist practitioners with programs and services that will need
additional support. The Older Adult Community Service Worker Program proposed by this
paper will outline the best way to train and employ older adults to partner with practitioners
by serving in a variety of roles in local communities by analyzing and evaluating the best
practices and outcomes from similar programs across the United States and Latin America.
By looking at the County’s demographic trends relative to the older adult population,
evaluating the best practices from similar programs across the United States and Latin
America, and using the Riverside County Office on Aging’s existing Senior Community
Services Employment Program (SCSEP) participant database as a case study to identify a
base of employable older adults, the program proposal will include a defined scope of work,
recruitment criteria to identify and retain workers from the SCSEP database, the basic
elements of a comprehensive education and training program, and clear evaluation criteria to
measure program outcomes and success. Finally, this paper will describe a process for
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modest implementation in Riverside County, as well as suggestions for adapting the program
in other Riverside County Agencies and potentially other Planning Service Areas (PSAs)
within California’s Area Agencies on Aging (AAA) network.
D. Research Questions
The following questions will guide the research and proposal:
1. What are the key elements of and best practices for a community service
worker program?
2. What can we learn by using the existing Senior Community Services
Employment Program (SCSEP) currently operating within the Riverside
County Office on Aging as a case study for employable older adults?
3. What is the feasibility of implementing the pilot program in Riverside
County?
E. Background and Origins of the Research
Early in the spring of 2013, I attended a symposium hosted by the University Of
Southern California School Of Social Work and the Roybal Institute on Aging. The purpose
of the symposium was to bring together older adult services practitioners from nonprofit and
governmental organizations in the Southern California area to discuss possible research
topics for the Roybal Institute on Aging. Although several specific ideas were discussed and
categorized into short, medium, and long term research opportunities, the overarching theme
of the day’s discussions focused on the funding cuts to aging services that occurred during
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the previous fiscal years as the result of the federal sequester, and the anticipated increase of
the older adult population due to the aging of the Baby Boom generation.
The general consensus among the practitioners present on that day was that the
political climate at the time made it unlikely that lost funding would be restored to their
agencies as quickly as the older adult population was expected to expand. The practitioners
brainstormed amongst themselves about how to keep up with the demand for services. One
of the practitioners asked the group if anyone was utilizing “promotoras” or a community
service worker-type program to assist with service delivery. Community service worker
programs train members of local communities to assist with service delivery by conducting
outreach, and basic health and program eligibility assessments of people in their
neighborhoods. The practitioners posited that a similar program, tailored to meet the needs of
older adults, could be utilized to offset reduced funding and to assist with the increased
demand for services. The group members looked from one to another in silence and then
turned to the researchers indicating that exploring the feasibility of such a program would be
an interesting research topic that might address several of the short and possibly long-term
concerns practitioners have about how to keep up with the growing demand for services.
Intrigued by the idea of exploring a community-based approach to service delivery that uses
the growing older adult population to serve itself and to assist practitioners I decided to
explore the idea further.

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Expansion of the Research Question
I expanded the research by looking at my current employment and the information
that I have worked with for the past four years with the Riverside County Office on Aging,
also designated as one of the State of California’s Area Agencies on Aging (AAA), where I
have served as a policy analyst, the Area Planner, and a program manager since 2012. Since
that time, I have had access to and regularly analyze key demographic data and conduct trend
analysis related to the older adult population, funding and program information, as well as
the evaluative metrics for the agency as part of my professional research and planning for the
County. Since 2014, I have managed all of the evidence-based health related programs,
including Stanford University’s Chronic Disease Self-Management Program (CDSMP) and
other peer community-based programs from the Arthritis Foundation. I am also the
supervising program manager for the County-wide outreach and education programming,
including nutrition education. In addition, for eight months during fiscal year 2014-2015, and
again as of August of 2016, I oversee the program operation for the Senior Community
Service Employment Program (SCSEP), which trains low income older adults for placement
in public and non-profit organizations all over Riverside County. As such, the majority of the
key research and program related information is readily available to me.
To begin the research, I utilized my combined knowledge and experience to develop
an idea of how the health promotion and SCSEP programs could be integrated to serve the
needs of both areas of work and the older adult population; programs that need community
service workers and older adults who need training and employment. However, since there is
no formal research linking the two programs or areas of work together, nor is there a program
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in Riverside County similar to the one proposed by the practitioners at the USC research
symposium, determining the best way to develop such a program required me to expand my
knowledge of the program legislation, rules and regulations, and parameters of the program
operations to ensure that the proposed program was possible per the federal and state
guidelines. I then furthered the research by exploring the historical role of elder care in the
United States to establish a basis for how elders have been cared for in the past and to
discover what the solutions to elder care have been. I then reviewed the role of the promotora
or community health worker in various settings, including hospitals, clinics, non-profit
organizations, and governmental offices as well as their functions across various disciplines
including social work, sociology, health care, and human services.
Approach to Research and Further Discussion
Beyond looking at the program parameters, the nexus for the research and further
discussion of the project proposal found its footing in the dilemma of funding and
sustainability since a viable community service worker program would need a secure source
of finding to insure its success. The decrease in national funding for AAA services in
conjunction with anticipated population growth is leading many AAA directors to look for
low cost alternatives to develop or expand programming by utilizing existing resources.
Older adults who still need or want to work are an untapped resource who can be trained to
assist aging services professionals with outreach to their communities, basic assessments for
public and behavioral health, referrals for services, basic health screenings, transportation,
social support, and peer health and wellness initiatives. To further explore the topic, I turned
to the work that I do for the County of Riverside. The Riverside County Office on Aging
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operates the SCSEP program for low income seniors with only 56 available training slots,
which has a wait list of over 1,000 able bodied older adults who are looking for work.
Because I both served as interim program manager, and am once again overseeing the
program, I am intimately acquainted with the program operation and its participant universe.
These older adults need to work, still have much to offer their communities, and many can be
employed with as little as six months of training in a specific area. Combining a need for
localized services for older adults, an existing older adult employment program, emerging
programs designed for community service workers such as peer chronic disease self-
management programs, and the best practices gleaned from various community service
worker programs, a solution to the service and funding dilemma can be proposed in response
to the questions posed by the practitioners at the USC symposium in 2013.
F. Significance of Study
For the past several years, practitioners across the nation have been meeting at
conferences, symposia, and seminars to discuss how to mitigate the impact of the growing
population on service delivery by brainstorming how to make the most of existing funding
through creative staffing and program design, how to secure additional funding through non-
traditional partnerships, and how to improve the implementation of existing programs.
These main factors - the older adult population increase, longer lifespans, increased
socio-economic diversity, rising rates of chronic disease and dementia, the need to develop
strategies for long term care, ways to better assist caregivers, the problem of supporting an
increasingly older and sicker population, reduced funding, and the need to supplement the
16

work of practitioners - will require aging services agencies to develop creative programs and
initiatives that go beyond traditional social service.
This study will be significant because it will provide practitioners with a potential
solution to population growth, increased diversity within the older adult population, and the
decrease in practitioners specifically trained to provide services to older adults. The program
will create a vehicle that combines existing service programs in an innovative way while
meeting the goals of each program, insures a stable source of federal funding, and mitigates
the issue of too few aging practitioners, but still serves the older adult population.
G. Definition of Terms
It is essential to the understanding of this research that the following key terms be
defined within the context of this study:
1. Older adult: People over the age of 65 years old, or those over age 55 years old
for the purpose of qualifying for specific Older Americans Act programs, such as
the Senior Community Employment Program (SCSEP)
2. Community service worker (CSW): All types of lay community-based workers
regardless of role, function or area/field of work. This term will be further
divided into two sub categories as follows:
a. Community Service Worker – Health (CSW-H) – All types of lay
community-based workers who perform functions in a health related field
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including, but not limited to, health care workers, health aides, community
health workers, promotoras, etc.
b. Community Service Worker – Community (CSW-C) -- All types of lay
community-based workers who perform functions in a non-health related
field including, but not limited to, outreach workers, social service
workers, community advocates, etc.
2. TAP:

The Riverside County Temporary Assistance Program (TAP) is the Human
Resources Department program responsible for the identification, screening, and
hiring of at-will temporary employees for the county

(Riverside County Human
Resources Department, Updated 2012).
3. SCSEP: Senior Community Service Employment Program is a national and
federally funded job training and employment program for low income older
adults over the age of 55 who need to update their professional skills. The
program currently operates within the Riverside County Office on Aging.
4. Peer (or peer led) education: An educational approach in which either paid or
volunteer non-professional community members encourage their peers to promote
and reinforce lifestyle changes with whom they may have similar social,
economic, or life experiences.
5. Chronic disease self-management program (CDSMP): A program for people
with chronic diseases that uses non-professional peer educators, or lay leaders, to
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teach skills used for managing chronic diseases in order to manage their own
conditions.
H. Assumptions and Limitations
Three assumptions have been made in this study. First, it is assumed that older
adults will want to become community service workers and that they will find such service
rewarding and enjoyable. The second assumption is that practitioners will want the assistance
of older adult community service workers. The third assumption is that the proposed Older
Adult Community Service Worker Program developed by using best practices of similar, but
not the same program, will have more successful outcomes than programs that have not taken
best practices of other program into account.
This study is limited to an evaluation of four things, one senior employment
program, the SCSEP participant quick screen employment applications from fiscal year
2014-2015, the Stanford University model for chronic disease self-management program, and
the Arthritis Foundation’s evidence-based health promotion programs all housed within the
Riverside County Office on Aging.
I. Conclusion
This study seeks to develop one concrete and specific way to harness the power of the
community to help practitioners by training and mobilizing older adults to serve as partners
with, rather than a burden to, service providers. Working as community service workers,
older adults can be trained to provide specific programs designed to support lay leaders and
19

peer educators in the health promotion field, such as chronic disease self-management
programs. Further, using the existing SCSEP program can generate a workforce of CSWs
who can perform other community-based functions that support the work of practitioners
and, if properly integrated into the social service system, can offset program costs and help to
deliver critical services to the growing older adult population of the Riverside County Office
on Aging.

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CHAPTER II. POPULATION CHARACTERISTICS
A. Introduction
The purpose of this research is to develop a pilot community service worker program
for the Riverside County Office on Aging that will train and employ older adults to work on
the front lines of social service delivery in local neighborhoods, senior centers, and adult
housing communities to provide outreach, evidence-based health promotion interventions
and other services for programs that need additional support. Placing critical services in the
community, rather than in traditional settings, has a basis in the history of how communities
have cared for elders in the past, and there are several reasons for why a community-based
approach is needed in Riverside County today. As such, the literature review includes an
overview of: the demographic trends of the older adult population across the nation, in
California and in Riverside County, which will determine the need for a CSW program such
as the one being proposed by establishing that there are currently and will be enough older
adults to support the program; a brief history of eldercare in the United States up to the
present time; a review of supportive policies, legislation, program initiatives, and funding
streams that will allow for the development of a CSW program linking SCSEP to health
promotion programs and other services; the multiple factors impacting the future of care for
older adults; and an evaluation of the best practices of various types of CSW programs to
determine the elements needed for a successful program.

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B. Overview of Demographic Trends
The primary reason for this project is the exponential growth of older adults in
America. Older adults in every area of the county are increasing and the financial, social, and
programmatic resources needed to care for them as they age are not keeping up with
increased demand. Costs for formal long term care are already unaffordable for many older
adults and informal family caregivers, who provide the majority of long term care, are left to
shoulder the burden of caring for the nation’s elder population. Organizations that serve older
adults need innovative and cost effective ways to provide ongoing services, mitigate funding
decreases, and expand existing programs.
Older Adults in the United States
Today, people over the age of 65 years old represent one in eight people in the United
States. Between 1900 and 2010, there was a moderate increase in the older adult population,
from 4% to 13%. (Uhlenberg, 2013) Generally speaking, this modest increase in the older
adult population over the last century can be attributed to two societal changes: 1) the
decrease in fertility rates among the U.S. population, and 2) declining death rates among
adults due to advances in medicine, public health, and epidemiological science, primarily in
the areas of communicable and infectious diseases.
However, in the 20 years between 2010 and 2030, the population will age more
quickly than ever before in history as the Baby Boomers enter older adulthood. Boomers
began turning 60 in 2006, and will continue to advance into older adulthood until 2024, when
the last of the Boomers reach aged 60. The Boomers alone will increase the older adult
22

population by 22% by 2024 (Uhlenberg, 2013). However, the Boomer generation is just the
beginning of the aging phenomena. In 2026, the succeeding generations made up of the
“Generation X” cohort will begin to reach age 60, followed by “Generation Y” or the
“Millennials” in 2037.
The 50 years between 2010 and 2067 will be a period of change toward an older
nation. In 1900, the average life expectancy in the United States was 47 years. At the
beginning of the 21st century, science and medicine have increased average life expectancy
to approximately 80 years old (National Center for Health Statistics, 2015). The average
person who turned 65 in 2010 can expect to live into his or her 80s, 90s, or beyond
(California Department on Aging, 2012). The increasing number of older adults in the United
States population not only makes them a significant demographic group, but the growing
number of what are called the oldest older adults - those over the age of 85 - will create new
challenges that have not existed before in society, science, or medicine. Already, there are
national concerns about Medicare and Medicaid spending and the potential collapse of the
social security system (Weil, 2014). Closer to home, families and local communities are
grappling with how to provide long term and supportive care for the growing number of
elderly and/or ill people in their midst.
Since 1900, the number of Americans over age 65 has increased more than 14 times,
from 3.1 million in 1900 to almost 45 million in 2013. The national older adult population
increased by 25% percent (or 8.8 million people) in just one decade from 2003 to 2013.
Those under age 65 increased by less than seven percent during the same time period. The
number of adults who will live to reach age 65 over the next two decades, from 2013-2030, is
expected to increase from 48 million to 63 million. The largest and most notable increase in
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the older adult population will be amongst those aged 85 years old and older, known as the
oldest old. This population is expected to increase by 310% (between 2013 and 2050),
increasing from 607,000 million to 2.4 million people (California Department on Aging,
2012). As a result, two new aging sub-groups are emerging – the Centenarian or those over
100 years of age, and the Supercentenarian – those over 110 years of age. Over the past 30
years, the Centenarian population experienced the largest overall percentage increase versus
the total national population. In 1980, there were 32,194 people over 100 years old. By 2013,
there were approximately 67,347 persons; more than doubling in a mere 30 years (United
States Department of Health and Human Services, 2014). All Centenarians are between 100
and 109 years old. On average, Supercentenarians, those over 110 years of age, average less
than .6 percent of the overall centenarian population in 2010 (United States Census Bureau,
2012), but this number is also expected to increase as the result of an aging, and longer
living, nation.
A child born in 2013 can expect to live an average of 80 years, almost 30 years longer
than a child born in 1900. The increase is due to two main reasons; reduced death rates for
children and young adults and reduced death rates for the population between age 65 and age
84 from 1990-2007. Overall life expectancy at age 65 increased by only 2.5 years between
1900 and 1960, but increased by 4.2 years from 1960 to 2007, and continues to advance.
The Baby Boomer generation is expected to be the longest lived generation in history.
Of the 78 million original Boomers born in the United States, more than 58%, or 45 million
people, are expected to live past the age of 90 (Weil, 2014). However, the aging of the
Boomer generation brings its own challenges. According to a recent study by Bowling Green
University (2012), Baby Boomers are more likely than the preceding generations to live
24

alone as they age, due to either divorce, death of a spouse or partner, or because
approximately 1/3 of the 78 million Boomers never married. This increase in unmarried,
middle-aged, and older adults represents a 50% increase over the past 35years. This potential
shift away from traditional family support will force policymakers and social service
practitioners to focus their attention on both widowhood in late life, which has been the
traditional focus of aging, and on the aging process of those who will have lived alone for
decades before they reach their later years.
The idea of Boomers as affluent, educated, successful, and retirement ready is based
on a normative construct that looks at middle-class White American Boomers. Although this
may be an accurate picture of some American Boomers, and may have been accurate for
many Boomers regardless of ethnicity prior to the Great Recession, it is not so today even
amongst those who may have once fit the description. Currently, 1/5 of all single Boomers
are living in poverty. These individuals are more prone to disability, tend not to have health
insurance or adequate retirement plans, and have fewer resources and savings (Bowling
Green University, 2012). Single Boomers are also less likely to have the systems of informal
care in place that many older adults rely on such as spouses, children, and/or other family
members. The normative view of American Boomers has never represented the uneducated,
low income individuals, most ethnic minorities, or people of color in this generation.
Studies of Hispanic and African American Boomers show that on average they have
lower incomes, fewer assets and savings, less education, live in poorer housing conditions,
and work in non-professional jobs that are more strenuous, dangerous, and offer few
retirement options than White Boomers (McNeill, et al., 2015; Villa, Wallace, Bagdasaryan,
& Aranda, 2012). Although Hispanic immigrants in the Boomer cohort tend to be healthier
25

than American born Boomers at the time of their immigration, the longer they live in the
United States, the poorer their health becomes. As they age, minority older adults tend to
have chronic conditions with more serious symptoms, which lead to more expensive
emergency room visits and hospitalizations due to a lack of adequate health care coverage
(Villa, et al., 2012). All of these factors paint a picture of minority Boomers as older adults
that shows a need for greater intervention and more targeted services for the communities in
which they live (Valencia, Oropesa-Gonzalez, Hogue, & Florez, 2016).
California’s Older Adult Population
The state of California’s older adult population is growing right along with the rest of
the nation. Partly due to the mild California climate, between 1950 and 2000, the older adult
population increased by 150% (from just under 2 million people to almost 5 million).
Between 2000 and 2050, as California’s Baby Boomers enter old age, older adults will
increase by more than 179%, increasing to almost 12 million older adults (California
Legislative Analyst's Office, 2016). In addition, California has the largest population of
Centenarians in the nation – approximately 5,921 people in 2010 (United States Census
Bureau, 2012). This sub-cohort is also expected to increase in proportion (.1%) with the
overall older adult population.
By 2060, the older adult population of California will have increased from five
million to almost 12 million (California Legislative Analyst's Office, 2016). By 2050, most
of California’s older adult population will be from many minority populations including
ethnic and racial groups (California Legislative Analyst's Office, 2016) as well as the poor
and other marginalized groups, each with their own culture and set of beliefs. Traditionally,
26

many of these groups belong to communities where resources are limited or are from
immigrant groups living outside of traditional American culture. The older adult population
is becoming more racially and ethnically diverse even within the broader racial categories,
with “Hispanic” and/or “Latino” now the most internally diverse group (United States
Census Bureau, 2010). More members of the gay, lesbian, bisexual, transgender and queer
(LGBTQ) population are aging, creating a unique set of challenges. A lifetime of
discrimination and rejection caused many of these older adults to avoid seeking services such
as health care, behavioral health, and other social services (Gardner, 2014). Although the size
of this population is more difficult to measure than those based on gender and ethnicity, it is
estimated that there are approximately 276,000 to 552,000 older LGBT Californians. By
2030, this number is expected to nearly double (California Department on Aging, 2012).
This increasing diversity will require California’s social service practitioners to
conduct culture specific outreach and education services and to develop programs that work
to mitigate any access issues. These older adults will have higher rates of chronic disease,
physical limitations, and behavioral health concerns, which will require more supportive
services and place more demand on families, communities, and governments to provide care.
In addition to increasing diversity, California will be faced with an increase in older adults in
their 80s, 90s, and older, which is a relatively new population for gerontologists and social
service professionals. This group will present new and unique challenges as practitioners
determine how to best serve them and if they will require specific types of care. The
University of California, Irvine has been conducting an extensive study of those individuals
over 90 years old since 2003 (Kwas, 2008). The study has access to medical, social, lifestyle,
and demographic data from thousands of older adults who lived in Southern California’s
27

Leisure World in the 1980s – some of whom still live in a community now known as Laguna
Woods. The ongoing research study has yielded some surprising findings regarding factors
associated with the “90+” population, including new information about dementia (Kawas,
2006); (Bullain & Corrada, 2013), the positive effects of weight gain as we age (Corrada &
Paganini-Hill, 2010), alcohol and caffeine consumption (Paganini-Hill, 2007), lifestyle
practices (Paganini-Hill, 2011), and many other factors that may contribute to a longer life.
The UC Irvine research findings may help inform the way that programs are structured and
how services will be delivered to older adults in the future.
Older Adult Population Profile in Riverside County
Geographically, Riverside County is the second largest county in California, covering
over 7,000 square miles of land from Los Angeles County to the west, Orange and Imperial
Counties to the south, San Bernardino County to the north, and the state of Arizona to the
east. The county is a mix of both urban and non-rural, isolated communities, as well as
remote desert, mountain, forest, lake, agricultural, and nationally designated Native
American communities (Riverside County Office on Aging, 2016). With a population of just
over two million people dispersed across these communities within the county, the challenge
of providing services to older adults in Riverside County will only increase in the future.
Figure 1 below shows the geographic area of Riverside County (including incorporated and
unincorporated areas) (Southern California Association of Governments, 2015).

28

Figure 1: Riverside County, California
In Riverside County there are currently approximately 300,000 older adults, however
by 2040 residents over the age of 65 will exceed a half a million and will be approaching one
million by 2060 (California Department on Aging, 2012). Reflecting the national statistics,
two subgroups of older adults are the fastest growing segments of the older adult population
in the County; adults aged 75 to 84 years old will increase by 240% and the subgroup over
age 85 is expected to increase by 443% by 2060 (Riverside County Office on Aging, 2016).
The 2014 population projections and percentage increases for 2010-2060 for older adults
(California Department of Finance, Demographic Research Unit , 2014) are shown in Table 1
below.
Table 1: Riverside County Population Projections by Age Group 2010-2060

Age Group 2010 2060 % of
Increase
ALL Age Group
(Total Population)
2,194,933 3,678,439 68%
Working Age (25-64 years) 1,085,492 1,750,307 61%
Young Retirees (65-74 years) 141,479 388,792 175%
Mature Retirees (75-84 years) 86,228 293,310 240%
Seniors (85+) 32,776 178,133 443%
29

As has been previously stated, California has the highest number of Centenarians than
any other state and Riverside County has the highest number of Centenarians in California.
(United States Census Bureau, 2012). This population makes up approximately 1% of the
total population in the state and Riverside County and is expected to increase by the same 1%
margin.
Growing Diversity in Riverside County
In addition to a rapid increase in the older adult population, an update of the United
States Census American Community Survey (United States Census Bureau, 2013) reported
that the racial makeup of Riverside County in 2013 was 81% White alone with no other race
reported; 38% White and another race that is not Hispanic or Latino; 47% persons of
Hispanic or Latino origin; 7% African American (non-Hispanic), 7% Asian; 2% Native
American and Alaska Native; less than 1% Hawaiian Native or other Pacific Islander; and
3% persons reporting two or more races. Figure 2 below represents data provided by the
California Department of Finance in 2015 (State of Callifornia Department of Finance,
2015). Figure 3 shows the projected increase in Riverside County’s ethnic population
between 2010 and 2060 (Riverside County Office on Aging, 2016).

30

Figure 2: 2014 Riverside County Population by Ethnicity

Figure 3: Riverside County Population Projections by Ethnicity (2010-2060)

7.0%
1.9%
6.8%
0.4%
3.4%
47.4%
37.4%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Black or
African
American
American
Indian and
Alaska
Native
Asian Native
Hawaiian
and Other
Pacific
Islander
Two or More
Races
Hispanic or
Latino
White, not
Hispanic or
Latino
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
2010 2020 2030 2040 2050 2060
Hispanic or Latino White Asian Black Multi-Race
31

Riverside County’s current lesbian, gay, bisexual, transgender, and queer (LGBTQ)
population is approximately 4.5%, making Riverside County one of the largest LGBTQ
communities per capita in the nation. Table 2 below, shows that 19 Riverside County cities
have the highest number of same sex couples in the state and are among the top 1,400 cities
in the nation for LGBT families. Five Coachella Valley cities are among the top 20 cities in
the nation for LGBT households (Gardner, 2014).
Table 2: Riverside County Cities Ranked by Same-Sex Couples per 1,000 Households,
Cities with 50+ Same-Sex Couples (2010 Census)
State
Rank
US Rank among
1,415 cities with
50+ same ‐sex
City
Same Sex
Couples
Same-Sex Couples
per 1,000 Households
1 3 Palm Springs 2,440 107.28
4 8 Rancho Mirage 462 52.29
5 11 Cathedral City 790 46.33
10 42 Desert Hot Springs 195 22.56
20 86 Palm Desert 334 14.47
43 219 La Quinta 142 9.56
86 465 Indio 165 7.05
100 557 Lake Elsinore 96 6.52
111 648 Beaumont 72 6.13
123 740 Riverside 526 5.72
155 934 Banning 53 4.86
156 937 Hemet 146 4.85
171 1,014 Eastvale 62 4.53
186 1,077 Moreno Valley 224 4.35
192 1,116 Perris 69 4.22
206 1,187 Menifee 108 3.95
230 1,306 Corona 153 3.4
250 1,394 Murrieta 86 2.64
251 1,394 Temecula 81 2.56

32

Population estimates are likely to underestimate the true size of this population due to
the reluctance of individuals to identify as LGBTQ (Gross & Landers, 2008). However, there
are various studies that estimate the total LGBTQ population to be between 3% and 10% (or
between 70,747 and 235,822 individuals) throughout Riverside County. The transgender
population of Riverside County is estimated to be between 2,358 and 7,075 individuals
(Gardner, 2014).
Figure 4: Estimated LGBTQ Population of Riverside County by Age Group, 2011

Figure 4 shows the potential range in the number of individuals in the older adult
LGBTQ population in Riverside County (Gardner, 2014). As older adults retire to California,
and to the Coachella Valley specifically, the number of older adults seeking LGBTQ friendly
services and relying on families of choice, made up of friends, rather than families and
children, will also increase.
6,555
54,364
9,828
21,846
181,215
65,107
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
12-17 years 18-59 years 60+ years
3% 10%
33

The LGBTQ older adult community presents a unique set of obstacles in terms of
aging, access to social services, and access to care. This community has historically been
wary of accessing services due to prior discrimination and victimization by the community
and by providers (Adelman, 2016). Issues of trust, fair treatment, and sensitivity come into
question whenever LGBTQ older adults seek mental or physical health care, social support,
or long term care options (Moone, Crojhan, & Olson, 2016). However, this population has a
high number of older adults who are aging with HIV and/or AIDS, suffering from multiple
chronic conditions that require special care and/or support, and/or are coping with higher
rates of limitations on activities of daily living (ADLs) (Emlet, 2016; Fredrikson-Goldson,
2016). The reluctance to seek care and social support increases health disparities and
isolation, which already exist among LGBTQ individuals (Fredrikson-Goldson, 2016). In
addition, LGBTQ older adults suffer from multiple layers of discrimination beyond ageism,
sexism (in the case of females), and racism. Other types of discrimination can include sexual
orientation, and gender identity, in the case of transgendered individuals, and HIV status. In
2015, 50% of people living with HIV in the United States were age 50 years old or older
(Karpiak & Bernnan-Ing, 2016). It is estimated that by the year 2020, more than 70% of
people living with HIV in the United States will be over the age of 50 (Emlet, 2016).
Older adults in the LGBTQ community are two times more likely to live alone,
without partners, spouses, or children (Adama, 2019) and tend to rely on “families of choice”
made up of selected family members, friends, neighbors, and others to provide support as
they age (Orel & Coon, 2016). However, many of the people who make up these “families”
are also aging with many of the same issues, making the possibility of them caring for one
another a difficult or unlikely prospect (Karpiak & Bernnan-Ing, 2016).
34

C. Older Adult Health and Socioeconomic Issues
Disability
In 2012, the U.S. Census estimated that the total civilian, non-institutionalized
population within Riverside County living with a disability was 246,387 persons, or 11% of
the total population (California Department on Aging, 2012). This percentage is higher than
the overall percentage for the State of California (10.3%); (United States Census Bureau,
2013). The percentage of those with disabilities is likely to increase as the population ages.
Older adults are significantly more inclined to live with one or more disabilities than the rest
of the population due to the rise in chronic diseases. Greater longevity, coupled with greater
rates of disability, means that the cost of and need for adequate health care and community-
based services must be anticipated.
Dementia
In 2015, more than five million adults over the age of 65 in the United States had
Alzheimer’s disease (Gaugler, James, Johnson, Scholz, & and Weuve, 2015). It is estimated
that one in nine older adults have some form of dementia and approximately one in three
adults over age 85 have Alzheimer’s disease. Women tend to be at higher risk of Alzheimer’s
disease, with almost 2/3 of all diagnosed cases in 2015 being women. Women tend to live
longer than men in general and men tend to die from other causes, such as heart disease,
before they can experience death from Alzheimer’s disease (Gaugler, et al., 2015).
35

Dementias, or those diseases that affect the mental capacity of an individual, such as
Alzheimer’s disease, are the sixth leading cause of death in the United States, the fifth
leading cause for those over the age of 65, and the leading cause of disability (Gaugler, et al.,
2015). It is the only cause of death that cannot be prevented or slowed (U.S. Department of
Health and Human Services, 1995). Although other causes of death between 2000 and 2013
decreased; deaths due to Alzheimer’s disease increased by 71% percent during the same time
period (Gaugler, et al., 2015).
In California, Alzheimer’s disease contributed to more than 31% of all recorded
deaths in 2013. As a person ages, the instances of death due to Alzheimer’s disease increase
from 18 instances per 100,000 age 65 to 74, to over 920 instances per 100,000 adults over the
age of 85 (Gaugler, et al., 2015). An older adult diagnosed with Alzheimer’s disease lives an
average of four to eight years. As the effects of the disease take their toll, spouses, friends
and family members are either drawn into the mental and physical strains of increased
caregiving responsibilities or into the financial burden of institutional care.
Based on the anticipated population increase, Riverside County can expect a similar
increase in cases of Alzheimer’s disease and other dementias. Table 3 (Ross, Brennan,
Nazareo, & Fox, 2006) below shows the expected increase in Alzheimer’s disease cases in
Riverside County. In 2015, there were approximately 37,000 cases. This number is expected
to increase by seventy percent by 2030.

36

Table 3: Number and Percent Change in People 55+ with Alzheimer’s Disease
(2008, 2015, 2030 — Riverside County)
2008 2015 2030
% Increase
2008-2015
Projected
Increase
2015-2030
Projected %
Increase
2008-2030
31,992 37,025 60,116 17% 70% 87%
HIV and AIDS (Riverside County – Coachella Valley)
According to a recent study by the Riverside University Health System- Public Health
published in 2011, there were 3,247 people reported living with AIDS and 1,521 people
living with HIV in Riverside County. Eastern Riverside County (the Coachella Valley) has
almost 2.5 times the number of cases of AIDS and HIV than any other county region.
Approximately 60% of people living with AIDS and 45% of people living with HIV in
Riverside County were 50 years old or older and between 2009 and 2011, 27% percent of all
new HIV cases were in people 50 years old or older (County of Riverside Department of
Public Health, 2012).
Poverty
In Riverside County, 80% of residents over the age of 65 for whom poverty status
could be determined have incomes at or above 150% of poverty. The remaining older adult
residents are either between 100% and 149% of poverty (11%) or below 100% of the federal
poverty level (9%) (United States Census Bureau, 2010). Older adults who rent their homes
need more than twice the amount established by the Federal Poverty Level (FPL) guideline to
37

meet basic living expenses, with housing and health care as the primary drivers of the high
costs (Wallace, Smith, & Padilla-Frausto , 2010).
Older adult poverty is measured in two ways, by using the standard FPL determined
by the federal government and used to qualify low income individuals for government
sponsored social services. The FPL measure was developed in the 1960s based on a “one size
fits all” approach using the same dollar amount across the county and based on the cost of
food alone. It has been determined that the FPL is an insufficient way of measuring poverty
for any person the United States (Levinson, Damico, Cubanski, & Neuman, 2013), regardless
of age or income. In 2011, the Census Bureau released a supplemental poverty measure
according to which 48% of older adults live at or below the FPL. In California, older adult
poverty doubles when using the new measure. Utilizing the FPL, approximately 20% of
California’s older adults were living below the poverty threshold of approximately $16,000
annually for an individual in 2013. When the new measure is applied, the number increases
to approximately 56% of older adults who are living in below the FPL or who are living in
extreme poverty. Post-recession, the number of older adults who may live in poverty has
increased due to higher credit card debt, higher unemployment rates, losses in home equity,
and stock market declines

(Levinson, Damico, Cubanski, & Neuman, 2013).
The Elder Index
(TM)
takes into account the actual cost of living within a county, by
adding in static monthly expenditures for housing, food, transportation, and health care for
older adults. On average, older adults in the United States need approximately $5,000 to
$10,000 more income annually to account for medical and other expenses. This revised
calculation shows that many older adults do not fall below the FPL, but according to the
Elder Index, many older adults still struggle to make ends meet, often choosing between the
38

monthly purchases of food or medications. In California, where the cost of living is high, the
FPL is inadequate as a measure of poverty for older adults. However, the FPL is still utilized
to determine income eligibility for many older adult programs, to allocate funding for
programs, and as an evaluation measure when determining program effectiveness. Table 4
shows the percent of older adults living below the FPL and those who are living in extreme
poverty in the state of California from 2009-2011 according to both the FPL and the
supplemental poverty measure (Levinson, et al., 2013). Table 4 also shows the disparity in
the actual poverty levels for Riverside County’s older adults when using both the FPL and
the Supplemental Poverty Measure (Riverside County Office on Aging, 2016).
Table 4: Percent of Riverside County Older Adults Living Below 100% of Poverty, Per
FPL and Elder Index (2011)
Federal Poverty Level
(FPL)
Supplemental Poverty
Measure
%
Difference
8% 20% 12%
Workforce and Volunteerism
Conversations about the aging of the Boomer population tend to focus on the burden
that so many elderly people will have on Medicare and Social Security. The “age dependency
ratio” (Halvorsen & Emerman, 2014) calculates the cost of fewer younger workers
supporting so many older adults still living in the population. The “age abundancy ratio”
(Halvorsen & Emerman, 2014) focuses on the contributions that older adults can make to
communities and society by continuing to work and volunteer beyond the traditional
retirement age. According to Halvorsen and Emerman (2014, p. 34), there are two reasons
that older adults want to give back to their communities. One reason is the desire to feel
39

connected to the larger society as they age and the other is the altruistic desire to make a
contribution to the community or the world. Their research suggests that 87% of American
older adults want to continue contributing beyond retirement.
Contrary to how previous generations viewed “old age”, Boomers are poised to
redefine what it means to be an older adult (Gibaldi, 2014). The new older adult is no longer
young, but not really “old” either, which is having a marked change on traditional retirement.
As Boomers approach retirement from their formal occupations, many are faced with an
additional 25 to 30 thirty years to fill. The post retirement years are now being viewed as the
“encore” (Halvorsen & Emerman, 2014), or the third phase of life, after childhood and
adulthood. Many retirees and older adults who need to remain employed for financial reasons
will use these years to follow their passions by changing careers, learning new skills, starting
businesses or non-profit organizations, or working part time in the community for causes of
interest to them. A third reason why older adults may want to remain active by making
contributions to their community is that by remaining active, older adults have a better
chance of remaining independent by preserving their physical and cognitive health (Warner,
Wolff, Zeiegelmann, & Wurm, 2014).
Before the Great Recession, more than 40% of American workers aged 45 to 55 had
less than $10,000 in retirement savings and seventeen percent had less than $50,000 put
away, but still had equity in their primary residence and/or an employer benefit plan. Only
20% of older adults had more than $50,000 saved for retirement. (Halvorsen & Emerman,
2014). Many adults who were approaching the traditional retirement age lost their homes
during the recession or find that the equity they were counting on for retirement has greatly
diminished. Displaced workers lost income and may have lost employee retirement or
40

insurance benefits, which may have eaten into their retirement savings and/or 401k accounts.
For these older adults, leaving the workforce is not an option.
The talents, skills, experience, and wisdom of the older adult generation can be a
valuable asset to every community, through continued employment or through volunteerism.
Finding and/or creating avenues of employment or volunteer opportunities for older adults to
continue to contribute could be a viable solution to the pressing problem of how to care for
the growing older adult population.
Even among Boomers who are financially secure in retirement, there is a growing
body of research that supports the importance of the social connections, interactions and
continued activity of older adults. The World Health Organization (WHO) defined an age
friendly community as one that “adapts its structures and services to be accessible to and
inclusive of older people with varying needs and capabilities” (World Health Organiation,
2007) and has identified eight characteristics that meet the definition of an age friendly
community.
Figure 5: World Health Organization Age Friendly Topic Areas
41

Figure 5 shows the WHO’s age friendly topic areas. Five of the eight key areas focus
on less tangible aspects of society such as social participation, social inclusion, civic
participation, employment, and community services and support (Gonzalez, 2009). These are
the areas that an older adult community service worker program seeks to address for the
older adults who participate.
The Corporation for National and Community Service estimates that between 2008
and 2010, more than eighteen million older adults over fifty five years old contributed more
than three billion hours of volunteer service in their communities, more than any other age
group. Older workers and volunteers serve in various capacities that help other older adults
live independently in their homes and communities, while keeping themselves active and
healthier. Volunteering and/or remaining active result in mental and physical health benefits
such as lower rates of mortality, depression, physical limitations, and higher levels of well-
being (Warner, Wolff, Zeiegelmann, & Wurm, 2014).
Community service organizations that provide older adults with opportunities to
remain active and engaged in the working world are beginning to develop. Umbrella of the
Capital District is a non-profit organization in Washington D.C. that utilizes retired
volunteers with specialized skills to assist their neighbors on a sliding fee scale (Corporation
for National Community Service, 2012). “Boomers Leading the Change in Health” is an
initiative in Denver that offers several ways for older adults to volunteer as health navigators
who assist community members with understanding the health care system. In this program a
community health worker outreaches to the community and explains the importance of health
care and prevention. Community service workers also serve as advocates who are trained to
inform decision makers about the impacts of health related policies and legislation. Senior
42

Corps utilizes federal funding to sponsor several volunteer initiatives including the RSVP
Program (formally the Retired Senior Volunteer Program), which places older adults in
various sites related to health and wellness, public safety, environmental preservation,
education, and food banks (Halvorsen & Emerman, 2014). Experience Corps recruits older
adults to work in schools. As more Boomers reach retirement, community and governmental
organizations should develop ways to recruit and employ those who need to continue
working in meaningful assignments that provide professional development and valuable
work for those who are volunteers.
The elder care workforce is a specific area of employment that is both growing and
changing. The current trend is to shift elder care away from institutional settings (nursing
homes and long term care facilities) to community-based, in home care. Between 2005 and
2015, this workforce increased by more than one million workers and the trend is expected to
continue (Campbell, 2016)
Social Support
Social support is an important factor in the aging process and several studies highlight
the important link between social interaction and positive health outcomes (Chappell &
Funk, 2011; Charles & Christensen, 2010; Rameriz & Palacios-Espinosa, 2016). Marital and
familial relationships can provide some measure of support, provided the relationships are
positive. Older adults tend to have fewer social connections, but those few connections are
stronger and deeper than those of younger adults (Honn Qualls, 2014). However, as adults
age, connections get severed and those with small networks can find themselves alone.
43

The benefits of social support fall into three categories: biological, psychological and
social. Biological benefits include reduced blood pressure, heart rate, and cholesterol levels
and social support can help older adults deal with the stresses that accompany the aging
process and mitigate risky and/or unhealthy behaviors (Chappell & Funk, 2011; Honn Qualls,
2014).
D. Policies Addressing Older Adult Care
The cornerstone of the social programs in the United States is rooted in the
Elizabethan Poor Laws of the 17
th
Century, which outlined a basic system for support for the
poor, the disabled and the elderly who lacked familial support. The system consisted of local
communities providing food, firewood and other basic supplies to the needy. If localized
options failed, magistrates from regional provinces would step in to assist by ushering the
indigent into poor houses and institutions (Achenbaum, 2013). The first settlers of the
American colonies brought this cultural ideology, grounded in Christian values, with them
and cared for the less fortunate and the few elderly people in their communities in the same
way. The Pilgrims of Plymouth created “outdoor relief” – meaning that older adults received
services in their homes, rather than in institutions or “poor houses”—which allowed people
to age in place. As the country expanded, so did the idea of providing formalized relief to
people in their homes. By the 1640s and 1650s, those receiving such relief in Virginia were
required to wear a “P” on their clothes to signify to the community their status as poor and
needy, or were separated from their homes and forced into “almshouses”, thereby creating
the stigma that persists today (Achenbaum, 2013). Almshouses eventually gave way to
public asylums wherein the poor, the old, the sick and the mentally ill were all confined. This
44

pattern of familial and informal community support, supplemented by state intervention in
the extreme cases, continued well into the 20
th
century. Eventually, religious organizations
and fraternal organizations built homes and provided food to members, businesses and
unions developed pension plans, and veterans’ organizations provided medical services and
relief for those displaced by their military service. Although these services existed in many
communities, the assistance was not regulated or evenly distributed (Achenbaum, 2013).
Three major pieces of legislation began to alter the course for aging services. The first
was the Social Security Act of 1935. This policy created a partnership between the federal
government and the states to create a financial system to assist older adults and required most
employers to contribute financially to a national retirement system. Unfortunately, at the time
it was instituted, Social Security benefits only applied to wage earners, who were typically
men, which left unmarried, abandoned, or widowed women with no formal means of support
as they aged.
The second major piece of legislation affecting older Americans was Medicare and
Medicaid, a 1965 amendment to the Social Security Act. The amendment created the first
system of national health care designed to cover acute care and some aspects of post-acute
care for the elderly, including nursing home and home health care (Davitt, 2008). Medicare
Part A covered in-home care for 100 days immediately after a three day hospital stay and
Part B covered eighty percent of the cost for 100 days of in-home care per year, with or
without a hospital stay, for those who met strict criterion for such care (Davitt, 2008). In the
1970s, Medicare was expanded to include in-home care for the chronically ill, and
homemaker services (where older adults are provided with assistance around the house) were
added as a more cost effective approach to older adult care than routine hospitalization
45

(Davitt, 2008). In the 1980s, the Omnibus Budget Reconciliation Act of 1980 sought to
further expand services by removing the three day limit for Part A and the twenty percent
deductible for Part B. In the 1980s, home health services were expanded when state
licensure requirements were relaxed allowing for-profit agencies to enter into the service
delivery system. In the 1990s, concerns about growing national health care costs forced
national discussions about how best to control costs. Since in-home care was the least
regulated of the Medicare supported fee-for-service programs, in 1994, the federal
government choose to freeze the reimbursable cost for care services, meaning that
organizations providing the services either had to reduce the number of patients they see per
year, or reduce the amount of service allotted per patient to even out the costs. Since that
time, the national discussion has focused on reducing or cutting Medicare costs in order to
preserve the system for future generations.
The third and most important legislation impacting older Americans was the Older
Americans Act (OAA) of 1965 passed by the Lyndon B. Johnson. The OAA entitles older
adults to income in retirement, physical and mental health services, restorative services, the
ability to pursue meaningful activity, access to community services, immediate
implementation of research results and findings, and the ability to chart the course for their
lives in their later years. At the same time, the Johnson Administration created the
Administration on Aging (AOA) to oversee the allocation of federal funds to each state
agency and the development of programming according to the guidelines set forth in the
Titles of the OAA.
Title IIIB provides funds for general supportive services, outreach, planning,
advocacy, and coordination; Titles IIIC1 and IIIC2 provide funding for congregate (meals
46

provided in community and social settings such as senior centers) and home delivered meals,
respectively; Title IIID provides for health promotion and disease prevention interventions;
Title IIIE provides funds to support caregivers; Title IV provides for programs for Native
Americans, older adult research, and the training and education of aging services
professionals; Tile VI provides more funding for Native American programming; and Title
VII provides funds for elder abuse prevention interventions (Administration on Aging, 2006).
As a part of the OAA, Title V, the “Older American Community Service Act”
provides funding for the Older American Community Service Employment Program and the
SCSEP program, which create part-time subsidized training and employment for low income
adults over the age of 55 who have low to very low employment prospects. The program goal
is to move these older adults from dependency to self-sufficiency through employment. The
program allows for employment training in the public and private sectors for up to forty eight
months in local communities. Training must be provided by knowledgeable and experienced
trainers, contribute to the betterment of the community, and result in improved employment
opportunities for those who participate in the program. The program also provides
participants with a minimum wage stipend while they are in training. In 1967, Congress
passed the Age Discrimination in Employment Act of 1967 (Pub. L.90-202) (ADEA), which
disallow employment discrimination against workers over 40 years of age.
In the 1960s when the OAA was passed, the national focus was on civil rights and the
Vietnam War so, beyond the legislation, funding for and attention to older adult issues was
scarce. (Achenbaum, 2013) The OAA has been amended several times over the past 30
years to expand and add to the scope of allowable services.
47

E. The Future of Older Adult Care
Staffing Shortages in Geriatric Care
For more than 10 years, health and social service organizations have been
highlighting the shortage of providers trained in geriatric care (Frank, et al., 2014; O'Brian,;
Spencer, Gunter, & Palmisano, 2010; Squires, Bixby, & Larson, 2009). This staffing
shortage, coupled with the exponential growth of the older adult population, has led to the re-
discovery of community and family-based assistance for older adults (Frank, et al., 2014).
More initiatives are now focusing on training lay community members to perform basic
functions, provide ongoing support to those who need care, and facilitate preventative
activities (such as exercise and education, etc.) to ease the burden on older adult practitioners
and to reduce the need for more expensive emergency or institutional care. These new
initiatives rely heavily on lower paid or volunteer workers as a resource operating in local
senior centers and housing communities, to assist with peer led programs and services. Both
the federal Health and Human Services Department and the California Department on Aging
have made a commitment to developing community-based programs and peer-led health
interventions that will rely on older adults for implementation.
Chronic Disease Self-Management Programs (CDSMP)
Chronic diseases, including heart disease, chronic obstructive pulmonary disease
(COPD), stroke, cancer, diabetes, obesity, epilepsy, and arthritis, are the leading cause of
disability in the world. Many older adults in the United States suffer from at least one chronic
disease, with many suffering from more than one (Chapman, 2014; Jones, 2016). Until very
48

recently, elder care in the United States has primarily focused on acute care, with little to no
attention to preventative care or patient self-management of medical and/or chronic
conditions. However the projected increase in older adults and those with chronic diseases
means that this approach will be ineffective moving forward, given that chronic disease
effects and treatments are the most preventable of all medical conditions but the most costly
in the long run (Chapman, 2014). As health care costs rise, policy makers and medical and
social service practitioners are looking for ways to combat the rise in these chronic diseases,
and health promotion and preventative wellness activities are now being integrated into the
health care system (Schreiber, 2016).
For the past decade, researchers have been studying the effects of chronic disease
self-management programs (CDSMP) on the older adult population and those with chronic
diseases. CDSMPs occur in community settings or small group settings (typically 10 people)
over a six week period, and are facilitated by two trained peer leaders who are from the
community and also have chronic diseases. The six sessions help those who suffer from
chronic diseases to manage their pain, medications and emotions, increase exercise, improve
communication with medical professionals, improve their nutrition and sleep, understand
what other community resources are available to them and how to provide feedback on new
treatments proposed by doctors, and make informed decisions about treatment options.
Overall, a CDSMP has shown to be an effective intervention with regard to several
factors including improved health status, decreased utilization of acute health care
(emergency room visits and short-term hospitalization), increased self-efficacy and problem
solving skills with regard to health management (Lorig, et al., 2001), and health care cost
savings to hospitals and Medicare (Ahn, et al., 2013). CDSMP focuses on the Triple Aim
49

goals of better health, better health care and better value for cost associated with care (Ory, et
al., 2013). A national study reviewed the outcomes of a CDSMP intervention for 1,170
participants from 22 organizations in 17 different states over a 12 month period to determine
the effectiveness of the intervention on changes in patients’ health behaviors, health status
and the cost savings associated with decreased utilization of the health care system (Ory, et
al., 2013). Seventy seven percent (77%) of participants completed the six month post
assessment and 71% completed the 12 month post program assessment. The results showed
that emergency room visits were reduced by 27% after 6 months and by 21% after 12
months. Hospitalization decreased by 22% after six months, but increased after 10 months
(Ory, et al., 2013). A study conducted in 2001 (Lorig, et al., 2001) reviewed the outcomes of
CDSMPs at one and two years post intervention and results showed that the program was
still effective even after two years. Although for some participants instances of disability did
increase over time, their utilization of medical services did not increase due to the lessons
learned during the intervention (Lorig, et al., 2001). The results of a 2013 study confirmed
the results of earlier studies, showing a decrease in post-intervention emergency room visits
by 5%, a reduction in hospital utilization by 3% after six months, and cost savings of
between $1,513 and $18,750 per client, depending on their chronic disease diagnosis and the
types of specific interventions they employed (Ahn, et al., 2013).
Evidence-Based Health Promotion Programs
Based on the positive research results on CDSMPs, the 2006 Reauthorization of the
Older Americans Act included a provision requiring that, as of October 1, 2016, all federal
funds set aside for health promotion, known as Title III D funds, could only be spent on
50

evidence-based health promotion programs, like CDSMP. Evidence-based programs are
clinically tested to result in the types of behavior changes needed to impact the participant’s
health and disease management. Similar to the CDSMP model, all evidence-based programs
identified as allowable under the new provisions are facilitated in community-based settings
with the goal of teaching participants the skills necessary to manage their own health and
wellness, be it chronic diseases, physical activity, or behavioral health interventions, in order
to reduce instances of emergency room care and hospitalizations. Per the United States
Health and Human Services Department, in order to qualify for the list of acceptable
interventions, the program must meet the highest level of evidence-based criteria, which
requires that the program or intervention has been evaluated and shown to be effective in
treating older adults and improving their health outcomes, and the results have been
published in a peer reviewed journal. The program must also be proven effective in more
than one community-based site and the training materials must be available to the public
(Administration for Community Living, 2017).
The Riverside County Office on Aging receives Title III D Health Promotion funding
and, therefore, provides several evidence-based programs to the public including the
University of Stanford-based chronic disease self-management program (CDSMP), which is
called the Healthy Options Program (HOP) in Riverside County, the Arthritis Foundation’s
physical exercise program and its walking program, and Bingosize, which combines physical
activity with a classic bingo game. These programs are offered free of charge throughout the
county and are available for all older adults within the planning service area.

51

Long Term Services and Supports (LTSS)
There is increasing demand for long term services and supports, such as homemaker
services (all types of housecleaning, cooking, etc.) and personal care (assistance with
bathing, eating, medication management, etc.), as the Boomer population ages. By
approximately 2020, it is anticipated that spending by both the federal government and the
states will range from $132 to $140 billion, with states contributing between 50% and 60% of
those costs. The largest cost area is projected to be in providing high cost nursing home care.
Approximately 12% of people who currently use nursing home care have functional
limitations that are considered mild or moderate and could be managed in a home setting
with assistance from an in-home care worker, such as a CSW (Felix, Mays, Stewart,
Cottoms, & Olson, 2011). Another 58% are considered dually eligible for Medicare and
Medicaid coverage, yet still have unmet long term care needs. Studies have shown that long
term care services provided in the home and local community are more cost effective than
institutional care and lead to better outcomes and greater overall satisfaction with the care
they receive (Felix, et al., 2011).
F. Summary
The older adult population in Riverside County is expected to increase substantially over
the next 30 years. As this population grows, there will also be high instances of disability,
dementia, and chronic diseases. Although a small percentage of Riverside County’s older
adults are expected to live at or below the federal poverty level, there are many more that will
most likely have trouble making ends meet due to those factors outlined by the Elder Index,
such as increased medical and housing costs, that come in older adulthood. Studies show that
52

maintaining social connections through work and volunteering can help to reduce the risks of
isolation and depression, and help reduce the need for more expensive interventions by
helping older adults to remain active and engaged in their communities. As the national
conversation moves toward ways to address these concerns, building an infrastructure of
peer-led health promotion programs, developing community-based long term services and
support, and implementing evidence-based practice across several areas of social service,
which are guaranteed to show results, seem to be taking us back to how we managed elder
care in the past, when communities cared for one another. The community service worker
pilot will provide a vehicle for older adults to be at the forefront of their own care.

53

CHAPTER III. COMMUNITY SERVICE PROGRAM GOOD, BETTER AND BEST
PRACTICES
Research Question 1: What are the key elements and best practices of a community service
worker program?
A. Introduction
The goal of this paper is to develop a proposal for a Riverside County older adult
community service worker (CSW) program that trains and employs participants of the Senior
Community Services Employment Program (SCSEP) to assist the Office on Aging
practitioners with program delivery. In order to develop such a program, it is critical to
determine what the key elements of a successful community service worker program are. The
goal of this chapter is to review various CSW programs in order to identify the key elements
of these types of programs and to identify the best practices in key areas.
Many formal CSW programs are based on the CSW promotora model, which has
been proven to be successful in impacting the health outcomes of low income women in
Central America and more recently in towns along the Mexican border of the United States.
This kind of work goes back much further than the 20th Century, and can be found all over
the world and throughout history. Much like their ancient forbearers, modern community
service workers are lay (non-professional) members of the community, have received some
sort of training and perform a variety of roles from simple community outreach to
paraprofessional functions like case management and referrals in order to implement
medical, social service, and mental health interventions in low income, minority, and rural or
isolated communities. Although various programs have the same overall goal – to engage the
54

above mentioned communities in some way – they utilize different program designs, follow
different implementation steps and are evaluated very differently.
The process of developing a CSW program pilot for the Riverside County Office on
Aging begins with an identification of the key elements of CSW programs. Although there is
no standard program design, as most programs are developed based on the needs of the
sponsoring organization, the literature suggests that there are five basic program elements
and areas of best practice that are key to developing a CSW program including, 1) role
development, 2) program design, 3) recruitment, 4) training and education, and 5) measuring
outcomes. Within most of the key area there emerge a set of best practices that can be
categorized into three levels of effectiveness, which I will call the “Good, Better and Best”
practice categories, with each level leading to potentially more successful outcomes. These
areas of best practice are described below.
B. Role of the Community Service Worker
The first community service workers were the “natural healers” found in most
indigenous communities around the world. These people were perceived as knowledgeable
and trusted by the community and provided medical care, spiritual guidance, and moral
support to their tribes and villages. In China, Africa, Finland, India, and precolonial America,
people known as “barefoot doctors”/shamans (with different regional terms) and midwives
provided medical assistance, herbal cures, and tinctures to the ailing. Latin America has a
long history of women working as promotoras in small villages and rural communities
(Spencer, Gunter, & Palmisano, 2010).
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In the United States, a formalized system of community services and lay health
workers was first documented in the 1950s operating primarily in Native American
communities. During the 1970s, CSW programs expanded in the United States as part of the
Johnson Administration’s antipoverty movement. The programs operated in low income
communities, urban and rural communities, and communities of color, with the goal of
increasing access to health care and improving nutrition. Most of these programs were grant
funded and short lived and their outcomes were not thoroughly or consistently evaluated. In
the late 1970s, universities began to study these types of interventions and attempted to
develop a standardized training and education model. As a result of that work, by the late
1980s and early 1990s, some states adopted legislation in an attempt to formalize the work of
CSWs, with some states even adopting formal credentials and licensing procedures (Spencer,
Gunter, & Palmisano, 2010).
CSWs grew in importance as communities became more ethnically and culturally
diverse and practitioners began to share fewer cultural, linguistic or ethnic similarities of the
communities they were serving. Today, aging service organizations and Area Agencies on
Aging have very few staff members who are specifically trained or educated in gerontology
or evidence-based work, and approximately five percent of staff are due to retire from the
field by 2020 (Frank, et al., 2014). CSWs, who are most often non-professional, lay
members of the local community, are either paid or volunteer to assist professionals with
providing services related to mental health (Siegel, et al., 2000), social services (Spencer,
Gunter, & Palmisano, 2010), infrastructure assessments such as parks, community assets, etc.
(Arrendondo, et al., 2013), as well as many other types of community-based services to the
56

communities in which they live, or with which they share cultural, linguistic, ethnic or
diagnostic similarities.
CSWs are valued as part of the social service delivery system because they can better
identify with those who are targeted for services, share their experiences, and integrate the
program or intervention into the community (Johnson, et al., 2012; O'Brian, Squires, Bixby,
& Larson, 2009; Reinschmidt, et al., 2006; and Murphy & Matos, 2011).
“Lorenza’s job was to know who was sick, who was pregnant, and who was not
taking prescribed medications so that she could visit them at home and make
arrangements for care… She also offered classes to women in basic homemaking
skills, parenting, first aid, and sanitation…She also is working for a project under
which she prepares other promotoras to reach mothers and grandmothers about
infant care” (Williams D. , 2001, p. 213).
Types of Community Service Workers
Community Service Workers (CSWs) are known by many names and perform
various roles in health and social service organizations that operate in urban, minority, and
rural communities. CSW programs fall into two main categories, which for this paper will be
referred to as CSW –Community (CSW-C) programs and CSW–Health (CSW-H) programs.
CSW-C workers are recruited for non-health related interventions and can be referred to as
peer advocates, peer educators (Spencer, Gunter, & Palmisano, 2010), outreach workers
(Kiger, 2003), support workers (McCrae, Banerjee, Murray, Prior, & Silverman, 2008),
57

community coordinators (Kash, May, & Tai-Seale, 2007), and/or frontline workers (Perez &
Martinez, 2008)
The most common type of CSW is the CSW-H worker who assists with interventions
that are directly related to health care or health outcomes. These workers can be known as
community health workers (Johnson, et al., 2012; O'Brian, Squires, Bixby, & Larson, 2009),
community health advisors, lay health advocates (Spencer, Gunter, & Palmisano, 2010), lay
health advisors, health aids, paraprofessionals, camp or village health aids when working
with migrant communities (Eng, Parker, & Harlan, 1997), promotoras (Keller, et al., 2012),
doulas, patient navigators, community health advisors or workers (Keller, et al., 2012;
Spencer, Gunter, & Palmisano, 2010), promotoras de salud (Keller, et al., 2012; Ingram, et
al., 2012), health or patient advocates, health advisors, patient navigators, health
representatives, health care advisors, community health aids (Kash, May, & Tai-Seale, 2007),
support workers (McCrae, N., Banerjee, S., Murray, Prior, & Silverman, 2008) and “natural
helpers” in Native American communities (Spencer, Gunter, & Palmisano, 2010; Perez &
Martinez, 2008).
Although there is not a defined set of roles for CSWs, organizations and academics
have attempted to establish a set of parameters for their work. The National Community
Health Advisor Study identified seven core roles for a CSW-H including, (1) bridging the
gap between community, practitioners and providers, (2) providing social support for
community members, (3) modifying the proposed intervention to the target population, (4)
working as advocates for the community, (5) assisting professionals with providing overall
services, (6) helping individuals and the community to advocate for themselves, and (7)
providing basic services to the community themselves (Rosenthal, et al., 1998; Reinschmidt,
58

et al., 2006). The Health Resources and Services Administration identified five key roles that
a CSW-H typically performs including, community organizing, outreach and program
enrollment, prevention and assistance with follow up care, patient navigation through the
health care system, and preliminary screenings (O'Brian, Squires, Bixby, & Larson, 2009).
Swindler (2002) in her analysis of several types of community health worker programs
identified seven core CSW roles including cultural mediation, informal counseling and social
support, providing culturally appropriate education, advocating for individual and
community needs, assuring that people get the services they need, building individual and
community capacity, and providing direct services to community members.
In some cases, CSWs of both kinds also provide other services specific to the
program, such as case management and referrals, translation, visiting community members to
provide moral and emotional support (Spencer, Gunter, & Palmisano, 2010), political
advocacy, community organization, structural changes to community services (Arrendondo,
et al., 2013), and leadership development (Spencer, Gunter, & Palmisano, 2010). Swindler
(2002) also identified broader, less specific functions found in other programs around the
world including, increasing access to services, strengthening the family and community,
providing community education, advocacy, and peer support. The Harlem Region Stroke
Recovery program trained community health workers to serve as medical, case work, and
occupational therapy assistants, outreach workers, electroencephalogram (EEG) technician
trainees, and to conduct patient follow up (Richter et al., 1974). The Center for Healthy
Aging in Santa Monica, CA conducted three separate programs, the “Tell a Friend Program”,
the “Witness Project”, and the “Promotora Program” for low income Hispanic and African
American women. Each program identified roles for CSW volunteers that included outreach,
59

leading support groups, providing informal counseling and emotional support, giving
information and referrals, and providing clerical support to the organization (Kiger, 2003).
Their duties included phone calls, distributing outreach materials, and workshop facilitation.
CSWs worked in local churches and community centers to increase awareness and provide
education about the health intervention activities. Two types of volunteers were trained:
“spiritual role models” who were breast or cervical cancer survivors; and “lay health
advisors”, who worked directly with the program to monitor the client’s health related
outcomes.
In the promotora styled program, geared toward Hispanic women, neighborhood
leaders trained as CSW-H workers provided training and education in Spanish about the
types of health screenings available in the community and where to find them (Kiger, 2003,
p. 311). Pacheco, et al., (2012) recruited 20 community members to serve as CSW-H workers
(promotoras) as part of an intervention designed to increase access to health care for 416
legal and undocumented Latina women. CSWs assisted women with program enrollment and
walked them through the screening process, explained their health care benefits, program
eligibility, advocacy with providers, and the initial screening processes. CSW-H workers also
helped patients to understand their diagnosis and assisted with follow up care, if needed. The
Salud Si program conducted from 2004 to 2008 in Santa Cruz County by the Mariposa
Community Health Center (CHC) and the University of Arizona Prevention Research Center
(AzPAC) utilized CSWs as promotoras to implement healthy lifestyle interventions for
Mexican American women to reduce stress by increasing physical activity and by improving
nutrition self-care. The Family Medicine Department of the Bronx Lebanon Hospital Center
60

in New York City utilized CSW promotoras to help navigate patients through the hospital’s
health care process (Murphy & Matos, 2011).
Regardless of the specific role that they play, the goal of most CSW programs is to
improve access and increase utilization of services in minority, low income, and/or isolated
communities. They serve as a link between local communities and social service, mental
health and/or medical organizations (Johnson, et al., 2012). As such, they are becoming a
critical part of the healthcare workforce in the United States. In 2012, CSWs, specifically
CSW-H workers, were recognized in the Patient Protection and Affordability Care Act
(Johnson, et al., 2012). In 2000, the Bureau of Labor statistics estimated that nationally there
were approximately 85,000 CSWs working in the health care field and approximately
121,000 by 2005 (Johnson, et al., 2012). This number was expected to increase as health care
organizations are increasingly tasked with providing services at lower costs. After the
implementation of the Affordable Health Care Act in 2010, there were as many as 32 million
people seeking some kind of locally based health care and supportive services (Johnson, et
al., 2012). However, despite official recognition, CSW services have still not been clearly
defined, roles and responsibilities have not been developed, funding for these kinds of
programs has been inadequate, and supervision and follow up training have not always been
available. All of these factors serve to diminish the legitimacy of the CSW (as a member of
the social service workforce practitioners to utilize them.)
The Importance of Role Development
McCrae, et al. (2008) highlight the importance of role definition in program success
in their study of CSWs and practitioners involved in mental health care teams assisting
61

cancer patients. Results from a series of focus groups and satisfaction showed that most
CSWs felt that, because their roles were not clearly defined by the program and their
responsibilities were not fully developed by the practitioners, they were underutilized
members of the care team. The practitioners surveyed felt that that because the CSW roles
were undefined, they did not know exactly what responsibilities to assign to them or how
best to utilize them as members of the care team.
For example, CSWs usually provide social support to clients, including emotional
support, however in the mental health field; it is believed that this type of support is best
provided by professionals, even though previous studies show that CSWs can deliver
emotional support as well as professional staff (McCrae, Banerjee, Murray, Prior, &
Silverman, 2008). The CSWs had an expectation that providing emotional support would be
chief among their job duties, but the practitioners did not. Although the practitioners were
grateful for the additional resources, feelings were mixed with regard to the overall
usefulness of the CSW contribution. The professionals felt that they should have been
consulted during the development of the CSW job descriptions so they could better
understand what roles to assign them.
O’Brian, et al. (2009) reviewed over 40 studies of CSW programs to identify a set of
best practices related to roles and program outcomes in order to develop a model that could
be used to guide future researchers in their evaluations and to begin the process of
formalizing CSW roles. The researchers suggested starting with pre-determining the
community need, the selection and training requirements, the key performance measures, and
developing the intervention’s process for evaluation. Without clearly defining these key
62

areas, the researchers believe that the program’s performance and the overall outcomes may
be compromised.
Wenzel, Jones, Klimmek, Szanton, & Krumm (2012) interviewed 48 older adult
African American cancer patients about their impressions of the CSWs involved in the
program to assist them with their cancer treatments. The participants echoed similar
sentiments as the practitioners in the McCrae study (2008). Most of the participants did not
understand the specific role that the CSWs were supposed to play and preferred that friends
and family perform the support role assigned to CSWs. The program participants identified
trust as the main characteristic needed for a CSW to be successful, which is why many of the
older adults preferred to have close friends or family informally perform these roles (Wenzel,
et al., 2012). In the instances wherein the older adult had no friends or family to perform the
role the CSWs were relied upon.
Alvillar, et al. (2011) proposed that CSW roles should be standardized in order to
develop job descriptions, establish pay rates and scales, and to facilitate better integration of
the CSW into the community-based or health workforce. A standard definition would
eliminate the confusion described above by the participants in the Wenzel, et al. (2012) and
McCrae (2008) studies. By providing a standard definition, role and job description, program
designers and employers can set performance standards and expectations and have a better
understanding about how to determine the value of the CSW worker. The discussion of role
development shows that it is key to a successful CSW program. Therefore, in order to
develop an effective pilot program for Office on Aging, determining the role that the CSW
will play in the program is the first step.
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Recommendations
Although no specific set of best practices can be found in terms of identifying the
roles for CSWs, the research shows that the best practice in this area is to clearly define the
CSW role, expectations, and time commitment up front, before the program begins. The roles
of the community service worker, regardless of the field in which they operate, fall into four
larger categories: community engagement, service assistance and social support, direct
service provision, and advocacy. Table 5 below shows the key roles associated with each
category. A CSW can perform all of the tasks in a particular column or various tasks across
the categories.
Table 5: CSW Role Options
Community
Engagement
Service Assistance &
Social Support
Direct Service
Provision
Community
Advocacy
Outreach
Informal counseling
(Providing moral and
emotional support)
Culturally appropriate
education (translation,
etc.)
Advocate on behalf
of the community
Community
organization
Prevention activities (self-
management and physical
activities)
Program enrollment
Building individual
and community
capacity
Community
education
(Presentations,
meetings, community
events, etc.)
Lay health advisors (Perform
pre/post assessments to
determine services needed
and/or outcomes)
Patient navigation
through the health care
system

Cultural mediation
Community
assessments and
surveys
Assistance with follow up care
Providing direct
services, preliminary
screenings, classes,
training sessions, etc.
Political advocacy
Visiting Translation
Cultural adaptation of
the intervention
Structural changes to
community services
Leadership
development
Training and access to care
Case management and
referral

Meeting facilitation Facilitate support groups
Skills based trainees
and assistants

Agency/Organization
administration support

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Community engagement activities include roles that require the CSW to work
primarily in the community as outreach workers, organizers, and educators. In these roles,
CSWs work on behalf of a health or social service agency to inform their communities about
the new program or intervention, to recruit community members to an information session
conducted by themselves or the agency staff, or to collect surveys. Additional community
engagement services could include visiting the elderly, disabled, or ill on behalf of an agency
to check in on the progress of the intervention, and the development and training of new
community leaders to continue the outreach and community education work.
The roles of CSWs who provide service assistance and social support can include
informal counseling to those involved in the formal intervention. Typically, these CSWs are
people who have direct experience with the illness or the type of care (e.g. cancer treatment,
mental health, substance abuse, etc.). These CSWs can also provide translation of
intervention materials, conduct prevention activities such as chronic disease self-
management, physical activity classes and or support groups, conduct initial assessments to
determine which services are needed in which communities, assist with follow up care to
ensure that participants keep follow up appointments, refill prescriptions, etc. CSWs can also
be used as administrative and program support to the agency sponsoring the activity.
Those CSWs involved in direct service provision can be differentiated from those
working as service assistants by their more integrated involvement in the program
intervention. These CSWs perform as paraprofessionals and may go beyond merely
translating existing materials to providing practitioners with language for culturally
appropriate education materials, actually enrolling program participants, and serving as
patient navigators by helping participants understand their benefits, the health care system,
65

and services provided by the intervention. CSWs that provide direct service often do initial
case management intake and referral, and conduct preliminary medical screenings. Some
CSWs in this category receive formal training, certification and licensure.
Many non-health related programs train and develop CSWs to become community
advocates who focus on empowerment, helping residents to build their capacity so that they
can advocate for themselves, eventually developing their skills to be able to advocate
politically for structural changes in the communities they live in.
C. Recruitment and Retention
Community Service Worker programs are designed to utilize non-professional, lay
leaders or persons from the local community who are then trained to provide a specific set of
interventions. To that end, after the role has been clearly defined, the recruitment and
retention of CSWs is the next critical step to the program’s eventual success. Typically,
CSWs are recruited from the communities that they are going to serve and share the culture,
language, gender and/or diagnosis of the target population. Some CSWs are paid, either a
stipend or a minimum wage, for their participation in the program, however some programs
also rely on volunteers. Due to these differences, there is no standard way of recruiting and
retaining CSWs and some methods are more successful than others. Given this, I will seek to
identify the “Good”, “Better”, and “Best” practices for recruiting and retaining CSWs.
Recruitment of CSWs should begin in the local community among those who have
been identified as informal leaders who have key social connections, possess a specific set of
characteristics needed for the intervention, and/or who have previous experience. The
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community service workers in San Diego were recruited from the church closest to the park
project, and two were recruited specifically because of their previous experience working on
other environmental projects that had successful outcomes (Arrendondo, et al., 2013).
Richter, et al. (1974) explored the recruitment process for the CHWs trained and
employed by the Harlem Region Stroke Program. The program utilized a two stage
recruitment process that started with referrals from the community and local organizations.
Those who were selected were further screened through a testing process. During the second
phase of recruitment, an evaluation committee screened the applicants for their interest and
motivation, previous community service experience, commitment to the Harlem community,
ability to complete the required coursework, and the ability to work with both clients and
other professionals in the health care field. In the Madres study (Keller, et al., 2012),
promotoras were recruited from the very blocks within a specific urban neighborhood that
the health intervention was intended to serve.
Rather than just relying on geography, Brownstein, et al. (2011) emphasized that
CSWs should be recruited for the characteristics or social connections that are most needed
to perform the desired tasks. Many CSWs are those who are already informally assisting their
neighbors and friends. These individuals are already trusted by the community and have the
ability to communicate effectively, and a more effective recruitment strategy is to recruit
CSWs from among program participants or graduates (Kiger, 2003).
Recruitment of CSWs is the first task, but retention is the more critical and important
piece of the work. The Center for Health Aging (CHA) in Santa Monica, utilized an ongoing
recruitment process for CSW volunteers (Kiger, 2003). The CHA has a long history of
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recruiting and utilizing volunteers in its organization. As a result, the organization developed
a type of volunteer university to facilitate ongoing recruitment and training of volunteers. In
order to overcome any cultural barriers and/or stigma associated with receiving free and/or
government services, program participants are encouraged to volunteer with the program as a
way of giving back to the community. The combination of using volunteers from the local
community and encouraging volunteerism within the program created a reciprocal process of
giving and receiving that removed some of the stigma (Kiger, 2003). In addition to appealing
to the participants’ altruistic nature, the program also identified trusted community leaders
and provided them with stipends to recruit volunteers and to perform a variety of volunteer
tasks. Once in the program, volunteers were asked to make a one year commitment to the
program, however the CHA reported volunteers who remained active in the program for up
to 10 years (Kiger, 2003). The main facet of the CHA’s retention strategy was the integration
of the volunteers and their activities into the organization through the use of bi-weekly
meetings with professional program staff, gifts and public acknowledgement of the
volunteer’s importance to the organization, and the opportunity to expand their existing
knowledge and skills with new projects and activities.
Recommendations
CSW programs, particularly if they use volunteers, have high attrition and high
turnover rates, which can have significant impact on program performance and outcomes.
Kiger (2003) identified challenges and lessons learned associated with utilizing volunteers in
her research of the Center for Healthy Aging. The main challenge was how to recruit the
number of volunteers the program would need to mitigate expected attrition. Kiger proposed
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cross training CSWs to perform multiple functions (Kiger, 2003), including training CSWs
for various tasks including, door-to-door outreach, phone calling, one-to-one discussions,
small group sessions, and presentations so that CSWs can move from task to task or
participate in multiple aspects of the program.
For many CSWs the key to retention will be determined by how well the program
they are employed with is able to provide the same kinds of supportive services that the
program participants receive. For example, many CSWs come from the same communities
and share many of the same socioeconomic and/or health conditions as their clients, and may
require assistance with transportation, childcare and access to medical services. In some
programs CSWs are retained through the expansion and development of their roles, such as
utilizing more experienced CSWs who can act as instructors to teach and train new workers
(Arrendondo, et al., 2013).
Richter, et al. (1974) made several recommendations for future CSW recruitment
processes and suggest linking recruitment with the training process. Specifically, they
suggest that programs include a training curriculum that is able to sustain a constant
workforce for the current program and provide for those who will desire to move into other
areas of the social services or health care system. Richter, et al. suggest that the CSW
recruitment criteria should include psychological evaluations, a clearly articulated statement
from the potential participant about why s/he wants to be in the program, an interview, and a
physical examination. Ongoing evaluation and counseling for CSWs should also be
integrated into the program once participants are accepted.
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The discussion of CSW recruitment and retention can be summarized into a “Good,
Better, Best” model (see Table 6). The “Good” Training model should be considered the
basic level for all CSW recruitment and retention. Based on the practices identified above, a
“Good” recruitment and retention strategy will at a minimum, recruit CSWs from the
community or constituency to be served, either through organizational referral or
volunteerism, who possess the specific characteristics or the key social connections needed to
implement the program. A “Good” recruitment and retention strategy will have at least a
single level of screening and recruit the number of volunteers needed to conduct the
intervention for the time period needed.
A “Better” strategy will include all of the components of the “Good” strategy and also
look for individuals who have previous experience as a CSW or in community-based work,
who demonstrate a commitment to the community being served, and once the intervention is
underway, will use the program participants as future CSW recruits. The program should
employ two levels of screening in order to further screen participants for the second set of
characteristics needed for the specific program intervention, their level of commitment, and
provide ongoing training through an evaluation committee or a similar body. The “Better”
recruitment and retention model should also recruit more volunteers than are needed for the
intervention to compensate for a ten to twenty percent attrition rate, and provide at least
minimal supportive services, such as transportation and childcare.
The “Best “ recruitment and retention strategy will include all of the elements of the
first two models and add in wages for CSWs or stipends for volunteer CSWs in exchange for
a firm time commitment to the program (six months to one year, depending on the timeframe
of the intervention). Under this model, the CSWs would be included in regular staff meetings
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with program practitioners, and the CSWs would participate in ongoing training designed to
deepen and broaden their skills, possibly using the more experienced CSWs to recruit and
train newer volunteers. This strategy also provides a full range of supportive services to
CSWs. Table 6 outlines the best practices for CSW recruitment and retention.
Table 6: CSW Recruitment and Retention Best Practices
GOOD BETTER BEST
Recruit from the local
community or constituency to
be served
Recruit from within the
program
Provide wages or stipends for
CSWs
Use organizational referral or
volunteerism
Use a dual level screening
process
Provide ongoing training to
deepen and broaden skill base
Look for specific
characteristics or key social
connections suited for the
intervention
Look for individuals with
previous experience and
demonstrate a commitment to
the community
Get time commitment from
CSWs
Single screening process
Ongoing training and
evaluation throughout the
program
Include CSWs in regular staff
meetings with program
practitioners
Recruit enough volunteers
needed to conduct the
intervention
Recruit more volunteers than
are needed for the
intervention to offset a 10-
20% attrition rate
Use more experienced CSWs
from within the program as
recruiters and instructors

Provide minimal supportive
services
Provide a full range of
supportive services
D. Training and Education
The goal of a CSW training and education program is to take those from the
community who possess some abilities and meet basic qualifications such as language
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capacity and literacy or who have key social connections, and make them into the
paraprofessionals needed to assist practitioners (Eng, Parker, & Harlan, 1997). Many CSWs
have some sort of training prior to beginning their work assignments, however many
programs, even those that perform the same or similar interventions do not have a standard
curriculum, which leads to role confusion as we look from program to program. As part of
their discussion about standardizing roles for CSWs, Alvillar, et al. (2011) also advocate for
the importance of standardized training for CSWs in order to further reinforce the CSW role
and to help employers understand the benefit of utilizing this resource. The lack of
standardized training and education makes it difficult for the CSW to be recognized as an
official position within the social service field, making mobility and career advancement
difficult. If a CSW program is to be successful as a community-based intervention, training
standards must be established.
Brownstein, et al. (2011) and Richter, et al. (1974) proposed that formalized CSW
training should consist of two components or phases. The first phase should include core
curriculum or basic training elements general to all social service agencies and possibly
designed in conjunction with a local community college in order to take advantage of
existing courses in psychology, social work, sociology, languages, and other topics that will
be common to many CSW programs and roles. Others feel that, based on best practices of
other programs, phase one’s core training could include a focus on developing skills in
outreach, interpersonal relations, meeting facilitation, survey taking, collecting data and/or
anything specific to the role they are required to fill (Spencer, Gunter, & Palmisano, 2010).
In these cases, phase two could be a combination of targeted college courses related to the
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specific area that the CSW will be working in, and field work or on the job training at the
intervention site.
The Harlem Region Stroke Program (Richter, et al., 1974) developed a 26 week (780
hour) two-phase training program for the CSWs they employed. The program was developed
in conjunction with social workers, medical professionals and community leaders, who
assisted with the facilitation of both the classroom and field training components of the
program. The participants in the program were provided with placements in specific settings
during the final phase of the training process. Stipends were also provided during the entire
training period. Other programs provided certification, either at the organizational or
community college level, and ongoing skills reinforcement as part of the training program.
The CSWs involved in the Madres promotora walking program intervention (Keller, et al.,
2013) received extensive training and program certification as well as a more comprehensive
understanding about the intervention, including practice and role playing to build program
knowledge and hone their techniques and confidence. The CSWs that participated in the
health access intervention discussed by Pacheco, et al. (2012) attended a two day training
facilitated by California State University at Fresno, which included an explanation of the
purpose of the program, the specific role of the CSW, basic outreach techniques, and
information about health insurance and the specific health interventions proposed. During
the program the CSWs were provided with coaching, mentoring, and ongoing refresher
training.
Other programs provided a stipend or an hourly wage as a key component in the
training program. According to Williams (2001), in response to the success of a CSW
program in Texas, the federal Health Resources and Services Administration funded a pilot
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promotora program in 1994 in which it was determined that a training program that paid the
CSWs for their time is the most effective. The ability of the program to provide a wage while
the CSW was in the training process served to validate the value of the training and the
overall contribution of the CSWs. In addition, the results of the pilot showed that the
educational process should be standardized and certificated in order to allow the workers
employment mobility.
Because much of the training offered to CSWs is informal, on-the-job training that is
specific to the program or intervention to be performed, many advocate for a standardized
curriculum for all CSW training. However, there are others who argue that standardizing
CSW training may actually serve to undermine why and how CSW programs are effective. A
formalized program may deter some potential CSWs from participating in the program due to
their low literacy, resident status, and/or the costs associated with obtaining any needed
credentials. These factors may lead others (from outside of the target communities) to seek
the training, which may in turn have a potentially negative impact on the success of the CSW
program (Spencer, Gunter, & Palmisano, 2010). Therefore, any type of formal training must
strike a balance between preserving the essential traits of the CSW and transitioning them to
a paraprofessional role.
O’Brian, et al. (2009) reviewed the research findings of 44 community health worker
(CHW) programs in order to develop a model for CSW selection, recruitment and training.
The most common training methodology was role playing and one-on-one mentoring
sessions, with follow up training and ongoing skill based assessments. They suggest that
regardless of the structure of the training, the focus should be on three main areas: skills-
based knowledge, program-specific information, and research-based knowledge. Skills-based
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knowledge should include the general information needed by all CSWs regardless of the
program such as developing interpersonal, team building, and relationship skills. Program-
specific knowledge should include any orientation or information relevant to the specific
intervention, such as general health or community information and resource identification.
Research-based knowledge should include all of the information needed to support the
evaluation of the program including record keeping, study or program protocols such as pre
and post testing, instruction procedures, survey administration, as well as all of the issues
related to human subjects such as ethics, confidentiality and the Health Insurance Portability
and Accountability Act (HIPPA), if necessary.
Two decades before O’Brian, et al. (2009), the Harlem Stroke Recovery Program
(Richter, et al., 1974) followed this basic training outline. After the initial training program,
graduates were placed in several types of roles within the health care system where they
received specialized training in their primary interest areas including, case work assistance,
community outreach, stroke unit worker, occupational therapy assistant, and technician
trainee. In addition to the field specific on the job training, all participants were provided
with continuing education in outreach techniques, symptom identification, advocacy and
education, and patient counseling. As an incentive to complete the training and to remain
active in the program, graduates were guaranteed job placement in paraprofessional jobs in
the health care field according to their specialized area of training and education.
In order to achieve a better response to the overall project and their advocacy efforts
to improve the local park environment, all of the San Diego community service workers were
additionally trained to discuss and encourage physical activity and healthy behaviors with
community members. (Arrendondo, et al., 2013)
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Recommendations
The Harlem Region Stroke Program researchers (Richter, et al., 1974) made several
recommendations for future CSW training processes. In order to insure the success and
sustainability of similar programs, the researchers highlighted the need to establish a link
between the training program and local universities and/or community colleges to both add
legitimacy to the training and to allow for college accreditation of the training program.
However, grounding the training in an academic setting is not enough. The training program
must also provide opportunities for practitioners (social workers, community leaders, health
care professionals, and program graduates) to serve as adjunct instructors in order to add a
practical educational component to the overall curriculum. Recently, Halvorson and
Emerman (2014) proposed that colleges and universities can train Boomers for continued
employment and highlight that the American Association of Community Colleges provides
funding for a new Plus 50 Initiative to train people over fifty five years old for new careers in
growing employment fields.
The discussion of CSW training can be summarized into a “Good, Better, Best”
model (see Table 7). The “Good” training model should be considered the basic level for all
CSW training. The “Good” model provides basic and general CSW skill development
training and training on some program elements such as outreach, interpersonal skills,
meeting facilitation, etc. This level of training can occur within the organization itself with a
specific focus on the program to be implemented. The “Good” CSW training does not have
to be facilitated by trained professionals (nurses, social workers, clinicians, etc.), but can be
facilitated by other CSWs in a train-the-trainer model. This level of training is the most
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common for CSWs and, although some basic skills are developed, the training usually only
lasts as long as the intervention itself and is not necessarily considered transferable to another
program.
The “Better” CSW training model includes the elements of the “Good” program
above, but adds more specialized training and education related to more types of CSW
interventions. This training level usually utilizes practitioners to help develop curriculum and
as training instructors and may have a formal link to a community college and/or include
university level courses as well as field or on-the-job training. This level can provide larger
organizational certification at the municipal or university level, and provide a stipend for the
training period.
The highest level or “Best” CSW training model has all of the elements of the first
two levels and guarantees college level certification, formal wages for training period, and
ongoing skills-based assessments and refresher courses both during and beyond the time
period for a specific intervention. Most importantly, this level should include training in
general research-based knowledge including record keeping, study/program protocols such as
pre and post testing, how to administer surveys, HIPPA regulations, human subjects
guidelines and compliance, as well as ongoing skill and career development, and job
placement as trained and certified CSWs, which is transferable to other programs.

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Table 7: CSW Training and Education Best Practices
GOOD BETTER BEST
Basic skills-based training
Specialized training and
education related to more
types of CSW interventions
Ongoing skills based training
and assessments both during
and after initial training
Training related to some
program elements (outreach,
interpersonal skills, meeting
facilitation, etc.)
Practitioners help to develop
core curriculum
Provide training in research-
based knowledge
Training occurs within the
organization
Includes university level
courses and provides
organizational certification
Municipal or college level
certification
Does not have to be
facilitated by professionals
Practitioners serve as training
instructors and facilitators
Ongoing skill and career
development and job
placement
Can use CSW train the trainer
model
Provide on-the-job training
with stipends
Provide formal wages for the
training period
E. Measuring Outcomes
There are several aspects to CSW programs that make measuring outcomes difficult.
Programs differ in design, recruit different types of CSWs to perform varying functions, and
most importantly, measure both qualitative and quantitative outcomes, depending on the
goals of the program. Most CSW programs are short term (six months to two years), grant
funded programs and are not in place long enough to measure significant outcomes over
time. The evaluations of many programs do not discuss how they recruited, trained,
supervised, or evaluated CSWs, so best practices and results in these areas are not easy to
come by. Outside of programs conducted in academic settings, there are very few published
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reports to highlight any research outcomes, and many practitioners who utilize CSWs are not
trained to develop program and research protocols needed to accurately measure outcomes.
The UCLA Center for Policy Research’s California Health Interview Survey (CHIS)
released a policy brief in August of 2014 (Frank, Kietzman, & Wallace, 2014) that analyzed
one hundred and forty two programs to evaluate the readiness and feasibility of
implementing community-based CSW type programs that target adults over age fifty. Based
on previous evidence, the UCLA researchers knew that the best interventions designed to
reach older adults tended toward a multi-pronged implementation approach. Therefore, of the
one hundred and forty two programs analyzed, twenty were found to meet a qualitative
framework known as RE-AIM. The framework has five criteria: 1) Reach - how assessable
the program is to the target audience; 2) Effectiveness - how well the program provides the
proposed intervention; 3) Adoption - the adaptability of the program to other organizations;
4) Implementation - an implementation process that allows for fidelity with program
delivery; 5) Maintenance - how the program is continued/funded beyond the development
phase.
The twenty programs that met these criteria included those that employed
practitioners, paraprofessionals, and lay members of the community in performing the
interventions. The programs operated in clinics and other types of medical facilities,
churches, community and senior centers, and participant homes. The most successful
programs were facilitated by hospitals, non-profit organizations, and county coalitions with
significant infrastructure to meet all of the RE-AIM criteria.
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Keller, et al. (2012) developed a similar qualitative framework for the promotora
styled Madres para la Salud program developed to impact overall health outcomes and post-
partum depression in Latina women. Both the promotoras and the clients were recruited from
the urban area targeted for services. The program was deemed effective because it adhered to
the cultural and social norms of the community. The intervention was also affordable and
could be adopted, implemented and maintained by the local community. These findings were
later validated by the CHIS study discussed above. The CSW promotora program reviewed
by Pacheco, et al. (2012) developed six evaluation areas in order to produce a set of
qualitative data specifically related to the program including, knowledge related to where and
how to apply for health care services, where to receive care, how to schedule and attend
appointments, sharing information with a doctor, understanding the diagnosis and prognosis,
and understanding the need for and process of any specialty and follow up care. Program
organizers sought to evaluate how more activity in these key areas would eliminate negative
experiences on the part of the patient.
The researchers studying the Harlem Region Stroke Program measured the success of
that program by looking at impacts in the community. The CSWs’ work was focused on
increasing patient follow up after stroke related appointments. The study determined that the
use of the CSWs increased the likelihood that stroke patients would make and keep follow up
appointments by ten percent during the first year and by twelve percent by the end of the
second program year (Richter, et al., 1974). The Madres walking intervention (Keller, et al.,
2012) measured the effectiveness of the CSW promotora training and program, rather than
the health outcomes of the participants since the focus of the program was to test the CSWs’
training and fidelity to that training. The San Diego based community service worker
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initiative to improve a local park through walkability assessments, community surveys, and
education measured success by determining physical improvements in the park that could be
attributed to the CSWs’ intervention. Unfortunately, the researchers could not evaluate the
total CSW contribution with regard to increased utilization of the park, since the city already
planned to upgrade the facility (Arrendondo, et al., 2013).
In one of the few studies that tracked qualitative outcomes over an extended period of
time, the Mariposa Community Health Center (CHC) and the University of Arizona
Prevention Research Center (AzPRC) utilized a two phase participatory evaluation method
over a ten year period. Phase One consisted of pre-testing program participants prior to the
program’s implementation and post-testing after the eight week program. The evaluators
conducted focus groups with CSW staff and program participants to see which program
format worked best, which activities and interventions were the most successful, and which
materials were the most effective in delivering the program message. Phase Two of the
program evaluation occurred two years after participants left the program and in the
tenth/final program year. The evaluators met with former participants and conducted
interviews to see how many interventions were successfully incorporated into their lifestyles
after the program, how many of the interventions had been maintained for an extended period
of time such as increased exercise and nutritional changes, and how many of the
interventions were too difficult to incorporate such as regular medical checkups due to the
demands of work, children, and family.
Although many programs do not have uniform qualitative evaluation measures
described above, even fewer have the ability to calculate the quantitative (financial) benefit
of their efforts. Whitley, et al. (2006) identified two models for measuring the quantitative or
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monetary value of community service worker programs: cost effective analysis (CEA) and
return on investment (ROI). CEA calculates the cost per unit of health effect based on the
goal of the intervention. For example, a cancer screening intervention could be evaluated
based on number of cases identified in early stages and number of years of life gained, thus
the higher the ratio, the more successful the intervention. This measure is not widely used
because of the length of time it takes to measure the outcomes.
The most common measure is the return on investment measure, which is most often
used for health intervention or prevention programs. ROI is measured by the total cost of
savings or revenue generated by the intervention divided by the total program costs.

The savings calculations should include all of the program utilization and preventive
care costs minus the cost of more expensive interventions such as health care costs,
emergency room visits, hospital stays, etc.

For example, Johnson, et al. (2012) studied the outcomes of the CSW program operated by
the Community Access to Resources and Education in New Mexico (CARE NM) and
observed that the costs associated with providing CSW services to the 448 patients studied
for a six month period were reduced by approximately $2,000,000, while the cost of the
CSW program (including salaries and benefits) for 25 months was only $521,343, for a
projected savings of $1,478,657. In addition, the program organizers collected qualitative
(CSW program related services + cost to operate the program) – cost of
reduced utilization of more expensive interventions
Savings and/or revenue
Program costs
ROI =
Savings=
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information showing that the program also contributed positively to the overall health and
service utilization (Johnson, et al., 2012).
The Salud Si program researchers in Arizona and Nevada set out to determine if
interventions in group settings were more cost effective or had better outcomes than those
conducted on a one-to-one basis. The program goal was to recruit and evaluate 1,600
participants, assigning 800 participants to each type of intervention delivered in a series of
six weekly sessions. All participants were asked to evaluate their interventions before and
after the six week period. The researchers evaluated a total of 509 participants who
completed the program. Of the two types of interventions, group interventions appeared to be
more cost effective than individual sessions. The research was able to determine that the
overall cost of administering group sessions was 26% less than the cost of individual sessions
($103.44 vs. $392.38), 67% less for the same level of medical screening in group vs.
individual setting ($262.44 vs. $862.38), and overall costs were 30% less for those who
completed the program ($516.53 vs. $1,716.22) (Larkey, et al., 2012). Although the Salud Si
researchers felt that the high attrition rate of program participants may have skewed the
overall outcomes, the researchers did not evaluate the CSW recruitment or training as a
possible factor in either participant attrition or the program outcomes.
The Arkansas Community Connection program utilized CSWs to connect older adults
to existing home and community-based services and in-home supportive services. The
intervention resulted in a 24% reduction on average in Medicaid spending per participant
from 2005-2008, which was a total projected savings of $2.6 million (Felix, et al., 2011). To
reach this conclusion, the researchers calculated the total cost for Medicaid inpatient and
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outpatient medical services, in home and community-based services, and nursing home care
for 63% of the 2,122 program participants during the years before and after the program
intervention, as well as for a control group with similar conditions. The program participant
group increased their use of community-based services by more than 20% (from $7,762 to
$10,618), while the control group increased their utilization of nursing home care from $1
per person to approximately $7,841 per person during the three-year intervention. This
increased utilization of home and community-based services over three years by the program
participants resulted in approximately $3.515 million in Medicare spending. In comparison,
the intervention cost less than $1 million savings to operate during the same time period,
resulting in approximately $2.6 million in projected savings in Medicare spending and a
return on investment of almost $3 for every one dollar invested in the program (Felix, et al.,
2011). This study suggests that CSW interventions can provide states with a viable
alternative to more costly care and reduce the amount of overall Medicaid spending.
After evaluating various CSW programs, many researchers made recommendations
for how to move forward in developing future programs in order to better measure outcomes.
Swindler (2002) reviewed several programs that evaluated CSW program outcomes and
effectiveness, and concluded that more research is needed in the areas of program design,
documenting CSW activities, and defining target populations in order to better evaluate the
programs. The study reviewed program results and categorized them by the types of
projected outcomes including participants’ access to care, knowledge about available
programs and services, self-reported behavior changes, and overall cost of the programs. The
authors noted that, although included as an outcome measure for the study, there was little
evidence to support the effectiveness of an increase in knowledge as a viable outcome, self-
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reported behavior changes lacked a standard measure, and therefore an analysis of the
program return on investment was inconclusive (Swindler, 2002).
The Texas based CSW promotora pilot program (Williams, 2001) determined that
standardized training and education, a core curriculum, credentialing, and wages for CSWs
lead to much higher success and better outcomes. The CSW program reviewed by Pacheco,
et al. (2012), utilized a pre-test assessment to establish a baseline for a set of participant
access indicators. During the intervention, program participants were phoned to conduct post
intervention assessment surveys to record any changes the participants may have made as a
result of the intervention. The post-tests showed that after three months there was a
significant increase in some of the access indicators, however, many of the barriers that
prevented access such as cost of care and culturally indigenous ways of managing illness
persisted.
The researchers studying the outcomes of the CSW program operated by the
Community Access to Resources and Education in New Mexico (CARE NM) recommended
that future programs utilize formal assessment tools provided by the medical and/or mental
health fields to analyze program results, or to evaluate client outcomes pre and post
intervention (Johnson, et al., 2012).
So far, most CSW program success has been confined to specific settings,
populations, and initiatives related to health promotion, chronic disease management, and
improving the utilization of health services. Evaluation research on outcomes of other types
of interventions outside of health care, are sparse. The analysis conducted by Spencer, et al.
(2010) concluded that although CSWs are effective when utilized in specific contexts, most
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researchers are unsure why they are effective. More research is needed to determine if the
characteristics of the CSW, the nature of the communities they are working in, the CSW
training and education curricula, or the specific type of intervention they are performing (or
some combination of these) is the key to successful outcomes (Spencer et al., 2010). Studies
show that there has been some impact on care and cost for chronic disease sufferers in terms
of reduced hospital admissions and emergency room utilization, however, without
standardized measures for program design and operation, CSW training, and program
outcomes, which allow the programs to be evaluated in comparison to one another, any
analysis of the factors shaping the overall effectiveness of any CSW interventions is purely
speculative. Spencer et al. (2010) also concluded that the research is also sparse with regard
to the claims that CSW programs are cost effective and contribute to the reduction of more
costly health care interventions.
The researchers of the Harlem Region Stroke Program (Richter, et al., 1974)
recommend integrating the CSW into the broader service community by considering the
position they can/should occupy in the municipal, regional, and/or statewide service delivery
system from the outset of the program’s design in order to insure that their contribution is
recognized and valued. At the very least, program developers must investigate
paraprofessional positions within the larger service delivery system to insure that those who
complete initial CSW training education will meet the general requirements for equivalent
positions in other agencies and organizations. Insuring this level of coordination and
integration will create a distinct place for the CSW and address issues such as duplicated
roles and fragmentation within the larger service delivery system.
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Recommendations
The discussion of measuring CSW program outcomes cannot be summarized into a
“Good, Better, Best” model as it seemed that there is no standardized set of recommendations
or best practices for this program area. The only recommendation appears to be that program
evaluators should decide what they intend to measure prior to the start of the program, be it
the CSW recruitment, retention, or training, etc., or the impact of the program intervention on
participants. All types of evaluation are needed in the CSW arena, including outcomes
measures such as CSW and community satisfaction, and the more prevalent the evaluations,
the better it will be for future researchers who wish to evaluate these programs.
F. Program Challenges
Several challenges have been identified by those trying to research and evaluate CSW
programs of all kinds, including funding, program durations, the lack of standard program
elements and evaluation measures, high turnover rate, and the reluctance of practitioners to
use them and integrate them into the formal social service structure. Most CSW programs are
grant funded and short lived. This lack of sustainable funding makes program expansion
impossible and evaluation difficult. CSWs do not have a specific job description, within the
larger context, which makes it hard for them to be accepted by professionals and
practitioners. Most CSW programs are not reimbursable through Medicare or other programs
that support programs for low income communities, and without another direct source of
funding, many organizations are reluctant to begin or sustain CSW programs. Most
importantly, the lack of standardized program elements and formalized inclusion in the social
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service process, limits the CSW’s ability to link the target communities to more services and
supports (Spencer, Gunter, & Palmisano, 2010).
In 2003, Kiger (2003) studied the program utilized by the Center for Healthy Aging
(CHA) in Santa Monica, CA, which implemented three health screening projects (African
American Tell A Friend, The Witness Project and The Promoatoa Program) designed to
improve early intervention behaviors among Hispanic and African American women at risk
for breast and cervical cancer. The three programs utilized the same combination of
professional and educated, trained, and supervised volunteer staff to accomplish the
cumulative goals of screening 1000 women and educating an additional 5,000 about the need
for early cancer intervention and prevention. The researchers identified the challenges of
making sure that the program information was made available to women who spoke
languages other than English in culturally sensitive and appropriate ways, finding ways to
overcome cultural biases against accessing free, government services, and assuring
immigrant women that participation in the program would not impact either the U.S.
citizenship processes or their resident status. However, the most critical challenge the
program had to overcome was establishing trust within the community.
Brownstein et al. (2011) highlight challenges that are specific to CSWs and CSW
programs including a lack of formal training in the field or area of work that the CSW is
assigned to do. Most CSW programs are health related and CSWs are called upon to perform
specific interventions, for which they do not have formal training. The lack of formalized
training can result in less than rigorous application of the program methodology, impacting
the overall results of the intervention. In addition, many CSWs are new to either the formal
workforce or a specific medical or social service workforce and may bring with them the
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same or similar issues as the clients they are seeking to assist, including childcare, chronic
illness, domestic concerns, and others. In addition, CSWs are prone to burnout and,
particularly if the work is done on a volunteer basis, it can lead to frequent turnover, which
requires that the recruitment and training processes begin again during the intervention. To
mitigate some of these challenges, the researchers recommend several ways to integrate
CSWs into professional teams including, 1) providing ongoing training and education to both
the CSW and the supervisors to insure program monitoring, 2) CSW coaching, and 3) hosting
regular meetings for CSWs to reinforce program protocols and outcomes. It is critical that
practitioners are part of developing the CSW scope of work, in order to understand the role
that CSWs have been called upon to play so that they can be used to their fullest and best
capacity within the program.
Alvillar et al. (2011) and Brownstein et al. (2011) both stress the importance of local
programs focusing on the development of the CSW workforce as part of an integrated
system. They stress that training and education of the workforce go both ways. CSWs should
be trained to perform their function, but practitioners should be educated and trained to
understand the role that CSWs play and how their contributions can be valued and measured.
They also encourage the development of a network of employers made up of organizations
that utilize and/or may utilize CSWs in order to encourage the development of a permanent
position within the social service structure.
The Harlem Region Stroke Program researchers (Richter et al., 1974, p. 1060)
suggest the CSW programs should be initiated by municipalities and those responsible for
service delivery and further developed in coordination with universities and community
organizations to insure a comprehensive and effective education, training and
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implementation program. Municipal social service delivery organizations have several
advantages that make them the ideal place from which to initiate such programs. There is an
existing operational infrastructure to support new programs and pilot initiatives such as a
CSW program. Such organizations have well established links to statewide and national
networks that can be called upon to enhance the education and training curricula, and
existing links to policy making networks to assist with formalization and duplication of the
program concept. Municipal social service agencies are also in the positon to convene
associated organizations (such as community-based, nonprofit and faith based organizations),
to assist with program development and to recruit program participants and employ program
graduates. Most importantly, municipal agencies can require CSW program implementation
through contracting and funding at the local level. The researchers further suggest that the
best way to develop and implement a CSW program is by utilizing federal funding due to its
typically broad mandates and flexibility, which results in a steady stream of funding and
allows for innovative programming within minimal guidelines.
Recommendations
The section above outlines several challenges faced by program implementers,
researchers and evaluators, although the challenges can be summarized into one challenge:
the need to develop structure for CSW programs in all areas including, process and
procedures for recruitment, education, training, role development, and evaluation, so that
CSWs can be integrated into the social service workforce and their role can become
formalized. However, there are more than a few limitations in relation to the CSW programs.
CSW programs can be time consuming to develop and recruit CSWs and participants, and to
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provide training prior to implementation. Many programs are funded through short-term
grants and are designed to target a specific health related intervention or task, such as
outreach. CSW programs tend to operate in siloes separate from organizational leadership
and professional members of the care team often leading to poor communication between
CSWs and other providers within the organization and duplication of efforts,
miscommunication, and wasted resources. Given these constraints, the time for the
development phase of CSW programs can be short and incomplete, leading to the kinds of
program challenges outlined above.
G. Summary
The goal of this chapter is to identify the key elements of and best practices for a
community service worker program in order to develop a pilot program for Riverside
County’s Office on Aging by analyzing various CSW programs. The analysis revealed that
although there is no standard program design, five key elements are CSW role development,
recruitment, program design, training and education, and outcomes. Best practices have been
developed for most of the key areas of the program that can be used to develop a pilot
program. The research and analysis in the two areas without a definitive set of best practices,
CSW role and outcome evaluation, do offer a set of recommendations for how best to avoid
any program challenges in these areas. The next step in developing the pilot program is to
analyze the existing Senior Community Service Employment Program (SCSEP), which
would serve as the vehicle for the CSW program, currently operating in the Riverside County
Office on Aging.

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CHAPTER IV. SCSEP IN RIVERSIDE COUNTY
Research Question 2: What can we learn from a case study of the existing Senior
Community Services Employment Program (SCSEP) currently operating within the
Riverside County Office on Aging?
A. Introduction
On June 18, 1974, the Board of Supervisors designated the Riverside County Office
on Aging as a County Department on Aging for the Planning and Service Area (PSA) 21. It
serves as the Area Agency on Aging (AAA) for all of Riverside County and is one of 33
AAAs within the State of California. The Office on Aging is also one of fifty five
departments within the County of Riverside. The Office on Aging offers a variety of
programs and services to older adults, including the national Senior Community Service
Employment Program (SCSEP). In order to assess the viability of the national SCSEP
program in general, as a vehicle for the Community Service Worker pilot program in
Riverside County, I reviewed Older Americans Act of 1965 and the amendment in 2000 to
determine if the current rules and regulations of the national program matched with the vision
for the project pilot. I then utilized the existing SCSEP project housed in the Riverside
County Office on Aging as a case study to see if the project could be modified to support a
small pilot program. I analyzed applicant and wait list data provided by the Office on
Aging’s SCSEP program database of participants in the 2014-2015 sample program year and
utilized my knowledge about the current Riverside County project’s administration and
operation. The goal is to assess the readiness of the Office on Aging in general, and SCSEP
program in particular, to house the pilot.

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B. National SCSEP Program
The SCSEP was created as part of President Lyndon B. Johnson’s “War on Poverty,”
in 1965. The legislation, known as Title V of the Older Americans Act (O'Shaughnessy,
2012; Public Law 89-73 Older Americans Act of 1965), was incorporated into Title V of the
Act in the late 1970s. The legislation, program compliance, and funding allocation are
currently overseen by the United States Department of Labor. SCSEP was created to “to
foster and promote useful part-time opportunities in community service activities for
unemployed low-income persons who are 55 years or older and who have poor employment
prospects, and in order to foster individual economic self-sufficiency and to increase the
number of persons who may enjoy the benefits of unsubsidized employment in both the public
and private sectors” (Public Law 106-501, Older Americans Act Amendments of 2000,
2000). The updated Act included several provisions that allow for a subsidized, minimum
wage stipend for low income (at or under 125% of poverty) older adult workers over age fifty
five in exchange for part-time community-based work in public and non-profit organizations
that operated in local communities. In addition to being low income and over age fifty five,
program participants must also be deemed to be the least employable and/or hard to place in
employment situations due to low literacy, lack of skill, medical condition, handicap, or
criminal record. The goal of the program is to provide both classroom and training
assignments that will help older adults move from subsidized to unsubsidized employment
within forty two months. SCSEP programs operate in all fifty states and are administered
either through the state or a state sponsored affiliate such as the local Area Agency on Aging.
Work assignments and projects must contribute to the betterment of the community at
large, and improve the employment prospects of those who participate, by providing general
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training that allows participants to either reenter the workforce or to enter employment in
growing fields. All SCSEP projects must be administered by people who specialize in
serving older adults, low income communities, communities of color, limited English
speakers and/or the low skilled, and they must do so in partnership with the local Area
Agency on Aging (AAA) for the designated Planning and Service Area (PSA) for the state.
Participants are screened into the program and provided with an initial individual
employment plan, which is reviewed and updated annually.
Funding is provided by the federal government through the states and passed to the
local program operators. Local program operators provide a program match either in cash or
in kind and are permitted to use 13.5% for administrative costs to provide training and
education. Seventy five percent of funding must be allocated for participant salaries and work
must provide for alternative modes of employment such as permanent part time employment,
job sharing and/or reduced physical exertion. The program also provides for on-the-job and
on-site training. After exiting the program, participants must remain employed for thirty days
within the initial ninety days after leaving the program in order for the program to get credit
for the placement, with the goal of the participant retaining said employment for up to six
months after their exit.
SCSEP Program Outcomes Metrics
There are six essential metrics for annually evaluating a SCSEP program including,
the total number of participants served; the total number of participants served who are most
in need; the total number of community service hours worked; the number of participants
who secured unsubsidized employment; and the number of participants that maintain
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unsubsidized employment for at least six months. Post program, two additional outcome
indicators include the length of time that former participants retain unsubsidized employment
and the level of satisfaction that program participants, employers, and host sites report
through follow up surveys. In 2012, the Department of Labor added another evaluation
metric that allows participants to exit to unpaid volunteer positions if permanent employment
is not an option, such as in the case of the recent recession, or not feasible for the participant
due to illness or advanced age (Kogan, et al., 2012).
The legislation also identifies a set of desired outcomes for the program such as
improved quality of life and increased self-sufficiency for participants. The hope is that
when a participant exits the program, he or she will be able to maintain financial
independence, approach society with more self-confidence, and be able to participate in the
life of their community. The new or improved skills learned in the program are designed to
link participants to the areas of the labor force with the highest demand and allow for more
flexible work hours such as part-time and job sharing options.
SCSEP Program Challenges
In the most recent SCSEP program evaluation study, Aday and Kehoe (2008)
researched the impact of the SCSEP program on one hundred and thirteen participants from
three projects in very different socioeconomic areas including, Modesto and Monterey,
California and Chattanooga, Tennessee. The goal of the research was to determine the level
of social support, self-esteem, life satisfaction, self-efficacy, employment, and job
satisfaction associated with involvement in the SCSEP program. The research found that the
SCSEP program does serve to return older workers to the workforce. However, more
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importantly, regardless of the length of time in the program, if the work is meaningful and
fulfilling for the older adult, participation improves social ties by strengthening social
networks, improves self-esteem and helps them to maintain connections to other people,
improves physical and mental health, and increases their sense of well-being.
Although the stereotypes and myths about older workers being hard and/or costly to
re-train, making more mistakes, and being less flexible as workers have not been found to be
true, older workers have been found to be steadier, more reliable with less absenteeism, and
once trained are better independent workers than their younger counterparts. The program
helped to retrain older workers and put them into meaningful work which improved the
participants’ views about themselves and older workers in general (Aday & Kehoe, 2008).
The effects of a SCSEP program are governed by several factors including the size of
the program, the number of participant training slots available, the amount of funding, the
level of pre-employment training and the quality of work site placements (Aday & Kehoe,
2008). However, as pointed out by Aday and Kehoe (2008) and confirmed by my
observations of the Riverside County project, the SCSEP program design and regulations
create several barriers within the program that must be overcome in order for an individual
SCSEP program to be successful. First, participants who have the lowest skill levels and are
the hardest to place are also the hardest to move to unsubsidized employment within the forty
eight month time frame for the program.
Second, the program requires that the project utilize SCSEP participants, who meet
the same criteria as other program participants, as administrative staff, thus creating a job
training program within the project and reducing overall staffing costs. Unfortunately, using
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participants as program assistants and case managers for other participants has been shown to
lower the overall quality of the program operation. The nature of the program population
makes it difficult to recruit those with the basic skills, training, or previous employment as
recruiters, job developers, coaches, or who have a good grasp of the types of community
resources available for job seekers. Developing these skills requires time and training,
however, the participants who work as program staff must also either rotate to new
assignments and/or move to unsubsidized employment as quickly as possible to help the
project meet the SCSEP program goals. High turnover in these assignments can have a
detrimental impact on project operations.
Third, the minimum wage stipend in exchange for part-time work is not enough
money for participants to sustain themselves and cover basic needs, and participants are not
permitted to draw any additional income that would place them over the one hundred and
twenty five percent poverty threshold for the program. Fourth, the program provides
participants with a minimum wage stipend, not a wage. This distinction is sometimes lost on
other types of aid programs that some participants may depend on such as food stamps,
subsidized housing and utility assistance, etc. Although SCSEP is a federal program that has
released several program memos classifying the training stipend as such, individual case
workers choose to include the stipend as income, which may disqualify the participant from
receiving the benefit. Accepting unsubsidized employment at a higher rate than minimum
wage can affect these other benefits. Fifth, even when a participant leaves the SCSEP
program, many job placements do not lead to the type of economic self-sufficiency
envisioned by the program. Post SCSEP employment tends to be low wage with few benefits.
Sixth, some SCSEP participants are unable to work beyond the program due to health or
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other concerns; still others have no intention of working after the SCSEP program. For many,
particularly those between age fifty five and sixty five, the program provides the kind of
short term income boost they are looking for or provides them with the type of daily activity
and social connections they desire before they “retire” for good. As the labor force ages,
older adults are working longer, however, those who retire at a “traditional” age are more
likely to return to work in a state of “unretirement” where they continue to work on a part-
time basis after formally retiring, as bridge employment (Maestas, 2007). Many employers
provide less substantial retirement plans than in the past and Social Security incentives
encourage people to wait until age seventy in order to collect the maximum benefit without
an income penalty, and many workers are not eligible for Medicare until age sixty five. For
those with lower incomes, particularly those between age fifty five and sixty four, SCSEP is
a viable short-term employment option. Those who are able to work but exit without a job
are considered a program failure, regardless of what other program objectives might be
achieved.
Although the program is targeted to low skilled workers, more educated and skilled
workers are enrolled in the program as well. Because the training sites focus on the lowest
skill levels, SCSEP does not always prove to be the right program for dislocated or laid off
workers, and it may become a hindrance to participants who need to return to full time work
in higher paying jobs. During the recent recession, SCSEP programs found placement even
harder than usual. In Riverside County, many sites were willing to take on more SCSEP
trainees as “free” labor in their organization, but were ultimately unable to hire the
participants as permanent workers. The stereotypes about older workers tend to prevail in
some training sites, with SCSEP participants relegated to the most menial tasks in
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organizations (filing, dish washing, reception, etc.), and finding worksites with quality
training projects can be a challenge for SCSEP programs. In addition, because a participant
can remain in the program for up to four years, many participants and host sites begin to treat
the training experience as a job, rather than as temporary training assignments. This
confusion creates a situation in which the host site sees no need to hire the participant and the
participant treats the training assignment as an actual job.
Elements of Successful SCSEP Programs
The 2012 SCSEP program evaluation (Kogan, et al., 2012) identified only four best
practices of the most successful programs among the one hundred thirty three programs
studied. The most successful programs utilize the local job center as the main host site for
most or all of their participants or rotate participants to new host sites approximately every
six months to remind host sites and participants that SCSEP is a training program, not
employment. Successful programs actively assist participants with their job search and make
job search training and education a mandatory component of the project.
Recommendations for Program Improvement
The SCSEP evaluation conducted by Kogan, et al. (2012) identified several
recommendations to improve local SCSEP projects. The main recommendations included
providing formal training for participants who serve as project administration and case
managers, mandatory formal job search training for all participants, and ongoing recruitment,
which would make the SCSEP projects’ administrative and program support assignments just
one of several available training opportunities available to participants. The researchers also
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suggest creating a separate track for work assignments with job search and training for those
who come to the program with higher education and/or more job skills. Projects can do more
to help participants understand and prepare for the financial impact of securing unsubsidized
employment, prepare for their financial stability after the program ends, help them make
choices related to other types of services available to them, and prepare them for the time
when they will no longer be able to work.
In addition, the researchers suggested that the programs form a stronger partnership
with local job search agencies such as American Job Search, the Workforce Investment
Board and local Employment Development Departments. SCSEP projects are small and
impact few participants each year. A “large” program can only serve one hundred and fifty
participants at a time (Kogan, et al., 2012) and a small program, less than fifty. In addition,
participants can remain enrolled in the program for up to four years. In many areas, this is not
enough to address the number of older adults who qualify for the program, which leads to
very long wait lists, and the need is only expected to grow. There is a growing need to
develop job paths for older adult workers in order to strike a balance between the program’s
need to rotate participants into and out of the program in fewer than forty eight months in
order to make room for more participants per year and the participants’ need for quality
training and job placement.
SCSEP projects are required to provide support services for participants including
transportation, food and/or housing assistance, while they are enrolled in the program.
However, these services are not always supported by the program funding and SCSEP
projects have to either partner with other community-based organizations or only provide
limited services, which may not fulfill the level of need.
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C. Riverside County SCSEP Program Project
The Senior Community Service Employment Program has been a part of the Office
on Aging’s program offerings for over a decade. The Riverside County SCSEP project is
considered a small project (Kogan, et al., 2012) with only fifty six employment slots and an
average budget of $750,000 per year. The program is housed in the Riverside County Office
on Aging’s Planning and Community Services unit and has one full time dedicated project
manager and a unit supervisor, who oversees the SCSEP operation along with several other
community-based programs including the health promotion programs, the outreach and
community engagement programs, and the area planning functions. The Riverside SCSEP
project also provides training opportunities for three SCSEP participants who, in accordance
with the national program model, serve as case managers and employment specialists who
assist participants with intake, training assignments and annual recertification. Due to budget
constraints, the program provides minimal skills based training for participants. There are
currently fifty two host training sites ranging from meal sites to other county agencies and
with annual project exits and new hires, the project currently serves approximately sixty three
active participants per year.
Administration
Over the past five years from 2012 to 2017, the Office on Aging’s SCSEP project has
had five project managers, and the department has had three directors, all with varying
degrees of experience in operating this kind of direct service and/or employment program. As
of October 2016, a new project lead was assigned who has very little experience operating
either community-based or employment programs; however the new unit supervisor, has
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more than twenty years of experience operating community-based programs for low income
individuals, although very little experience in employment services. In addition, the current
unit supervisor is also responsible for several other community-based programs and the
Riverside County Office on Aging’s overall strategic planning functions, meaning that the
bulk of the project management falls to an inexperienced project lead.
The program’s budget is currently over $750,000, with more than $600,000 dedicated
to the employment stipends for a maximum of fifty six participants, leaving a little over
$100,000 for administration and supportive services for participants. The program is staffed
by three part time SCSEP program participants who serve as project assistants and help with
case management and job development for their fellow participants. As is consistent with the
national SCSEP program design, the SCSEP program administration role is supposed to
function as a training assignment for those participants, teaching them the critical skills
needed to exit the program with unsubsidized employment. Unfortunately, there has been
little training provided by the Riverside project because of the constant turnover in the
program’s supervisors. Worse yet, the SCSEP participants who staff the program have been
the only constant in the last four years and have been able to “design” many of the program’s
form, processes, and procedures without the input or guidance of an experienced program
manager.
D. Data Collection
For the past four years, the Riverside County SCSEP project has had an average of
sixty three active participants annually with a waiting list of more than twelve hundred
applicants. The Riverside County SCSEP project screens participants all year using a “Quick
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Screen” application (Appendix). The quick screen procedure is a Department of Labor
required activity for all SCSEP projects and is designed to determine the eligibility and
appropriateness of a potential participant during a ten to fifteen minute initial phone
screening.
Quick Screen Application
The Riverside County Quick Screen application is three pages and has seven sections.
Section one requests the applicant’s name, the name of the staff members taking the
application, personal information about prior participation in the SCSEP program, if
applicable, as well as some basic demographic information including gender designations
such as “male” “female” and “other” for the prevalent LGBTQ older adult residents. Section
two is a brief assessment of the applicant’s skills and includes open ended questions about
the geographic locations that the applicant is willing to accept training assignments in, their
past profession and education. The skills assessment includes a list of office related skills
including Microsoft computer programs, proficiency with standard office equipment and
experience working with the public. Section three requires income information that verifies
eligibility by using the 2016 Federal Poverty Guideline (FPL). If the applicant is within the
acceptable income range for the national program, they move on to section four of the
application. Section four includes a two question depression screening. Those who give a
response indicating depression are then referred to the Riverside University Health System,
Behavioral Health department for follow up. Section five is an agency satisfaction survey,
section six is a referral to another older adult employment initiative, the Riverside County
ENCORE initiative, for those who do not quality for SCSEP, and section seven is for office
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use and eligibility determination. Those who qualify for the program are put on the bottom of
the project’s long wait list until a training slot becomes available. Because the project
participants who serve as project assistants have devised the process for moving applicants
from the wait list by taking them in order of application, many applicants can remain on the
wait list for years.
E. Data Analysis
As the Office on Aging Planner and interim program manager for SCSEP from
January 2015 to July 2015, and as the current supervisor of the Planning and Community
Services unit into which the program was recently reassigned in October of 2016, I have
access to the annual quick screen data and as the lead planner, one of my primary functions is
to analyze and report on all agency data. In addition, I have been with Office on Aging for
more than four years in a position to observe and advise previous SCSEP project managers
about program administration. For the purposes of this study, in September of 2015 the entire
quick screen Access database was converted into an Excel file and downloaded onto a
portable drive. Participants with a quick screen application dated after June 30, 2015, were
eliminated, resulting in screening information for 1,201 individuals who had either been
active SCSEP participants in the program, approved for the program but placed on the wait
list, or deemed ineligible for the program prior to that date. All names and/or identifying
information were also deleted. The data then included information in the following
categories: age, gender, languages spoken, ethnicity, major skill categories, educational level,
retirement status, income, disability and/or risk for homelessness, referral status, previous
SCSEP status, citizenship status, program eligibility, enrollment status, and retirement status.
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Issues Affecting the Analysis
While attempting to analyze the database for program year 2014-2015, two major
issues were identified. First, SCSEP participants serving as program assistants were
responsible for entering the data and a combination of poor training and low literacy levels
among the participants further complicated the data analysis due to unclear or incomplete
data entry. Some entries were incomplete or were misspelled, such that the applicant’s
response was unreadable. Those responses had to be excluded from the analysis. Second, it
was discovered during the analysis process that the Office on Aging’s Quick Screen Access
database was developed by the Riverside County Information Technology department based
on the paper quick screen application. The techs created a simple data entry “form” for the
SCSEP program assistants to enter information just as they would on a paper application,
with open ended spaces and “yes” or “no” responses to other questions as indicated by the
paper quick screen. Many of the most critical evaluation categories, such as age, education,
skills, and languages spoken were phrased as open ended questions rather than defining
specific response options. To address the issue, these responses had to be grouped into broad
categories pertaining to gender, age range, ethnic group, bilingual status and language
spoken, educational level, major skill categories, type of income, and general program
eligibility. The results of the analysis for each category are as follows.
Age
Participant ages were grouped into broad categories by decade up to age 69 (50 to 59:
28.9% and 60-69: 48.9%) and from age 70 to 90 (18.8%). An additional 3.2% of all
participants did not provide their age.
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Gender
Participant genders self-identified as male (31.6%), female (68.3%). An additional
0.8% of participants identified “other” as their gender designation.
Ethnicity
Participants’ stated ethnicities were sorted into the following broad ethnic categories:
White (25.7%), African American (17.2%), Hispanic (12%), Asian/Pacific Islander (3.7%),
Native American (0.6%), or Other (2.4%). More than one third of the applicants (38.5%)
either declined to state an ethnicity or no response was recorded.
Languages Spoken
Two hundred and two (16.8%) non-English speaking or bilingual individuals were
identified, but unfortunately nearly seventy percent (69.9%) indicated that they were
bilingual, but no specific language was specified. For the remaining group who did indicate
the ability to speak a second language, their capability was sorted into the following major
language categories: Spanish (23.3%), Asian languages (including Vietnamese, Ilocano,
Kampangan, Mandarin, Chinese, Taiwanese, and Tagalog) (2.7%), Arabic/Persian/Farsi
(including “some middle eastern) (2.1%), German or French (1.7%), Italian (1%), American
Sign Language (2.7%), and less than one percent (0.3%) reported language capacity in other
languages such as Hebrew/Yiddish, Polish, Dutch, Romanian, Hindi, and/or African
Languages, which included languages from the African continent.

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Educational Level
Information regarding each applicant’s educational attainment was sorted into broad
categories including those possessing a high school diploma or GED (31.6%), some college
(21.9%), certifications (4.3%), an AA or Technical degree (4.5%), a Bachelor’s degree
(5.2%), a Master’s degree (2.8%), or a Doctorate (0.4%). More than half of the SCSEP
applicants reported no educational data, which could indicate either that they had less than a
high school diploma or that no response was recorded.
Major Skill Categories
The Quick Screen questions related to applicant skills were designed as open ended
questions and the responses were varied, requiring that each applicant’s skills be categorized
into broad areas including, “Management” (including general office management and/or
project management), “Office/Administrative Support”, “Social Work” (including
counselors, social workers, and religious workers), “Education” (including teachers or
school related work, and college professors), “Banking/Financial”, “Insurance”, “Human
Resources”, “Childcare”, “Adult Care”, “Medical” (including medical assistant/technician,
registered nurse, dentist, physician or surgeon), “Art/Design”, “Sales/Marketing/Public
Relations”, “Trucking/Driving/Delivery”, “Cashier”, “Food & Beverage Preparation or
Service”, “Installation/Maintenance/Housekeeping”, “Accounting/Auditing”, “Security”,
“Beauty/Fashion” (including hairdressers and cosmetologists), “Legal” (including paralegal,
legal assistant, lawyer, and judge), “Information Technology”, “Real Estate”, “Psychology”
(including therapists), “Consulting”, “Construction Support”, “Automotive
Repair/Maintenance”, “Welding/Machinist/Fabrication”, “Sports Related”,
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“Entertainment/Performer”, “Military/Active Duty”, and “Public Safety” (including police
and fire personnel).
Table 8: SCSEP Quick Screen Major Skill Categories (Self-Reported)
*n=1201
Major Skill Category Number Percent of Applicants
Management 91 7.6%
Office/Administrative Support 206 17.1%
Social Work 31 2.6%
Education 50 4.2%
Banking/Finance 36 3%
Insurance 24 2%
Human Resources 12 1%
Childcare 90 7.5%
Adult Care 90 7.5%
Medical Field 64 5.3%
Art/Design 3 0.2%
Sales/Marketing/Public Relations 65 5.4%
Trucking/Driving/Delivery 30 2.5%
Cashier 16 1.3%
Food/Beverage Service 42 3.5%
Installation/Maintenance/Housekeeping 32 2.8%
Accounting/Auditing 22 1.8%
Security 14 1.2%
Beauty/Fashion 9 0.5%
Legal 9 0.9%
Information Technology 14 1.2%
Real Estate 13 1.1%
Psychology 2 0.2%
Consulting 2 0.2%
Construction Support 21 1.7%
Automotive Repair/Maintenance 22 1.8%
Welding/Machinist/Fabrication 22 1.8%
Sports Related Field 2 0.2%
Entertainment/Performer 2 0.2%
Military/Active Duty 2 0.2%
Public Safety 1 0.1%
No Skills Identified/Reported 569 47.3%

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What is significant regarding these results is that, based on previous employment
and reported skills an initial group of one hundred and eighty five individuals (15.4%) had
experience in social work, adult care, or the medical field. The results also show that 47.3%,
or more than 500 applicants reported no marketable skills or no data was recorded. Within
this group could be more individuals with skills that might be applicable to the program pilot
and/or may be interested in being trained for the program. The Office on Aging’s SCSEP
project has already begun to re-contact the list and re-screen participants to gather any
missing information.
Other Information
Other information requested by the Quick Screen including retirement status,
disability, risk of homelessness, and possession of a California Driver’s License was
collected and the results are shown in Table 9 below. In addition, only 2.2% of the 1,201
applicants has previously applied for or been enrolled in the SCSEP program, and only
ninety eight (8.2%) of the applicants base were actually enrolled in the program in fiscal year
14/15, leaving 91.8% of the applicants on the program’s wait list.

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Table 9: Additional SCSEP Quick Screen Data Categories
*n=1201
DATA CATEGORY TRUE FALSE
Formally Retired 197 1004

16.4% 83.6%
Disabled 93 1108

7.7% 92.3%
Homeless or At Risk 77 1124

6.4% 93.6%
Possess a Driver’s License 686 515

57.1% 42.9%
F. Discussion
In order to assess the viability of the SCSEP program as a vehicle for the Community
Service Worker pilot program in Riverside County, the existing SCSEP project housed in the
Riverside County Office on Aging was analyzed as a case study to see if the project could be
modified to support a small pilot program. The analysis reveals a SCSEP project that has the
potential to develop such a program.
Program Administration
Due to the constant turnover in the department during the last four years, the SCSEP
program has been operating at a minimal level and very little has been done to grow or
change the program in recent years. Very few participants have been rotated out of the
program and the current SCSEP project assistants are due to reach their lifetime duration
limits within the next year. However, the current departmental administration is new and
eager to develop the program, so now is a good time to modify the program’s infrastructure
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in order to support a small community service worker pilot within the current SCSEP project.
Another significant concern regarding the Riverside County SCSEP project is the recent
change in the process for onboarding new program participants. In the last fiscal year
(2015/16), the process for transitioning participants into the program was shifted in part to
Riverside County’s Temporary Assistance Program (TAP) housed within the Human
Resources (HR) Department. The process now includes health screenings and background
checks, neither of which are required by the program, and the results of which cannot be used
to exclude participants from the program. The results can only effect where the SCSEP
participant can be placed, meaning that those who do not “pass” the background screenings,
per the County of Riverside requirement, cannot work in county facilities but can be placed
in other organizations that do not require background screening. This more formal HR
process adds several weeks or months to the onboarding process, creates a hardship for
participants who have to travel many miles for the screening activities, and may serve to
discourage those who are low income, disabled, or homeless from participating in the
Riverside County SCSEP project.
Quick Screen Data Analysis
The analysis of the quick screen database for the sample program year of 2014/15
revealed a total of 1,201 SCSEP applicants. Of those applicants, almost 1,000 people (77.9%)
were between the ages of 50 and 69, which are the prime ages for the pilot program, with an
additional 17.7% between ages 70 to 79, who may also be interested in the pilot program.
Although males can be community service workers, most programs employee females and
68.3% of the database is female, and remains predominantly female into this program year.
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Two hundred and ninety two people identified that they potentially spoke a second language
and of those, 23.3 % indicated Spanish language ability, which is the second most common
language spoken in Riverside County. A quarter of the applicants identified as White,
followed by 17.2% identifying as African American and an additional 12% who identified as
Hispanic. White is the predominant ethnicity in Riverside County at this time, however, the
minority population is growing each year and most of the low income communities in
Riverside are made up of the African American and Hispanic population. The majority of
applicants (70.8%) has at least a high school diploma or more education, do not consider
themselves to be formally retired from the working world (83.6%), suffered from no
disability that could limit their work performance (92.3%), and possessed a valid driver’s
license (57.1%). Unfortunately, because there were issues with the data collection process,
the SCSEP database was not as useful as it could have been.
G. Summary
The SCSEP program provides an adequate vehicle for the Older Adult Service
Worker pilot program. Its goals are to build community-based and social support for older
adults by identifying those older adults who are most in need of employment opportunities
and training them to move into the workforce, and into unsubsidized employment, preferably
in a growing field. SCSEP provides up to four years of training time with minimum wage
stipends, and makes permanent, long-term employment the focus of the program. Best of all,
for the CSW pilot, the SCSEP legislation does not prohibit the development of specific
initiatives within each project, but encourages each individual project to develop strategies to
improve training opportunities, increase placements, and improve the odds of employment
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retention. The analysis of the Riverside County Office on Aging’s SCSEP project and wait
list database shows that, with the new organizational structure, new department and project
leadership, and a viable group of approximately 1,000 potential participants who could be
further screened for the CSWs pilot, the Older Adult Community Service Worker pilot is a
viable option to accomplish the national program goals, provide meaningful work for
participants, and assist the growing older adult population.

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CHAPTER V. COMMUNITY SERVICE WORKER PROGRAM
A. Introduction
Research Question 3: What is the feasibility of implementing the pilot program in
Riverside County?

The purpose of this project is to develop a pilot community service worker program
for Riverside County that can fill current and potential future gaps in service due to a lack of
older adult professionals. The Riverside County Older Adult Community Service Worker
Program proposed by this paper outlines the best way to address the needs of the growing
older adult population. The pilot will seek to recruit and employ Riverside County’s older
adults to perform a variety of functions in local neighborhoods, senior centers, adult housing
communities, and community-based clinics in Riverside County by analyzing and evaluating
the best practices and outcomes from community service worker, community health worker
and promotora programs across the United States and by exploring the existing Riverside
County Office on Aging’s Senior Community Services Employment Program (SCSEP) as a
case study to identify a base of employable older adults. The program proposal includes a
defined scope of work, recruitment criteria to identify and retain workers from the SCSEP
universe, the basic elements of a comprehensive education and training program, and clear
evaluation criteria to measure program outcomes and success. Finally, this paper includes a
process for modest implementation in Riverside County, as well as suggestions for adapting
the program in other Riverside County Agencies and potentially other Planning Service
Areas (PSAs) within California’s Area Agencies on Aging (AAA) network.

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B. Need for the CSW Pilot Program in Riverside County
The Riverside County Office on Aging is a small, independent department within
the County of Riverside structure. It is also one of 33 Area Agencies on Aging (AAA) in
California. The Office on Aging provides over 24 different programs and services to over
25,000 individuals annually either directly or through contracted providers, which allow
older adults to remain independent and living in their homes and communities. All Office
on Aging programs and services are free to those who meet the minimum qualifications
for each program. The agency provides an array of services to over 25,000 individuals in
FY 2015-16 including in-home services and care coordination, options counseling and
decision support, healthy lifestyle and wellness programs, activities for social
engagement, advocacy and coordination, outreach, and community education. Table 10
highlights the programs and services provided by the Office on Aging.

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Table 10: Overview of Office on Aging Programs and Services
Care
Coordination
Options
Counseling
and Decision
Support
Healthy
Lifestyle
and
Wellness
Programs
Social
Engagement
and
Community
Activation
Advocacy &
Coordination
Outreach &
Community
Education
Multipurpose
Senior Services
Program (MSSP)
Helplink:
Information &
Assistance
Call Center
Healthy
Options
Program
(Stanford
Chronic
Disease Self-
Management
Program)
Coachella
Valley RSVP
Program
(formerly the
Retired
Senior
Volunteer
Program)
Aging and
Disability
Resource
Connection
designation
Outreach
and
Information
Van (Info
Van)
Carelink/Healthy
IDEAS
Network of
Care
Arthritis
Foundation’s
Walk with
Ease
Program
Volunteer
Connect
Initiative
Grandparents
Raising
Grandchildren
Task Force
Healthy
Lifestyle
Van
Access Legal
Assistance
Fit After 50
(Arthritis
Foundation’s
Exercise
Program)
Senior
Community
Services
Employment
Program
(SCSEP)
Planning
Services
Family Caregiver
Support Program
(FCSP)
Health
Insurance
Counseling
Congregate
& Home
Delivered
Meals

Grandparents
Raising
Grandchildren
(GRG)
Long Term
Care
Ombudsman
Program
Bingosize
Hospital Liaison
Program
Elder Abuse
Prevention
Education
Health &
Nutrition
Education
(including
SNAP Ed)

Assisted
Transportation
Mental
Health
Liaisons

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Care Coordination
Care Coordination services offer frail and vulnerable older adults, persons with
disabilities, and their caregivers an alternative to more costly institutional and nursing
home care by offering a variety of options for care in the home. Trained social workers
and public health nurses conduct comprehensive in-home evaluations and provide links
to critical services including homemaker (assorted housecleaning duties, cooking, etc.),
personal care (bathing, eating, medication management, etc.), emergency aid (utility bills,
home repairs, durable equipment, such as wheelchairs, etc.) and respite, training, and
support groups for caregivers. Care coordination programs also assist older adults with
care transitions from hospital to home and reduce the rate of costly readmissions. Specific
services include:
1. Multipurpose Senior Services Program (MSSP): MSSP is a Medi-Cal waiver long
term case management program for eligible adults over age 65 who have complex
medical and psychosocial needs, which require specialized medical and social
support services in order to postpone or eliminate the need for institutional care.
MSSP is an integral part of the statewide Coordinated Care Initiative (CCI).
2. CareLink and Healthy IDEAS Programs: The CareLink and Healthy IDEAS
programs provide case management services for older adults and disabled persons
over the age of 18 who still live at home. There are no income requirements for
the programs. Both programs were selected for innovation awards by the
California Association for Area Agencies on Aging and the National Association
of Area Agencies on Aging in FY 2015/2016.
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3. Access: Access is a short-term case management program for adults over age 60,
regardless of income. The program provides… care planning and care
management, which enables functionally impaired persons to obtain services
which promote and maintain the optimum level of functioning in the least
restrictive setting possible.
4. Family Caregiver Support Programs (FCSP): FCSP are a group of programs that
provide support and resources to caregivers, making it possible for them to
provide vital care services to their loved ones. To qualify for services, the care
recipient must be over age 60 and the caregiver must be over age 18. Services
include: advocacy, care management, education, counseling, care assistance,
respite services, in-home assistance and supplemental services. The Care
Pathways program, which is allowable under the FCSP guidelines, provides
training and 12 weekly support groups for caregivers, was recently designated a
“Bright Idea” program by the Harvard Ash Center for Democratic Governance
and Innovation.
5. Grandparents Raising Grandchildren (GRG) Program: GRG is a unique program
that provides assessment, advocacy, case management and other links to critical
services for grandparents over 55 who are (formally or informally) raising their
grandchildren up to age 18. Through a grant with First 5 Riverside, the GRG
Program offers subsidized respite childcare for children 0-5 years of age. The
program has no income requirements. The GRG program has been used as a
model program for other AAAs in the United Stated.
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6. Hospital Liaison Program: Via the evidence-based Care Transitions Intervention
(CTI) program, social workers from the Office on Aging are embedded in
Coachella Valley acute care hospitals to partner with hospital social workers and
discharge planners to assist older adult patients who are returning home after an
acute care admission, with issues related to that transition. The CTI program helps
patients avoid repeat hospitalizations and unnecessary institutionalization.
Options Counseling and Decision Support
The Office on Aging provides interactive decision-support and option counseling
to consumers, family members, and/or caregivers to assist with any decisions related to
services and care options appropriate to the consumer's needs, preferences, values, and
individual circumstances. Services include:
1. HelpLink: Information and Assistance Call Center: HelpLink is the entry
point for consumers who need information and/or referrals to in-house, other
county, and/or community-based services and programs through the main 800
number for Riverside County (1-800-510-2020). Consumers are able to speak
with trained and certified Information and Assistance Specialists who
understand available programs, eligibility requirements, and current
availability. I&A Specialists are also qualified to perform comprehensive
assessments for those consumers who require more specific case management
services.
2. Network of Care: Office on Aging oversees and maintains the Network of
Care website, a comprehensive, internet-based resource for older adults,
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people with disabilities, their caregivers, and other service providers. Users
can receive assistance with medications, search for services, use the health
library, search for assistive devices, link to city, county, state and federal
governments, track legislation and give feedback to legislators, complete and
print a personalized emergency care card, and use a password protected
personal folder to keep track of medical information and store personal
medical information to share with providers who use the system.
3. Legal Assistance: Through a contracted provider, the Office on Aging
provides legal assistance to adults over age 60, providing them with
information, advice, counseling, administrative representation and judicial
representation. Legal representation is provided by a member of the California
State Bar or a non-attorney under the supervision and control of a member of
the California State Bar.
4. Health Insurance Counseling: Through the Health Insurance Counseling and
Advocacy Program (HICAP), the Office on Aging provides free information
and assistance with Medicare, managed care, long-term care insurance and
other related health insurance issues. Trained volunteer counselors offer
educational presentations and objective information to help older adults and
other Medicare beneficiaries.
5. Long-Term Care Ombudsman Program: Through a contracted provider, the
Office on Aging offers Ombudsman services in order to assist older adults
with their effort to seek resolution to problems and to advocate for the rights
of residents in long term care facilities.
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6. Elder Abuse Prevention Education: The Office on Aging provides ongoing
public education and training sessions to older adults, professionals, and
caregivers on elder justice and abuse issues. The Office on Aging also
produces and distributes educational materials and participates in coordinated
activities that address elder abuse prevention, investigation, and prosecution,
such as the County’s World Elder Abuse event held each June.
7. Assisted Transportation: The Office on Aging provides assistance with
identifying and accessing transportation resources in order to help older adults
with access medical, meal and community-based services. As part of this
program, volunteers are reimbursed by the mile for transportation services.
During FY 14/15, the Office on Aging provided over 15,000 one way trips.
Healthy Lifestyle and Wellness Programs
The Office on Aging provides an array of services and programs to assist older
adults with maintaining their overall health and wellness as they age. Through a
combination of physical fitness programs, chronic disease self-management programs,
congregate and home delivered meals, nutrition education, behavioral health screenings
for depression, and activities that promote social engagement and connections with
others, Office on Aging assists older adults with understanding what a critical role good
health plays in the quality of their lives. The evidence-based programs are designed for
lay leaders, volunteers, and paraprofessionals so they are best suited for the CSW
program. Specific programs include:
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1. Healthy Options Program (HOP): This evidence-based, chronic disease self-
management program from Stanford University is offered to older adults
experiencing chronic health conditions such as hypertension, arthritis, diabetes,
heart disease and/or stroke. Office on Aging has three Stanford-trained Master
Trainers on staff that train and certify other community or lay leaders with
chronic diseases to conduct self-management classes with their peers in local
senior centers, community centers and housing communities. The sessions are
most often facilitated by Office on Aging staff, which include three Master
Trainers, four Spanish leaders, and two additional English language leaders. A
few volunteers assist with facilitation, but the program has relied heavily on staff
and the few SCSEP participants whose training assignment is the health
promotion programs.
2. Walk with Ease Walking Program Pilot: Starting in Fiscal Year 16/17, the Office
on Aging piloted the evidence-based “Walk with Ease” Program from the
Arthritis Foundation, which is proven to reduce the pain of arthritis and improve
overall health. The program consists of 30 minutes of instruction on health and
nutrition topics and 30 minutes of waking activity. In FY 14/15 the program was
piloted in six locations across the county and fully implemented during FY 15/16.
3. Fit After 50: Fit After 50 is an exercise program that improves strength, balance
and mobility through stretching, upper and lower body resistance, and core
exercises. The program is proven to prevent falls, reduce injuries and mortality
rates, prevent or decrease the effects of chronic illnesses, and prolong
independence. The program uses volunteers to facilitate the exercise classes a
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minimum of twice per week, has been in existence for almost 10 years, and now
has 35 classes with over 1100 participants and 40 volunteer leaders throughout
Riverside County. Classes are facilitated by unpaid volunteers and the issue of
retaining the volunteer base is an ongoing concern at certain sites.
4. Bingosize: Bingosize combines the game of bingo with physical exercise through
the use of resistance bands, walking in place and gentle stretching. The program
focuses on improving cardiovascular/cardiorespiratory fitness, muscular strength,
flexibility, and balance. Bingosize currently operates at only one site in the Blythe
Community Center twice a week with approximately 15 participants attending.
The program is currently facilitated by senior center staff, but the Bingo sessions
are designed to be run by volunteers. In order for Office on Aging to expand the
program beyond the Blythe areas, volunteers will have to be secured.
5. Congregate and Home Delivered Meals: Congregate and home-delivered meals
are provided to persons over age 60 (and their spouses). Congregate services are
available at over 30 sites throughout Riverside County and provide daily meals to
over 6,000 (mostly low income) older adults. The Home Delivered Meal Program
serves home-bound older adults over age 60, who are considered to be at the
greatest nutritional risk and who are unable to access the nutrition sites. Office on
Aging provides this service directly to older adults in Blythe. With the exception
of the Blythe site, the meals programs are run by Office on Aging contractors
who, in some cases, outsource certain aspects of the food service and delivery to
trained volunteers. In Blythe, meals are served and delivered by staff with
assistance from volunteers.
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6. Health & Nutrition Education: Though a trained and certified Health Educator
and a Registered Dietitian, the Office on Aging provides quarterly health and
nutrition education at all congregate meal sites and through the contracted
providers along home-delivered meal routes. In addition, staff members provide
general nutrition education at fairs, senior and community centers and housing
communities for older adults. The Registered Dietician oversees site menus and
trains meal providers about proper food preparation and storage procedures. In
addition to general nutrition education, the Office on Aging also participates in
additional initiatives sponsored by the United States Department of Agriculture
and the Administration for Community Living, including the annual farmer’s
market coupon distribution and education in support of the Supplemental
Nutrition Assistance Program (SNAP-Ed).
SNAP-Ed: The Office on Aging participates in the state-wide educational
Supplemental Nutrition Assistance Program (SNAP-Ed) initiative to improve the
likelihood that persons eligible for food assistance will make healthy choices
within a limited budget and choose active lifestyles. The program offers nutrition
classes and information to low income older adults and encourages them to apply
for food assistance. Nationally and in California, only 10% of eligible older
adults receive food assistance benefits. Although evidence-based, SNAP Ed
requires no special certification and is currently facilitated by the Office on Aging
Nutrition Educator, however there is no specific certification required and the
program could be facilitated by a lay leader.
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7. Mental Health Liaison Program: Though a partnership with Riverside University
Health System – Behavioral Health, counseling staff are imbedded in the Office
on Aging to assist older adults with navigating the behavioral health system and
providing depression screenings at community events, health fairs, and other
community-based locations. Depression screenings are conducted by mental
health professionals.
Social Engagement and Community Activation
The Office on Aging provides specific programs and services designed to
encourage social connections and to keep older adults active in their communities
through employment, intergenerational activities and volunteerism.
1. Coachella Valley RSVP Volunteer Program (formally known as the Retired
Senior Volunteer Program): For the past 22 years, the Office on Aging has
sponsored the RSVP Program in the Coachella Valley and Blythe. RSVP places
adults over the age of 55 in volunteer positions in public sector and community-
based agencies, allowing them the opportunity to continue contributing their skills
and wisdom for the betterment of their communities and overall health and
wellness. The program is partially grant funded by the Corporation for National
Community Service and currently has over 800 active participants.
2. Volunteer Connect Initiative: Through a grant agreement with the Regional
Access Project Foundation (RAPF), the Office on Aging is co-developing
intergenerational volunteer activities and events that bring together younger and
older volunteers. The goal of the initiative is to encourage younger volunteers to
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make community service a lifelong activity and to allow older adults to impart
their expertise and wisdom to subsequent generations.
3. Senior Community Service Employment Program (SCSEP): As previously
discussed, the SCSEP project is a federal community service and work based
training program for older workers that provides subsidized, service-based
training for low-income, unemployed adults over age 55 with low employment
prospects. The program focuses on skill improvement and work readiness and
serves as a bridge to unsubsidized employment opportunities. Participants must
have a total household/family income of no more than 125% of the federal
poverty level.
Advocacy and Coordination
The Office on Aging participates in various collaborations and coalitions that
address many of the issues that affect older adults. However, as one of California’s 33
AAA-assigned key coordination duties, there are two coalitions the Office on Aging
takes main responsibility for. Those activities include:
1. Aging & Disability Resource Connection (ADRC): In 2008, the Riverside County
Office on Aging received an Aging and Disability Resource Connection (ADRC)
designation and is part of a collaborative effort of the U.S. Administration on
Aging and the Centers for Medicare and Medicaid Services. The collaboration
initiative is designed to streamline access to long-term services and supports by
creating a “no wrong door” approach to assisting all individuals, regardless of
age, ability or income. ADRC partners work together to help consumers with
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planning for their current and future long-term care needs and to advocate for
consumers and clients. The coalition is organized by the staff and the coalition
members determine their main areas of focus and work plan.
2. Grandparents Raising Grandchildren Task Force (GRGTF): The goal of the
GRGTF is to address the multiple and complex issues faced by grandparents who
are primary caregivers of their grandchildren. The Task Force serves to identify
needs and resources, collect data, advocate on behalf of grandparents, and educate
other service providers about the special needs and concerns of the GRG
population. This coalition is also organized by the staff with the coalition
members determining their main areas of focus and work plan.
Outreach and Community Education
The Office on Aging offers information and education through a variety of
innovative programs and services. Programs include:
1. InfoVan Program: The InfoVan Program is an outreach and community education
program. The Office on Aging has two general information vans staffed by
information specialists. Vans travel throughout the County attending community
events and visiting senior and community centers and other places where older
adults congregate to provide information about Office on Aging services and
other services available throughout the County for older adults.
2. Healthy Lifestyle Van: The Healthy Lifestyle Van is an Info Van dedicated to
health and wellness information. Staffed by the Nutrition Educator, the van also
travels throughout the County attending health related events, visiting senior and
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community centers and other places where older adults congregate, providing
information about Office on Aging’s health and wellness programs and initiatives.
3. Planning Services: The Planning team is responsible for research, legislative
analysis, developing and analyzing community assessments, tracking and
evaluating program performance, developing public education information (such
as presentations, publications, reports, etc.), and drafting and updating the four
year Riverside County Area Plan on Aging. These activities help to determine the
current and future needs of older adults in the county. The Planning staff, with
the assistance of the outreach and health promotion staff, collect approximately
2,000 surveys annually.
Potential CSW Integration at Office on Aging -- Planning and Community Services Unit
The Office on Aging operates with an annual budget of approximately $13
million in federal, state, and local funds and currently has only 68 authorized full time
staff positions, with a 20% vacancy rate on the program and direct service side of the
agency (Martinez, 2016). The Executive Team consists of the director and two deputy
director positions for fiscal and program operations and the Leadership Team consists of
an additional nine supervisors who oversee the program and operational units described
above (Riverside County Office on Aging, 2016).
Some programs must be implemented by trained, credentialed, or certificated
personnel, but many programs rely on lay leaders or paraprofessionals to facilitate them
either by design, as in the case of chronic disease self-management programs, or because
there is not enough staff to implement the program. Care Coordination programs,
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including MSSP, Carelink/Healthy IDEAS, Access, the Family Caregiver Support
Program (FCSP), Grandparents Raising Grandchildren (GRG), and the Hospital Liaison–
Care Transitions Intervention (CTI) program, currently operate with professional staff
and there is not a clearly defined role for a CSW, however perhaps at a later stage in the
pilot program, CSWs could perform initial assessments or conduct follow up visits to
assist social workers with their caseloads and duties. Options Counseling and Decision
Support activities such as information and assistance calls, updates to the Network of
Care website, and providing older adults with transportation, would be ideal roles for
CSWs in the future.
The Planning and Community Services (PCS) Unit of the Riverside County
Office on Aging is responsible for the all of the Healthy Lifestyle and Wellness activities,
excluding Congregate and Home Delivered Meal services, all of the Outreach and
Community Education activities, and the SCSEP employment project. PCS is overseen
by one supervisor and operates with 5.5 full time employees. The outreach program’s
operations are facilitated by only 2.5 staff and as a result the reach into the community is
limited. The evidence-based programs are facilitated through the efforts of trained
volunteers, whose turnover rate is high in some areas of the county, and who must be
continually recruited by one staff member. All of these programs would benefit from the
assistance of CSWs. Figure 6 shows the scope of work for the PCS unit. Since the SCSEP
project, the health promotion programs, the outreach activities, the employment program,
and the planning functions are all housed within the same internal unit of the Office on
Aging, it should be easy to implement the initial pilot program and to evaluate the results.

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Figure 6: Riverside County Office on Aging
Planning and Community Services Operational Unit

Most of the Healthy Lifestyle and Wellness programs facilitated by the PCS unit,
including the Stanford Chronic Disease Self-Management Program (CDSMP) and the
Arthritis Foundation Exercise Program (AFEP) called the “Healthy Options Program”
and “Fit After 50” respectively, the Arthritis Foundation’s Walk with Ease Program,
SNAP Ed, which is a form of nutrition education, and Bingosize, are all evidence-based
programs designed to be peer led and/or facilitated by volunteers. Classes occur in local
communities in senior centers, senior housing complexes, and other places where older
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adults gather. Additionally, congregate and home delivered meals are currently delivered
by trained volunteers and this role could be facilitated by CSWs.
Social Engagement and Community Activities, such as the Coachella Valley
RSVP Program, and the SCSEP project all have roles and functions that CSWs can
fulfill. These activities can be facilitated by CSWs at the initial stages. Duties could
include interviewing and assessing potential participants, recruiting and maintaining
active sites for volunteers, SCSEP workers, and program administration duties.
The Outreach and Community Education programs facilitated by the PCS unit
would be greatly enhanced by the assistance provided by CSWs. Whether CSWs provide
support to outreach staff for smaller events, larger events and fairs, or assist with visiting
senior centers and housing communities on a regular basis, almost all of the CSW
programs studied for this research had an outreach component, and outreach and some
form of community engagement seem to be fundamental roles for CSWs. In addition,
through the outreach process, the Planning unit collects over 1,500 general and
constituent based community assessment surveys each year, which CSWs could be
trained to administer and collect. The advocacy initiatives such as the ADRC and the
Grandparents Raising Grandchildren Taskforce are also areas where CSWs could be
utilized, if the program manager can determine a clear role and set of responsibilities.
The projected increase in the older adult population in Riverside County, the need
to supplement staff efforts with CSW support, the current outreach efforts, health
promotion and other potential programs, gives the CSW pilot a strong foundation upon
which to grow and flourish.
131

C. Program Design and Implementation
According to the Riverside County Area Plan on Aging, there are approximately
289,649 adults over the age of 65 in Riverside County and approximately 26,068, or 13%
were living at or below the federal poverty level in 2016. However, when the Elder Index
is applied to the Riverside County older adult population, approximately 33% of older
adults do not have enough income or resources to make ends meet. In addition, the
population projections show that the older adult population will increase by 175% for
those between 65 and 75 years old, 240% for those between 75 and 84 years old, and
443% for those over the age of 85 years old by 2060. Diversity will also increase, with
the Hispanic population increasing to over two million also by 2060 and Spanish is
already the most prevalent language spoken at home in Riverside County, after English.
The LGBT population is also the largest per capita in the country with an estimated 9,000
to 65,000 people currently (Riverside County Office on Aging, 2016).
The projected population growth only increases concerns about how to keep older
adults healthy as they age and to provide localized, accessible services, to a population
that is expected to be more disabled, suffer from many types of dementia and multiple
chronic diseases, including HIV and AIDS, and require service providers to come up with
new ways of providing service. Given the large and varying areas of need, there is the
potential for a pilot program to work within the Office on Aging, with the initial areas of
work focused on outreach activities, health and wellness programs, and survey collection.
If the pilot is successful in the initial phase, it could branch into the other Office on Aging
program areas, such as care coordination, in a second or third phase.
132

Targeted Communities
Once the need has been determined and the initial programs identified, the next
step is to identify target communities. Using the information provided by the Office on
Aging’s 2016-2020 Area Plan on Aging, target communities for both older adults in
poverty and disability can be selected. Table 11 identifies all of the Riverside County zip
codes, identifies the total number older adults living in each zip code, and the number of
older adults living in poverty within each zip code (Riverside County Office on Aging,
2016).
Table 11: Riverside County 65+ Population by Zip Code
Zip
Code
City Population Population 65+
65+ Population
in Poverty
91752 Mira Loma/Eastvale/Jurupa Valley 28,649 10% 2,865 12% 344
91761 Jurupa Valley 59,892 7% 4,192 8% 335
92028 Temecula 48,335 18% 8,700 8% 696
92060 Aguanga 61 69% 42 0 0
92086 Aguanga 1,335 29% 387 9% 35
92201 La Quinta/Indio/Coachella 63,915 12% 7,670 16% 1,227
92203
La Quinta/Indio/ Coachella/Bermuda
Dunes/Palm Desert/Desert Palms
27,466 18% 4,944 9% 445
92210 Palm Desert/Indian Wells/La Quinta 4,839 61% 2,952 4% 118
92211
Thousand Palms/Rancho
Mirage/Palm Desert/Indian
Wells/Desert Palms/La
Quinta/Indio/Bermuda Dunes
24,564 47% 11,545 7% 808
92220
Banning/Beaumont/Cabazon/
Whitewater
32,793 27% 8,854 9% 797
92223
Banning/Beaumont/Calimesa/
Cherry Valley
46,719 14% 6,541 7% 458
92225 Blythe/Ripley/Mesa Verde 23,509 9% 2,116 15% 317
92230 Banning/Cabazon/Whitewater 3,297 5% 165 14% 23
133

92234
Palm Springs/Cathedral City/
Rancho Mirage
52,534 14% 7,355 14% 1,030
92236
La Quinta/Indio/ Coachella/
Thermal/Vista Santa Rosa
43,037 5% 2,152 19% 409
92239 Desert Center 428 9% 39 0 0
92240
Desert Hot Springs /Palm
Springs/Cathedral City/Desert
Edge/Garnet
35,878 11% 3,947 12% 474
92241
Desert Hot Springs/Palm Springs/
Cathedral City/Desert Edge/
Garnet/Sky Valley/ Thousand
Palm/Desert Palms/Indio/Coachella
9,156 31% 2,838 11% 312
92253 Palm Desert/Indian Wells 38,462 24% 9,231 7% 646
92253
La Quinta/Indio/Bermuda Dunes/
Vista Santa Rosa
38,462 24% 9,231 7% 646
92254 Mecca/North Shore/Oasis 12,300 5% 615 21% 129
92258 Desert Hot Springs/ Palm Springs 520 19% 99 10% 10
92260
Rancho Mirage/Palm Desert/Indian
Wells/Palm Springs
32,855 32% 10,514 8% 841
92262 Palm Springs/Cathedral City 26,693 21% 5,606 9% 504
92264
Palm Springs/Cathedral City/
Rancho Mirage
19,754 35% 6,914 8% 553
92270
Palm Springs/Cathedral City/Thousand
Palms/Rancho Mirage/Palm Desert
17,634 45% 7,935 4% 317
92274
La Quinta/Coachella/
Mecca/Oasis/Thermal/
Vista Santa Rosa
18,937 6% 1,136 19% 216
92276
Cathedral City/Sky Valley/Thousand
Palms/Rancho Mirage/ Palm
Desert/Desert Palms/Indio
7,921 22% 1,743 6% 105
92282
Desert Hot Springs/Palm
Springs/Whitewater
783 19% 149 4% 6
92316 Jurupa Valley 31,720 8% 2,538 13% 330
92320 Beaumont/Calimesa/ Cherry Valley 8,097 29% 2,348 9% 211
92324
Riverside/Jurupa Valley/Moreno
Valley
58,013 7% 4,061 15% 609
92337 Jurupa Valley 37,844 6% 2,271 4% 91
92373 Beaumont/Calimesa 34,017 15% 5,103 9% 459
92399 Banning/Calimesa/ Cherry Valley 54,056 14% 7,568 12% 908
92501 Riverside /Jurupa Valley 22,216 8% 1,777 12% 213
92503
Home Gardens/Riverside/
El Sobrante/Lake Mathews
92,959 8% 7,437 12% 892
92504
Riverside/Jurupa Valley/Lake
Mathews
53,960 13% 7,015 7% 491
92505 Riverside/Jurupa Valley 49,064 9% 4,416 9% 397
92506 Riverside 45,993 14% 6,439 5% 322
134

92507 Riverside/Highgrove/Moreno Valley 55,156 8% 4,412 16% 706
92508
Riverside/Lake Mathews/Moreno
Valley/March ARB/Mead Valley
36,583 8% 2,927 11% 322
92509
Riverside/Glen Avon/
Pedley/Rubidoux/Jurupa Valley
78,221 8% 6,258 12% 751
92518
Riverside/Moreno Valley/Perris/
March ARB/Mead Valley
1,129 48% 542 8% 43
92530 Lake Elsinore/Lakeland Village 51,816 7% 3,627 12% 435
92532
Menifee/Warm Springs/Lake
Elsinore/Canyon Lake
21,260 8% 1,701 11% 187
92536 Aguanga/Anza/Lake Riverside 2,750 24% 660 5% 33
92539 Anza/Lake Riverside 3,890 23% 895 5% 45
92543 Hemet/East Hemet/San Jacinto 34,680 20% 6,936 15% 1,040
92544
Hemet/East Hemet/San Jacinto/
Valle Vista/Anza
47,136 14% 6,599 10% 660
92545 Green Acres/Winchester/ Homeland 41,078 26% 10,680 12% 1,282
92548
Green Acres/Menifee/Homeland/
Romoland/Hemet
7,020 16% 1,123 9% 101
92549 Idyllwild-Pine Cove/Mountain Center 2,652 26% 690 6% 41
92551 Moreno Valley/Perris/ March ARB 33,050 6% 1,983 14% 278
92553 Riverside/Moreno Valley/March ARB 73,803 7% 5,166 16% 827
92555
Moreno
Valley/Perris/Lakeview/Beaumont/
San Jacinto
40,419 8% 3,234 9% 291
92557 Riverside/Moreno Valley 51,871 8% 4,150 10% 415
92561
Anza/Idyllwild-Pine Cove/Mountain
Center/Palm Springs. Palm Desert
1,600 30% 480 10% 48
92562 Murrieta/Temecula/Menifee 63,293 12% 7,595 4% 304
92563
Menifee/Murrieta/Temecula/French
Valley
57,605 9% 5,184 6% 311
92567
Nuevo/Lakeview/Romoland/
San Jacinto
9,469 10% 947 8% 76
92570
Perris/March ARB/Mead
Valley/Menifee/Warm Springs/Lake
Elsinore/Canyon Lake/Lake
Matthews/Good Hope
56,766 8% 4,541 15% 681
92571
Moreno Valley/Perris/March
ARB/Mead Valley/Nuevo/Lake View
54,825 5% 2,741 10% 274
92582 Hemet/San Jacinto 16,200 11% 1,782 3% 53
92583
Beaumont/Hemet/San Jacinto/
Valle Vista
31,167 13% 4,052 10% 405
92584
Menifee/Winchester/Lake Elsinore/
Murrieta/French Valley
46,346 10% 4,635 4% 185
92585
Perris/Nuevo/Menifee/Romoland/
Homeland/Sun City
20,148 12% 2,418 5% 121
135

92586 Perris/Menifee/Sun City 19,384 43% 8,335 9% 750
92587
Perris/Menifee/Lake Elsinore/
Canyon Lake/Sun City/Quail Valley
16,787 14% 2,350 11% 259
92590 Murrieta/Temecula 3,841 15% 576 13% 75
92591 Murrieta/Temecula 39,767 10% 3,977 7% 278
92592 Temecula 74,558 9% 6,710 6% 403
92595
Menifee/Lake Elsinore/Lakeland
Village/Murrieta
31,139 10% 3,114 11% 343
92596
Green Acres/Menifee/Winchester/
Murrieta/Temecula/French Valley
26,044 7% 1,823 3% 55
92596 Hemet 26,044 7% 1,823 3% 55
92860 Norco/Riverside/Jurupa Valley 27,304 11% 3,003 6% 180
92879
Riverside/Corona/El Cerrito/Home
Gardens
48,654 8% 3,892 10% 389
92880 Corona/Coronita/Norco/Eastvale 61,187 7% 4,283 6% 257
92881
Corona/El Cerrito/Home
Gardens/Temescal Valley/El Sobrante
32,817 10% 3,282 6% 197
92882 Corona/Coronita 70,188 8% 5,615 10% 562
92883
Corona/El Cerrito/
Temescal Valley/Lake Elsinore
31,940 11% 3,513 11% 386

Table 11 shows that there are 13 zip codes with more than 700 older adults living
in poverty. Table 12 below identifies 51 Riverside County zip codes with more than
1,000 disabled persons.

136

Table 12: Riverside County Total Disabled Population and Disabled Population Over 65
Zip
Code
City
Total
Populati
on
% of Total
Population
Disabled
% of 65+
Population
Disabled
91752 Mira Loma/Eastvale/Jurupa Valley 28,649 11% 3,151 40% 1,261
91761 Jurupa Valley 59,892 8% 4,791 34% 1,629
92028 Temecula 48,335 12% 5,800 37% 2,146
92060 Aguanga 61 0 - 0 -
92086 Aguanga 1,335 20% 267 26% 69
92201 La Quinta/Indio/Coachella 63,915 12% 7,670 40% 3,068
92203
La Quinta/Indio/ Coachella/Bermuda
Dunes/Palm Desert/Desert Palms
27,466 10% 2,747 34% 934
92210 Palm Desert/Indian Wells/La Quinta 4,839 17% 823 27% 222
92211
Thousand Palms/Rancho Mirage/Palm
Desert/Indian Wells/Desert Palms/
La Quinta/Indio/Bermuda Dunes
24,564 17% 4,176 27% 1,127
92220 Banning/Beaumont/Cabazon 32,793 18% 5,903 39% 2,302
92223
Banning/Beaumont/ Calimesa/
Cherry Valley
46,719 10% 4,672 28% 1,308
92225 Blythe/Ripley/Mesa Verde 23,509 11% 2,586 46% 1,190
92230 Banning/Cabazon/Whitewater 3,297 8% 264 49% 129
92234
Palm Springs/Cathedral City/
Rancho Mirage
52,534 12% 6,304 34% 2,143
92236
La Quinta/Indio/ Coachella/ Thermal/
Vista Santa Rosa
43,037 9% 3,873 52% 2,014
92239 Desert Center 428 12% 51 26% 13
92240
Desert Hot Springs /Palm Springs/
Cathedral City/Desert Edge/Garnet
35,878 13% 4,664 43% 2,006
92241
Desert Hot Springs/Palm Springs/
Cathedral City/Desert Edge/ Garnet/Sky
Valley/ Thousand Palms/Desert
Palms/Indio/Coachella
9,156 18% 1,648 31% 511
92253
La Quinta/Indio/Bermuda Dunes/
Vista Santa Rosa/Palm Desert/
Indian Wells
38,462 12% 4,615 24% 1,108
92254 Mecca/North Shore/Oasis 12,300 9% 1,107 37% 410
92258 Desert Hot Springs/Palm Springs 520 23% 120 15% 18
92260
Rancho Mirage/Palm Desert/Indian
Wells/Palm Springs
32,855 14% 4,600 18% 828
92262 Palm Springs/ Cathedral City 26,693 16% 4,271 34% 1,452
92264
Palm Springs/Cathedral City/
Rancho Mirage
19,754 20% 3,951 36% 1,422
137

92270
Palm Springs/Cathedral City/
Thousand Palms/Rancho Mirage/
Palm Desert
17,634 15% 2,645 26% 688
92274
La Quinta/Coachella/ Mecca/Oasis/
Thermal/Vista Santa Rosa
18,937 10% 1,894 41% 776
92276
Cathedral City/Sky Valley/
Thousand Palms/Rancho Mirage/
Palm Desert/Desert Palms/Indio
7,921 19% 1,505 44% 662
92282
Desert Hot Springs/Palm Springs/
Whitewater
783 21% 164 32% 53
92316 Jurupa Valley 31,720 11% 3,489 51% 1,779
92320 Beaumont/Calimesa/ Cherry Valley 8,097 19% 1,538 39% 600
92324 Riverside/Jurupa Valley/Moreno Valley 58,013 9% 5,221 42% 2,193
92337 Jurupa Valley 37,844 10% 3,784 46% 1,741
92373 Beaumont/Calimesa 34,017 11% 3,742 34% 1,272
92399 Banning/Calimesa/ Cherry Valley 54,056 12% 6,487 37% 2,400
92501 Riverside /Jurupa Valley 22,216 11% 2,444 41% 1,002
92503
Riverside/El Sobrante/Lake
Mathews/Home Gardens
92,959 9% 8,366 37% 3,096
92504 Riverside/Jurupa Valley/Lake Mathews 53,960 10% 5,396 34% 1,835
92505 Riverside/Jurupa Valley 49,064 8% 3,925 38% 1,492
92506 Riverside 45,993 10% 4,599 30% 1,380
92507 Riverside/Highgrove/Moreno Valley 55,156 8% 4,412 36% 1,588
92508
Moreno Valley/March ARB/Mead
Valley/Riverside/Lake Matthews
36,583 7% 2,561 34% 871
92509
Riverside/Glen Avon/
Pedley/Rubidoux/Jurupa Valley
78,221 10% 7,822 37% 2,894
92518
Moreno Valley/Perris/ March
ARB/Mead Valley/Riverside
1,129 26% 294 32% 94
92530 Lake Elsinore/ Lakeland Village 51,816 11% 5,700 47% 2,679
92532
Menifee/Warm Springs/Lake Elsinore/
Canyon Lake
21,260 6% 1,276 27% 344
92536 Aguanga/Anza/Lake Riverside 2,750 10% 275 21% 58
92539 Anza/Lake Riverside 3,890 20% 778 46% 358
92543 Hemet/East Hemet/ San Jacinto 34,680 19% 6,589 44% 2,899
92544
Hemet/East Hemet/San Jacinto/Valle
Vista/Anza
47,136 17% 8,013 41% 3,285
92545
Green Acres/Winchester/Homeland/
San Jacinto
41,078 20% 8,216 41% 3,368
92548
Green Acres/Menifee/Homeland
/Romoland/Hemet
7,020 16% 1,123 35% 393
92549 Idyllwild-Pine Cove/Mountain Center 2,652 13% 345 21% 72
92551 Moreno Valley/Perris/ March ARB 33,050 9% 2,975 51% 1,517
92553 Moreno Valley/March ARB/Riverside 73,803 10% 7,380 46% 3,395
92555
Moreno Valley/Perris/Lakeview/
Beaumont/San Jacinto
40,419 8% 3,234 41% 1,326
92557 Riverside/Moreno Valley 51,871 10% 5,187 35% 1,815
138

92561
Anza/Idyllwild-Pine Cove/Mountain
Center/Palm Springs/Palm Desert
1,600 11% 176 24% 42
92562 Murrieta/Temecula/Menifee 63,293 9% 5,696 34% 1,937
92563
Murrieta/Temecula/French Valley/
Menifee
57,605 7% 4,032 32% 1,290
92567 Nuevo/Lakeview/Romoland/San Jacinto 9,469 10% 947 36% 341
92570
Lake Mathews/Lake Mathews/
Good Hope/Perris/March ARB/
Mead Valley/Menifee/Warm Springs/
Lake Elsinore/Canyon Lake
56,766 11% 6,244 43% 2,685
92571
Moreno Valley/Perris/ March ARB/
Mead Valley/Nuevo/Lake View
54,825 9% 4,934 41% 2,023
92582 Hemet/San Jacinto 16,200 13% 2,106 33% 695
92583
Hemet/San Jacinto/Valle Vista/
Beaumont
31,167 16% 4,987 54% 2,693
92584
Menifee/Winchester/Lake
Elsinore/Murrieta/French Valley
46,346 10% 4,635 37% 1,715
92585
Menifee/Romoland /Homeland/Sun City/
Perris/Nuevo
20,148 11% 2,216 29% 643
92586 Menifee/Sun City/Perris 19,384 23% 4,458 38% 1,694
92587
Menifee/Lake Elsinore/Canyon Lake/
Sun City/Quail Valley/Perris
16,787 9% 1,511 28% 423
92590 Murrieta/Temecula 3,841 12% 461 29% 134
92591 Murrieta/Temecula 39,767 8% 3,181 32% 1,018
92592 Temecula 74,558 8% 5,965 34% 2,028
92595
Menifee/Lake Elsinore/
Lakeland Village/Murrieta
31,139 11% 3,425 42% 1,439
92596
Green Acres/Menifee/Winchester/
Murrieta/Temecula/French Valley/Hemet
26,044 9% 2,344 33% 774
92860 Riverside/Jurupa Valley/Norco 27,304 9% 2,457 40% 983
92879
Corona/El Cerrito/
Home Gardens/Riverside
48,654 8% 3,892 38% 1,479
92880 Corona/Coronita/Norco/Eastvale 61,187 7% 4,283 35% 1,499
92881
Corona/El Cerrito/Home
Gardens/Temescal Valley/El Sobrante
32,817 7% 2,297 31% 712
92882 Corona/Coronita 70,188 7% 4,913 34% 1,670
92883
Corona/El Cerrito/Temescal Valley/
Lake Elsinore
31,940 8% 2,555 29% 741

By combining the information from both tables, twelve zip codes in Riverside
County (highlighted in yellow) are identified as having both a high number of older
adults living in poverty and a high number of disabled persons living within them. Those
zip codes include 92201, 92211, 92220, 92234, 92399, 92503, 92509, 92533, 92507,
139

92543, 92545, and 92886. These zip codes cover most of the cities of Riverside, Menifee
(formerly a large retirement community called Sun City), Moreno Valley, Perris (a low
income community), La Quinta, Indio (which has a large Hispanic community), Banning
and Beaumont (including isolated hill communities), Hemet (a large rural area), and their
surrounding communities. These communities are the best areas to recruit CSWs from
and for the CSW pilot program.
Role of the CSW
The goal of the initial CSW pilot program is to recruit and train CSWs to assist
with two key areas of work: 1) general community outreach and recruitment for
participants in Office on Aging health promotion activities, and 2) facilitation of Office
on Aging’s evidence-based health promotion activities including the Healthy Options
Program (based on the Stanford chronic disease self-management program), the Arthritis
Foundation’s Walk With Ease, the Arthritis Foundation’s Exercise Program, known as
Fit After 50 in Riverside County, and Bingosize classes. Each of these programs is
designed to operate with lay leaders and requires minimal certification at the leader level,
and recruitment and retention of volunteers is an ongoing issue with these programs.
Utilizing the best practices to develop roles for the CSWs outlined in Table 5, and
focusing a portion of the pilot program on outreach activities, CSWs will perform most of
the tasks outlined as “Community Engagement” activities including general outreach to
the community at large, community education activities such as presentations, meetings,
and community events to present general information about the Office on Aging and
referral to the department’s 800 number, conducting and collecting community
140

assessment surveys, and visiting senior centers and housing communities on a regular
basis to check the status of Office on Aging programs being provided in the community
and/or to assist with the expansion of existing programs.
The portion of the pilot program that will focus on health promotion activities will
include all of the outreach activities listed above with a specific focus on recruiting
participants for the evidence-based programs that the Office on Aging already offers. In
this area the CSWs roles could include some of the tasks outlined in the Service
Assistance and Social Support category of the CSW Role Options table (Table 5)
including, informal counseling, prevention activities including self-management, the
provision of lay health advise, assistance with follow up care, translation, training, group
facilitation, and organizational support for the programs. The other areas of work on the
CSW Role Options table, including Direct Service Provision and Advocacy, could be
integrated into the CSW program during future phases of the pilot.
Recruitment and Retention
Program participants for the initial pilot will be recruited from the SCSEP project
waitlist. The analysis in Chapter IV identified 1,000 people who are between the ages of
50 and 75, the prime age group for the pilot program. Of that group, 68% are female,
which is the predominant gender for most CSWs. Of the 292 people who indicated that
they might have a second language ability, 23% or 67 people indicated that they speak
Spanish, which is the primary second language for Riverside County. The other 77%
either indicated that they spoke a second language other than Spanish, or did not indicate
what second language they spoke. Many (25% or 250) of the 1,000 applicants identified
141

as “White”/non-Hispanic, but there were enough participants who responded as African
American (170) and Hispanic (120) to be able to identify enough participants for most of
the target areas of the County that have been identified. Thirty two percent indicated that
they have a high school education, with an additional 13% indicating that they possess a
bachelor’s degree or higher, and 9% indicating that they already possess some
certification in a professional field. Additionally, 15% indicted that they have previous
experience either working with older adults, in social work, or in the medical field, who
might have some prior training, education, or certification related to the CSW project.
Utilizing the “Good” Recruitment and Retention Best Practices (Table 6), the
pilot program will utilize the existing SCSEP infrastructure for the initial participant
screening and referral to identify an initial group of 50 participants who live within the
targeted communities, express a general interest in the pilot, and through a series of
interviews are deemed to be active in the community with a wide social network that can
be beneficial to the intervention.
Utilizing the “Better” Recruitment and Retention Best Practices , each participant
will be further screened for their educational level, Spanish language ability, prior
experience in either the medical field, social work, work with older adults, or a similar
field, or who possess an adaptable skill set such as other types of community-based work,
teaching, or service work, etc. All potential CSWs will also have to meet the
qualifications for the SCSEP project and pass the Riverside County Temporary
Assignment Program (TAP) requirements for a clear physical and background screening.
Another key will be to identify those potential CSWs who will require only minimal
supportive services to participate in the program pilot, since the Riverside County SCSEP
142

project has less than $50,000 annually to provide supportive services to all 68
participants, regardless of their assignment.
Utilizing the “Best” Recruitment and Retention Best Practices aimed at retention
of CSWs, the project will seek to retain 25 (or 50%) of the 50 initial CSWs through the
three month initial training phase. The SCSEP project funding will provide stipends for
each CSW while in training, and throughout the intervention, at the minimum wage rate
in exchange for the number of hours of participation, and allows a maximum of 42
months of participation in the project, the pilot, and any subsequent CSW program that
may result. Each CSW will be asked to commit to an 18 month CSW pilot including
three months of initial training, 12 months of programming, and three months of post
program evaluation. CSWs will be required to participate in ongoing quarterly staff
meetings with all personnel involved in the CSW project, in order to share best practices
across all of the project areas. In later iterations of the pilot project, more experienced
CSWs can conduct the quarterly meetings and the training sessions.
Training and Education
Utilizing the “Good” Training and Education Best Practice model (Table 7), the
initial pilot program will have a training curriculum developed by the Office on Aging
and training sessions will be facilitated by department staff. All CSWs will participate in
skills-based training including outreach methods, interpersonal relations and customer
service, how to conduct meetings and presentations to small groups of 10 to 15 people,
and how to collect the Office on Aging Community Assessment surveys. Those CSWs
chosen to facilitate the health promotion interventions will receive additional training
143

specific to those interventions. They will receive the mandatory number of hours of
Stanford Chronic Disease Self-Management leader training required for certification,
which covers a variety of topics related to the intervention itself, but also includes
additional instruction on general facilitation, limited curriculum development, and
performance evaluation. All of the evidence-based interventions come with training
certification, either from the research institution or the national program, which can be
used for the same intervention in other areas and with other organizations. CSW project
participants will also participate in regular training meetings to reinforce the program
structure, insure fidelity to evidence-based practice, review outreach activities and
techniques, and share best practices. Since the pilot participants will be enrolled in the
SCSEP project, they will be paid during the initial training period and during on-the job-
training.
Measuring Outcomes
Per the analysis in Chapter 4 of this paper, the process of measuring outcomes
does not have a set of “good, better, or best” practices. The general consensus among the
researchers seems to be that the best way to measure program outcomes is to clearly
define the outcomes that the program is seeking to measure prior to beginning, In the case
of the initial Riverside County pilot, the program will measure success in the areas of
CSW recruitment and retention, number and type of outreach efforts completed, and the
number of persons who completed a health promotion activity within the 12 month
period as a result of the CSW intervention. The program will seek to recruit 50 initial
CSWs, provide initial training to 25, and retain 20 CSWs for an 18 month period. CSWs
144

will outreach to 1,000 people throughout Riverside County, and the program will engage
300 people in the Office on Aging’s main health promotion activities, which include a
variety of physical exercise programs and Stanford University’s chronic disease self-
management program. The pilot program would also seek to measure qualitative success
by utilizing the added outcomes provided by the SCSEP program including measuring
the total length of time that a participants remains in the pilot program, the level of CSW
and host site satisfaction, if the CSW perceived that his or her quality of life has
improved, and if the program served to increase CSW knowledge and self-efficacy.
All of the parts of the pilot program have their own tracking and evaluation
mechanisms, including the additional program outcomes added by SCSEP in 2000. The
SCSEP program utilizes the SPARQ (SCSEP Performance and Results QPR System)
database to track each participant’s involvement in the program, and the training, work
assignment, and program progress of all CSWs involved in the pilot will be monitored
through the SCSEP monitoring process. The Office on Aging has existing tracking
mechanism for outreach activities, and the evidence-based health promotion programs
have their own tracking forms and procedures including sign-in sheets, pre-and post-tests,
and evaluation forms in the appropriate language and at the literacy level preferred by the
CSW, in order to capture participation.
Overall, the pilot will make use of most the “Good” practices, some of the
“Better” practices, and a few of the “Best” practices related to CSW recruitment and
retention and CSW training and education outlined in Chapter V, while adhering to the
overall best practice of clearly defining the role that CSWs will play in the program and
identifying the outputs and outcomes measures that the program will seek to measure.
145

D. Opportunities and Challenges to Implementation
There are several opportunities and one significant challenge to implementing this
program in the Office on Aging’s Planning and Community Services unit. The main
opportunity is related to the previously mentioned structure of the PCS unit, wherein all
of the programs proposed for the pilot – the SCSEP employment program, the outreach
activities, the health promotion programs, and the community assessment surveys – are
housed within PCS and are overseen by a single manager. In addition, because the
programs are in the same unit and operate with few fulltime staff members, the programs
are already operationally integrated to the extent that the outreach staff assists the health
promotion programs, and the SCSEP program already assigns participants to assist with
the health promotion programs. As a result, an informal administrative and programmatic
foundation already exists for the pilot. A second opportunity for implementation is that,
based on this preliminary research, as of the writing of this paper the Office on Aging’s
SCSEP project has already begun to revise the wait list database. Much of the wait list
has been re-contacted and applicants have been rescreened for program eligibility, and
some of the questions needed to begin the CSW screening process have already been
added to the quick screen.
Additional opportunities exist in support of the pilot because many of the
challenges to successful CSW programs identified by the research studies reviewed for
this paper (such as program administration and an ongoing source of funding) are not an
immediate concern for the Office on Aging CSW pilot program. Third, the SCSEP
program provides a source of sustainable funding for the pilot’s operation and the Office
on Aging can continue to provide the administrative infrastructure for the pilot, as it
146

currently does for the SCSEP project and the health promotion programs. Fourth, the
health promotion programs have standard, easy to follow program elements and each has
standard metrics and an evaluation tool for measuring success embedded in the evidence-
based criteria. Fifth, the proposal to develop and implement the pilot with significant
input from the practitioners on staff, who will be using the CSWs to enhance their work,
will address the issues highlighted by several researchers regarding understanding the
role the CSWs will play and the need to integrate them into the formal social service
delivery structure. By focusing on the two areas of outreach and the evidence-based
health promotion programs, the CSWs’ role will be clearly defined within the context of
that work, especially since the health promotion programs are not designed to be
facilitated by professional staff.
Sixth, the Office on Aging’s outreach efforts are already focused on making the
department’s information and programming accessible to the Hispanic community
through Spanish translation of written materials and bilingual outreach staff who work
with consumers in the community. In addition, all of the evidence-based programs
already have a culturally competent, evidence-based module in Spanish that can be used,
and Office on Aging staff members are both Master Trainers and session leaders trained
in English and Spanish for chronic disease self-management.
Seventh, since the main focus of the SCSEP project, even without the inclusion of
the pilot program, is training and supportive services, there are many opportunities for
CSWs to broaden their skill sets either to enhance the pilot program or to move beyond it.
Unlike other training opportunities for older adults within and outside of the SCSEP
program, the pilot program will provide skills that link the CSWs to areas of work that
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are growing and under addressed, such as older adult care and evidence-based health
promotion, allowing them opportunities to seek employment after the pilot and their time
in SCSEP has concluded. Finally, the four year participation maximum for the SCSEP
may serve to reduce turnover amongst the CSWs and potentially allow for more
opportunities to evaluate both individual CSWs and the pilot program over time.
The main challenge to implementation is the fact that the Planning and
Community Services unit is made up of only 5.5 FTEs who all have split responsibilities,
and the Office on Aging does not currently have the resources to hire additional staff to
develop and implement the training curricula and to operate the pilot. The Office on
Aging is responsible for minimum levels of performance in the current program areas,
and adding an experimental pilot program to the current workload of the staff would
present a significant burden, particularly in the short term when much of the pilot’s
infrastructure and the training module will need to be developed. Shifting PCS resources
into the pilot program will either cause deficiencies in the performance metrics of
existing programs or the pilot program will suffer from an incomplete implementation.
The most significant challenge to implementing the pilot is the tenuous nature of
SCSEP program funding. Funding for all Older Americans Act programs is still
vulnerable to reduction and some, including SCSEP are proposed for elimination. As
non-defense, discretionary funding, Older Americans Act funding is still subject to the
Budget Control Act of 2011, or sequestration. Funding can be cut every year until either
the Act is repealed or the time frame for sequester is over. In addition, the Trump
Administration’s proposed budget is passed, funding for the national SCSEP program
will be eliminated. These changes may affect the timing of the pilot; since a critical part
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of the program’s potential success is tied to the stipends that SCSEP participants receive.
If the program survives the 2018 federal budget process, the pilot program should be
implemented as soon as possible to insure that the program has a full 12 months to
operate and measure results, just in case the program’s funding is cut or eliminated in the
future.
Summary
It has been demonstrated that the Older Adult Community Service Worker pilot
program is feasible within the Riverside County Office on Aging’s Planning and
Community Services unit. Further, the CSW program design proposed would alleviate
many of the main issues and concerns raised by researchers of previous programs. By
linking the pilot with the existing Riverside County SCSEP project and the existing
Office on Aging programs and services that align with the roles that CSWs have
traditionally filled in community-based programs, such as outreach and health promotion
programs, the pilot would begin with the infrastructure that it would need to be
successful.
E. Advance in Practice
The research regarding the use of community service workers is not
comprehensive. There are many gaps in the research, and although I was able to develop
good, better, and best practices for CSW programs, the research results are based on
specific research studies, which were looking at aspects of specific programs, not the
concept of CSWs as a whole. Although this research is a good start, there is still much
149

work to be done. With regard to this specific study, the opportunity to advance the
practice of social service delivery through the use of CSWs is threefold.
1. Office on Aging’s Planning and Community Services unit is but one area of
program operation. As previously stated, if it is successful the CSW program can
expand to include other health and wellness activities, such as congregate and
home delivered meals where CSWs can serve as helpers with both preparing
meals, delivering meals, and in providing some level of companionship to home
bound seniors who receive meals. The presence of trained CSWs in the homes of
these older adults, no matter how briefly, can allow them to serve as the eyes and
ears of social workers and adult protective services officials who may be
otherwise unaware of issues that occur between their regularly scheduled monthly
or quarterly visits.
2. The CSW program can also expand to include other Office on Aging services,
such as Options Counseling and Decision Support, where CSWs can be trained to
provide information and assistance to older adults and their families who are
seeking help and access to available resources and to update the online Network
of Care database where older adults can go to find services in Riverside County.
CSWs can also be trained to provide local transportation through the TRIP
program, and potentially to become a Long Term Care Ombudsman who
advocates for older adults in long term care facilities. CSWs can also assist with
the Office on Aging’s advocacy and coordination efforts to build individual and
community capacity by helping staff to develop and maintain critical coalitions
such as the Aging and Disability Resource Connection’s Long Term Services and
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Supports Coalition, and the Grandparents Raising Grandchildren Task Force, as
well as helping to establish new, much needed coalitions focused on affordable
housing and integrated transportation systems that work for older adults and the
community at large. Both topics are becoming more important in all communities,
which will require structural changes to their systems. With a more rigorous
strategy and training program, CSWs can also branch into the area of Care
Coordination and help social workers by providing preliminary screenings,
program enrollment, case management and referral, and patient navigation
through the health care, social security, and Medicare systems with culturally
appropriate interventions.
3. Beyond the Office on Aging, a more developed CSW program could further
expand to other County of Riverside Departments, such as the Riverside
University Health System – Behavioral Health department, which has a substance
abuse peer support program, and the Riverside University Health System – Public
Health department, which can utilize the CSWs as traditional community health
workers. In addition, CSWs can offer assistance to the Department of Public
Social Services’ Adult Protective Services unit, In Home Support Services, and
the Public Authority, which provide in home support for older adults through
trained, paid, and unionized workers. These organizations already use a form of
CSW in specific roles, but these disparate programs do not have an official,
universal county-wide designation that allows the CSWs to transfer their skills
and knowledge to similar programs within the county. Beyond the County of
Riverside, any promising results of an expanded pilot can assist other counties
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and AAA planning and services areas with the anticipated shortage of
professionals by partially incorporating CSWs into the social service delivery
system.
F. Areas of Future Study
The pilot program is only a proposal and as such is an immediate area of future study.
If the pilot program were implemented in Riverside County or in any other area, the best
practices identified herein will still need to be applied. The pilot will need to operate for the
entire 18 month period, including three months for training, 12 months of program work, and
a final three months for evaluation of the 12 month effort to determine if the pilot was
effective and what the overall outcomes are. The pilot will also include ongoing training of
the CSWs as needed, and supervision by Office on Aging staff. If the result of the pilot
demonstrates success, it can then expand to other areas of the Office on Aging’s work, and
/or other departments in Riverside County, and the cycle of study and evaluation must begin
again.
However, in order for the pilot to be its most successful and useful to other areas of
adult services work, the research indicates that the pilot program will need to become
formalized with a county-wide or possibly AAA level of certification. The training and
education program should be linked with a community college or university in order to
standardize the curriculum, include university level courses, provide training in research
based knowledge, study programs and protocols, and provide college level certification for
CSWs so that they can be used to further expand their scope of work and transfer their skills
and experience from program to program. A social service and university collaboration will
152

allow researchers access to the program development, ongoing research, and the results of
future efforts. However, in order to be successful, the university and social service
collaboration will have to be a true joint effort so that the needs of the programs and the
researchers can be met. Practitioners are skilled at operating programs, but not at designing
or implanting them for a research context.
Tiamiyu’s study (2000) of human service workers’ views about university
collaborations consisted of a survey of twenty-four agencies that serviced the elderly to ask a
series of questions related to how collaboration with their agency could be useful or
beneficial. The survey asked four questions about how university collaboration might assist
with making services more accessible to the target community, communication to clients and
stakeholders, referrals for services, and volunteer recruitment and retention. More than
seventy percent of respondents either skipped the questions or did not know how university
collaboration could be helpful. The twenty-four percent of those agencies that responded to
each question did provide some suggestions that might be helpful in developing agency-
university collaborations in the future. The agencies requested assistance from the university
in developing tracking systems and true outcome measures (versus outputs) for the chronic
disease self-management program and with developing pre-and post-tests, research results on
best practices, analysis on return on investment for community-based services, the
development of evaluation tools, translation and culturally competent ways of developing
and/or revising program materials and recruiting staff from diverse ethnic backgrounds, and
grant writing for increased salaries (to improve recruitment) and program resources.
The practitioners made the following recommendations in order to foster more
meaningful collaborations with researchers: Each project should begin with a call for
153

proposals from relevant stakeholders and include a requirement that the CSW projects will
involve community collaboration/input from stakeholders; more academic studies that
identify factors that improve or hinder community collaboration/participation; universities
approach social service organizations and propose solutions to problems identified by
practitioners in the field; more conferences co-hosted by agencies and universities to
highlight their collaborations and the results of their combined work; and the development of
awards/recognition for some of these kinds of collaborations.
Although there has been much research done with regard to the different aspects of
community services worker programs, including their various titles, roles, scopes of work,
evaluation and outcomes, the field is still wide open. Since there is no standard for the
development, implementation, or evaluation of these program, researchers and practitioners
alike are free to explore new research areas or expand on existing ones, to continue to
develop best practices, and to design standardized curricula, training, and evaluation
methods. The outcomes of future research could lead to regional or statewide certification of
CSWs, and a full integration of their role into the social service workforce, even beyond
older adult services.
G. Conclusion
This study sought to address the questions raised by the older adult service
practitioners at the USC symposium in 2013. The practitioners were seeking a solution to
dilemma of program funding and future sustainability the best way to address the in older
adult services. As the population grows, the current and future numbers of older adult
ractitioners for the aged practitioners will not be able to meet the need. P will soon be
154

including forced to address a variety of concerns how to care for more older adults for a
growing diversity and the need for longer period of time, new demands created by
culturally sensitive approaches to services, the rise in chronic disease and other types of
illness, the need for community-based long term care and most importantly, the issue of
reduced and, in the current political climate, very uncertain funding for all types of social
services. The Older Adult Community Service Worker pilot offers one potential solution
exists that goes beyond current program operation. The proposal takes what programming
is and already designed for older adults, and reimagines and integrates a few key
hat each programs in such a way t program can still accomplish its individual goals, and
practitioners can meet a larger set of needs.
The SCSEP project provides the CSW pilot with a source of older adult workers
who need training and increased job skills, and links them with outreach activities that
are a traditional part of CSW work and with health promotion programming, which
this already has a structured program and clear evaluation metrics built in. However,
proposal is for one county, one small department, and one operational unit within that
department. If the initial pilot is successful, the opportunities to expand the model exist
within the Office on Aging and the County of Riverside, and possibly within the
statewide AAA network. The proposed pilot is also modest in its scope, with many of the
more comprehensive areas discussed by the researchers, such as partnerships with
universities for curriculum development and CSW certification and more concrete ideas
about how to better integrate the CSW role into the social service delivery system, left to
future research.
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Appendix
(Riverside County) Senior Community Service Employment Program QUICKSCREEN

156

157

158

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Abstract (if available)

Abstract The purpose of this project is to develop a community-based pilot program —the Older Adult Community Service Worker Program for the Riverside County Office on Aging—in order to supplement the efforts of social service professionals who are tasked with providing services and support to the growing number of people over the age of fifty-five. The pilot proposes that older adults be trained and employed to provide an array of services staring with outreach, evidence-based health promotion interventions, and other services for programs that need additional support, which will place critical services in the community, rather than in traditional settings, where older adults need them to be. The study reviews the demographic trends of the older adult population

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Asset Metadata

Creator Bell, Jamiko Rei (author)

Core Title Older adult community service worker program for Riverside County: community-based solutions for social service delivery

School School of Policy, Planning and Development

Degree Doctor of Policy, Planning & Development

Degree Program Policy, Planning, and Development

Publication Date 07/20/2017

Defense Date 06/13/2017

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag community health worker,community service,community service worker,community-based,OAI-PMH Harvest,older adult worker,older adults,promotora,SCSEP,volunteerism

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Robertson, Peter (committee chair), Aranda, Maria (committee member), Lewis, LaVonna (committee member)

Creator Email koreicc@gmail.com,koreicc@yahoo.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c40-404435

Unique identifier UC11263787

Identifier etd-BellJamiko-5554.pdf (filename),usctheses-c40-404435 (legacy record id)

Legacy Identifier etd-BellJamiko-5554.pdf

Dmrecord 404435

Document Type Dissertation

Rights Bell, Jamiko Rei

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA