College for the pros

Next Step teaches those who reach out to Worcester's most vulnerable residents

by Kristen Lombardi

It's six o'clock on a Wednesday night and, save for the tick of the clock, the bland, institutional classroom at Worcester State College is still. The instructor, a tall, lanky, subdued man, leans against one wall, his arms crossed, his gaze expectant. His students, 16 men and women, who range in age from 30 to 50, hunch over their desks, scribbling fiercely. They hang on his every word.

Suddenly, the stillness is interrupted. The tinny ring of a cell phone calls out: DoDoDoooo. The students look up, amused.

A short, robust woman answers. "Hello," she says, her voice hushed yet firm. "I'm in class. What is it you want?"

Her classmates stop scribbling. Her instructor stops gazing. They glance at each other knowingly, some stifle a smile.

Seconds pass, and the woman continues, "I said I'm in class. I'll be home later . . . later."

So goes the sound of working parents, otherwise known as "non-traditional students," enrolled in school. Yet in this class, the students are the first to enroll in an innovative, four-year pilot called the Next Step Initiative -- a pilot that's organized and funded by a host of local institutions, including Worcester State, Quinsigamond Community College, and the University of Massachusetts. Unlike regular adult education, Next Step, while open to all residents, is designed especially for the city's health-care workers -- nurses, home health aides, outreach specialists. In other words, it's created for the very workers tending to the city's most vulnerable, poor, and hard-to-reach residents.

Officially launched last fall, the unique collaboration has come together in response to a specific industry problem: more and more, low-paying, direct-care staff -- many of them minorities tending to minority communities -- are finding a college degree crucial, indeed essential, for professional advancement. But Next Step doesn't just help them get their desired degrees. Ultimately, the program improves health care throughout the city. By reaching out to the workers most familiar with and attuned to the ever-growing, diverse populations here, Next Step is ensuring that Worcester's health-care providers remain effective.

And this isn't lost on its students. One Wednesday class member explains that the Next Step Initiative tells her and her fellow classmates, as she says, "We know what you do is key in this community. We want you to stay." Indeed, the energetic, eager-to-please, and serious attitude among students on this particular evening suggests that they're all aware they can make an even bigger difference among the people whom they've served for years.

As Nancy Jodaitis, the program coordinator, poses, "Is the health-care mecca of Central Massachusetts prepared to deal with diverse populations it serves?" With Next Step, she adds, "we think so."

In many ways, the Next Step Initiative is a testament to the power of grassroots organizing. For it stems from three years' worth of research and planning by the Worcester Latino Coalition, a health-care advocacy group, and the UMass Medical School's Office of Community Programs. As Jodaitis says, "This came from the community, built from the bottom up."

Back in 1993, Worcester became one of several cities to participate in a national survey meant to improve health professionals' education. To this end, the Latino Coalition and its UMass counterpart sought out health workers -- in particular, those with lower-paying, direct-care jobs-- to gauge interest in attending graduate school. Daniel de la Torre, the coalition's coordinator, who helped carry out the survey, says he and his colleagues assembled interpreters, nursing home aides, health counselors, among others, to ask about career and educational goals.

Overwhelmingly, though, workers on the frontlines -- many boasting years of experience, as well as long-term perspectives about the changing health-care issues of underserved, poor, and minority groups here -- had yet to earn any college degree. And because they lacked the credentials, they were increasingly shut out of advancement opportunities. "There was an element of that glass ceiling," de la Torre explains. "Voices from the field were saying, `We're out there, committed, but we cannot advance.' "

One of those voices could easily be Cristine Rivera, a 39-year-old mother of three who has worked without a degree in the health-care industry for 16 years. Rivera now supervises home-visiting programs for pregnant teenagers at Family Health Center on Queen Street. On any given day, she, along with her seven staff members, can be found at homes of pregnant girls and young mothers, teaching better parenting skills, preventing risky behaviors, and helping navigate the system. It's a demanding position, which Rivera's managed to earn despite numerous setbacks. Once, for instance, she tried to apply for a management job at St. Vincent Hospital. But even though she had carried out similar duties for nearly a decade, the hospital refused to grant Rivera an interview, instead telling her that she was unqualified because, she suspects, "I didn't have the degree."

More recently, Rivera was not awarded a much-desired promotion at Family Health Center after job requirements were changed. Indeed, she'd already overseen the state-funded program for two years. But when the center applied to re-fund the program, the state issued new guidelines requiring that Rivera's position be filled by a college graduate. Her application was turned down despite support of her co-workers. Later, she had to train her own replacement.

"That was a real eye-opener," she recalls. "I made a decision [then] never to allow someone to deny me a position I feel qualified for ever again."

Maria Gonzalez would probably agree. For years the 33-year-old single mother of two worked at Community Healthlink on Jacques Street as a Latino health advocate -- enrolling Spanish-speaking mentally ill patients in social services, teaching them basic life skills like learning how to take the bus, and ensuring they understood physicians' requests. Soon, she realized, in spite of her tenure, she couldn't move up the proverbial ladder; and so, she left. "I felt shut out without the degree," Gonzalez admits.

Even today, working at UMass, where she enrolls Latinos in MassHealth (the state's Medicaid program), Gonzalez bumps up against professional barriers. For while she juggles management duties -- assessing community needs, measuring program efficacy -- she doesn't receive the higher salary, which leads her believe that, as she says, "When people don't get an education, they get walked on."

What Next Step does is help low-paying workers like Gonzalez and Rivera earn the degrees needed to improve their professional lives, largely by giving college credit for past work experience, and thus speeding up the educational process. Students, for example, take a year-long portfolio-development course, during which they relay stories to demonstrate what they've learned on the job. Miriam Torres, 48, a Family Health nurse and a Next Step student, is currently creating her portfolio, writing about her childhood days as a Spanish volunteer interpreter at local health centers, where she translated doctor diagnoses to adult patients. "It's like an autobiography," she explains, "but the point is to teach about the pros and cons of using kids as interpreters."

Aside from personal accounts, portfolios may include awards, volunteer efforts, and family health issues. Each is reviewed by a team of professors and then assigned up to 30 credits. "What sold me," Torres adds, "is the idea of getting credit for my 20 years [of] experience" as a nurse.

This aspect of counting life as credit is a big draw for students, no doubt, especially since it can eliminate several years of study toward a degree. But the "credit for prior learning," as it's called, isn't the only thing unique about Next Step. The initiative is also an unusual partnership between area colleges -- specifically, Worcester State, Quinsigamond, and the UMass system.

Typically, participants enroll at Quinsigamond for their general requirements, and then transfer to the UMass University Without Walls, a well-known adult-education program, initially established at UMass/Amherst in 1971, which has proven to be successful at helping non-traditional students earn degrees. Here, Next Step participants develop portfolios. Eventually, they attend Worcester State, enrolled in a new program there, and gain a community-health degree, a non-medical degree that essentially teaches students how to identify, aid, and address the health-care needs within poor and largely immigrant populations. With the degree, students will be eligible to become counselors, case managers, licensed social workers -- the very things unattainable to them today.

Even more unique is that Next Step is designed especially for working adults, providing a flexible, supportive atmosphere. "We are actively involved in guiding people," says Rick Hendra, a University Without Walls instructor who helped shape Next Step. "It's more like mentoring. It's important for adults juggling families, work, and school."

Back in the Next Step classroom, this support comes across in subtle, simple ways, in the instructor's gentle prodding ("Talk to me.") and gushing praise ("Wow! Great!"). And it looks to be working: students will tell you that they're "grateful" for and "excited" about the program -- particularly, its attendant possibilities. One woman, a medical-records clerk at UMass Memorial Health Care, sums up the attitude, equating Next Step with "freedom . . . the freedom to move ahead."

But the initiative's value extends far beyond the classroom. More and more, the city's health-care providers are finding it difficult to retain experienced, "culturally competent" employees -- employees who tend to be Latino, Vietnamese, and Albanian, for example. They may not have degrees, yet they know their communities and can present vital information in a way patients understand.

"These people are valuable and effective," notes Frances Anthes, the director of Family Health Center, who says half the 175-member staff is in this category.

Health-care funders, however, as well as insurance companies, aren't recognizing the ability of these workers; instead, they're recognizing the credential. "Funders," Anthes continues, "are saying, `To do this, you need someone with a degree.' "

Which is exactly why the diversity that exists in the direct-care levels of the industry rarely stretches to the "Anglo-heavy" top. The disparity, in fact, is compounded by the small number of minorities with health-related degrees today. Jodaitis, for one, says that only five Latinos finished health-related majors at Worcester State in the past five years; at the same time, though, the city's Latino population practically doubled.

Such a difference makes it tough for the city's health-care providers to handle community needs, Jodaitis argues. Take the local Latino population: it suffers disproportionately from diseases like HIV/AIDS, diabetes, and high-blood pressure. For health workers to treat these problems, they must develop outreach strategies that demand lifestyle changes. To do this, they must understand Latino culture.

"You need someone with experience working with the community to design the right program," Jodaitis says, "not just someone with the degree coming fresh out of college."

Taking the longer view, Next Step tries to correct the disparity by propelling minority employees to the field's upper echelons, helping them attain leadership posts to make a difference. And so, the initiative does more than benefit health-care providers.

"This," Anthes says, "will better the health of the whole community."

First, though, Next Step must prove its effectiveness. Right now, the $400,000 program is operating as a four-year pilot, funded by the UMass Medical School's Office of Community Programs, as well as by institutions like Worcester State and UMass Memorial. When the pilot ends, at least 60 employees are expected to finish, re-entering the work force even more prepared to deal with the city's changing population.

There is little doubt that Next Step will reach its goal -- and not just because Jodaitis has managed to attract 41 students since January. It's also because what makes the program so unique -- namely, the portfolios, in which students assess their prior work experience -- happens to be its biggest indication of success. Ever since the University Without Walls started, the portfolio has remained the central, most significant feature. And this explains -- at least partly -- why the acclaimed program's enabled more than 1300 students at the Amherst campus -- all working adults -- to receive undergraduate degrees. Nearly 60 percent have gone on to graduate school.

Such success is what first prompted Latino Coalition and UMass advocates to approach University Without Walls. The long-standing program is, as de la Torre says, "a natural partner for us."

Still, if there is any question about Next Step's future, it has to do with ensuring the program survives. Ideally, organizers hope it becomes institutionalized, incorporated into Worcester State's and Quinsigamond's regular curriculums and operations.

This remains to be seen, of course. But it's safe to say that, were it to be embraced, Next Step would surely help Worcester live up to its health-care mecca reputation.

Kristen Lombardi can be reached at

klombardi[a]phx.com.