The investigators want to find out if providing a Community Health Educator Referral Liaison (CHERL) helps practices help their patients change risky behaviors (tobacco use, physical inactivity, unhealthy diet, and risky drinking) by connecting patients to available services in the community or directly providing behavior change support.

What is this about? Prescription for Health (P4H) is a national initiative funded by the Robert Wood Johnson Foundation. Nine projects have been funded nationally in this second round to advance the goals of improving health behavior identification and delivery in primary care practice. Each project is conducted through a practice-based research network (PBRN). In Michigan, our PBRN is called the Great Lakes Research In Practice Network (GRIN).

What is the purpose of the CHERL project? In our study, we want to find out if providing a Community Health Educator Referral Liaison (CHERL) helps practices help their patients change risky behaviors (tobacco use, physical inactivity, unhealthy diet, and risky drinking) by connecting patients to available services in the community or directly providing behavior change support.

Primary care providers play a key roll in encouraging patients to choose healthy behaviors. However, effective behavior change requires long term follow up and support that may not be readily available within the office practice. CHERL can help provide or link to those services thus helping the healthy message promoted by the clinician to have a more powerful and lasting effect.

What is the CHERL intervention? With this funding, we will hire and train a CHERL to work with practices. The purpose of the CHERL is for him/her to help secure behavior change support for your patients either by referring to an available resource within the community or directly providing the service. This service is available to patients with or without chronic disease diagnoses (i.e, patients with diabetes, heart disease, hypertension, obesity, back pain, lung disease, or generally healthy with opportunities to change unhealthy habits).

Patients are referred to the CHERL and he/she will determine an appropriate next step for your patient - either referral to a community program or the CHERL will provide brief telephone counseling. The health care provider will receive feedback specifically on each patient referred.

In addition, some practices (consultant-enhanced) will receive additional assistance from the CHERL, as he/she serves as a consultant to the practice, helping the practice to identify systematic mechanisms for identification and referral of at risk patients to the CHERL.

Inclusion Criteria:

• Patients, clinicians, and their staff participating in this GRIN study.

Exclusion Criteria:

• Patients, clinicians, and their staff who are not participating in this GRIN study.