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Roles and Functions of a Community Health Worker

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The American Public Health Association CHW Section has adopted the following definition of a community health worker: A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.1

A community health worker also strengthens individual and community capacity by increasing health knowledge and self-sufficiency through a spectrum of activities such as outreach, community education, informal counseling, social support and advocacy.

El Sol CHWs/promotores develop a variety of knowledge and skills that are disseminated throughout Southern California communities, while also providing linkages to resources as needed. They are trained to strategically provide community members with health resources, education, and referrals to basic and preventive services, including those that address the Social Determinants of Health. They do this by:

The following section highlights specific functions and roles where CHW’s have may have the most promise

CHWs have a unique understanding of the experience, language, culture, and socioeconomic reality of the communities that they serve. They apply this unique understanding to develop rapport with patients, which make a significant contribution to improving health outcomes. Research indicates that CHWs play an important role in improving health through enhancing clinical outcomes using a person-centered focus, and by addressing the social conditions that impact disease and health status, called social determinants of health (SDOH). 

One of the critical linkages that community health workers can play is making medical services more accessible to underserved and low status communities. Rural residents, immigrants and farming communities may not feel comfortable accessing healthcare or have medical homes in their community. Poverty, poor transportation, and the misinformation about the medical services offered by the different hospitals and health centers also may present barriers to care. Community health workers educate vulnerable populations about the available services offered by hospitals and health centers, support navigation and provide translation. These community members may find it more comfortable to deal with health workers because they have been trained to be empathetic, active listeners, and because the CHWs cultural competencies may create warmer handoffs into the healthcare system. 

California, there are newly defined roles for CHWs to support Health Home Programs and Whole Person Care goals. The California Advancing and Innovating Medi-Cal (CalAIM) initiative creates new imperatives for MCPs to meet member needs by supporting nonclinical interventions to address health-related social needs and to reduce health disparities, including through partnerships with community-based organizations like El Sol. CHW/P can provide their range of services to help achieve these goals. 2
Two proposals in the CalAIM initiative ― enhanced care management (ECM) and in lieu of services (now renamed Community Supports) ― offer MCPs financial mechanisms to contract with organizations that employ CHW/Ps and innovate how care is delivered. In responding to the requirements and opportunities of these CalAIM proposals, MCPs can apply lessons from California’s Health Homes Program and Whole Person Care pilots; in many of these programs, MCPs either directly employed CHW/Ps or contracted with community partners that employ CHW/Ps.3

CHW/Ps also train community members to better understand risk factors, prevention, drivers, and remedies for chronic disease, including asthma, diabetes, heart disease, and cancer. CHW/Ps can provide targeted health education materials related to lifestyle, environment and hygiene. Incorporating their unique skills and strengths through workshops and discussions, CHW/P can be crucial members of interdisciplinary teams.
Two proposals in the CalAIM initiative ― enhanced care management (ECM) and in lieu of services (now renamed Community Supports) ― offer MCPs financial mechanisms to contract with organizations that employ CHW/Ps and innovate how care is delivered. In responding to the requirements and opportunities of these CalAIM proposals, MCPs can apply lessons from California’s Health Homes Program and Whole Person Care pilots; in many of these programs, MCPs either directly employed CHW/Ps or contracted with community partners that employ CHW/Ps.

CHW/Ps can be better integrated into healthcare coordinated by MCP and providers. CHW/Ps, with their lived experience and unique understanding of the communities they serve, can play an important role in data collection, especially related to SDOH and improved access to and usage of primary care . CHW/Ps already have the relationship with and trust of community members, and can fully explain the reason for collecting certain information while addressing concerns and barriers around data sharing. CHW/Ps should also be integrally involved in the design of appropriate health and well-being outcome measures.

Two proposals in the CalAIM initiative ― enhanced care management (ECM) and in lieu of services (now renamed Community Supports) ― offer MCPs financial mechanisms to contract with organizations that employ CHW/Ps and innovate how care is delivered. In responding to the requirements and opportunities of these CalAIM proposals, MCPs can apply lessons from California’s Health Homes Program and Whole Person Care pilots; in many of these programs, MCPs either directly employed CHW/Ps or contracted with community partners that employ CHW/Ps.

Community health workers also inform healthcare systems, government entities, and stakeholders about the assets and needs in specific communities. This role is transformative, especially in communities that don’t have the time, trust or value to participate in traditional advocacy channels, or where interpretation and translation is critical.

CHW/P programs (defined as programs that include CHWs as integrated parts of care teams) show a return on investment ranging from $2.28 to $4.80 for every dollar spent on CHW/Ps for managed care plans (MCPs).4

Research has found that CHWs can be trained in simple psychosocial interventions which are found to be effective in reducing symptoms of depression and anxiety, 5 in addition to the distress related to the COVID-19 pandemic. Trained in non-judgemental, active listening, cultural sensitivity, empathy and motivational counseling, CHWs provide crucial peer counseling support. Given the current rise in mental health-related diseases and the aftermath of the COVID-19 pandemic, free and low-cost counseling is critical. 

Conclusion

When people have access to health care that respects their cultural values and behaviors, delivered in language they can understand, and centered within their lived experience, they are more likely to have positive health outcomes. CHW/Ps strengthen individual, community and organizational capacity to meet the SDOH in low status communities. Community health workers (CHWs) and promotores are at the center of everything we do. Each year, El Sol serves over 50,000 community residents through its programs led by CHWs and promotores. El Sol has been serving the Inland Empire for more than 30 years working to achieve positive, measurable change. El Sol offers foundations and other organizations technical assistance on the development and implementation of CHWs and promotores programs to identify and target community priorities.

To learn more about how to strengthen the roles and functions of CHW/Ps in your community or organization, contact [name], [title] at [email address].

[1]https://www.apha.org/apha-communities/member-sections/community-health-workers
[2] https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf
[3] https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf
[4]https://www.chcf.org/wp-content/uploads/2021/09/AdvancingCAsCHWPWorkforceInMediCal.pdf      [5]https://chwcentral.org/chws-and-mental-health-equipping-community-health-workers-with-essential-skills-for-addressing-mental-health-and-violence-in-the-home/

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