Successful community health worker programs don’t just happen by magic: Providers have to plan the initiative carefully and be clear about the roles and responsibilities, says April Hicks, MSW, chief operating officer of the Community Health Worker Network of NYC.
“Providers often don’t recognize all of the complexities of a community health worker program. They hear other providers’ success stories and think they can bring CHWs into their facility and magic will happen. It won’t,” Hicks says.
There’s no one-size-fits-all model for a community health worker program, Hicks says.
She advises organizations to take their time when planning a program. Determine the patient population you want to reach, research how other programs work, and design a program tailored to the unique needs of your community, she adds.
“There is often confusion about the role of community health workers. The entire treatment team should have a clear understanding of what community health workers are and their role in the organization,” Hicks says.
The Community Health Worker Network of NYC began in 2001 as a way to support community health workers and give them an opportunity to learn from each other, Hicks says.
“We want to raise the profile of community health workers and ensure that they are integrated into the continuum, but make sure that they aren’t turned into something they are not,” she says. (For information about the organization and community health workers, visit www.chwnetwork.org.)
For instance, some providers are trying to use community health workers as mini medical professionals or extenders for licensed staff, but that’s not within their scope of practice, Hicks says. “If they are asked to perform duties similar to those of licensed staff, such as coordinating care in the community, it can lead to a turf war,” she says.
“Instead of feeling threatened, the interdisciplinary team should understand that that community health workers focus on the social determinants of health,” Hicks adds. “They are not clinical. They add value to the team, allowing others to work at the top of their license by taking on tasks that don’t require a licensed clinician. Their scope of practice is complementary to the work of the rest of the team.”
Before starting the community health worker program, researchers at the University of Pennsylvania Health System conducted extensive research to find out what other organizations were doing and what patients needed.
The community health worker program was a vision of Shreya Kangovi, MD, MS, a pediatrician and assistant professor of medicine at Perelman School of Medicine at the University of Pennsylvania, who wanted to reach beyond the hospital and clinic walls to help patients, says Jill Feldstein, MPA, chief operations officer for the Penn Center for Community Health Workers at the Philadelphia-based health system.
Kangovi and her team talked to hundreds of patients to get an understanding of what patients thought was getting in the way of their health.
“They described a sense of disconnect from providers. They felt that their physicians were good at describing their illness and medication regime, but they had no idea of what was happening in the patient’s world in the community,” Feldstein says.
The research uncovered three areas where patients thought a community health worker could benefit them: help in navigating the healthcare system; connections to resources in the community, such as food banks, housing assistance, transportation, and childcare; and emotional and instrumental support — someone to accompany patients to physician visits, help them fill out forms, or go with them to exercise programs.
“Community health worker programs have been around for a long time with mixed success. We determined what the major pitfalls were and designed our program to avoid them,” Feldstein says.
Since many programs they reviewed reported high turnover, Kangovi’s team explored better ways to recruit and hire the right people. They developed standardized work practices and created very clear responsibilities for the role and the focus of the CHWs, including a goal of providing holistic patient care.
The result was the Individualized Management for Patient-Centered Targets (IMPaCT) program that is currently used at the University of Pennsylvania Health system and outlines how hospitals can create an effective and standardized program. (For more details on IMPaCT, visit: http://chw.upenn.edu.)