A recent immigrant in Kansas City, Missouri was using the ER regularly for routine care. He didn’t understand that there were health clinic options available until a Community Health Worker from KC Care Clinic helped him find a doctor to replace his ER visits.
On a Navajo reservation in the southwest United States, Community Health Worker Marie Begay drives to the rural home of a 73-year-old heart patient who only speaks the Navajo language. Begay checks her blood pressure and makes sure her diabetes management is going well-a level of care the tribal elder would not receive without Begay’s help.
According to a World Health Organization definition, Community Health Workers (CHWs) encompass a variety of community health aides selected, trained, and working in the communities from which they come. CHWs have long been used to deliver health care to people in rural and poverty-stricken areas of the world, and now the concept is starting to make inroads in urban settings as a way to reduce health disparities.
A Growing Movement
In Community Health Workers — A Local Solution to a Global Problem, published in The New England Journal of Medicine article, Drs. Prabhjot Singh, M.D., Ph.D., and Dave A. Chokshi, M.D. state that, “We believe that scaling up the community health workforce in the United States could improve health outcomes, reduce health care costs, and create jobs.”
They go on to say that “CHWs can mobilize social support, create avenues for family members to engage in the care process, and strengthen long-term community relationships that help patients sustain healthful behaviors.”
The Bureau of Labor Statistics offers employment statistics for CHWs that show which areas of the country most heavily use CHWs and what the prevailing mean wage is for each state.
The American Public Health Association (APHA) also believes CHWs have a place in our health care system. Several sessions for CHWs will be held during the APHA annual meeting in Boston on November 2-6, 2013. APHA sees CHWs as frontline public health workers who are trusted members of the communities they serve.
Taking it Local
Rebecca Burns is Manager of Care Coordinators at the KC Care Clinic. The clinic was the first free clinic in the Kansas City area and has been serving the population since 1971. They currently employ six full CHWs from diverse backgrounds, including two that grew up in poverty in the Kansas City area and know the long-term challenges the community has faced.
“It’s that relatability piece that is so important. To understand where the patient is coming from.”–Rebecca Burns of KC Care Clinic
The CHW program is the first in the Kansas City area and has been in place a little more than two years. “It is very different from the old model where a care provider would identify a problem and then send the patient out to find their own resources,” Burns said. “The Community Health Workers are very actively involved in everything the patient does. They are in the home, they go with them to get signed up for services, they attend appointments.”
The program is paid for with grant funding,and the clinic currently does their own training of CHWs, but a local community college has recently developed a program that could give certification and then CHW services could be reimbursed through Medicaid.
- The Arkansas Department of Health trained nine CHWs to serve three counties as part of a STAR.Health initiative. In the first year the CHWs made 5,482 public contacts, with nearly half of them taking place in clients’ homes. Successes include getting children signed up for health coverage, assisting young mothers with completing their education, and helping families control medical costs.
- New Mexico had a significant reduction in Medicaid costs by assigning CHWs to high-consumer health service users.
- Effective Diabetes self-management rose significantly in border town populations of Texas when CHWs were used to deliver culturally competent instructions and support.
- Minnesota has a Community Health Worker Alliance that focuses on building awareness of and expanding CHW programs. They helped make sure CHWs were integrated into the Healthy Minnesota 2020 Plan.
Tools for Change
A Community Health Needs Assessment (CHNA) report can help states recruit effective CHWs by pinpointing where culturally diverse populations live and the overall health needs of those communities. With report indicators like:
- linguistically isolated households;
- populations in poverty;
- heart disease prevalence;
- access to primary care; and
- preventable hospital visit rates
a wealth of community health information is only a few clicks away. Make a CHNA report here now.
Does your area use Community Health Workers? What successes have you seen? Share your stories and strategies on the Commons so that we can collaborate, learn, and make change together.
feature image credit: The Jordan and Harris Community Health Center, a project of the Rutgers School of Nursing, in Newark, NJ.