JULIE TROCCHIO, BSN, MS
Community health workers can be valuable resources in health care organizations' efforts to establish trusting community relationships and to address entrenched social determinants of health. They can be part of community health improvement strategies, from prenatal outreach to vaccine acceptance.
During the 2021 Catholic Health Assembly, Maria Lemus, founder and executive director of Visión y Compromiso, an organization of promotores and community health workers, described the value and potential of these important workers. Here is a summary of that discussion, along with other information from the literature.
1. Community health workers can help establish trusting community relationships.
The American Public Health Association defines a community health worker as "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."
2. Community health workers can impact health and welfare of the community.
- Outreach to new and existing service recipients.
- Trust building.
- Patient and community empowerment once trust is established.
A focus on social determinants recognizes that much of what drives health is located in the environment, community or family relationships and that solutions often require resources or services beyond health care, such as transportation, housing or food. The community health worker connects people to these services.
3. Community health workers are known by various titles.
Some of the titles used for community health workers include promotores, promotores de salud, community health representatives, community health advisors, lay health advocates, outreach educators, peer health promoters and peer health educators.
4. Community health workers are part of the community.
Community health workers reside in the community. They usually share ethnicity, language, life experiences and socioeconomic status with community members. According to the National Heart, Lung and Blood Institute's Community Health Worker Health Disparities Initiative, they "can reach community residents where they live, eat, play, work and worship." The organization calls community health workers "frontline agents of change, helping to reduce health disparities in underserved communities."
5. Community health workers can carry out diverse activities.
Activities carried out by community health workers can include health promotion and health education, assistance in accessing medical and nonmedical services and programs, translation and interpreting services, counseling, mentoring, social support, transportation, case management and risk identification.
6. Community health workers are being tapped for help during COVID.
In 2021, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services funded nonprofit health and community organizations to mobilize community outreach workers, including community health workers, to educate and assist individuals in accessing and receiving COVID-19 vaccinations. This included activities such as conducting face-to-face outreach and reaching out directly to community members to educate them about the vaccine, assisting individuals in making a vaccine appointment, providing resources to find convenient vaccine locations, assisting individuals with transportation or other needs to get to a vaccination site.1
7. Community health workers provide services in various settings.
The original community health workers and promotores were community members who voluntarily checked in on others, took food to shut-ins or sick neighbors, gave rides or helped with local information. Today, most of these workers are in community-based organizations or health care organizations such as hospitals and clinics. A recent study found a shift toward health care organization employment. Frequent employers are private and public health and service organizations, community-based organizations, health plans and health systems.2
8. Community health workers are not typical health care organization employees.
Community health workers can be valuable members of the health care team but do not have typical education, credentials and other qualifications of most staff employed by health care organizations. Human resource departments may need to have flexible policies for hiring, training and supervising these workers, permitting them to work to their capacity and integrating them into health care teams.
9. Health care organizations can support community health workers they employ.
Community health care workers can be integrated and supported within health care organizations when they are recognized and respected by others in the organizations, including health care leaders, clinicians and clerical staff. Other staff members should realize that community health workers spend most of their time in the community, not at a desk or even in the health care organization.
10. Health care organizations also can empower community-based health workers.
Health care organizations can support these workers by recognizing their value and treating them as team members. Health care organizations can also assist in funding positions in community-based organizations or advocating for their funding and use.
JULIE TROCCHIO, BSN, MS is senior director of community benefit and continuing care for the Catholic Health Association, Washington, D.C.
- "Local Community-Based Workforce to Increase COVID-19 Vaccine Access," Health Resources & Services Administration, https://www.hrsa.gov/grants/find-funding/hrsa-21-140.
- Mary-Beth Malcarney et al., "The Changing Roles of Community Health Workers," Health Services Research 52, sup. 1 (February 2017): 360-382, https://dx.doi.org/10.1111%2F1475-6773.12657.
National Association of Community Health Workers, https://nachw.org/.
Visión y Compromiso, which supports and advocates for promotores and community health workers, https://visionycompromiso.org/.
"Community Health Worker (CHW) Toolkit," Centers for Disease Control and Prevention, https://www.cdc.gov/dhdsp/pubs/toolkits/chw-toolkit.htm.
"Community Health Worker Resources," American Public Health Association, https://www.apha.org/apha-communities/member-sections/community-health-workers/resources.
"The Role of Community Health Workers," National Heart, Lung, and Blood Institute, https://www.nhlbi.nih.gov/health/educational/healthdisp/role-of-community-health-workers.htm.
"Community Health Worker National Workforce Study," U.S. Department of Health and Human Services Health Resources and Services Administration (March 2007), https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/community-health-workforce.pdf.
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