Project Name: Supporting Community Health Workers to Enhance Effectiveness of Behavioral Health-Primary Care Integration

Project Overview:

The goal of this planning project was to identify how Community Health Workers (CHWs) can be leveraged to enhance the effectiveness of integrated behavioral health (BH) and primary care (PC) services in community health centers (CHCs). In recent years, CHWs have gained recognition as valuable members of the health care workforce. Evidence documents that CHWs are effective in facilitating access to care, improving chronic disease management, reducing unnecessary emergency room use, and organizing communities to address the social determinants of health. Despite this recent recognition, efforts to train, integrate and evaluate the efficacy of CHWs remain fragmented. The development of a coordinated strategy that maximizes resources for training, incorporating and sustaining CHWs and CHW programs as part of an integrated care model, rests on the evidence and the engagement of CHWs themselves. Over the course of this project, NWRPCA engaged with colleagues from Community Mental Health Centers (CMHC) to understand how CHWs, including peer support counselors/specialists, are utilized in CMHC settings, and led an effort aimed at enhancing the effectiveness of CHWs in CHC settings, including integrated care models.

Project Objectives were to:

  • Assess current utilization of CHWs in community health center-based settings;
  • Evaluate the training required for CHWs to work effectively with adults in PC-BH settings;
  • Support CHC organizational readiness to incorporate CHWs as part of PC-BH integrated services; and
  • Initiate the development of a CHW Training Institute aimed at supporting integration of CHWs into clinical and community-based teams.

Project Activities Included:

  • Recruiting an advisory group comprised of regional and national experts and CHC stakeholders to help inform and guide the project, assist with survey development, and help identify needs, gaps and best practices;
  • Partnering with the Latino Center for Health at the University of Washington to conduct a literature review and environmental scan that analyzed existing programs and training related to the utilization of CHWs in PC-BH settings,
  • Developing a bilingual English/Spanish survey tool and conducting a survey that received more than 200 responses (estimated response rate = 30%). Survey respondents included CHWs, managers and administrators, outreach and enrollments specialists, senior leadership, and behavioral health providers;
  • Reviewing current CHW training modules/curricula to assess the extent to which current training incorporates topics related to mental health as well as aspects of PC-BH integrated services;
  • With the support of project partners, convening five focus groups, varied in composition and primary language, with a total of 57 participants from Region X states (Alaska, Idaho, Oregon, Washington) to assess current utilization of CHWs in PC-BH and identify training gaps; and
  • Conducting outreach to CHCs and allied organizations in the region to identify potential opportunities to enhance both the availability and content of CHW resources and training, both for PC-BH efforts and broader community health center integration of community health workers.

Key Project Outcomes:

  • Through deep and continuing engagement with the project Advisory Group, strengthened existing partnerships and built new organizational relationships to support CHW training and integration;
  • Identified financial and systemic barriers to utilizing CHWs to support the delivery of behavioral health services, including: a lack of Medicaid/Medicare reimbursement for services provided by CHWs; differing perspectives on general wellness care and direct behavioral health interventions that are more likely to be reimbursed; lack of clarity among providers about the roles of CHWs on care teams, the benefits they provide, their impact on patient outcomes, and value to the team; and provider reluctance to involve non-clinical staff in care teams;
  • Identified potential training needs to support CHW engagement in varied settings; and
  • Produced a concept paper in conjunction with leading subject-matter experts that will be disseminated to community health centers as a resource to support effective deployment of CHWs in integrated PC-BH care models.

Project Partners:

The key collaborators in this project supporting the advisory group and staff team were the Latino Center for Health at the University of Washington, Vision y Compromiso, The Next Door, Inc., Sea Mar Community Health Centers, the Oregon Community Health Workers Association, the Washington Promotoras Network.

About the Grantee

Northwest Regional Primary Care Association (NWRPCA) is a not-for-profit 501(c)3 membership-driven organization that serves community and migrant health centers (C/MHCs) in Alaska, Idaho, Oregon, and Washington (federal Region X). Founded in 1983, NWRPCA offers a range of programs and services to support and strengthen C/MHCs in the Northwest. NWRPCA works to ensure equal access, regardless of one’s financial or insurance status, to primary and preventive health care for all residents living in the region.