In this two-part series, we spoke to colleagues from Mariposa Community Health Center, Nogales AZ;, St John’s Well Child and Family Center, Los Angeles CA;, and Northwest Regional Primary Care Association, Seattle WA, to learn more about the role of CHWs in the community health center landscape. Part 1, ‘Profiles – Community Health Workers in the Community Health Center Setting’ can be accessed here.
Community health workers (CHWs) are an integral part of the health care landscape. CHWs vary broadly in title, role and scope of work. Known by various names – Promotoras, Community Lay Worker, Community Health Liaison, and many more – the American Public Health Association defines CHWs as “frontline public health workers who are trusted members of, and/or have an unusually close understanding of, the community served. This trusting relationship enables CHWs 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.”
Whether strengthening ties through community outreach, providing clinical support as members of the primary care team, or serving one of many roles within or outside their organizations, CHWs are an invaluable bridge between communities and local health infrastructure. Embedded in the very communities they serve, CHWs have a lived understanding of their communities, and their unique cultural and social characteristics. Such insights into the specific issues and needs of the local populace are crucial to the success of community healthcare teams.
CHWs may serve in any number of different roles, including as counselors, helping low-income and underserved patients overcome the barriers that prevent them from seeking vital healthcare; as health educators, providing vital education about preventive health as well as available healthcare options; and as health monitors, supporting the care and treatment of patients living with chronic illness so that they can live healthier and longer lives.
Though CHWs and CHW programs are well established as essential workforce in some organizations and health centers, the role of CHWs in health centers is still not widely understood or accepted, and uncertainty persists. “There’s still a profound misunderstanding of who CHWs are inside of community health centers (CHCs).” explained Seth Doyle, Director of Strategic Initiatives at the Northwest Regional Primary Care Association (NWRPCA). “I think what really needs to happen is an understanding of how the services that CHWs can provide or do provide is complementary to all of the different services that health centers are providing…they are not meant to take the place of any existing work force, they’re really meant to enhance what the full workforce of community health centers are intending to do.”
Mr. Doyle contends that it really comes down to trust and, “the ability that CHWs have to gain access to communities who may not have a lot of trust in the health care system who, for whatever reason, are alienated from that system. So a CHW who is able to be that bridge, is really vital.”
Community health workers provide the community with greater access to the health care system, assisting in mitigating and overcoming barriers to care, especially in hard to reach populations. Mr.Doyle, whose organization provides services to CHCs in Region X, encompassing the states of Alaska, Idaho, Oregon, and Washington explains, “I think it would be important to note – specifically around Region X, but also likely true for other grantees around the country – that we tend to see a stronger representation of CHWs in the special populations health centers, among migrant health grantees and health care for the homeless grantees in particular.” The community health center model has long recognized the needs of special populations within their communities, Mr. Doyle explains that “health centers overall, and with some of the special populations health centers in particular, migrant health and health care for the homeless have for decades really engaged CHWs as an essential workforce for them to be able to carry out their missions.” For example, CHWs working with homeless populations may recognize the complex needs of people experiencing homelessness and provide trauma-informed care and outreach. They build trust through their own lived experience, community ties, and engagement, forging a bridge to care and services.
The bridging is also essential to address the particular needs of immigrant communities, where cultural perspectives on health and health care, language, and even policy create complex dynamics. For example, the public charge rule, whose implementation has been blocked by temporary injunctions, has created a lot of fear, anxiety and confusion in immigrant communities. CHWs may be a trusted source of information and guidance. Mr. Doyle emphasized that CHWs are often part of an immigrant community themselves or may be impacted in a way other health center staff are not. “The combination of the lived experience, I think, adds to the trust community members have in CHWs. I think that’s an important issue and with regard to immigration, having CHWs, outreach workers, or promotoras in the community helping separate myth from fact and educate community members is key.”
Deeply invested in serving their diverse urban, rural, special and at-risk populations, CHWs are embedded in many health centers, and play a pivotal role, yet more work is needed to highlight their value. Mr. Doyle further suggests, it is necessary to “understand[ing] the range of roles that CHWs can play and how to best leverage that to enhance the organization overall.” By investing in CHWs, health centers can overcome barriers to care and help improve the health of those they serve.
 “Community Health Workers,” American Public Health Association accessed September 1, 2019, https://www.apha.org/apha-communities/member-sections/community-health-workers.
 “Who Are Community Health Workers And What Do They Do?,” Unite for Site accessed September 1, 2019, http://www.uniteforsight.org/health-workers-course/module1