‍‍This month, Dr. Kiiera Robinson, Waymark’s National Community Health Worker (CHW) Lead, describes her doctoral dissertation, which detailed which policies and practices drive success in Community Health Worker programs.

Waymark has adopted a care model that pairs CHWs with social workers, care coordinators, pharmacists, and primary care providers. A critical question for this model is: what makes it work? Under what circumstances do CHW programs thrive, and conversely when do they fail, and why?

Through a detailed qualitative study interviewing 40 CHWs across the country, I explored CHW’s perceptions of what internal and external factors impact success and describe those below.

CHW’s were provided the opportunity to discuss:

• Typical roles and responsibilities,
• How the CHW role initially affected by the COVID-19 pandemic
• What competencies are needed to be successful
• Methods in which they acquire knowledge
• Additional factors that can help or hinder their success when delivering care.

Keys to the role

CHWs are often relied upon to be the “bridge” or “liaison” between patients and the healthcare system. “To be like the foot soldiers,” said one CHW. “We make contact with individuals who either haven’t had contact with their health plan or they’re high-risk individuals.” CHWs help patients understand plans for their care, the health insurance benefits, and which providers they need to see. CHWs attended medical and social services appointments with members to ensure that members could explain their concerns and understand those of their providers.

Effects of COVID-19

The COVID-19 pandemic made care more challenging for CHWs, but also highlighted the many ways CHWs can be of service to the community during national emergencies. “COVID, it affected everything,” said one CHW. “It made the job a lot more stressful, a lot more challenging because we couldn’t go into people’s homes. So, rain, snow, blazing sunshine didn’t matter, we were outside. We were in all those elements all the time. There were changes in outreach, barriers to connecting to all types of services, and an implementation process for the use of personal protective equipment.”

Competencies Associated with Success

Networking skills, communication, empathy, cultural competence, and understanding services were all identified as essential skills for being a successful CHW. “Being open-minded and willing to listen and understand people that are unlike you and diverse,” was key, as one CHW summarized. “People have a background and a story that is unlike your own. In the field of community health, you don’t know who you’re interacting with, and it’s people from all over who have gone through all sorts of experiences and walks of life.”

Preferred Method of Training

Hands-on training was the preferred method of instruction resoundingly supported by the CHWs in the study. “Field observations are good because it’s real time,” said one CHW. “You can assess the situation with the CHW. If they get stuck, you can help them out and it’s also a teachable moment. You just let them know this is how you’re supposed to approach this situation and this is how you do it.” Hands-on training includes, but is not limited to, simulations, role-play, safety demonstrations, field observations and shadowing.

Impacts on Success

CHWs highlighted some key personal and organizational factors associated with their success: bilingual skills, ongoing training, compensation, and supportive management. 70% of the individuals who participated in the study were bilingual, and 81% of those individuals spoke Spanish.

A participant described how previous work experience affected their success, “I think being a teacher was super helpful because I have the ability to multitask and to manage multiple things happening at the same time. I also have that communication experience with a diverse group of people.”

Incorporating CHW perspectives at Waymark

Providing high-quality, consistent training is key to equipping CHWs with the knowledge they need to continue to have a positive impact on the healthcare system and the communities we serve. Where available, we at Waymark support the acquisition of state CHW certifications to ensure our CHWs have a path to advancement and recognition in their field. We seek to provide CHWs with a safe environment to work, providing both necessary equipment and training.

Waymark’s goal is to support the CHWs we employ with the understanding that these individuals will come from a range of backgrounds, while still looking for the competencies to care for patients in their neighborhoods. We provide the paid training to enable continuous learning (both up front and on the job), along with mentorship and support, to achieve career success for CHWs and health benefits for patients.

The resilience and community orientation of CHWs places them in an ideal position to serve their communities and be on the front lines of both major healthcare disasters and the continuing everyday challenges of the US healthcare system.