Introduction

A Community Health Worker (CHW) as defined by the APHA is 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.”¹

Though CHW is the most commonly accepted title nationwide, they are known by a variety of titles including Promotores, peer educator and patient navigator. Regardless of the title, what distinguishes a CHW is that they are part of the community they serve, either geographically or through shared life experiences. The consequent title will vary depending on the role they will play within the organization.

Despite the fact that the Community Health Worker model has been around for several years, their potential to enhance primary care access and quality remains underutilized.² The following section will explore the benefits of having CHWs on a clinical care team by considering how their skills make them better equipped at reaching their community and making a lasting impact.

Who do CHW’s Serve and How? 

Although CHW programs have historically been grassroots, community-based programs, health care reforms have illuminated the important role a CHW can play on a health care team. In order to transition CHWs into clinical settings, it is important that clinicians understand exactly how a CHW can contribute to a care team and the limitations of their position.

The Community Health Worker Core Consensus or C3 project is a national project that explored and defined the CHWs roles in depth. This project produced recommendations that are now being used nationwide to better outline the CHW Scope of Practice and Core Competencies. Some of which include:

• Cultural mediation among individuals, communities, and health and social service systems
• Providing culturally appropriate health education and information
• Care coordination, case management, and system navigation
• Advocating for individuals and communities
• Providing direct service
• Participating in evaluation and research³

Even though CHWs possess the necessary skills to fulfill each of these roles, it is unlikely that one person will be responsible for all of them in any given position. Generally, the role, scope of practice, and duties will vary based on the organizational needs.

Benefits of Having a CHW on a Health Care Team

Community Health Workers have an ability to relate to patients based on shared life experiences. This connection enables them to identify distinct obstacles that many vulnerable, underserved, or hard to reach populations may face. Having this connection serves a two-fold purpose, the community can provide feedback to the clinic through the CHW and consequently,  the clinic is able to improve service delivery and quality of care.

Doctors who worked with CHWs in a program in the Bronx, New York reported that CHWs helped them understand their patient’s backgrounds, constraints, and preferences; ultimately allowing the team to provide better service to the patient and genuinely focus on their medical needs.⁴ This information serves invaluable in clinical settings where CHWs can help healthcare providers work towards improving health outcomes.

In addition to improving health outcomes and quality of care, CHW programs are often cost-effective because they allow health care organizations to utilize their resources more efficiently and reduce the use of unnecessary medical services. For example, a CHW program in Arkansas saw savings of over $2.6 million  for  a final return on investment of $2.92 over a three-year period.⁵

Increased health care costs and demand have accelerated the need for resource-saving approaches. Community Health Workers are a unique workforce that has been able to adapt to the needs of their community and improve the access and delivery of primary care services.²