Community health workers (CHWs) are trusted public health workers who come from the communities they serve. They build relationships with people who are often from similar backgrounds and cultures to help connect them to medical care and social services. The goal of community health workers is to create healthier communities. This includes everything from helping people access routine health screenings and immunizations, to assisting them with managing chronic conditions like diabetes and asthma, to addressing social drivers of health by connecting them to nutritious food, housing, jobs, and transportation.
While some community health workers are employed within the traditional healthcare delivery system, many others serve through organizations, community centers, insurance companies, and local programs. Regardless of the setting in which they operate, a community health worker’s most important contribution is guiding individuals with unmet social needs to connect with important services and resources.
“Community health workers’ inside knowledge of the community enables them to gain the trust of residents and steer them to the right resources for their needs,” explained Geoffrey Wilkinson, Director of the Leadership Core for the Center for Innovation in Social Work and Health at the Boston University School of Social Work. Wilkinson is also a founding board member and current treasurer of the National Association of Community Health Workers.
Protecting the Core Value of Community Health Workers
In recent years, many states have undertaken efforts to support community health workforce development through training and credentialing programs. But the desire to increase the pool of certified community health workers can come into conflict with the benefits of training community health workers from within their own communities.
“Community health worker credentialing can be a double-edge sword,” Wilkinson said, pointing out that credentialing programs sanctioned by state governments can open up community health worker positions to anyone, even if they are not community members and don’t understand the lives of the people they serve. Wilkinson emphasized that organizations hiring community health workers should be clear about what defines and distinguishes community health workers from other health professionals and plan carefully for their full integration into health teams and community partnerships. “Otherwise,” he stressed, “they risk missing the very core of what makes community health workers so effective.”
How Community Health Workers Benefit Community Health
The benefits of community health workers who come from the communities they serve are multifold, from preventing emergency department visits and hospitalizations to heading off serious disease and achieving better outcomes for people with chronic conditions. They can also fill knowledge gaps in the medical system. For example, the Brooklyn Center for Independence of the Disabled’s Community Health Worker program trains community health workers with disabilities to care for similarly disabled peers. Building on shared experiences to create trust, they can provide emotional support, guidance on navigating healthcare services, advice on advocating for themselves, and links to local resources.
The data on community health workers paints a clear picture of the value this role brings. For instance, a study published in the Journal of Ambulatory Care Medicine found that after adding community health workers to a South Bronx, New York patient-centered medical home, emergency room visits decreased by 5% and hospitalizations for people with diabetes and other chronic health issues fell by more than 12%.
While community health workers cannot take the place of clinicians or fix systemic problems with the medical system, they can strengthen population health by building relationships in a non-medical manner to help groups at risk for poorer health outcomes access the resources that exist in their communities and encourage follow through to take better care of their health, Wilkinson noted.
Employing community health workers to support community health can also save healthcare dollars. A study published in Health Affairs found that every $1.00 invested in community health workers yields an average return of $2.47 to Medicaid payers for each affected beneficiary within the fiscal year. Other studies have found similar results, and Wilkinson said that in some situations the savings can be even higher.
Training and Supporting Community Health Workers
In 2016, the Community Health Worker Core Consensus (C3) Project updated previous research and established a nationally recognized description of community health worker roles, core competencies, and qualities that can drive community health worker efforts. The effort was coordinated by the University of Texas–Houston School of Public Health’s Institute for Health Policy in collaboration with Texas Tech University Health Sciences Center/El Paso and the American Public Health Association (APHA) CHW Section.
C3’s guidance for improving community health worker practice includes providing culturally relevant health information, providing coaching and social support, building individual and community capacity, offering advocacy and assessment, and participating in evaluation and research, among many other things. The project also provides a toolkit that groups can use to guide their own community health worker initiatives.
The Community Asthma Initiative Model
The Community Asthma Initiative (CAI) at Boston Children’s Hospital is one example of how community health workers can make a real difference for the people they serve. The model, which has been replicated by communities around the country, was started almost two decades ago to address the high asthma rates among Black and Hispanic/Latino children in the Boston area.
Today, the program brings community health workers to families whose children have experienced a severe asthma episode and have been treated either through the emergency department or as an inpatient, according to Elizabeth R. Woods, MD, MPH, Associate Chief, Emeritus, of the Division of Adolescent/Young Adult Medicine at Boston Children’s and Director of CAI.
Every year, approximately 125 to 175 families enroll in the CAI program and receive case management. Most of these families allow community health workers to perform home visits to conduct environmental assessments and make recommendations to address asthma triggers. The community health workers work with a nurse manager and primary care providers to coordinate services for the children. They help families to manage medications and provide supplies, such as vacuums with HEPA filters and mattress and pillow covers, to help asthma-proof their surroundings.
The latest data from CAI illustrates some clear benefits, including:
- 55% reduction in asthma-related ED visits
- 82% reduction in asthma-related hospitalizations
- 45% reduction in children missing school due to asthma
- 55% reduction in parents/caregivers missing work due to their child’s asthma
Woods also stressed that this approach is a cost-effective option for insurers and accountable care organizations: “To break even and improve the health and quality of life for young people would be enough,”she said. But the cost savings, documented in a 10-year follow-up study coauthored by Woods, makes this model even more compelling.
The study, published in the Journal of Asthma, found that CAI’s average total cost per patient was $2,636. The program reduced costly emergency department visits and hospitalizations and recognized a financial return on their investment after three years, with a two-fold savings by 10 years. “This long-term follow-up evaluation demonstrates that the shift in improved health trajectory persists after one year of services,” Woods said, adding, “Therefore, we need to keep engaging insurers to cover home visits [and other programs like this].”