Community health workers
Local governments can invest in this strategy using State and Local Fiscal Recovery Funds (SLFRF) from the American Rescue Plan Act (ARPA).
- This strategy can help residents access health services. The U.S. Department of Treasury has indicated that strategies that help achieve this outcome are eligible for the use of Fiscal Recovery Funds.
Program overview
Bridging gaps between health care system and community members: Community health workers (CHWs) are frontline public health workers who provide a wide range of non-clinical health care services. There is some evidence that CHWs can improve access to health care, increase uptake of preventative care services, and increase uptake of healthy behaviors.
Offering a large scope of non-clinical health services: CHWs can function as care coordinators, community health educators, outreach and enrollment agents, case managers, advocates, and translators. They often conduct home visits to deliver educational interventions, conduct follow-up assessments, or provide social support to patients navigating the health care system.
Community representatives embedded in the health care system: CHWs are most often employed by public health departments, community health centers, and local nonprofit organizations, but also sometimes by health systems or insurers. They can work independently or as part of a primary or specialty care team. The training and certification process to be a CHW varies across states but generally a high school diploma or GED is required.
Serving under-resourced communities: CHWs predominantly serve communities and people who face barriers to accessing health care, such as ethnic or racial minority groups, immigrants, or formerly incarcerated individuals. Patients are most commonly referred to community health worker programs by physicians or other members of a health care team. CHWs often spend time working within the community at settings such as clinics, schools, or people’s homes.
- Cost per Participant
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Not available
Multiple studies with rigorous designs provide some evidence for community health workers as a strategy to increase patient knowledge and healthy behavior and improve access to care and uptake of preventive care.
- This assessment is based on evidence from a 2023 research synthesis.
Provide sufficient training for CHWs: CHWs need training to develop professional, medical, and interpersonal skills to support their work across a diverse range of functions. Professional skills may involve organizing and keeping detailed records of interactions with patients, especially in compliance with other health care system policies. Medical knowledge could include the importance of preventive medicine so that CHWs are prepared to educate community members on healthy behaviors. Interpersonal training should focus on earning trust with clients and building rapport across differences in social class or race.
Establish collaboration and coaching practices: Offering coordinated health care services is central to the CHW model. Establishing practices that encourage collaboration within the health care team is essential to achieving this coordination. These routines may include morning rounds, which give CHWs a chance to discuss outstanding issues or concerns and appropriately reprioritize patient needs, or daily huddles, which can help establish clear goals, keep CHWs accountable, and encourage regular sharing of patient information.
Conduct ongoing evaluations on process and outcomes: Evaluations should be used to assess how CHW services are being delivered and received. Evaluation data should address the experience of care (e.g., process of care and utilization, behavior change, satisfaction) and larger scale population health metrics (e.g., per capita cost).
Identify sustainable funding: Long-term sustainable funding helps to ensure that CHW programs have enough time to fully embed in a given community and can decrease pressure and time demands on CHW program leaders to seek out new funding sources. Medicaid funding is one strong example of a sustainable funding source; currently, over half the states allow Medicaid payment for CHW services. In addition, studies show that integrating CHWs into larger health care systems may be cost-effective for some medical conditions.