Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States

Background: Limited support for healthcare services is one reason rural Appalachia is among the unhealthiest regions in the United States.Objective: Evaluate Level 1 of a multi-level community health worker (CHW) training program designed to train CHWs easily so they can affect community health.Methods: 198 CHWs evaluated their training curriculum. CHW activities were tracked for 19 months. Group data were analyzed with t-tests and ANOVA using mean ± SEM comparisons. Correlation coefficients and rank sum difference analyses were used to evaluate ranked variables. Statistical significance was set at p<0.05.Results: Excellent or good rankings were given by 100% of CHWs for their instructor’s knowledge, 100% being treated fairly, 99% overall class rating, 97% fairness of exam, 96% course objectives met, and 92% course manual. CHW test performance did not affect any variable. CHWs were only asked one question every two months they could not answer. CHWs talked to four new people each month, two people a month for multiple visits, and three people a month for follow-up visits.Conclusions: No need to change the CHW curriculum, training materials, or testing procedures. A 15-hour CHW training program is adequate enough to provide valid healthcare service support in rural Appalachia, USA.

Download Full-text

Being a Community Health Worker Means Advocating

Anthropology in Action ◽

10.3167/aia.2019.260202 ◽

2019 ◽

Vol 26 (2) ◽

pp. 9-18

Author(s):

Ryan I. Logan

Keyword(s):

United States ◽

Health Disparities ◽

Community Health ◽

Health Worker ◽

Social Determinants ◽

Health Workers ◽

Well Being ◽

The United States ◽

The Social ◽

New Framework

Community health workers (CHWs) participate in advocacy as a crucial means to empower clients in overcoming health disparities and to improve the health and social well-being of their communities. Building on previous studies, this article proposes a new framework for conceptualising CHW advocacy, depending on the intended impact level of CHW advocacy. CHWs participate in three ‘levels’ of advocacy, the micro, the macro, and the professional. This article also details the challenges they face at each level. As steps are taken to institutionalise these workers throughout the United States and abroad, there is a danger that their participation in advocacy will diminish. As advocacy serves as a primary conduit through which to empower clients, enshrining this role in steps to integrate these workers is essential. Finally, this article provides justification for the impacts of CHWs in addressing the social determinants of health and in helping their communities strive towards health equity.

Download Full-text

A Real-World Community Health Worker Care Coordination Model for High-Risk Children

Health Promotion Practice ◽

10.1177/1524839918764893 ◽

2018 ◽

Vol 20 (3) ◽

pp. 409-418 ◽

Cited By ~ 3

Author(s):

Molly A. Martin ◽

Kenita Perry-Bell ◽

Mark Minier ◽

Anne Elizabeth Glassgow ◽

Benjamin W. Van Voorhees

Keyword(s):

Mental Health ◽

High Risk ◽

Community Health ◽

Health Worker ◽

Community Health Worker ◽

Care Coordination ◽

The United States ◽

Individualized Care ◽

Wide Range ◽

Risk Patients

Health care systems across the United States are considering community health worker (CHW) services for high-risk patients, despite limited data on how to build and sustain effective CHW programs. We describe the process of providing CHW services to 5,289 at-risk patients within a state-run health system. The program includes 30 CHWs, six care coordinators, the Director of Care Coordination, the Medical Director, a registered nurse, mental health specialists, and legal specialists. CHWs are organized into geographic and specialized teams. All CHWs receive basic training that includes oral and mental health; some receive additional disease-specific training. CHWs develop individualized care coordination plans with patients. The implementation of these plans involves delivery of a wide range of social service and coordination support. The number of CHW contacts is determined by patient risk. CHWs spend about 60% of their time in an office setting. To deliver the program optimally, we had to develop multiple CHW job categories that allow for CHW specialization. We created new technology systems to manage operations. Field issues resulted in program changes to improve service delivery and ensure safety. Our experience serves as a model for how to integrate CHWs into clinical and community systems.

Download Full-text