Community health worker roles and their evolving interprofessional relationships in the United States

ABSTRACT

In the United States, growing attention to the cost of care, the social determinants of health, prevention, and population health, signals a refocusing of efforts on value-based care. Just as Accountable Care Organizations and alternative payment models exemplify this shift in attention, so does the increasing integration of Community Health Workers (CHWs) into the US health care system. CHWs are often referred to as “bridge figures,” helping clients to navigate what are oftentimes complicated pathways to access a variety of needed services. The integration of CHWs into interprofessional care teams is a process that takes time, and can lead to conflict as traditional care models are disrupted. Through focus groups with CHWs in rural and urban areas of four states, this work identifies and describes three early stages in the evolving interprofessional relationships between CHWs and other care providers. These stages are characterized by: (1) a lack of knowledge and understanding of CHW roles, (2) conflict and competition, and (3) engagement and integration of CHWs into patient care teams. A better understanding of the evolving process of CHW integration is critical to facilitate education and training that will more quickly encourage the development and efficacy of modern models of interprofessional care that include CHWs.

KEYWORDS:

• Community health worker
• health workforce
• interprofessional relations
• patient care team
• social determinants of health

Author contributions

David J. Washburn and Timothy Callaghan initiated the project, conducted all of the focus groups, and carried out data collection and analysis. All other authors contributed to the study conceptualization, design, logistics, and material preparation. The first draft of the manuscript was written by David J. Washburn and all authors commented on subsequent versions of the manuscript. All authors have read and approved the manuscript.

Declaration of interests and compliance with ethical standards

The authors have no relevant financial or non-financial interests to disclose.

Researchers obtained informed consent from each of the participants in either English or Spanish, depending on their preference.

The transcripts of the focus groups used for the analysis presented here are available upon request. To protect the privacy of participants, no names are used in our manuscript.

Additional information

Funding

This research was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), of the US Department of Health and Human Services (HHS) as part of an annual award of $700,000 with 0% financed with non-governmental sources under grant number #U1CHR30040.002; Health Resources and Services Administration;

Notes on contributors

David J. Washburn

David J. Washburn, ScD, SM is an Assistant Professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health and the Co-Director of the Program on Global Health Research.

Timothy Callaghan

Timothy Callaghan, PhD is an Assistant Professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health, the Co-Chair of the PhD Program, and the Director of Evaluation for the Southwest Rural Health Research Center.

Cason Schmit

Cason Schmit, JD is an Assistant Professor in the Department of Health Policy and Management at the Texas A&M University School of Public Health and Director of the Program in Health Law and Policy.

Emily Thompson

Emily Thompson, MHA is a health care administrator who received her Masters in Health Administration at the Texas A&M University School of Public Health.

Denise Martinez

Denise Martinez, MPH, CHWI is a certified Community Health Worker Instructor and the Manager of the National Community Health Worker Training Center at the Texas A&M University School of Public Health, where she received her Masters in Public Health.

Megan Lafleur

Megan Lafleur, MPH is a Program Specialist at the Texas Department of State Health Services who received her Masters in Public Health at the Texas A&M University School of Public Health.