Embrace of community health worker (CHW) models lags in the United States relative to most low and middle-income countries. To those familiar with global health beyond US borders, CHWs function as integral components of health systems across the world. Consider Sub-Saharan Africa's push for 1,000,000 CHWs by 2015 – while we lack conclusive numbers, a 2007 report from the Health Resources and Services Administration (HRSA) estimates there may be as few as 120,000 CHWs currently employed in United States. While robust evidence supports the efficacy of CHWs in low and middle income countries, sound evidence has also shown that CHWs in the US context can improve health outcomes, lower resource utilization and cost, and create jobs in struggling communities.
If and how to mainstream community health worker models into US health systems is a large, complex topic, especially considering the widely varying capacities that CHWs can serve in any given setting. Instead of limiting this unwieldy topic into a single discussion, this forum represents the first in a series of panels about how CHWs can and should play a role in the US healthcare context. Our discussion begins with the following questions, with insight from our panel of experts on the utility of CHWs in US communities.
● Evidence suggests CHW programs are particularly effective in certain types of disease prevention, asthma management, certain types of cancer screening, and supporting appropriate health care utilization. What kinds of conditions or challenges have you worked with CHWs to address? Are there areas you believe CHWs are best equipped to have the most impact?
● CHW interventions have been particularly effective in some studies, while showing limited impact in others - in your experience, what are the key factors of successful CHW programs?
● CHW programs work closely with, and are often embedded in, the communities they serve. Since every community is different, how have you adapted CHW models or training programs for the communities you work with? What advice do you have for colleagues who might be beginning to develop CHW programs in their work - how can they ensure these programs are culturally appropriate for the communities they serve?
● Some evidence to suggests that CHW interventions have the potential to reduce costs across health care systems, primarily by supporting appropriate health care utilization. One opportunity for further cost savings lies in further integrating CHWs into care delivery teams and systems - what are the barriers to more robust integration? How can we overcome them - are the examples of systems doing this well?
We are pleased to have an exciting group of panelists joining us for this discussion:
• Heidi Behforouz, MD, Founder and Executive Director of the Prevention and Access to Care and Treatment (PACT) project
• Sheila Davis, DNP, ANP-BC, FAAN, Chief Nursing Officer at Partners In Health
• Gail Hirsch, MEd, Director of the Office of Community Health Workers, Massachusetts Department of Public Health
• Carl H. Rush, MRP, Project on CHW Policy & Practice, University of Texas School of Public Health
This panel is part of our US Communities Initiative, which is supported by the Agency for Healthcare Research and Quality (AHRQ), and aims to foster discussions between health care professionals on evidence-based practices, and translating these practices across disparate settings, to improve health care delivery in underserved populations in the US.
In an effort to understand the impact of our Expert Panels, please take our short (4 question) survey before the discussion begins: https://www.surveymonkey.com/s/7ZNL9WQ
Looking forward to a rich discussion next week – please join the conversation and share your questions or comments for our panelists!