Roles of Community Health Workers

How CHWs Help Dental Providers

Research is pointing to the major impact of oral health on quality of life through its impact on chronic illness, growth and development, good nutrition and overall health. Yet, many families lack access to dental services and may not practice daily preventive oral health habits, for a variety of reasons. Untreated oral disease can lead to painful and costly complications, even death.

According to Minnesota’s new oral health plan, the state’s rankings, while overall quite good, leave room for improvement, especially among children and adults living in poverty, people of color, and the elderly. One way to improve dental access is through a more diverse dental workforce. Adopting CHW services is a workforce strategy to address dental health disparities.

• Are you seeing baby bottle mouth and high rates of preventable dental caries among young children?
  • CHWs can teach families about the value and practice of sound oral hygiene, acquaint them with a regular schedule of routine preventive dental care, and help prepare those patients who may need oral surgery with accurate and culturally-appropriate information.
• Do you find that foreign-born patients are in need of oral health education in their own language in order to make a difference—but translated brochures are just not working?
  • CHWs bridge cultural and language barriers.
• Do you need to find a way to eliminate the waste associated with missed appointments?
  • CHWs  reduce missed appointments.  They can make reminder calls and arrange for transportation in a busy dental office, enabling other practitioners to work “at the top of their licenses
• Are you finding that families do not have regular access to fluoridated drinking water?
  • CHWs can help organize communities in support of fluoridated water and dental health equity.
• Are you looking to gear up and retool your practice to address the dental health needs of many individuals and families who previously lacked dental benefits?
  • Consider integrating CHW services on your team along with dental therapists and dental hygienists to build an effective model.

Spotlight:  Children’s Dental Services, St. Paul

With multiple locations in the Twin Cities and across the state, CDS employs 18 public health outreach specialists—a role under the CHW umbrella—and expects to hire two more this year. Reflecting the diverse population served by CDS, they come from 10 countries in Africa, the Middle East, Latin America and Southeast Asia. Jeff Bartleson of CDS shares the following story on how their CHW staff make a difference:

“One of our Head Start home visitors…was meeting with a family in their home. There was a very young child in the home who was in pain but would only open his mouth for his uncle. It turns out that his uncle would periodically sterilize a pin or needle to drain fluid from an infection in his mouth. After spending some time with the family, the CDS staff member was able to visually inspect the child’s mouth. We then utilized one of our Hmong-speaking Public Health Outreach Specialists (CHWs) to work with the family to follow-through with the recommended treatment. In this case the child was referred for hospital-based care. We worked with the family to have a pre-op physical performed and had all necessary treatment performed under general anesthesia. As we are the dental provider for this Head Start program and many others, we were able to continue to see the child who still has great oral health.”

How CHW Strategies Benefit Individuals and Families

We need health coverage and health care but it can be hard to understand and complicated to use, especially when we’re sick or taking care of a family member. It can seem like a different world with its very own language and rules, whether we’re born in the US or elsewhere, whether English is our first language–or maybe our second or third.

Culturally-competent, multi-lingual community health workers can provide valuable guidance, resources and support, working in health care settings or in neighborhoods, including:

• Insurance has been too expensive for our family to buy.  Now that Minnesota has a health insurance exchange, we’d like to find out about the options that might be available to us.  We hear that everything is online but we don’t have a home computer.
  • As trained assisters and navigators, CHWs will be providing outreach and enrollment assistance in many different organizations that are working with MNsure to provide access to affordable, quality coverage to uninsured and underinsured Minnesotans.
• I’m a diabetic and a cancer survivor with two kids.  I filed my renewal for Medical Assistance on time but the county said it was late.  I don’t know what to do.
  • CHWs help people complete the application process for public programs.  They also teach people how to navigate complicated coverage and care systems.
• I lost my job and it’s hard for me to pay for my medicine when I also have to pay for rent, heat and food.
  • CHWs help people find financial resources and assistance.
• I never sleep well…the bad dreams come, the fear, the fighting, the death. There’s no way out and no one can help me.
  • As trusted and knowledgeable members of the communities they serve, CHWs bring an  in-depth understanding of how life experiences and culture can impact mental health.  They’re sensitive to cultural attitudes about mental health.  CHWs can provide support and information to individuals and groups as members of teams based in clinics, community mental health centers, public health home visiting programs, schools and community-based organizations.
• My grandmother is on dialysis and she needs transportation.  The rest of us are all working and we can’t leave our jobs all the time to get her to the center.
  • CHWs can arrange for transportation and other needed services that are critical to patient access to care and follow-through on care plans.
• My baby cries so much after he gets his shots and I worry about him.  I don’t know why he needs to get so many shots…he’s healthy. 
  • CHWs can take time with families—in the clinic, at home or in the community–to explain the value of immunizations and regular check-ups, review the well child visit schedule and address a range of concerns including cultural considerations.
• My clinic referred me for a colonoscopy and gave me a brochure and instructions in my own language.  I never learned to read very well and I’m scared and confused about the test.  I want to talk to someone from my own community.  
  • Drawing on their bilingual and bicultural skills along with their training, CHWs can review and reinforce cancer screening and testing instructions with patients and their family members and address their questions and concerns.   CHWs will refer medical issues to their supervisors and clinical team members.
• My doctors tell me I need a kidney transplant soon and they tell me that our daughter is the best match of everyone in my family.  I’m so upset.  We love our daughter and in our culture, this would affect her marriage prospects.  Family is everything.
  • As critical links between communities and the health care system, CHWs bring cultural sensitivity and accurate health information to their conversations with patients facing health decisions, large and small. They can serve as cultural liaisons and consultants.
• Before I left the hospital, they gave me prescriptions for new medicines.  Now that I’m home, I’m confused.  Do I keep taking the ones from before….or do I take both sets?  I’m not scheduled to see my doctor for another two weeks and when I call the clinic, I can never talk to anybody.  I have to leave a recorded message.
  • CHWs who work on clinical teams can follow-up with discharged patients at home to help them better understand their care plan.
• My daughter has a really bad toothache.  My husband and I each work but we have seasonal and part-time jobs that don’t have insurance.  We don’t have a dentist and  we’re afraid of getting a big bill if we go to the emergency room.
  • CHWs link patients to affordable and convenient primary and urgent care, avoiding expensive services and long waits at the emergency department.

Spotlight: Portico Healthnet

Since 1995, Portico Healthnet has helped thousands of Minnesotans overcome barriers to health care coverage and services. Through outreach, application and enrollment assistance offered at no charge and its own model of coverage and care management, Portico enables uninsured individuals and families to access affordable coverage and care. Portico employs multi-lingual and culturally-competent CHWs and care management coordinators in order to effectively serve the diverse populations representing Minnesota’s uninsured.

For more information, call 651-489-CARE (2273).

CHWs in Rural Settings

CHWs can be a vital link to health in rural settings, particularly in understaffed and underresourced areas. Here’s more information about CHWs working in this context, and how they can be effective.

• Community Health Workers in Rural Settings, Rural Health Information Hub
• Advantages of Community Health Workers in Rural Programs, Rural Health Information Hub
• Community Health Workers: Recommendations for Bridging Healthcare Gaps in Rural America (PDF), National Rural Health Association (NRHA)
• Promising Practices for Rural Community Health Worker (PDF), Rural Evaluation Brief, Rural Health Research Center, University of Minnesota

How CHWs Help Public Health Agencies

Public health agencies across the country face mounting challenges coupled with tight budgets. In Minnesota the public health workforce is aging and does not reflect our state’s ever more diverse population. This is an opportunity for new staffing models in order to build greater capacity and get better outcomes with limited tax dollars.

• Are you encountering challenges in recruiting breastfeeding support peer educators from diverse communities?
  • Consider contracting with or hiring CHWs with breastfeeding experience to play this important role with members of their own communities.
• Are you finding that you have waiting lists, refusals and uneven results for maternal and child health home visiting programs?
  • The addition of CHWs to team-based home visiting programs can build trust, staffing capacity and better results. In Milwaukee, public health nurses and CHWs have worked on teams for several decades. Nurses report that the rapport and trust that CHWs foster is essential to paving the way to an effective relationship with clients.
• Are you finding an increased acuity rate among new refugee arrivals, e.g. immediate need for medication, kidney dialysis, hospice care or other services?
  • Major health needs can overwhelm refugee families who are attempting to navigate the unfamiliar and complicated health care system while also seeking employment, attending school and learning a new way of life. Bilingual CHWs working in teams with a nurse and/or social worker can help families learn how to navigate the care system and follow-through with care plans in a culturally and linguistically-appropriate way.

How CHW Strategies Advance Health Policy

The federal government as well as many states are taking greater interest in the CHW role. At the federal level, exciting policy developments include the Dept of Health and Human Services Working Group on CHWs, HUD’s CHW Initiative, CMS Medicare Diabetes Disparities pilots and the CMS Center for Innovation’s Workforce Innovation Awards.

The Patient Protection and Affordable Care Act lists CHWs as a member of the health care workforce and as a health professional. It defines CHW as “an individual who promotes health or nutrition within the community in which the individual resides.”

According to the law, a CHW promotes health in the following ways:

• – Serving as a liaison between communities and healthcare agencies;
• – Providing guidance and social assistance to community residents;
• – Enhancing community residents’ ability to effectively communicate with healthcare providers;
• – Providing culturally and linguistically appropriate health or nutrition education;
• – Advocating for individual and community health;
• – Providing referral and follow-up services or otherwise coordinating care; and
• – Proactively identifying and enrolling eligible individuals in Federal, State, local, private or nonprofit health and human services programs.

New CHW investigations are underway in Delaware, Missouri, North Dakota and Utah while Massachusetts pursues a year-long effort to establish a CHW certification process under the direction of a new board of certification and with input from CHWs from around the state.

New CHW developments in Arizona, Illinois, Missouri, New Mexico and South Carolina share some common characteristics including:  focused education and awareness, agreement on scope and qualifications/skill standards, move towards certification on the part of many, strategy for sustainable financing, resources for workforce development and mobilizing CHWs to participate (Carl Rush, Oct 2012).

• • Are you interested in ways to address health equity and also control costs?
    • CHW strategies tackle health disparities.  They can also help reduce costly, avoidable use of emergency departments and preventable hospital readmissions.
  • Are your constituents contacting your office with concerns about navigating complicated systems of coverage and care?
    • CHWs work with patients and caregivers experiencing barriers related to culture, language, literacy, income, mistrust, isolation, income and other related factors. They teach patients how to access affordable coverage and quality care. They help patients understand how to use their health benefits, prepare for physician visits and follow their care plans.

Spotlight: Current Legislative Work in Minnesota

The Minnesota Community Health Worker Allaince’s Legislative Committee is currently working to get legislation introduced in Fall 2021 that would better define the work of CHWs and ensure it is easier to pay them for their services.

Click here to see the Call to Action from March 2021

The committee is working to find support for the bill and continues to stratgize for reintroducing it this fall. If you would like to be apart of this effort contact registry@mnchwalliance.org.

How CHWs Help Providers and Community-Based Organizations

• Are you finding that your patients are unclear about their benefits, how to stay enrolled  and how to access care?
  • CHWs educate community members about their benefits, how and when to renew and how to navigate the complicated health care system. They take a holistic approach to their work and provide information and referral to address a wilder array of needs, some which may get in the way of their care if not addressed.
• Are you concerned about the use of childhood preventive services such as immunization and well child checks, especially among underserved, low income or foreign-born families?
  • As trusted members of the communities they serve, CHWs work with parents to help them understand the value and importance of childhood preventive care, learn how to access services and follow schedules for immunizations, tests and screenings. They address barriers related to culture and language.
• Are you noticing differential rates of screenings among your patient population leading to later detection and reduced survival rates?
  • CHWs have been found to be successful in increasing rates of cancer screenings among low income populations and communities of color.
• Are you working on ways to reduce avoidable hospital readmissions?
  • Here in Minnesota and across the US, hospitals are now focused on how to reduce avoidable readmissions effectively. Among successful strategies is the incorporation of CHWs as team members to visit patients prior to discharge and subsequently at home to help the patient and caregiver better understand and carry out the care plan. For more information including a set of examples and patient indicators, click here to see a webinar presentation by the Minnesota CHW Alliance and Spectrum Health, Grand Rapids, MI.
• Are you concerned about missed appointments?
  • CHWs reduce the no-show rate which can translate into thousands of dollars saved.
• Are you finding that medication non-compliance is a recurrent problem?
  • In-home patient education by CHWs can help decrease medication errors, especially when there are communication barriers related to literacy and language ability among foreign-born, deaf and/or low income patients. CHWs can also find out if patients are using traditional medicines or engaged in polypharmacy,  go over side effects, and reinforce the need to complete the entire course of medication.
• Is your health care home committed to continuous improvement in goal setting and patient activation, among especially with underserved, low income or communities of color? 
  • CHWs can improve communication, coordination and the team’s cultural competence. They can improve patient satisfaction as well as improve family and caregiver support. For example, with specialized health coaching training provided under the CMS Community Transformation Grant, CHWs and other health care home team members at Hennepin County Medical Center are now equipped with skills to work more effectively on disease self-management and behavior change for better health and quality of life.

Spotlight:  Health Care Home

Across the country, clinics are transforming their primary care practices to become “patient-centered medical homes.” In our state, they are known as “health care homes” and four health providers integrate community health workers into their health care home programs including Essentia in Ely;  Hennepin Health, multiple locations in Minneapolis and adjacent suburbs; and NorthPoint, a federally-qualified health center located in Minneapolis.

Click here to learn more about Health Care Home in Minnesota