What are the best practices for engaging and empowering community health workers?

It is not uncommon for partnerships between healthcare systems and CHWs to begin with power imbalances. It is essential for healthcare systems to recognize that if they hope to impact the health of underserved and underrepresented populations they must let the community lead. This means that, when finding common values and goals, healthcare systems must be intentional about listening to the the voices of CHWs and letting those voices drive the work. Otherwise, they end up exploiting CHWs and creating more mistrust among hard to reach populations.

When chronically ill patients leave the ER/hospital, they frequently fall off a cliff, setting the stage for a vicious cycle of ER visits and readmissions. There can be a myriad of reasons—lacking a PCP &/or necessary specialists, unsafe/premature hospital discharges, lack of care coordination, inability to afford their meds, and the list goes on. Implementing a Mobile Integrated Healthcare program with a patient-centered concept involving community paramedicine and CHWs, in collaboration with a PCP and nurse coordinators, is beneficial for underserved populations– in both metro and rural areas. It takes a village to deal with a fragmented healthcare system and having a shared vision for patient well-being is key.

Knowledge adds value to CHWs. It is also advantageous to reinforce the training essential for optimal job performance and outcomes. Another key point is to include competencies that are offered during the onboarding process, annually, and as new services are added.

We must be cautious when considering the term "supervision". CHWs bring a skill set to the table when they collaborate with healthcare organizations that healthcare systems do not have. If the goal is a true partnership, healthcare providers and systems must also be evaluated and supervised by CHWs. CHWs can offer training and supervision for healthcare systems on cultural approaches, and on the lived experiences of communities being served. Without this training and supervision, healthcare providers and systems can end up injuring community trust and relationships beyond repair. Paternalism has no place in the CHW-Healthcare system relationship.

According to the World Health Organization, Task shifting III is the extension of the scope of practice of community health workers (CHWs) (often called non-professional health workers or lay providers) in order to enable them to assume some tasks previously undertaken by senior cadres (e.g., nurses and midwives, non-physician clinicians, and medical doctors). Having a mechanism to establish competencies, train, supervise, evaluate, and certify CHWs is critical. However, ongoing training with commiserate remuneration will retain CHWs. Appropriately extending health care interventions to the lowest level possible is essential in resource-constrained areas. Reference: WHO, The Global Recommendations and Guidelines on Task Shifting

As a young Ambulance company director, we had a fleet of 15. The capital equipment replacement plan hadnt been enforced or even created. We allowed our junior EMT's , Paramedics, and Shift supervisors to design the new/refurbished Ambulances within a tight budget. Not only did the TEAM grow and unite, but the results were a state of the art fleet saving a 1/4 million dollars over 10 years.

I have found in my many years of collaborating with CHWs that healthcare providers and systems should be the ones asking CHWs to involve them in their decision-making and planning processes. Healthcare providers should be asking how they can be involved in the work already being done at the community level. We must avoid further oppression of communities that rely on CHWs to help them navigate the complex healthcare system by assuming the attitude that we (providers and healthcare systems) are the ones "allowing" CHWs into our owned world.

CHWs want autonomy in their practice. When people are informed of their independent expert work matters in the decision-making table, work motivation and morale increases. Organization need not to spend so much resources in advertising for engagement if they involve CHWs in the first place when planning and implementing initiatives.

Our CHWs drive, period. We discuss the opportunity/challenge at hand, sharing evidence through literature, Community or patient stories. Then, we discuss how best to address the need, what will and won’t work. It’s about collaboration, trust and respect for lived experiences and knowledge.

Premier Healthcare Strategies, LLC likes to identify the key stakeholders to ensure that collaboration streamlines the workflows to provide the best outcomes! In reality, we are all in this together!

We must include CHWs in any decisions about collaboration and communication. They must guide the approach based on their lived experience without their voice, representation, and perspective we have no assurance that selected methods will be culturally informed, relevant and meaningful. We must avoid enforcing strategies that are familiar or comfortable for the dominant culture only. We must also be mindful of how we use technology in collaboration and communication, keeping in mind that what makes CHWs effective in their approaches is that they, themselves ,are members of the communities served. This means that often times CHWs experience the very same barriers as those they represent.

Representation is obligatory. The best way to have approaches, strategies and even sensitivity adaptation is to have representation on the team, in leadership, in drafting and reviewing policies and procedures. Let’s move away from adaptation and move towards representation. *Beware of tokenism in the above move.

Respecting and valuing diversity and culture are not enough. Full inclusion and the relinquishing of power to allow CHWs to guide the work that must be done in their communities is what is needed. We need to avoid DEI platitudes and get healthcare to a place where power is truly and openly shared.

Working with CHWs, or Promotoras, as they are known in the Latino(x) community is a hot topic at the moment-everyone wants to utilize CHWs. I am concerned that healthcare systems and providers do not know enough about the history and work of CHWs and as a result will approach collaborations from a biomedical explanatory model and using paternalistic approaches that further injure communities. My expertise is in working with CHWs and I have seen many an attempt at collaboration fail because of the insistence of healthcare providers and systems to hold on to control and power in the relationship.

What is needed is payment reform that supports the utilization of CHWs. We also need to align CHWs with value based care as opposed to models that operate on a fee-for-service reimbursement scheme. I train CHWs, I supervise CHWs, and I leverage my CHWs in primary care delivery. Now we need a payment model that supports such a structure.