1. [Name] [Organization] [Date]
CHWS on Care Teams
Introduce yourself and your organization. If there are 20 participants or fewer, ask each participant to introduce themselves.
[Name]
[Organization]
[Date]

2. Objectives
Participants will define who Community Health Workers are and what they do.
Participants will be able to list at least 5 roles a CHW can play on a health care team.
Participants will identify at least 3 benefits of having a CHW on a health care team.
Explain the objectives and, if applicable, why this presentation is relevant to them (for example: the health organization just received funds to start a CHW program).

3. Who Are Community Health Workers (CHWs)?
“A frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.”
- American Public Health Association
Use the APHA definition to define ‘Community Health Workers’.

4. Other Titles Peer Educator/Peer Health Educator
Community Health Representative
Health Coach
Health Aide
Patient Navigator
Promotora de Salud
While ‘Community Health Worker’ is the most commonly accepted job title nationally, CHWs are still known by a variety of titles. Regardless of the title, what distinguishes a CHW is that they are part of the community they serve.
Modify this list to include any titles you have heard that are not included.

5. Who Do They Serve Any hard-to-reach population
A CHW’s ability to relate to the patients based on shared life experiences makes them well equipped to work with any vulnerable, under-served, and/or hard-to-reach community.
If there is a specific population that is particularly relevant to the audience, tailor this part of the presentation to include information on that population. For example, if there is a large Spanish-speaking population that the clinical team has struggled to reach, include information about successes CHW have had reaching this population.

6. What do CHWs do?
Cultural mediation among individuals, communities, and health and social systems
Provide culturally appropriate health education and information
Care coordination, case management, and system navigation
Provide coaching and social support
Advocate for individuals and communities
Build individual and community capacity
Provide direct services
Implement individual and community assessments
Conduct outreach
Participate in evaluation and research
The roles included on this slide fall within a CHW’s general scope of practice in any setting. CHWs are qualified to fill these roles because:
A CHW is both a skilled professional and a peer to the community they serve, putting them in a unique position to address the social determinants of health in any underserved community.
They are able to establish a trusting relationship with the community that might not otherwise be possible.
A CHW serves as a liaison between health center staff and members of the community so that both can work towards better health outcomes.
Source: Community Health Worker Core Consensus Project (2016). Understanding scope and competencies: A contemporary look at the United States community health worker field. Available at

7. Value of a CHW Improve access to care and health outcomes
Improve service delivery and quality of care
Reduce costs of care per patient
As both peers and professionals, CHWs bring a completely different skillset and knowledge base to bring to a health care team.
Their insight can be pivotal in understanding the most complex and challenging patients.
Working with a CHW, a team can develop new approaches to treat patients that are tailored to their specific situation and needs. Ultimately, this leads to improved access to care and health outcomes; improved service delivery and quality of care; and reduced costs of care per patient.

8. Improve Health Outcomes
6 studies of CHW interventions focused on cervical cancer reported: At least one positive outcome including the significant increase in the number of patients \ receiving a Pap smear and a larger change in the number of patients ever having a Pap smear At least 6 studies on CHW interventions on prevention and management of diabetes show: At least one significant positive outcome, including changes in HbA1c levels and improved self-reports of dietary changes A program for pediatric asthma patients demonstrated: Over the course of a year, emergency department visits related to asthma were reduced by 68% and hospitalizations decreased by 84.8%. Additionally, there were significant decreases in activity limitations, missed school days and parental missed work time.
Through health promotion, culturally-competent education, patient advocacy, and skilled case management, studies have connected CHWs to improving health outcomes for underserved populations.
The following studies show the results from some of these studies.
Source: Institute for Clinician and Economic Review. Community Health Workers: A review of program evolution, evidence of effectiveness and value, and status of workforce development in New England. The New England Comparative Effectiveness Advisory Council. Boston, Massachusetts: July, 2013

9. Improve Service Delivery and Quality of Care
Make the health care system more responsive to the needs by communicating information from the community to the health care providers and vice versa:
“[CHWs] teach me how to be a better doctor, to understand a patient’s whole context before constructing and communicating a care plan…they help me build a more meaningful relationship with even my toughest patients.”
-Dr. Behforouz
CHWs can communicate information from the community regarding barriers to service to health care providers, allowing providers to adapt their services, and thus improve service delivery and the quality of care.
If possible, include any local anecdotes or examples you know of.
Source: Behforouz, H. (2014). Bridging the Gap: A community health program saved lives, then closed its doors. Health Affairs. 33(11) doi: /hlthaff

10. Reduce Costs of Care per Patient
Denver Health: Return on Investment (ROI) of $2.28 in savings for each dollar spent due to decrease in urgent care and uncompensated costs. Annual savings were $95,941.
Arkansas Community Connector Program: Tracked Medicaid spending of patients and saw a 3 years savings of over 2.6 million, or $2.92 savings for each dollar spent.
Spectrum Health (Grand Rapids, MI): $2.53 savings for every $1 of cost for patients diagnosed with diabetes or heart failure.
CHW programs are often cost-effective because they allow a health care organization to utilize their resources more efficiently and reduce the use of unnecessary medical services.
The following studies on the return on investment of these kinds of program illustrate that, overtime, the programs can be very cost-effective.
Sources:
Whitley, E., Everhart, R & Wright, R. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor and Underserved, 17,
Felix, H., Mays, G., Stewart, M., Cottoms, M. & Olson, M. (2011). Medicaid savings resulted when community health workers matched those with needs to home and community care. Health Affairs, 30(7),
Michigan Community Health Worker Alliance. (2015). Community health workers & Michigan: Outcomes.

11. Case Study
If time is limited, this activity can be cut out.

12. Why a CHW on a Care Team? Community Organization Care Team Physician
Improve communication with patients
Improve effectiveness and efficiency of patient visits
Increase focus on medical issues
Improve clinical, financial, and/or quality measures
Achieve or maintain Patient-Centered Medical Home status
Improve the organization’s ‘brand’ or reputation
Improved population health
Increased community capacity
Develop higher impact interventions and care plans
Stronger team coordination
Including a CHW on a care team produces changes on multiple levels. Their work impacts each physician or clinician, the health care team, the health care organization, and the community in the ways listed on this slide.
Provide a brief description of each bullet point, but highlight any benefits that are particularly relevant to the audience. For example, if you know the health system has struggled to reach a certain performance measure, go into detail about that measure and how it relates to CHWs.

13. A CHW s Role on a Care Team‘
On a care team, CHWs are the experts in the patient’s environment and culture
CHWs should be treated as peers to other team members
CHWs do not have a clinical role on a team
CHW’s bring a unique expertise, skillset, and perspective to a care team.
They can provide the care team with invaluable insight into a client’s health behaviors that can help clinicians make the best possible treatment decisions.
They should be treated as peers for this expertise they bring to the team. However, CHWs do not play have a clinical role on a care team. They do not have the credentials to perform clinical work or make clinical decisions and it is not their role to do so.
Be sure to emphasize the expertise a CHW can bring to a team, while clarifying that they will not have a clinical role on a care team.

14. What IS and IS NOT a CHW S Role on a Care Team’
On a care team, a CHW DOES
On a care team, a CHW DOES NOT
Conduct outreach
Measure and monitor blood pressure
Assist with medication or treatment adherence
Facilitate goal setting with patients
Problem-solve obstacles to comply with a given treatment
Navigate healthcare and other social service systems
Provide health education
Provide patients and their family with social support
Assess how a self-management plan is progressing
Assist patients in obtaining home health services
Give patients medical advice
Do administrative work for the care team
Complete or participate in clinical procedures (unless specifically trained to do so)
Analyze clinical data
Make clinical decisions regarding a patient’s care or care plan
Provide formal counseling or therapy
Administer medications, wound care, or other interventions (unless specifically trained to do so)
With the appropriate training, CHWs are able provide any of the services listed on this slide.
There are some responsibilities that are not appropriate for a CHW to assume on a care team, which are listed on this slide as well.
The majority of any CHW’s work revolves around providing social and other supportive services.
Most CHWs do not receive clinical training, and therefore it is not as common for them to complete clinical procedures. However, some care teams do include the performance of some basic clinical procedures or interventions, such as taking vital signs during home visits, in the job description of the CHW.
Whether or not clinical procedures are part of a CHW’s job typically depends on the needs of the employer. If the CHW position will include the participation in clinical procedures, a CHW with the necessary credentials will be hired or the necessary training will be provided for them by their employer.

15. 2015 Clinical CHW Study Results
The most frequently reported CHW roles on care teams are:
Helping people gain access to medical services (86%)
Advocating for individual needs (86%)
Teaching people how to use health care and social services (78%)
Helping people manage chronic conditions (77%)
A CHW’s role on a care team may vary from one location to the next, but this recent study shows which roles CHWs most commonly filled in clinical settings across the country. None of these roles require a CHW to perform clinical work.
Use this slide to, again, emphasize how the peer relationship with the community a CHW has makes them well-equipped to fill these roles.
Source: Allen, C., Escoffery, C., Satsangi, A. & Brownstein, J.N. (2015). Strategies to improve the integration of community health workers into health care reams: “A little fish in a big pond”.Preventing Chronic Disease, 12, E124.

16. CHWs Role ‘ Primary Roles CHW Case/Care Manager Nurse
Cultural mediation among individuals, community, and health and social service systems X
Provide culturally appropriate health education and information
Care coordination, case management, and system navigation
Provide informal counseling and social support
Provide coaching and social support
Advocate for individuals and communities
Provide direct services and administer health screening tests (as appropriate)
Build individual and community capacity
Assist with medication or treatment adherence
Facilitate goal setting with patients
Problem-solve obstacles to comply with a given treatment
Provide outreach
Asses how a self-management plan is progressing
Assist patient in obtaining home health services
Role overlap can be confusing for care team members and create conflict and doubt regarding the CHW position.
While some of the roles a CHW could have overlap with a nurse or care/case manager, a CHW can bring assets to the team that would otherwise be unavailable.
Depending on the needs of the team and health care organization, the roles of each team member should be defined by their distinct skillsets and abilities.
A CHW will not be responsible for all of these job duties in one position.

17. CHW Education and Training
Majority of knowledge base does not come from formal training
Rely heavily on ‘soft-skills’
Qualified candidates demonstrate
A strong desire to and are passionate about serving the community
Strong interpersonal communication skills
An ability to gain respect and build rapport with community members
A strong sense of empathy
Creativity and resourcefulness
Natural leadership ability or potential
Responsive to the needs of others
Cultural competence
CHWs are unique from other health professionals because their level of formal training and education is not used as an indicator of success in the field.
CHWs rely more on their life experiences and other ‘soft skills’ that cannot be easily taught through formal education.
The best candidate for a CHW position may not have a high level of formal education for this reason.
The qualities listed on this slide are often as important, if not more, in determining the qualifications and future success of a CHW candidate.

18. CHW Education and Training
Some states require a CHW certification
Typical organizational training/orientation of 40 hours
Specialty training on health topics
All practicing CHWs in a clinical setting will be proficient in these core skill areas:
Communication
Interpersonal and relationship-building
Service coordination and navigation
Capacity building
Education and facilitation
Individual and community assessments
Outreach
Professional skills and conduct
Evaluation and research
Knowledge base (core principles of public health)
Although many of the skills that are central to the CHW profession are not reflected by formal education or certification, CHWs typically do receive some training to prepare them for their work.
Some states offer a CHWs certification to verify that they have completed a state-approved training course. These trainings are typically based on the core competencies established by the state or state CHW associations. 
If there are no certification requirements or guidelines for education or training set in place by the state, the state CHW association may offer recommendations or the employer can determine the level of training the CHW should receive, which is typically at least 40 hours.
If a CHW will need training or certification on a specific health topic or skill, the employer will typically provide this training as well.
Regardless of a CHW’s prior training or educational background, a clinician can expect a CHW to be proficient in the core skill areas listed on this slide.
Be sure to emphasize that although these are the standard competencies addressed in CHW training, many of the skills a CHW needs are ‘soft skills’ and will not come from formal education. It is also a good idea to do some research about your state’s certification requirements and modify this slide to include this information.

19. How do you believe a CHW could benefit your practice?
This discussion question can be cut out if there is not enough time.

20. Questions?
Leave about 3-5 minutes for questions at the end of the presentation.

21. Resources Clinical Promotora Job Description
Integrating Promotores(as) de Salud into Patient-Centered Medical Homes
9 Tips to Integrate Promotores(as) Into Health Center Care Teams
Guide to Integrating Community Health Workers into Health Disparity Initiatives
Brief Report: ROI Analysis of CHW Programs
If applicable, add other relevant resources.