#1 New Course
Chapter 1:
The Role of CHWs
Chapter 2:
The Evolution of the CHW Field in the United States: The Shoulders We Stand On
Unit Lesson
Community health workers (CHWs) are special people. They have to be special people to succeed in the role they fill for their communities each day. The work of a CHW takes determination, patience, extensive knowledge, specialized skills, and above all else, the ability to work with people. Human skills are absolutely essential for a community health worker. Many CHW clients are going through very stressful circumstances in their lives. They may not be at their best in terms of cooperating and following through on guidance from healthcare professionals. The CHW knows that, and makes the most of the situation anyway. There are wins and losses in community health. Nobody bats 1000, but we keep trying anyway.
It all starts with making a connection first, building a relationship of trust and mutual respect with the client so that good things can happen. Not everyone is capable of achieving that kind of relationship. Not everyone is well suited for work in community health. But perhaps you are, and you will certainly have a better understanding of that by the time you complete this course.
Some readers of this lecture will become community health workers, practicing in any one of the diverse settings, which we will describe in this course. Other readers will function as administrators or health commissioners, managing health departments or medical facilities which employ CHWs. In either case, practicing or managing, you need a solid understanding of the CHW role. UNIT I STUDY GUIDE Community Health Workers
The CHW Role UNIT x STUDY GUIDE Title
CHWs are experts at connecting community members with health and human services. They have special knowledge and special skills in cultural competence. They have a rapport with the community and are respected within that community for their resourcefulness. Also, they are committed to living in, and serving, their communities for the long haul. In some medical professions we often see “job hopping” in which caregivers move from hospital to hospital, community to community every few years, perhaps looking for better pay or a bigger career opportunity. But that is typically not the case with CHWs. They serve a particular community, their community, and many CHWs are in their positions for their entire career. That creates a special relationship between the CHW and the community. Additionally, many CHWs are bilingual, and one can easily see why that aspect is so valuable in their work today. They speak the language of their community, and the language is not necessarily English.
CHWs practice in both urban and rural settings, wherever the need exists. They generally share ethnicity, language, and life experiences with their clients. That is part of what makes a CHW successful, different from the typical physician-patient relationship. CHWs are seen as part of the community, working to help others in the community.
CHWs often interpret and translate health information for clients, explaining things in a way which the physician is unable to do, or perhaps is unwilling to spend the necessary time to do. CHWs provide counseling and guidance on health behaviors, things that the client can do to help himself or herself to recover from illness and to stay well for the future.
Direct medical services provided by CHWs are limited, however, they are typically trained to do at least vital signs, blood pressure checks, finger-stick blood sugar checks and a few other basic health services, depending upon the need and the specific setting.
What is in a Title?
Community Health Workers are identified by many different titles in different parts of our nation, and in different parts of the world. In the Hispanic community, they are often called “Promotoras,” those who teach about health and promote health. In some areas CHWs are called Outreach Educators, or Community Health Educators, or Community Health Representatives. Some health departments designate them as Peer Health Promoters, or Peer Health Educators. You will find CHWs working under all of those titles.
What Do They Actually Do?
The Community Health Worker National Workforce Study estimates that there are 86,000 CHWs in the United States. Some of the most common health areas in which CHWs practice are (HRSA, 2007):
· ( Women's Health and Nutrition (46 and 48 percent of CHWs, respectively)
· ( Child Health and Pregnancy/Prenatal care (41 percent of CHWs)
· ( Immunizations (37 percent of CHWs)
· ( Sexual Behavior (34 percent of CHWs)
· ( HIV/AIDS (39 percent of CHWs)
· ( Diabetes (38 percent of CHWs)
· ( High Blood Pressure (31 percent of CHWs)
· ( Cancer (27 percent of CHWs)
· ( Cardiovascular Diseases (26 percent of CHWs)
The actual work of CHWs is very diverse, but it all falls under the scope of culturally appropriate health promotion and health education. In fact, 82 percent of CHWs accept that description of their role. (HRSA, 2007)
Other areas in which CHWs work include:
· ( Assisting clients in accessing medical services (72 percent of CHWs)
· ( Translating/interpreting medical information (36 percent of CHWs)
· ( Counseling clients (31 percent of CHWs)
· ( Mentoring clients (21 percent of CHWs)
· ( Social support (46 percent of CHWs) CHE 6301, Foundations and Methods in Community Health 2
· ( Transportation of clients (36 percent of CHWs). UNIT x STUDY GUIDE
· ( Risk identification (41 percent of CHWs)
· ( Patient navigation (18 percent of CHWs)
· ( Direct services such as blood pressure screening (37 percent of CHWs).
Above all else, CHWs work to create more effective linkages between their communities and the health care delivery system. CHWs play important roles in nations around the world, but they are so essential in America because of the extreme complexity of our health care system, and the extraordinarily high cost of care (approximately double the cost of any other developed nation). It has been said that America’s healthcare system is actually a “nonsystem.” CHWs help to make some sense of healthcare for their clients, functioning as traffic cops, steering clients in the right directions.
CHWs are active in providing health education and health information for clients, advocating for underserved individuals in both urban and rural settings to receive appropriate services. They also provide counseling and assistance with basic healthcare needs. And CHWs do something bigger than just working with individual clients, they work to build community capacity for addressing unmet healthcare needs. Across our nation, many new medical services and even new facilities have come to exist specifically because CHWs in the community identified an unmet need, spoke up, and then worked through appropriate channels to see the need addressed.
Conclusion
During this course you will learn a great deal about community health workers and you will come to have high regard for them, and for the work they do in their communities. Hospitals, medical technology, doctors, nurses are all important for the health of a community of course, but without CHWs many clients would never even get access to those things. This is an important point to consider as you begin this course.
Reference
Community health worker national workforce study. (2007, March). U.S. Department of Health and Human Services. Retrieved from http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf