Perceptions of organizational readiness for training and implementation of clinic-based community health workers

Community Health Work and Social Work Collaboration: Integration in Health Care and Public Health Settings: A Conceptual Framework

Community health worker (CHW) and social worker (SW) collaboration is crucial to illness prevention and intervention, yet systems often engage the 2 workforces in silos and miss opportunities for cross-sector alignment. In 2021, a national workgroup of over 2 dozen CHWs, SWs, and public health experts convened to improve CHW/SW collaboration and integration across the United States. The workgroup developed a conceptual framework that describes structural, systemic, and organizational factors that influence CHW/SW collaboration. Best practices include standardized training, delineated roles and scopes of practice, clear workflows, regular communication, a shared system for documentation, and ongoing support or supervision.

Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce

BACKGROUND

Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV.

SETTING

Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi.

METHODS

Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders.

RESULTS

Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility.

CONCLUSION

Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.

Workforce Readiness Training: A Comprehensive Training Model That Equips Community Health Workers to Work at the Top of Their Practice and Profession

Background: Recent reports have recognized that only 20 percent of health outcomes are attributed to clinical care. Environmental conditions, behaviors, and social determinants of health account for 80 percent of overall health outcomes. With shortages of clinical providers stressing an already burdened healthcare system, Community Health Workers (CHWs) can bridge healthcare gaps by addressing these nonmedical factors influencing health. This paper details how a comprehensive training model equips CHWs for workforce readiness so they can perform at the top of their practice and profession and deliver well-coordinated client/patient-centered care.

Methods: Literature reviews and studies revealed that training CHWs alone is not sufficient for successful workforce readiness, rather CHW integration within the workforce is needed. Consequently, this comprehensive training model is developed for CHWs with varying skill levels and work settings, and supervisors to support organizational readiness and CHW integration efforts. A systematic training program development approach along with detailed implementation methods are presented. Continuing education sessions to support CHW practice and Organizational Readiness Training for supervisors, leadership and team members directly engaged with CHWs in the workplace are also discussed. CHWs were involved in all phases of the research, development, implementation, and actively serve in evaluations and curriculum review committees.

Results: Components of the comprehensive training model are presented with an emphasis on the core CHW training. Two CHW training tracks are offered using three delivery modalities. Process measures with student learning objectives, outcome measures developed using the Kirkpatrick model to capture attitude, perceptions, knowledge acquisition, confidence, behavior, and overall experience, and impact stories by two CHWs are presented. Lessons learned from the implementation of the training program are discussed in three categories: Practice-driven curricula, student-centered training implementation, and adaptations in response to COVID-19 pandemic.

Conclusion: This comprehensive training model recognizes that training CHWs in a robust training program is key as the demand for well-rounded CHWs increases. Furthermore, a comprehensive training program must include training for supervisors, leadership, and team members working directly with CHWs. Such efforts strengthen the CHW practice and profession to support the delivery of well-coordinated and holistic client/patient-centered care.