On July 27, 2015, the National Office of State Offices of Rural Health (NOSORH) hosted the fifth webinar installment of the Rural Health Learning Collaborative, highlighting the importance of community health workers (CHW) in meeting the access needs of rural Americans. Sponsored by the Federal Office of Rural Health Policy (ORHP), the Collaborative is an educational initiative convening diverse stakeholders around the common goal of improving health care quality for America’s 61 million rural citizens.
The webinar featured six expert panelists from organizations working with CHWs – many of whom serve rural and frontier communities. The panel of researchers, program leaders and community health workers shared key findings, concerns and best practices related to the work of CHWs, while underlining the value of the CHW role within the larger health care system.
Susan Wilger, director of programs at the Southwest Center for Health Innovation and the National Center for Frontier Communities, began by noting that the scarcity of typical health care providers in rural areas means there is a greater need for CHWs to fill those gaps.
“CHWs have been instrumental in assuring that people are enrolled in insurance, helping with care transitions and supporting patient after-care,” Wilger said. “One of the advantages of using CHWs in rural and frontier communities is that you’re gaining geographic equity, which is important because we want to make sure our health care system isn’t congregated around urban centers.”
Wilger also mentioned that rural and frontier areas can require specialized interventions that only CHWs may be able to provide. She said that because rural populations are commonly older, poorer and more often uninsured, CHW services can be especially valuable when they are tailored to the needs of specific populations.
"Community Health Workers can work on a population-health basis, but they can also work one-to-one with individuals and families.”
Carl Rush, MRP, a lead author of the Project on Community Health Worker Policy and Practice at the University of Texas Institute for Health Policy, said, “CHWs can work on a population-health basis, but they can also work one-to-one with individuals and families.”
He added that the roles and skills of CHWs differ from those in clinical occupations. Traditionally, CHW work has operated separately from clinical care, but more CHWs are now being integrated into the clinical setting. Rush says this requires better policy infrastructure, including a stronger definition of CHW skill requirements. Rush mentioned the Core Consensus Project (C3), which aims to produce contemporary recommendations for CHW roles while endorsing identified qualities essential to their work.
Maia Ingram, deputy director of the Arizona Prevention Research Center at the University of Arizona, said that professional advancement is also a key concern among CHWs. She cited a recent survey indicating that while CHWs care about professional development, only 20 percent of participants said they were aware of opportunities for better pay in their current workplace.
Other noted challenges included the need for better integration of geographically isolated care teams, transportation solutions, increased access to training, more effective supervision, improved ability to evaluate effectiveness, more access to peer support and other issues related to matching skills with community needs. A chief concern moving forward is helping CHWs maintain their unique roles as they increasingly transition into the clinical setting.
Each panelist concluded with recommendations for a more effective CHW workforce. Suggestions included establishing stronger local capacity among geographically remote CHWs and empowering CHWs to better advocate for their communities and their profession.