The Value of Partnering with Community Health Workers

Community health workers (CHWs) provide a wide range of services and advocacy that help increase access to healthcare and promote health and well-being. We spoke to MHP Salud’s Venita Perales, CHW, and Amy Moncion, LCSW and community liaison director, about how partnering with CHWs can help clinicians improve patient outcomes. 

–EDITORS

EDITORS: Why did you become a community health worker?

VENITA PERALES: I’ve had the title “community health worker” (CHW) for about six years, but I was doing this work long before I knew the term. After college, I was a home aide and helped clients with their daily needs, whether it was getting their medications, arranging transportation to doctors’ appointments, or helping them enroll in Medicaid. Later, as a registered medical assistant in a cancer clinic, I helped patients who couldn’t do much independently and often had no one to bring them a bag of groceries or a hot meal. Then I worked with Texas home- and community-based service programs helping elderly clients, children, people with disabilities, and families who needed support caring for their loved ones with special needs. Whether it’s sitting down with them to make an appointment or find assistance or resources, I’ve always wanted to help and make sure my community is taken care of. Now I bring it all together by helping my community access health insurance, find healthcare and services, and connect to resources and support for basic needs.

AMY MONCION: I’ve been a practicing clinical social worker for nearly 17 years, but I started working as a health educator with the University of Central Florida 20 years ago—and back then, “community health worker” wasn’t a well-known term. I didn’t know I’d been a CHW all along until being introduced to the work of MHP Salud. Now I support CHWs and help expand the profession across Florida through MHP Salud’s CHW training program, and it’s one of the most fulfilling roles of my career.

As an individual who identifies as Hispanic/Latina, I really appreciate MHP Salud’s legacy of supporting Latino communities. But more than that, we are doing true preventive work and impacting community health from the inside out, which is far more impactful than playing a reactive role in addressing the concerns of underrepresented and underserved communities.

I feel pride in this work because I really do believe CHWs at their core change the communities they live in. I spent a long time in the child welfare space, an environment where you don’t always get to see big outcomes. But I’ve really gotten to see the massive impact of the CHW model.

EDITORS: Why are community health workers so essential?

VENITA: Many times, clinicians don’t have time to sit down and give patients all their options—where they can go for services or who can help them complete applications they’ve never seen before—or even to sit down with them and ask, “How are you today? What do you need and how can I help you?,” and really listen to the answer. That’s what a CHW does. We follow up to make sure patients understand those long lists of medications they were prescribed and why they need to take them. We also help clients who have been incapacitated after a serious illness. Life changes so quickly, and many times people don’t know who to turn to for help or to get questions about their new reality answered.

CHWs coordinate with clinicians to get answers to questions like “Do any of my medicines interact with those that another doctor prescribed? Does my pharmacy carry them? Does my insurance cover them as written, or do I need to get generics?” If patients are prescribed something they can’t afford or that their insurance doesn’t cover, many will just go without—and it may be weeks or months before the clinician discovers it at their next appointment.

Another issue is that some patients are discharged from the hospital with equipment they don’t fully understand how to use, or they need follow-up care and resources that they don’t know how to get. Without help, they often end up right back in the emergency room. CHWs bridge these gaps to get patients what they need.

What really sets CHWs apart as well is that we share and deeply understand the culture and language of those we serve. Imagine trying to understand a new diagnosis when you don’t speak the same language as your doctor. We are instrumental in providing culturally competent care and support to our communities.

AMY: Charge nurses and discharge planners would love to sit and go line by line through the care plan with each patient, but they don’t have much time. The CHW can directly intervene in patient care to find solutions as new issues arise. That frees up nurses to continue doing their day-to-day activities.

VENITA: I recently helped a gentleman who was unhoused and had no place to go after being discharged following a foot amputation. I told him, “We’ll figure it out.” We filled out his Medicaid and Supplemental Nutrition Assistance Program application together, and then I helped him find a program that would give him a place to stay.

CHWs are passionate about their communities, and they’ve experienced some of the same issues they’re helping with. I had a family who needed to get a loved one into hospice but didn’t know how to do it or what to expect. I shared that I went through a similar situation with my dad. Sharing those experiences creates connection and trust. We know what it’s like to navigate the healthcare system to get services—or to choose between healthcare and keeping the lights on or the rent paid. We come alongside clients, connect them to nearby resources, and empower them to advocate for themselves. People don’t want someone to come in and talk down to them, telling them what they need to do. They want someone to see them as a person who may be hurting and who needs help and to take the time to help them figure out the next steps.

EDITORS: How do CHWs facilitate change in their communities?

AMY: Community-based organizations and large healthcare facilities across Florida are starting to see what can happen when you let the community lead. Our CHW trainees go into their communities to obtain feedback and assess needs, and they use this information to inform change. We also partner with other CHW organizations to share resources and best practices. In truly listening to their communities, CHWs have developed resources to address summertime food insecurity for youth and embedded healthy nutrition and eating practices education for children, including family outreach, to reinforce healthy practices and lifestyle changes at home. Some CHWs also identified a need for additional support for unhoused individuals and families and worked with a local organization that has since expanded support services to four sites across Central Florida. These sites provide lockers, mobile showers, and hygiene areas so unhoused individuals have dignity and a safe place for their belongings.

CHW trainees in one very rural area identified that several of their diabetic patients weren’t taking their insulin because they didn’t have access to cooling lockers, so trainees rallied organizations to donate lockers to the community. In another area, CHWs working with clients who had mobility issues learned their clients didn’t have the right shoes to complete their occupational or physical therapy without pain. The trainees had therapeutic shoes donated to meet that need.

That’s what CHWs do: they figure out how to eliminate barriers to care. No challenge is too big or too small. CHWs are always looking for opportunities to improve their clients’ health outcomes.

EDITORS: What are some of the challenges of this work?

VENITA: There are not enough CHWs being hired. There are plenty of people who want to become CHWs, and still more who are already unofficially doing this work or who are certified but are not working as CHWs because funding is not available to employ them. The irony is that the return on investment for CHWs, both in client health outcomes and in the organizational bottom line, is indisputable—and far outweighs the investment in the CHW workforce.

There is such a passion among CHWs that many even serve as volunteers, so they work when they can. But the need is overwhelming. My phone doesn’t stop ringing—I have to remind myself to stop answering in the evenings or on weekends because I’m off the clock and I have a family to take care of, too. If there were more CHWs, I could trust that even though my workday is over, others will step in to take care of our community. I can’t stand the thought that if I don’t pick up, someone who needs help might not get it.

AMY: There’s a great need for funding so more facilities can bring on CHWs, and we also need funding for more programs like ours that can strengthen the CHW workforce. Our training program is primarily funded through a Health Resources and Services Administration grant, and over the last two years we’ve had 175 individuals receive CHW training. About 86 percent have completed on-the-job training to go with their related classroom-based instruction, and 92 percent have been eligible for state certification. We have successfully certified 64 individuals, and our first-time passing rate is about 80 percent.

We also utilize a peer mentor coaching model to assist trainees through the program from start to finish. With this model, we’re not just preparing them; we’re also modeling how to be a CHW, how to be flexible in changing situations, and how to advocate for themselves and their clients.

VENITA: Having worked in healthcare administration, I know how necessary this work is—and it’s imperative that we continue to educate and advocate for increased funding to support this workforce. The payoff is immediate: if facilities hired more CHWs, more patients could be taken care of and fewer clinicians would be overburdened.

AMY: If we invest in the people who have the community’s trust, we have a great opportunity to not only elevate the CHW profession but also create partnerships that drive better health outcomes. At the end of the day, if we can connect CHWs to more clinicians and facilities, the sky’s the limit.

[Photos by RGV Photo + Video, Courtesy of MHP Salud]