Success of community health programs hinges on thoughtful design

Community health workers (CHW) can play an invaluable role in keeping patients out of the hospital and at work or school, as long as programs are well-designed, according to an article from Kaiser Health News.

"A lot of people think… they can sort of make it up as they go along, but the reality is that it is really hard," said Shreya Kangovi, M.D., assistant professor of medicine at the University of Pennsylvania and director of the Penn Center for Community Health Workers. To succeed, community health programs must do the following, she said:

  • Hire the right people, who are not necessarily medical professionals, but who share the patients' community and language and are empathetic listeners.
  • Focus on health and wellness broadly rather than just certain diseases.
  • Operate in conjunction with the medical system.
  • Follow the best scientific evidence.

At Los Angeles County-USC Medical Center, the county's biggest and busiest public hospital, for example, the CHWs who work with about 150 patients are considered part of the medical team. The patients are selected based on their illnesses, how often they end up in the hospital and whether doctors believe they would benefit, according to the article. But the CHWs help address these problems in the context of social issues, mental health, substance abuse problems and other chronic diseases.

The key ingredients that allow these workers access to the big picture of patients' health are time and trust, noted Janina Morrison, M.D., a physician at the hospital clinic. "There are all these mysteries of my patients' lives that I know are getting in the way of taking care of their chronic medical problems. I either don't have time to get to the bottom of it or they are never going to really feel that comfortable talking to me about it."

This theme is also evident when CHWs are working with school-age children, according to an article from MLive. At the School Health Advocacy Program in Michigan, for example, community workers team up with school nurses and the students' parents to help meet various needs of children suffering from autism, seizures, diabetes, food allergies and other problems that could otherwise compromise their education and long-term productivity.

"Because children and families trust us, we are able to identify a variety of medical, dental and mental health concerns and assist with appropriate triage to services not available in the school," Stephanie Painter, director of the program for Grand Rapids Public Schools, told the newspaper.

To learn more:
- read the KHN article
- see the story from MLive