Outreach Agent Model
The outreach agent model is similar to the screening and health education model, with additional outreach responsibilities. In this model, community health workers (CHWs) may:
- Deliver psychosocial support
- Engage individuals and families in healthcare and supportive services
- Improve maternal, infant, and child health
- Provide education
- Conduct environmental health and home assessments
- Offer one-on-one advice
- Provide navigation services
- Make referrals
- Support access to telehealth equipment and appointments
- Help community members enroll in health and social services
Through outreach efforts, such as home visits, CHWs can work with patients to identify issues such as health problems, health-related social needs, social isolation, and loneliness.
Examples of Rural Outreach Agent Models
- The ASPIN Network: Community Health Worker Program provided training to CHWs for health insurance enrollment navigation to help address services gaps in behavioral health and primary care in rural Indiana.
- KanAWARE is a school-based behavioral health program that integrates CHWs who work to meet the needs of students and their families. CHWs provide clinical services, prevention services, and engagement and family support. The program also utilizes telehealth to deliver telebehavioral healthcare in rural communities.
- The Mobile Integrated Healthcare Network (MIHN) is an outreach program in rural Missouri through which community paramedics and CHWs conduct home visits to patients with chronic illnesses and challenges with access to care. During home visits, CHWs facilitate telehealth visits, conduct assessments, and provide enrollment, navigation, and care coordination, among other services.
- The Rural Libraries and Health Cooperative Agreement program seeks to increase access to healthcare and social services via library systems in rural South Carolina. Participating libraries have utilized CHWs and social workers to address health and social needs of community members. CHWs have helped connect residents to social services, resources, screening, and healthcare providers.
- ROAMS (Rural OB Access & Maternal Service) is a program in rural northwestern New Mexico that utilizes CHWs who work as family navigators to connect patients to healthcare benefits and programs, lactation services, and telehealth services.
Implementation Considerations
Effective outreach involves understanding the needs and preferences of the community served. CHW programs should tailor outreach strategies, so they are suitable to the community and feasible to implement. Examples of effective outreach strategies include:
- Home visits
- Local events, such as health fairs or markets
- Webinars
- Workshops
CHW programs that are conducting home visits should consider the following:
- Acquiring liability insurance prior to employing CHWs
- Encouraging CHWs to be aware of their surroundings, for example, instructing CHWs to discontinue a home visit if they feel uneasy
- Educating CHWs on eligibility requirements for relevant state and federal programs
- Hiring bilingual CHWs to facilitate communication between non-English speaking patients and agencies or providers
- Intervening in cases of social isolation and loneliness in older adults