Outreach and Enrollment Agent Model
The outreach and enrollment agent model is similar to the screening and health education model, with additional
outreach and enrollment responsibilities. In this model, community health workers (CHWs) conduct intensive home
- 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
As outreach and enrollment agents, CHWs also help individuals to enroll in programs that provide healthcare and
social services. CHWs that serve in an outreach capacity typically receive specialized training. CHWs may assist
people who are eligible for programs but experience barriers to enrolling.
Through outreach efforts, such as home visits,
CHWs can work with patients to identify issues such as social isolation and loneliness. These are critical
public health challenges discussed in National Academies of Sciences, Engineering, and Medicine 2020 report, Social
Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The report notes the
need for education and training of the health care workforce, including CHWs, and for CHWs to work with other
health professionals to address social isolation and loneliness among older adults.
The Community Preventive Services Task Force (CPSTF) recommends interventions that engage CHWs for
disease prevention and diabetes prevention and management. The evidence reviewed by the CPSTF included interventions that engaged CHWs
as outreach and enrollment agents.
Examples of Rural Outreach and Enrollment Agent Models
The ASPIN Network: Community Health Worker
Program provided training to CHWs and certified health insurance enrollment navigators to increase
access to health insurance enrollment in rural Indiana.
The Prevention through Care Navigation
Outreach Program, implemented by the Tri-County Health Network, utilized CHWs to reduce diabetes and
cardiovascular disease prevalence. The CHWs conduct outreach by meeting community members where they are:
homes, libraries, churches, human services offices, and other settings. They also provide screenings,
referrals, education, and peer support.
As outreach and enrollment agents, CHWs may visit hard-to-reach populations in their homes. CHW programs
implementing components of this model 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
Intervening in cases of social isolation and loneliness in older adults
Providing culturally competent outreach
Program Clearinghouse Examples
Resources to Learn More
the Connection: The Role of Community Health Workers in Health Homes
Describes the health home option for coordinating comprehensive care across all healthcare settings. Highlights
the potential roles in which CHWs can help health homes improve patient outcomes and reduce cost.
Author(s): Deborah Zahn, Sergio Matos, Sally Findley, et al.
Organization(s): Health Management Associates, Inc., NYS Health Foundation