Member of Care Delivery Team Model
In this model, community health workers (CHWs) may collaborate with or work alongside medical professionals. They may work in a variety of settings, such as a federal qualified health center (FQHC), rural health center, primary care office, healthcare clinic, or pharmacy. The CHW works to increase access to healthcare services, deliver services, and improve disease management.
When collaborating with medical professionals, CHWs may render health services such as:
- Measure blood pressure and pulse
- First aid care
- Medication counseling
- Health screenings
- Other basic services
Other programs may adopt a more holistic approach or a medical home model. CHWs may work alongside a team comprised of a physician, nurse or allied health worker, or assistant to deliver health education or screening services while the medical provider conducts a medical exam.
CHWs may also be medically trained as a registered nurse or phlebotomist prior to CHW training. These CHWs often work with medical providers in a mobile clinic setting and may provide education, screening, referrals, or follow-up services.
The Community Preventive Services Task Force
recommends interventions that engage CHWs to prevent cardiovascular disease. Specifically, the CPSTF finds
strong evidence of effectiveness for interventions that engage community health workers in a team-based care
model to improve blood pressure and cholesterol.
Examples of Member of Care Delivery Team Models
- Community Connections program of the Northeast Vermont Regional Hospital (NVRH) integrates CHWs as part of a diverse team of healthcare professionals, including physicians, nurses, behavioral health specialists, chronic care coordinators, and dietitians. The CHWs provide services that align with other CHW models, including meeting with patients, linking them to services, and enrolling them in insurance.
- Hidalgo Medical Services – Family Support Program uses Provider-Integrated Care Team Coordinators (CHWs) to work with clients who have or who are at risk for developing diabetes.
- In the Prevention through Care Navigation Outreach Program, CHWs provide biometric screenings, assess and refer clients to services, and provide peer support to increase coordinated care in rural Colorado.
When seeking to integrate CHWs into healthcare teams, it is essential to create a clear plan and delineate the specific role of the CHW and how their role relates to the other members of the care team. Other implementation considerations for this model are described below.
Programs may experience barriers integrating CHWs into the care delivery team. Some providers may be less willing to work with CHWs, particularly if they do not recognize the value of CHWs to the care delivery team. Further, CHWs must be sure to maintain their ties with the communities they serve. Successful integration relies on communication and collaboration, and potential co-location CHWs and members of the care delivery team at work settings.
A major consideration for implementing this model is identifying a funding source. Funding for incorporation of CHWs into care-based teams can come from grants, but increasingly, states are implementing reimbursement for CHWs in medical settings. In some states, reimbursement for CHW services is provided by Medicaid programs. In other states, public health plans have begun reimbursing for CHW services and or using teams of in-house CHWs. Healthcare providers may also develop other internal financing strategies to support CHWs.
CHWs rendering limited direct health services raises questions about
consequences of mistakes or negligence. In some states, including Virginia, there is a
statute addressing civil liability issues for CHWs. For example, people voluntarily performing certain types of
care in good faith are immune from civil liability for acts or omissions resulting from that care. However, if a
volunteer or paid CHW is negligent, the community health organization or employer may be liable.
Most CHW programs recognize these liability issues but few have formal policies. Programs should explore whether their state has relevant laws to understand the broader context of their activities. Programs should also assess liabilities, including:
- Do CHWs drive their own vehicles to appointments and/or transport patients in their vehicles?
- Is the employer responsible for a CHW who is injured on the job?
- Does the employer's liability change if the CHW is a paid versus volunteer employee?
Organizations hiring CHWs may consider acquiring malpractice insurance and should educate CHWs about their scope of practice and responsibilities.
Resource to Learn More
Practice Guidelines for Implementing and Evaluating Community Health Worker Programs in Health Care
Guidance document that presents guidelines and information to support the effective implementation of CHW programs within healthcare settings. Includes information on hiring, training, supervision, integration into healthcare systems, and program evaluation.
Author(s): Gutierrez Kapheim, M. and Campbell, J.
Organization(s): Sinai Urban Health Institute
Bringing Community Health Workers into the
Mainstream of U.S. Health Care
Discussion paper that focuses on the current state of integrating CHWs into the health care workforce including promising CHW programs, evidence of CHW effectiveness, and obstacles to and recommendations for integration.
Author(s): Pittman, M., Sunderland, A., Broderick, A., and Barnett, K.
Organization(s): Health and Medicine Division (HMD), National Academies of Sciences, Engineering, and Medicine
Aide Program 2007 Overview
Provides a detailed overview of Community Health Aide Program (CHAP) including history, current practice, training, field supervision and quality assurance of this program facilitating healthcare services in remote Alaskan villages.
Author(s): Gage, S.
Organization(s): Alaska Association of Community Health Aide Program Directors
Community Health Workers: Expanding the Scope of the
Health Care Delivery System
Provides an overview of CHWs including workforce, impact, relevant legislative action, and policy considerations.
Organization(s): National Conference of State Legislatures (NCSL)
Community Health Representative Program
Provides outreach healthcare services and health promotion/disease prevention services to American Indians and Alaska Natives within their communities.
Organization(s): Indian Health Service
Focus: Integrating Community Health Workers into Care Teams
This newsletter describes health care organizations that have integrated CHWs into multidisciplinary teams.
Author(s): Hostetter, M. and Klein, S.
Organization(s): The Commonwealth Fund
Integrating Community Health
Workers on Clinical Care Teams and in the Community
A best practice guide for integrating CHWs on clinical care teams in order to increase patient knowledge and adherence in multiple settings.
Organization(s): Centers for Disease Control and Prevention
How CHWs Help Dental Providers
Describes the contributions CHWs can offer for improving dental health disparities.
Organization(s): Minnesota Community Health Worker Alliance