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Additional Implementation Considerations for Community Health Worker Programs

Specific implementation considerations for rural CHW programs include partnerships, policy approaches, and technology. For information on common implementation considerations for rural health programs, see Implementation Considerations in the Rural Community Health Toolkit.

Partnerships

Many existing CHW programs have established partnerships with other community organizations and consider these relationships to be important to success. These partners may serve as funders for rural CHW programs and provide guidance for the program.

Potential partners for CHW programs include:

  • Public health organizations
  • Universities and colleges
  • Health and dental plans
  • Foundations
  • Government organizations
  • Community service organizations
  • Volunteer groups
  • Multicultural alliances and associations
  • Local hospitals or clinics
  • State and local health departments
  • Faith-based organizations

CHWs that work with partners such as hospitals to deliver services to patients must be properly introduced to staff at the partner organization to clarify their roles. This ensures other health workers, such as nurses or social workers, do not perceive CHWs as a threat to their duties and understand the unique value and contributions of CHWs.

Policy Approaches

In some instances, policy changes may be necessary to increase CHW involvement. Potential policy options may address CHWs' provision of services, involvement in care delivery teams, implementation of certification or training, and defining scope of practice. The National Academy for State Health Policy’s State Community Health Worker Models webpage tracks CHW legislation at the state level. For additional policy considerations related to sustainability, see Module 6.

Technology

Technology is increasingly important to support CHWs, especially in certain models like the Care Coordinator/Manager Model. Technology can improve care coordination by helping CHWs identify and track referrals and next steps for clients and by supporting information-sharing with other providers and services. For more information on care coordination and the use of health information technology, see the Rural Care Coordination Toolkit.

CHWs should receive training for any technology that they are required to use. This may include videoconferencing technology for check-ins with supervisors or trainings, scheduling applications or email for interactions with other team members or clients, or electronic health records or mobile applications for documentation. One program in rural Montana was able to engage CHWs in leveraging technology during home visits to connect patients with other members of the care team.

Resources to Learn More

Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services
Document
Helps CHW programs assess their functionality and improve their performance. Provides a core of 15 components critical for developing effective programs and includes a guided self-assessment tool to assist organizations in identifying their program strengths and weaknesses. Offers a process to build consensus and a commitment to change.
Author(s): Crigler, L., Hill, K., & Bjerregaard, D.
Organization(s): USAID from the American People
Date: 9/2013

Community Health Workers in Health Care for the Homeless: A Guide for Administrators
Document
Demonstrates to health program administrators how the CHW model of providing basic health services can be integrated into homeless communities.
Author(s): Valesky, K.
Organization(s): National Health Care Council for the Homeless
Date: 6/2011

Incorporating Community Health Workers into State Health Care Systems: Options for Policymakers
Document
Identifies several state CHW programs, their key funding and the services they provide in their states. Discusses policy options and state legislation related to the implementation of CHW programs.
Author(s): Blackman, K. &Scotti, S.
Organization(s): National Conference of State Legislators
Date: 8/2015

Promising Approaches to Integrating Community Health Workers into Health Systems: Four Case Studies
Document
Describes the challenges and opportunities for integrating CHWs into health systems by highlighting four case studies in Texas, Minnesota, North Carolina, and Ohio.
Organization(s): Urban Institute
Date: 3/2014

Start to Finish: Your Toolkit to Plan and Run a Heart Health Program
Website
Supports the implementation of a CHW program to improve heart health.
Organization(s): National Heart, Lung, and Blood Institute

States Implementing Community Health Worker Strategies
Document
Presents a technical assistance guide compiled from interviews with nine organizations who successfully integrated CHWs into their healthcare teams. Offers insights and recommendations for states that are implementing CHW programs.
Organization(s): Centers for Disease Control and Prevention
Date: 12/2014

National Rural Health Association Policy Brief: Community Health Workers: Recommendations for Bridging Healthcare Gaps in Rural America
Document
Reviews the literature relevant to the development of CHW programs in rural areas. Analyzes relevant policies at the state and national levels, discusses the challenges of implementing CHW programs, and offers recommendations for developing programs in rural areas.
Organization(s): National Rural Health Association
Date: 2/2017