Supporting the Community Health Worker Workforce

Rural programs should implement strategies to ensure adequate support for community health workers (CHWs). Strategies for supporting CHWs include defining roles and competencies, supervision, and mentoring.

Defining CHW Roles and Competencies

Supporting CHWs in rural programs involves clearly defining their roles and competencies. The National Council on CHW Core Consensus Standards (National C3 Council) defines the core roles and competencies CHWs should possess to do their jobs well.

• CHW Roles: A CHW's scope of work can be wide-ranging. Rural programs should establish a scope of work that clearly defines a CHW's roles and responsibilities. Depending on the program, a CHW may have a narrower scope of work that specifically aligns with program goals and addresses community needs.
• CHW Competencies: Competencies are the personal qualities and skills that enable a CHW to complete their scope of work effectively. Some important CHW competencies include communication, relationship building, and outreach.

In addition to clearly defining a CHW's roles and competencies, it is important to ensure other staff are educated about a CHW's scope of work. Program and organization staff who should be aware of and understand a CHW's role include leadership, administrators, program managers, supervisors, and other program staff. CHWs most often work as part of a team, so helping others to understand who CHWs are and what they do within the organization promotes support for, minimizes confusion about, and ensures the effectiveness of CHWs.

For more information about CHW roles, see Roles of Community Health Workers in this toolkit.

Supervision

Ongoing, supportive supervision is a best practice for CHW programs. Supportive supervision involves open communication, constructive feedback, and mutual trust. The role of a supervisor is to be regularly available, use supportive approaches, prioritize safety, and offer monitoring and coaching to CHWs. Supervisors that use supportive strategies can improve CHW motivation and engagement.

Programs should identify an individual who can be responsible for supervising CHWs. This can be someone with a social work or public health background, a healthcare provider, an experienced CHW, or another individual. Supervisors should receive training to ensure they can effectively support CHWs. Supervisor training may include topics such as the history of CHWs, communication, and supervision strategies. It is also important that a supervisor fully understand the CHW's scope of work within the organization. Supervisors must have sufficient time to dedicate to CHW supervision. Having a supportive manager for the supervisor can help ensure that the supervisor's workload can accommodate their duties for supervising and mentoring CHWs.

Supervision can consist of one-on-one and group supervision. Group supervision provides an opportunity for CHWs to support and learn from each other, while one-on-one supervision allows the CHW to discuss topics in a private environment. In rural areas, it may be necessary to conduct supervision meetings via phone or video conference. Prior to conducting remote meetings, the supervisor should ensure that both they and the CHWs can connect to and are comfortable with the technology required for remote supervision.

It can be beneficial to schedule regular supervision meetings with CHWs to:

• Discuss activities and workload
• Conduct team-building exercises
• Review documentation and data
• Provide feedback on progress and performance
• Identify training and resource needs
• Discuss and address issues or challenges, such as burnout
• Commend accomplishments

Outside of regular meetings, supervision can also entail ongoing encouragement of self-care activities or overseeing annual performance reviews. Supervisory tools, such as guides, logs, and checklists, can facilitate supervision.

Mentoring

Some programs provide peer mentoring opportunities for CHWs. Peer mentoring can empower CHWs with more experience to share their experiences and offer support and guidance to CHWs with less experience. Peer mentoring can also help CHWs build rapport with other staff, increase teamwork, and expand knowledge.

One peer mentoring strategy is to organize CHWs into teams with a range of experience. Mentorship can support CHWs on an ongoing basis, while some programs have implemented mentoring programs for specific processes, such as quality improvement, that include less frequent mentoring sessions. Mentorship may also involve training, convening group discussions, reviewing patient cases, helping CHWs solve problems and communicate with other team members, and connecting CHWs to resources to support their work.