Supporting Community Health Workers who provide medical and behavioral health support in underserved communities: Stakeholders’ Perspectives


Background: Community Health Workers (CHWs) have been effectively used around the world to deliver physical and mental health services for the past several decades. In the United States, CHWs support underserved and hard-to-reach communities, with an estimated 54,760 CHWs working as of 2017. CHWs promote overall physical well-being in the communities they serve. However, they have recently begun to engage in assessing, referring, and even providing basic interventions that address mental health concerns. CHWs are uniquely positioned to help underserved communities because they often live in the same communities they work in, and can provide invaluable culturally informed care. However, continued training and support of CHWs is vital in order to utilize the program to its full potential. Stakeholders play an important part of training, implementing, and supervising the CHWs. Current stakeholders for CHWs include: training directors, supervisors, researchers, and other public health experts involved in the program.Methods: Individual semi-structured interviews were conducted with stakeholders (N = 6) who are directly involved with the training or supervision of CHWs (Female = 67%). The interviews were then coded using a grounded theory method. A guided thematic analysis was then used to identify excerpts from stakeholders that related to suggestions for changes or future implementations to address the needs of the CHWs they work with. Results: All the stakeholders provided suggestions for changes or additions to the CHW program (N = 69). The suggestions centered around three main areas: Training (N = 14), Supervision (N = 17), and Decision making (N = 15). One stake holder commented about increased mental health training: “It would be a great help to the community, and it would be a big help to [the CHWs]. Because what I do know for a fact is they would get the families to opening up to them...Take advantage of the fact that the community, you know, will open up to them." Another stake holder suggested having a structured process to make decisions: "a triage flowchart or something more structured would be helpful."  When asked about supervision, another stakeholder suggested increasing the amount of professional development and continuing education the CHWs receive: “There are just so many variables in [CHWs] day to day work…from professionalism…to documentation because the CHWs usually come from jobs where there isn’t a lot of documentation.”Implications and Future Directions: Stakeholders provide a unique insight into the CHW program. Their suggestions inform possible improvements that will promote the efficacy of CHWs through quality support, supervision, and training. Additionally, the findings show that stakeholders are committed to continuing to support and improve the CHW program. Future research will focus on how to best incorporate these suggestions into the CHWs training and supervision.