Helping those who help others: A qualitative analysis of Community Health Workers’ Training and Supervision Needs


Background: CHWs have been hailed as one of the solutions to the growing disparities in access to mental health treatment both nationally and internationally (Barnett et al., 2018). As frontline lay health workers who are members of the communities they serve (Viswanatha et al. 2010), CHWs have an acute understanding of their clients’ specific life stressors and circumstances. Despite their more limited academic preparation, we expect CHWs to perform similar tasks (i.e., deliverer of an evidence-based practice) as community-based providers who are highly trained (usually masters level clinicians) with populations that are severely underserved. As such, the very nature of their role puts them at heightened risk for feeling under-prepared, unclear about the boundaries of their roles, and insecure about their clinical decision-making. As a result, many are highly stressed and at-risk for higher job turnover. This project seeks to understand the training and supervision needs of CHW’s to better serve vulnerable children and families. Methods: Individual semi-structured interviews were conducted with nine Community Health Workers (78% = Latin, 67% = Female) and six stakeholders (67% = Female). Grounded theory methods (Glaser and Strauss 1967; Strauss and Corbin 1998) guided an iterative thematic analysis to identify themes related to CHW and stakeholder perspectives around sources of stress experienced by both CHWs and the families they serve.
Results: When asked about their training and supervision needs, participants commented that they desired more training focused on navigating the school systems and mental health support strategies. They also expressed wanting more active learning strategies and more support transitioning from the classroom to real-world work. In terms of supervision, they expressed interest in more hands-on supervision supports and professional development opportunities. Finally, participants commented on their confidence around clinical decision-making, and reported wanting more structured decision-making protocols to improve their confidence in care delivery.
Conclusion and Future Directions: Based on the data above, efforts are underway to develop and implement a training and supervision model to support CHW wellbeing and increase their confidence in caring for vulnerable families. We will work to determine its feasibility, acceptability, promise, and utility as well as ensure it is sustainable without research support.

Keywords: Community Health Workers, Training, Supervision