Community Health Workers as members of a care delivery team: Two models in Washington, DC Healthy Start Programs

There are two federally funded HS programs in Washington, DC that serve diverse populations of low-income pregnant women and their children through home visitation services by CHWs and nurses. This study sought to understand the perceptions of the CHWs about their work, as well as the structure of the programs they worked in. The study design is qualitative semi-structured interviews with CHWs and nurses employed by the two HS programs in DC (n= 34).

The care delivery models differ by program. Program 1 employs CHWs to perform outreach services, administer screens (i.e., domestic violence, depression) and refer/provide social services (i.e., linking clients to housing assistance and education programs, providing social support). CHWs work under the supervision of an RN who provides in-home clinical care to clients.

Program 2 employs CHWs to perform outreach services and provide home visitation services, which include the administration of an initial psychosocial assessment. Program 2 CHWs provide a range of services (i.e., screens, referrals to community-based services, and patient education) and refer clients for clinic based services either on-site, or to a local clinic.

CHWs from HS programs in DC have different levels of independence and responsibility in their scope of work, and provide a range of services. Hybrid nurse-CHW models involve a negotiation of care provided, especially with the administration of psychosocial screens. Clear delineation of roles and responsibilities, as well as communication among team members is necessary for successful home visiting programs with CHWs and RNs.