Collaborating with community health workers to improve health of a high-risk population

Background: In the wake of the Affordable Care Act (ACA), there is increased pressure on the healthcare system. A continued nursing and primary care provider shortage aggravates access to care issues. A Community Health Worker (CHW) initiative, which began in January 2011, is an innovative solution to these pressing issues. This evolving program utilizes not only the skills of advanced public health nurses (APHNs) but also builds on innate strengths of lay community leaders to positively influence the health of their communities and vulnerable populations. Description: With private funding and guidance of a steering committee of local PHNs, the mission of this program is to improve health and health literacy of high-risk patients of a rural community health center in Virginia. The program utilizes one-on-one health promotion to high-risk families by CHWs trained and supervised by an APHN. The health center is a federally funded clinic that provides care to underserved populations. As an organization that serves insured, Medicaid/Medicare, and currently uninsured populations, the health center is the perfect location for this initiative. Lessons Learned: Although in formative development, this CHW program empowers caring individuals to give back to their community through lay health promoter work. Dominant areas that require intentional decision-making and actions include selective recruitment of CHWs, and staff and provider “buy-in.” Recommendations: In the current regulatory environment and context of the ACA, greater emphasis should be placed on population-focused providers, such as APHNs, in collaboration with CHWs, to coordinate care and meet the needs of high-risk families.