INTEGRATING COMMUNITY HEALTH WORKERS (CHWs) INTO THE MEDICAL MODEL: OBSTACLES AND OPPORTUNITIES

As innovators grapple with defining and implementing patient-centered medical care, issues concerning the incorporation of CHWs into healthcare delivery teams arise. Medical professionals and managers trained to perform within hierarchical medical environments struggle to understand the value that members of affected communities can bring as a component of cost-effective strategies to address the needs of underserved groups. The Prevention and Access to Care and Treatment (PACT) Project has employed CHWs to work with the ‘hardest to reach' HIV/AIDS patients in Boston for over a decade and recently expanded to new populations and conditions. Introducing CHWs into a variety of settings (disease-specific at multiple clinics, disease-specific within a community health center, and multiple chronic conditions in an MCO environment) created an opportunity to explore and compare barriers and successes in their integration. The variability of roles, training tracks, reimbursement models and supervisory structures places CHWs in a vulnerable position with regard to other providers and can lead to unclear expectations about knowledge, skills and responsibilities. Many clinicians protect their “turf” from others with different training or experience, and are often ill-prepared to work within multidisciplinary teams where every member functions at the top of their skill level. Upfront and continuous assessment of organizational culture and specific training of professional staff at all levels will be necessary to enable CHWs to achieve their true value.