Hope for Health: A Multi-Level, Block-by-Block Community Health Worker Initiative for Local Health Improvement in a Low-Income Urban Neighborhood in Baltimore, MD

The Tumaini (Hope) for Health Program is an emerging neighborhood-based community health worker (CHW) initiative co-developed by a collaborative of neighborhood residents, community-based organizations, local health care and social service providers, representatives from municipal government, and an academic health system in low-income, predominantly African American urban neighborhoods in East Baltimore, MD with historically poor health outcomes. This novel “block-by-block” approach to CHW research and practice aims to strengthen and integrate existing networks of care providers to expand possibilities for achieving health through social support and accompaniment; resource navigation and care coordination; access and adherence to health services; building capacity for chronic illness management; and supporting caregiving relations. We will describe the history and evolution of this collaborative; briefly characterize the local “ecologies” of poverty and care delivery within which it operates; outline key components of the multi-level CHW workforce model; and present outcomes from the first six months of CHW service provision. Particular attention will be given to how two CBOs have partnered with the academic health system to develop two innovative, geographically-organized CHW roles: part-time “Neighborhood Navigators” focused on block-by-block outreach, community organizing, and longitudinal connection to resources for all residents of the neighborhood; and full-time, intensively-trained “Community Health Worker-Case Managers” providing community-based case management services to medically and socioeconomically precarious individuals with multiple co-morbidities and high rates of ED utilization. Together, these CHW modalities will build multiple layers of support to better meet the complex needs of residents of low-income urban localities in the context of health reform.