Taking Care of the Neighborhood:  Community Health Workers on the Front Line and Beyond

The helping hands of a CHW Credit: CHW Association of RI (CHWARI)

In the last few years, if you visited a local health or community center for your Covid vaccine, spoke to someone who followed up with you after the visit, or were interviewed following a bout with the illness, you most likely met with a Community Health Worker (CHW), though you may not have known it. 

Community Health Workers have been around for decades and have a long history of supporting public health. But in 2019, with the onset of the Covid pandemic, their work took on new meaning in Providence, especially in historically underrepresented and underserved neighborhoods. The importance of CHWs to community well-being in RI and, more generally, nationwide, has become increasingly apparent.

Covid-19 created a crisis in our communities; CHWs were there to help. 
Credit: CHW Association RI.org

What is a Community Health Worker? CHWs often serve the communities in which they live and share experiences, language, and culture. They are community-based front-line workers who support residents with matters as simple as following doctor’s orders to matters as complicated as navigating our various federal, state, and local social service systems–like the Department of Human Services (DHS), Supplemental Security Income (SSI) and an alphabet soup of others such as social, medical, and dental services, and food and nutrition services. Community Health Worker is an umbrella term; other terms for CHW include Patient Navigator, Community Advocate, Outreach Worker, Health Educator, Case Manager, and Community Liaison.

  • RI is one of the few states where CHWs can work independently, with some services delivered by a certified CHW now billable to Medicaid. This measure allows CHWs to be self-employed in the field. https://chwari.org/medicaid-reimbursement-for-chw-services/
  • RI was selected as one of 5 states in the United States to be awarded a grant from the Centers for Disease Control (CDC) to expand and strengthen the CHW workforce and focus on addressing policy, systems, and environmental change.
  • RI has a long history of advocating for public health equity and is home to CHW and public health leaders. Dr. Dannie Ritchie, a pioneer in the field, recognized the importance of this workforce early on. She led the Transcultural Community Health Initiative (TCHI) in the early 2000s to address health disparities and promote health equity. TCHI led to the development of what is now the CHW Core training course that all CHWs must take to become certified in RI. TCHI also spearheaded the formation and passage of RI legislation to form a Commission of Health Advocacy – a law that requires public input on reporting health disparities to legislators and the executive office for measurement and accountability.

Even apart from Covid, you may have already engaged with a CHW. Many organizations are hiring CHWs in local community medical clinics, dentist offices, food pantries, refugee centers, faith communities, and shelters. CHWs have always worked in grassroots and non-profit organizations. Still, many can now also be found working for state agencies, health insurance providers, and in areas of specialty care or populations.

CHWs are great at adding important context to a situation. Patients may want to keep their struggles private from their doctor but might feel more comfortable with the CHW. For example, a client with diabetes who is having difficulty following their care plan is connected with a CHW. Through the CHW, it is learned that their refrigerator is broken, and they have been using their neighbors” to keep the insulin cold. This has resulted in missed doses and frequent ER visits. The CHW would work to support this individual in repairing their refrigerator and finding another source for safe insulin storage in his home. The CHW would also connect to other supports, such as a diabetes group, for education and ongoing support.

CHWs can help the community locate vital resources like food and housing; they help parents work through language barriers, bureaucratic red tape, and confusing forms to sign their children up for health insurance; they can connect new immigrants to agencies designed to settle them into their surroundings; they can connect recently laid-off workers with various support structures.

CHWs and their colleagues at PCHC toy drive    Credit: Marimir Lora Nunez, Providence Community Health Centers

In September, Rhode Island held its first-ever CHW conference, led and created by CHWs and allies. Over 100 participants gathered for professional development and networking opportunities at Brown’s Warren Alpert Medical School. There were workshops around self-care, resources, policy & advocacy, and workforce development, all of which are important components of community health work. In addition, many CHWs in RI attended the Unity Conference in Austin, Texas, where we learned best practices, unified our voices, and met other CHWs from across the nation.

Once a CHW receives CORE training through the CHW Association of RI, they can take additional courses and volunteer or work in the field to fulfill the requirements to obtain their state certification through the RI Certification Board. This state certification is also a requirement to bill Medicaid for CHW services, both for organizations and independent CHWs. Part of being a CHW is ongoing professional development and networking. As with many other professions, CHWs must remain current with the latest resources and information that could affect our community. We attend conferences and seminars in areas related to our work to support our work and meet the requirements for state recertification. Many are cross-trained and hold multiple certifications and disciplines in other areas. Some RI CHWs are also social workers, non-profit leaders, and peer recovery specialists, and have masters in areas such as public health and science.

CHWs and allies at the 1st RI CHW Conference    Credit: CHW Association of RI (CHWARI)

There are many reasons for choosing to become a CHW. Some, as in my case, are children of immigrants who saw how difficult it was to negotiate and understand new environments, systems, laws, institutions, and language–all the various components of their new lives.  Others say they felt they were always doing this work of helping others, just not under this title. CHWs are still among the lowest-paid public health professionals.  However, as with others in the helping professions, we are service-oriented and community-facing, and there is satisfaction for many of us in our work. I recently spoke with several CHWs in Providence (#CHWSINRI) who talked about their work:

“Being a CHW Latina in my community makes me feel great; I am very passionate about my job.  Being able to connect my people with all the resources around, support them, and be the voice of many of them who have a language barrier, is an amazing experience in this role.” -Lina Roman (CCHW at Integra and Bilingual Coordinator for the CHW Association of RI)

“It means we get to build a happier and healthier community.” -Marimir Lora CCHW (Community Outreach Advocate Supervisor at Providence Community Health)

“CHW’s are a growing workforce of diverse representation from the community, leading the charge to connect residents to social determinants of health (SDoH), resources, and to advocate for the betterment of their communities.” – Kinzel Thomas (LCSW, CCHW, and VP of Equity & Community Development at Family Service of RI)

I am a Community Health Worker    Credit: CHW Association of RI (CHWARI)

“There is no better reward than that of a patient thanking you for caring, even if you’re unable to resolve their troubles or make them go away. But just knowing they’re not alone, that you are next to them, walking along the same road…it’s the ultimate and most gratifying experience.”  Jerica Dunbar CCHW (Community Outreach Advocate at Providence Community Health Centers)

Community Health Workers have always interacted with individuals who are overlooked, mistreated, misunderstood, or in crisis. Overwhelmed systems and inequitable laws can create further challenges and barriers for some of our most vulnerable residents. CHWs, with their unique vantage point in the neighborhood, often speaking the language of its residents, and with their mission to educate, support, advocate, and remove obstacles to care, can drive positive change for all in RI.

Author advocating for a bill at the State House to support the First Connections program 
Photo credit: FSRI

Swanette Salazar is a Certified Community Health Worker (CCHW), CHW Supervisor at Family Service of RI, and the current RI ambassador for the National Association of CHWs. As a home visitor in First Connections, Swanette supports high-risk prenatal women and caregivers of newborns. She is also the Lead CHW Consultant for EOHHS Rhode to Equity Initiative.  In that role, she supports CHWs in being an engaged partner in multidisciplinary teams working to advance community and clinical linkages.