Community Health Workers Provide Maternity Support
Monday, May 11, 2015
by G. Maria Carlos, Program Manager in Parent Child Health, Community Health Service, PHSKC
Community Health Workers (CHWs) have been called out as an emerging health care provider in the Affordable Care Act. At Public Health – Seattle & King County (PHSKC), community health workers are not new. They’ve had roles in several different programs – and in particular, they’ve been providing Maternity Support Services (part of Washington’s First Steps program) to pregnant women at our Public Health Centers since 2009.
Community Health Workers are an integral part of the Maternity Support Services team, helping clients find and access the resources and pregnancy and parenting supplies they need. This in turn allows licensed members of the team (the PHN, RD and SW) to focus on the physical, nutritional, and psychosocial needs of the clients.
In my role, providing program and quality support to the CHWs in our MSS teams, I get to hear many stories of the clients we serve. This story helps illustrate the value added by a Community Health Worker:
Tanya arrived in King County from the Midwest with her husband, hoping that he would find a job. They moved in with her aunt, in a rural part of the county. Nineteen and newly pregnant, Tanya sought help from a public health clinic, having heard she could get WIC food and nutrition education there.
The Public Health staff offered more than WIC, and she agreed to enroll in the Maternity Support Services program to be able to receive services from a nurse, nutritionist, social worker, and community health worker. At her first appointment, she met with a community health worker, who reviewed her health coverage and her social needs. The CHW also offered to connect Tanya to many community resources.
She was reluctant to take information about the childbirth classes, saying she didn’t think she needed them. As they continued to talk, Tanya confessed that she felt a little isolated, living with her aunt in a rural part of King County, especially since she was used to living in a big city and she had left friends and other family back in the Midwest.
The community health worker asked, “Do you want to make new friends?” As Tanya’s eyes lit up, the CHW said, “In this childbirth class, you can meet new people who are in the same situation as you, and make new friends.” Tanya took the information, and seemed willing to follow up.
She met with a nurse and nutritionist, and she seemed eager to come back for her next appointment, to share her progress in making new friends in her community.
Rather than focusing on the medical and health needs like a nurse, or nutritional needs like a dietician, the Community Health Worker focused on the life needs of this woman and understood that isolation was her primary issue. Once that was taken care of, the client relaxed and was able to meet the nurse and the nutritionist. On a multi-disciplinary team, there’s a key role for Community Health Workers.
The decision to add CHWs to existing teams of licensed providers grew out of an “equity impact” review process. The equity analysis indicated that CHWs would help us to engage with pregnant women in their own language or from their own experience. A CHW with life experiences similar to the client’s can help build trust between the client and the care team and can serve as a cultural bridge between a traditional clinical service and women in hard circumstances.
Initially, when we first hired our CHWs, we provided eight weeks of training to two separate cohorts. The training began with didactic half-day sessions (three days a week) and hands-on, site-based observation and shadowing (two days a week). Over the eight weeks, the number of didactic sessions decreased and the number of site-based days increased, until the CHW trainees were seeing clients on their own at the end of the eight weeks. Because these were new positions, we identified team members who mentored them at each site, helping them to get incorporated into the existing teams. Each person was “checked off” a list of competencies by their site mentor or supervisor after the eight- week training.
When budget cuts forced lay-offs within the health department, we reorganized the remaining teams and solidified the CHWs as team members at each site.
After six years, CHWs are an integral part of the MSS/ICM teams. They fulfill an important dual function – delivering service to clients and serving as cultural bridges to our teams.
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