Extending Community Health Worker Programs with the Multi-tiered Approach
Wednesday, February 10, 2016
By Elaine Ezekiel, MHP Salud Community Manager
As the Community Health Worker (CHW) profession grows, it is increasingly common for programs to employ CHWs with varying levels of responsibilities. A multi-tiered model is used to distribute the responsibilities of CHWs based on the time commitment and expectations of their position, which can range from a part-time volunteer to a full-time staff member. When used effectively, this model allows a program to maximize resources, extend the reach of CHWs, and create a greater program impact. It is typically used in programs that cover a broad geographical span or that have complex program activity plans.
In one version of the multi-tiered model, CHWs assume the role of supervisor to “Community Leaders.” These leaders share similar traits with CHWs, such as having a deep understanding of the community based on similar life experiences, background, and culture. However, these leaders have less specialized training and fewer job responsibilities than the CHWs. Community Leaders are typically volunteer, contracted, or part-time workers. They work within their own and surrounding communities; whereas the CHW may provide services to a broader geographic area.
“Regardless of the version of the program,” says MHP Salud Chief Programming Officer Colleen Reinert, “what’s important to remember is that each of those levels of CHW programs still requires that there is a supervisor, coach or mentor—somebody providing support to those individuals at each level.”
The role of the Community Leaders is to support the CHWs, and the CHWs are usually the supervisors of the Leaders. The Leaders’ main job is to serve as a local resource, cultivate interest and support for the program, and help plan logistics for implementing a program in their communities (such as finding and securing an ideal venue for classes). By having a local resource like this, the CHWs can focus on other, more specialized tasks.
This model can be mutually beneficial by allowing staff CHWs to strengthen their leadership abilities and build upon organizational and communication skills as points-of-contact for volunteer CHWs, and by enabling the Community Leaders to gain community-based outreach experience while fostering their professional development.
MHP Salud’s El Arte de Sobrevivir (The Art of Surviving) support group program uses the multi-tiered CHW model to provide support to low-income, Hispanic, Spanish-speaking survivors of sexual assault, domestic violence, dating violence, and/or stalking. This model employs a CHW who is a member of the community served: those living in colonias in Hidalgo and Cameron Counties in Texas’ Rio Grande Valley. Colonias are unincorporated neighborhoods developed outside of city limits that lack city services such as transportation, utilities, and road signs. As part of the multi-tiered approach, the program also recruits Community Leaders, who are independently contracted to fully embed the program into the culture of the colonia in which they live.
The program’s CHW, Noelia Serrano, established support groups across the two counties by networking with schools, community resource centers, local police stations, local women’s shelters, and churches. In order to maintain these new-found community bonds, once the support group sessions were completed, Serrano identified a member of the support group to serve as an ongoing Community Leader.
“The outspoken participants were the ones I could see as leading the group forward,” said Serrano.
This individual receives 40 hours of training, and they continue to lead the classes on an informal basis as independent contractors, embedding the support groups in colonias across the two-county region.
“We could not have done the job without the Community Leaders,” said El Arte de Sobrevivir Program Director Moises Arjona. “They are really an extension of the CHW to further our program’s outreach.”
You can find more information about supervising CHWs in a multi-tiered program in MHP Salud’s new free resource, the Promotor(a) de Salud Supervision Manual.
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