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Supporting Community Health Workers, the First Responders to Community Crisis

Monday, February 12, 2018   (0 Comments)
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Elizur                              Martha                            Lorena


Elizur Bello, Director of Programs, The Next Door, Martha Lucia Garcia, Assistant Professor, Marist College, Lorena Sprager, Project Manager, Health Promotion Services, The Next Door


Elizur, Martha, and Lorena will be presenting on this topic at NWRPCA's Western Forum for Migrant and Community Health



The study discussed in this article was partly conducted at the 2016 Northwest Regional Primary Care Association’s (NWRPCA) Western Forum for Migrant and Community Health. Co-designed by Community Health Workers (CHWs) and social workers, it aimed to learn about the involvement CHWs have in meeting the mental health needs of the Latin@ community.  The results affirm that CHWs are responding to a mental health crisis, filling a gap in adequate services, but may might not be trained to address.  CHWs want to serve their communities and recognize that, to this goal, they need additional training, recognition of the complexity of this work, and support from supervisors and their institutions.  The article concludes with the recommendations and requests CHWs make of their supervisors and allies, so that they may be better able to continue to serve the Latin@ communities in Oregon and beyond.  Community Health Workers ask for more training on mental health, more understanding of the work they do, more supervision and support to do it, culturally relevant training for providers, and additional resources.


Our Interests and Our Study

Initially, the authors and co-researchers were introduced by Dr. Tina Castañares, an honored longtime leader in the farmworker healthcare community. She called a meeting with the authors, social workers and CHWs in Hood River, Oregon in April of 2014. At the meeting, the group discussed the serious lack of and urgent need for culturally relevant mental health services for the Latin@ communities in Oregon. As a result of that meeting, we the authors, organized a study with the intent of learning how CHWs can best meet the mental health needs of Latin@s in Oregon and beyond. From the initial meeting as well as our years of experience in the field and academia, we suspected CHWs were already responding to those mental health needs.  We wanted to explore the possibility of providing training to CHWs to better support them, therefore allowing them to better support their community members.


Given CHWs’ earned trust in the communities they serve, we suspected they had more and deep access to, and knowledge of the problems their Latin@ community members face. Community Health Workers have deep ties to the communities they serve. Consequently, they create positive relationships with the people they work with. In turn, community members may confide their deepest fears, pains and worries with CHWs. 

This led to a participatory research project, consisting of focus groups. We held five focus groups with CHWs in Oregon where we asked them questions about:


  • Mental health issues and situations CHWs encounter in their work
  • What CHWs currently do when encountering challenging mental health situations
  • Strategies that have been helpful in responding to mental health issues
  • How community members respond to these strategies
  • What mental health training CHWs have received
  • What mental health related training CHWs want and or need
  • What happens when CHWs or other providers make referrals to mental health professionals
  • Anything else CHWs wanted to share related to mental health

We conducted two of the focus groups at the 2016 Western Forum for Migrant and Community Health. We held an additional two focus groups in Hood River County and one in Benton County in Oregon.


Summary of Key Findings

Some of the lessons learned in the CHW focus groups were:

  • Based on pressing community needs, CHWs are going beyond their ‘job description’ as they are asked to assist on a regular basis in more than merely providing health information and access to services. Indeed, they are providing emotional support to many community members in distress.  And they report seeing cases of mental health concerns.
  • Some CHWs have received some mental health training, while most have not.
  • Across the board, CHWs stated wanting and needing more training as regards mental health.
  • CHWs shared a desire to continue to support their community members as regards mental health matters and a desire to collaborate with social workers and other mental health providers.
  • CHWs were consistent as to the serious challenges they face. Among others, these include burnout, compassion fatigue, vicarious trauma and lack of support, which complicate matters as they navigate complex systems.
  • In order to properly support community members as regards mental health, CHWs stated they need ongoing support through:

o   Effective and proper supervision

o   An understanding at the administrative level of the significance of their work and the value of their service to their communities

o   The creation of CHW support networks to support them and help them build skills to deal with burnout, compassion fatigue, vicarious trauma and reliving personal trauma, as many CHWs have themselves experienced what they are seeing in their communities


What Community Health Workers (CHWs) Encounter in Their Communities

Many CHWs in the focus groups voiced the impact of chronic health issues, and the traumatic emotional impact when receiving serious diagnosis. There is a sense health care providers lack compassion and sensitivity when delivering such difficult news to Latin@ community members.


Another significant issue CHWs expressed is the ongoing daily stress immigrants face. These include language barriers, culture shock, not knowing the systems, fear and threat of deportation, and fear of losing children. These are of particular importance in the current political climate in our nation.


However, immigration issues were not the sole focus of what CHWs encounter. Another issue the CHWs discussed is lack of financial and other resources, leading to poverty as well as lack of health insurance for the people they serve. Additionally, CHWs mentioned issues related to suicide, depression, substance abuse, alcoholism, domestic violence, and psychotic episodes. There were also issues related to gender discussed in each of the focus groups including the specific challenges women face. These include worries about children, feeling the need to be ‘super moms’, and contradictions of gender roles such as being a homemaker as well as laborer. Finally, the CHWs mentioned isolation as a significant issue in the Latin@ population. All of these issues listed above are a partial list.  Even so, they highlight the need for and importance of appropriate training and support for CHWs.


Mental Health Training

According to focus group respondents, some CHWs have received mental health related training in the following topic areas: crisis intervention, substance abuse, and domestic violence. Most agreed that these trainings were not enough. The CHWs voiced a need for, and desire to receive additional training.


Some of the training topics they would like to receive are self-care, suicide prevention, mental health and counseling in general, special needs of children, how to work with families, and what to do if a parent is deported. That said, CHWs understand they are not mental health professionals. They are also clear with the boundaries of their work. However, they would feel better equipped to work with their Latin@ communities if they had general trainings on the topics mentioned. It is important to note that CHWs are already facing all of the above issues with the community members they serve.  Consequently, CHWs have come up with strategies – often on their own - that are currently working for them.


Strategies Community Health Workers Use that They Feel Have Been Effective

There are many things CHWs are good at. One of the most important parts of their role is to learn about their community, understand cultural nuances, and gain trust. They have a clear understanding that this takes dedication and time, and that they must earn the respect of the community. Once CHWs have accomplished this, they can be creative.


Many participants spoke of the effectiveness of connecting people to others who experience similar issues.  Creating communities of support to connect immigrants together and creating more formal support groups has been very effective. Some CHWs are privileged enough to have a professional counselor on site in the health center where they work and mentioned this is a very effective strategy for helping the people they serve. They are able to make immediate and direct referrals that will be followed up. Without this onsite counselor, service recipients may get lost in the process and not receive the service needed. Thus, it is important to connect people directly to the service provider.


What Is Most Difficult for CHWs to Deal With?

Community Health Workers discussed the powerlessness and helplessness they feel when they are not able to help the people they work with. These feelings are often compounded by a lack of resources in the community, as well as problems with poor and ineffective translation or interpretation. In addition, CHWs experience vicarious feelings like sadness when they realize that the stories that people share with them are similar to their own and some CHWs stated that ‘I’ve been there’.  A number stated there is a fine line between where they themselves are now and where the community member is.


They mentioned anger at witnessing so many injustices, increased hatred directed at them (CHWs and their communities) by some legislators, and the difficulty of dealing with social and health policies that are not equal for all. Some are frustrated by community apathy, and the lack of an organized community response.  Community Health Workers expressed the burden of community expectations on them, as they do not want to disappoint their community members. In addition, CHWs expressed a lack of support from their co-workers, and that supervisors do not understand the depth of the challenges they face. They would like their employers to understand what it takes to do what they do, and that it goes beyond providing health information and connecting people to resources. Community Health Workers expressed feeling that supervisors cannot understand the weight of having to witness the pain and suffering of their community.


Solutions from the Community Health Workers: What CHWs Can Do?

One of the most popular ideas CHWs discussed across the five focus groups is to develop self-help groups. That is, putting people together with similar issues in order to help themselves. Similarly, CHWs feel it is important to establish advisory groups to address cultural differences in the delivery of services, including education on cultural humility for clinicians.


As for CHWs working in more rural areas, or areas that are impacted by a lack of access to transportation, tele-health was discussed to deal with access problems. Additionally, in true CHW fashion in thinking of prevention, the CHWs shared a belief that it is imperative to work with families before problems reach serious levels. Finally, to gather support and to get a better sense of community resources, CHWs recommend expanding their networks of support to meet with other CHWs outside of their organizations. All of their suggestions can be helpful insights as we imagine what CHW allies can do in support of the important work CHWs do in their communities. 


Solutions: What Allies Can Do With and For CHWs

Together, CHWs and their allies can come together to continue to transform care for populations such as Latin@s. One of the primary steps allies can take with CHWs is to involve them in the development of innovative programs that will be meaningful to the populations they serve. Working alongside CHWs, content experts can help inform projects CHWs feel will make a difference in their communities. Given their connections to the communities being served, as well as being a part of them, CHWs can serve to develop programs that are responsive to the community’s needs in creative and culturally appropriate ways. This will help ensure interventions that make sense to community members, and thus increase their effectiveness. In addition, providers can reach out to learn more from CHWs and the community members they serve about the most helpful ways to share a serious diagnosis.


Allies, including agency leaders and program managers, can ensure that CHWs have the appropriate support needed to do their work through ensuring CHWs receive appropriate supervision.  Like all human service professionals, CHWs need a safe space where they are able to discuss difficult situations and problem solve. They also need a safe space to discuss the issues that may cause vicarious trauma.  Consequently, CHWs need to know how to get the support they need in such cases, whether through supervision or other means. In doing so, CHWs can practice establishing healthy and caring boundaries with the people they work with and allies can help prevent CHW burnout and compassion fatigue by offering appropriate support.


Providing ongoing support, resources and appropriate trainings mentioned in this article are just a few ways allies can support CHWs and the meaningful services they provide. Allies can also continue to be champions and advocates of CHWs in the communities where they work. Given that CHWs are still not widely recognized and their value is hard to measure, it is imperative that allies help convey the impact CHWs can and do make in their communities and organizations. Allies can advocate for the necessary awareness, support and training to assist CHWs in best serving their community members, therefore improving physical health, mental health and overall wellbeing. Finally, allies can also realize the value CHWs can bring to health care transformation, by providing professionals with training around the needs and strengths of the communities they serve.



MHP, Salud Para Todos, Mental Health Curriculum


The Salud Para Todos Facilitator’s Guide is a comprehensive tool for (Community Health Workers), or other peer educators, to prepare and implement community education sessions on mental health topics. The Facilitator’s Guide provides the information, session plans, and other materials needed to facilitate educational sessions the topics of mental health, stress, domestic violence, substance abuse, and the relationship between chronic disease and mental health.


The Silent Crisis: Doing Outreach in an Anti-Immigrant Climate


The anti-immigrant climate in many communities creates a serious challenge for health centers as well as social service and education programs. Some immigrants are not going in for care or services. Others come in once a problem is extreme. There are many ways that health centers, social service, and education programs can help.


In this booklet, we give you ideas and resources for doing outreach in an anti-immigrant climate. These come from outreach program workers from around the country.


There are sections on barriers to health and wellbeing with solutions to those barriers. You can use the “My Notes” page at the end of each section to keep track of barriers, solutions, and people or groups that can help in your community.



NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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