Community Health Workers and Peers Are Essential to Counties’ COVID-19 Response

Health care providers meet to discuss COVID -19 safety
A Ventura County Health Care Agency safety briefing for community health care workers participating in the local Whole Person Care project. Photo: Deanna Handel

While community health workers (CHWs) and peers operate under many different job titles, they share the critical role of “connector,” linking community members to systems of care and fostering relationships with clients based on shared experience and a deep sense of empathy.

During the COVID-19 pandemic, these essential workers have stepped up to a new challenge, working on the front lines of the emergency response in order to care for those most vulnerable to the virus, and linking members of the community to critical health and social services. Whether making food deliveries in the field, coordinating services at shelter-in-place sites, or using telehealth to improve care transitions, the contributions of CHWs and peers have been vital.

In California, CHWs and peers are an essential part of Whole Person Care (WPC), a five-year program under California’s Section 1115 Medicaid waiver. There are 25 WPC pilots operating across the state through regional coalitions of service providers. This structure enables public health care systems, behavioral health providers, Medicaid managed care plans, and social service organizations to work together to improve care for people with complex health and social needs. Many Whole Person Care clients face circumstances that make them particularly vulnerable to COVID-19, such as living in crowded shelters and multifamily homes, and lacking access to food and hygiene supplies.

CHWs and peers from WPC pilots are helping those most vulnerable to COVID-19 stay healthy and safe. Here are some examples:

Santa Cruz County: Providing Individualized Services to Support Sheltering in Place

When COVID-19 cases began to rise in Santa Cruz County, WPC partner and community behavioral health provider Front St. quickly adapted its approach to help clients safely shelter in place. Gabriel Samara, a peer support coach at Front St., started going into the field to deliver essential items like food and household supplies. “If a client has money, I can go to the store for them; otherwise, I can do food bank runs. I also deliver necessities, like paper towels, toilet paper, and disinfectant,” said Samara.

Recognizing that many clients may need additional support to shelter in place, WPC peers also conduct physically distanced home visits, taking clients for walks or other outdoor activities to keep them engaged and active. “Just today, a client mentioned to me that they recently became homeless. I talked to their coordinator and posted an ad online to look for housing with a housing choice voucher. They were really appreciative of me doing that, since access to a computer is difficult due to libraries being closed,” said Samara. “It’s the least I can do.”

Ventura County: Caring for the Homeless Population at Isolation/Quarantine Sites and on the Streets

Ventura County’s WPC pilot program has partnered with organizations that support people experiencing homelessness, including the emergency operations center, Continuum of Care programs, the county health care agency, behavioral health and public health departments, and community-based organizations. Together, they provide emergency shelter in isolation and quarantine sites set up for people experiencing homelessness. CHWs provide on-site care management and support at these locations.

During intake, CHWs screen clients to identify social needs and reduce barriers to sustaining shelter. “It’s important to address challenges up front when clients enter the site,” said Deanna Handel, Whole Person Care Manager. “Some have been living in encampments, and it makes sense that they want to bring their lives with them — their pets, their possessions. They need support to adapt to such a different environment, especially when they are grappling with substance use or behavioral health needs. CHWs help ease that transition and make it feel safe.”

CHWs also play an important role on the county’s Backpack Medicine team, which conducts street outreach to triage and test those at high risk of COVID-19. CHWs help connect people living on the streets to health care and other social supports. The team also provides portable shower pods and hygiene supplies.

Los Angeles County: Supporting Posthospital Discharges for Vulnerable Patients

For people with complex health and social needs, the 72 hours following hospital discharge are critical. In Los Angeles County’s WPC pilot, community health workers reach out and establish rapport with patients during their hospital stay and provide support as patients leave the hospital, reaching out again 30 days after discharge to ensure a safe transition to their home or an alternative care facility. CHWs help patients connect to primary care and a pharmacist, remove barriers to attending health care appointments, and link to existing benefits. In response to COVID-19, some CHWs have transitioned to a telehealth model, connecting with patients by phone and video visits.

In Los Angeles, CHW members of Whole Person Care’s transitions of care team have a virtual meeting with their supervisor. Photo: Amy McKnight

“CHWs adapted very quickly to ensure patients received the support they needed,” said Letty Rodriguez Avila, the director in charge of capacity building for LA County’s WPC pilot. “They continue to help patients prepare for their telehealth primary care provider appointments and accompany patients to appointments to help them advocate for their needs, all via phone or video.”

CHWs also provide a range of services to support patients’ mental health, such as breathing techniques, meditation suggestions, and other tips and resources to stay safe. “Even before I explain the program,” said CHW Stephanie Ellis, “I always ask patients how they are feeling. Patients appreciate it because a lot of times there isn’t an open forum to share their true feelings, and they appreciate the acknowledgement that there is a lot going on and that their feelings are valued, and knowing that they are not alone.”

CHWs Are Essential to the State’s Pandemic Response

In the face of a dangerous pandemic, CHWs and peers leveraged two of their greatest assets — flexibility and community connections — to adapt how they provide services and help clients safely shelter in place. The end of the Whole Person Care program is drawing near, and the state is preparing to transition to CalAIM, a multiyear process led by the California Department of Health Care Services to improve the health outcomes and quality of life experienced by Medi-Cal patients. It is critical that policymakers, health care organizations, and Medi-Cal managed care plans value and raise up CHWs and peers so that they can continue to play their essential role in the COVID-19 pandemic and beyond.

This blog post was adapted from an article previously published by the California Association of Public Hospitals and Health Systems, the Safety Net Institute, and the National Center for Complex Health and Social Needs.

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