Challenges and Ingredients for Success

MCPs and their partners often experience challenges related to defining CHW/P roles and recruiting CHW/Ps. Some of these challenges are described below, along with potential considerations for how organizations can navigate these barriers. For additional detail, access “Common Challenges and Ingredients for Success” (PDF) in the “Establishing Roles and Recruiting CHW/Ps” section of the Resource Guide.

• Creating flexibility within a structured framework. When defining CHW/P roles, employers will need to balance more prescribed responsibilities with creating the flexibility for CHW/Ps to do what they know best — developing trust with members based on shared life experience. Narrowly defining their roles and activities to focus on more clinical tasks “dilutes the very strength for which they were hired.”
• Considering human resources and policy constraints. Employers must balance developing job qualifications that do not create barriers for talented potential CHW/Ps with internal human resource requirements. Certain minimum qualifications related to employment history or language, technical, or other skills may restrict people from applying who would bring valuable skills in connecting with members and the community. As MCPs prioritize hiring CHW/Ps with lived experience, human resource staff need to recognize that many Medi-Cal members and their communities are impacted by mass incarceration, and a criminal record should not be a barrier to employment. One solution some health care entities have used is to contract with CBOs for CHW/P programs to avoid the constraints of large health care systems. MCPs will need to champion policy changes and provide guidance to decrease hiring barriers.
• Integrating a new role into interdisciplinary teams. It can be challenging to incorporate a new team member role into an existing interdisciplinary team with predefined roles and responsibilities. The task of reexamining and redistributing job duties can be arduous and sometimes contentious given “turf issues” related to interdisciplinary team roles. MCPs should engage all program partners, including CHW/Ps, to carefully define program requirements and team composition and roles to best address the needs of prioritized populations.

“I feel as though CHWs do not get the credit that we deserve. We talk to doctors and nurses and connect to the plans and housing authorities all day, all while also communicating with our patients. The medical field may not realize how much we do to assist individuals.”

—California CHW/P

Spotlight on Health Homes Program and Whole Person Care: Inland Empire Health Plan and Los Angeles Department of Health Services

Inland Empire Health Plan (IEHP) hires CHWs both directly and through contracts with providers. The health plan understands that recently hospitalized members are often more motivated to engage in care and that CHWs can play a critical role in care transitions. Consequently, IEHP CHWs coordinate directly with the assigned care team to visit members during their hospitalization and postdischarge and to enroll new eligible members who receive a visit in the hospital. IEHP’s health homes–eligible members who receive a CHW visit in the hospital have a 38% engagement rate (PDF), which is significantly higher than the plan’s traditional telephonic outreach. By defining the CHW role to support care transitions, IEHP is able to increase connections with members.

Los Angeles Department of Health Services (LADHS) incorporates CHWs into its Whole Person Care program, which serves eligible Medi-Cal member populations including homeless high-risk, reentry high-risk, mental health high-risk, substance use disorder high-risk, perinatal high-risk, and medically high-risk. In this model, the CHW role includes outreach, engagement, assessment, peer support, accompaniment to appointments, and other care coordination activities. The CHW works with the patient’s primary care team as well as with hospital case management for transitions and with community organizations for referrals. LADHS employs more than 200 CHWs who each serves anywhere from 10 to 35 patients. LADHS worked with human resources to identify ideal CHW candidates through a process that included (1) traditional interviews to identify a candidate’s motivation for the program and position, awareness of the challenges faced by the priority populations, and experiences working with community members from the priority population; and (2) discussion of case scenarios to help LADHS learn about an interviewee’s ability to build trust, receive and respond to feedback, and communicate with empathy.

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