Barriers and facilitators to the implementation of a health-related social needs screening and referral intervention in the Bronx

OBJECTIVE: The Community Health Worker Institute (CHWI) addresses health-related social needs (HRSNs) by integrating Community Health Workers (CHWs) into patient care. This study explores the barriers and facilitators to HRSN referrals and the integration of CHWs within clinical teams. 

METHODS: Qualitative interviews were conducted with CHWs, CHWI program staff, and clinicians from ambulatory care clinics. Semi-structured interviews, guided by the Consolidated Framework for Implementation Research, were audio-recorded, transcribed, and analyzed using rapid qualitative methods. 

RESULTS: Preliminary findings found that while clinicians support the CHWI and referral program, time constraints during patient visits likely hinder effective screenings and referrals. CHWs are seen as valuable advocates but continue to face challenges due to confusion about their clinical role from patients and clinicians. Hierarchical power dynamics seen between providers and CHWs likely contribute to this confusion. Clinics with strong leadership, clear role delineation, and clinical site preparation appear to have better CHW integration. 

CONCLUSION: CHWs play a crucial role in addressing HRSNs, but their integration into clinical teams requires overcoming logistical and educational challenges. These findings offer insights for improving the HRSN referral process and integrating CHWs into healthcare systems.