Clinical integration of Community Health Workers to reduce health inequities in overburdened and under-resourced populations

The COVID-19 response has resulted in broader awareness of health inequities across the United States and their impact on overburdened and under-resourced communities. Investing in and more effectively integrating community health workers (CHWs) into health care delivery been prioritized in the COVID-19 response given the importance of trust and community connection to move people toward behavior change during times of uncertainty. CHWs serve as liaisons and connectors between patients, communities, and health/social care systems, providing culturally appropriate education and addressing complex social needs within the individual and community context. Given the pervasive health inequities that continue to persist despite decades of efforts to curb them, health care systems should reimagine current care delivery models to fully integrate CHWs into care teams. However, barriers exist to effectively deploying CHWs in health care systems. Through 20 years of experience developing, implementing, evaluating, and scaling CHW interventions, Sinai Urban Health Institute has learned valuable lessons in overcoming the common barriers to true and effective CHW integration. Organizations that approach CHW program implementation with a deliberate focus on recruitment and training and career pipelines/pathways, and adequately prepare their organization for CHWs will realize the benefits this unique workforce has to offer. Our experiences have demonstrated that if you hire the right people, train them effectively, and provide appropriate supervision, CHWs are transformative to health care delivery. We discuss our solutions in these areas within the context of integrating CHWs into our health care system to work with our most medically and socially complex patients.