Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings.

Abstract

Shifts in health care toward value-based payment (i.e., payment based on outcomes rather than units of service) have drawn increasing attention to health-related social needs and social determinants of health1. As trusted community members, Community Health Workers (CHWs) are well positioned to support marginalized patients2 in addressing unmet social needs, navigating the health care system, informing health behaviors, and supporting communities in addressing the underlying causes of health inequities. The recent changes in the administration of health care services in the United States have also shifted discussions around the CHW workforce from fundamental considerations such as CHW acknowledgment, inclusion, and remuneration3 to more sophisticated human resource 1 For more information, see Social Determinants of Health 101 for Health Care: Five Plus Five at https://nam.edu/socialdeterminants-of-health-101-for-health-care-fi ve-plus-fi ve 2 The manner in which CHWs refer to individuals with whom they work changes by setting. In the communitybased programs where CHWs have traditionally worked, individuals are referred to as “participants” or “community members”; in the health care fi eld the individuals are referred to as “patients. 3 See U.S. Bureau of Labor Statistics, Occupational Employment Statistics, 21-1094 Community Health Workers https:// www.bls.gov/oes/2018/may/oes211094.htm management issues such as inclusion into reimbursement mechanisms, training [1], job satisfaction, engagement, and supervision methodologies [2]. As the CHW workforce is formally integrated into health care systems of diff erent confi gurations across the globe and in the U.S., (e.g., facilitated by structural, systematized payment mechanisms), issues about human resource management have risen and matured to the extent that research and evaluation on these issues [3] have been called for by the World Health Organization [4]. Tools have been developed and research has been conducted to assess these issues in the international arena, particularly in lowand middle-income settings. For example, the Community Health Worker Assessment and Improvement Matrix toolkit seeks to support the eff orts of those assessing, planning, implementing, and managing CHW programs [5]. The toolkit includes programmatic components that address workforce issues like recruitment, roles, training, supervision, performance evaluation, incentives, and advancement opportunities. Another example is the Perceived Supervision Scale, which is an internationally validated tool that measures supervisory experience from the CHW perspective [2]. Specifi cally concerning the supervision of CHWs, the concept of supportive “Patients will sometimes come to the doctor’s offi ce looking for me. I’m not always there. I’m a partner with the doctor’s offi ce and part of your care team. But you’ll see me in the street, you’ll see me in your community center, at the YMCA, and also at your doctor’s offi ce.” — Orson Brown, Community Health Worker