As trusted advocates, navigators, and educators, community health workers break down barriers and empower people to take control of their well-being, especially in populations experiencing health disparities.
Samuel U. Rodgers Health Center, under the guidance of leaders like behavioral health director Dr. Manuel Solano, has become a trailblazer in community health by establishing Missouri’s first community health worker (CHW) program within a Federally Qualified Health Center (FQHC). Its innovative program has grown significantly, reflecting the importance of CHWs as vital connectors between clinical settings and the communities they serve. By addressing social drivers of health and reducing barriers to care, the CHW program at Sam Rodgers plays a crucial role in advancing health equity.
“A community health worker consistently expands the range of available resources for the people we serve – does so in a culturally competent manner,” said Sam Rodgers CEO Bob Theis. “They understand the importance of sharing reliable information and resources because sharing truly is caring. The Samuel U. Rodgers’ team of CHWs takes pride in addressing needs with an equity lens, while also adding valuable options to our resource menu.”
As for community engagement, it is at the heart of the CHW program’s success. Dr. Solano highlights the importance of building trust and rapport within the community, noting that CHWs are often integrated into outreach events and health education initiatives. “Our CHWs are more than just service providers; they are members of the community who are invested in the well-being of their neighbors,” he said.
Unlike one-time events or interventions, Sam Rodgers deploys a programmatic approach, rather than a transactional one, which is key to building lasting relationships and addressing those complex needs. By being embedded within the community, CHWs can identify emerging issues, connect people to resources, and advocate for policies that improve health outcomes.
Collaborative partnerships have also played a significant role in the program’s success. Sam Rodgers works closely with other health care providers, community organizations, and training programs to build capacity and share best practices. For example, partnerships with the Community Health Council of Wyandotte County provide specialized training for CHWs, enhancing their skills and expanding their ability to meet community needs.
The Evolution of the CHW at Sam Rodgers
The CHW role at Sam Rodgers has evolved from its early beginnings when staff were informally supporting patients as caseworkers, clinical navigators, and advocates. “We had support teams within the organization for nearly 15 years, performing roles that eventually evolved into what we now recognize as community health workers,” Dr. Solano said. The transition formally recognizing these roles as CHWs began over a decade ago, when the Mid-America Regional Council (MARC) identified the need for dedicated CHWs, and Sam Rodgers quickly became a leader in professionalizing these roles.
CHWs at Sam Rodgers are now recognized for their essential contributions in providing direct services, support, and counseling. Dr. Solano emphasized that the program’s success is rooted in Sam Rodgers’ commitment to continually evolving the CHW role beyond traditional boundaries to meet the needs of the community.
Workforce Development: Recruiting, Training, and Mentorship
Recruitment begins with identifying specific needs of patients, which then drives the justification and budgeting for new CHW positions. The Human Relations Department manages this process, working closely with managers to ensure that each CHW position is tailored to meet community needs.
Training is a critical component of the CHW program. New hires undergo a comprehensive onboarding process that includes general training on health care concepts, organizational policies, and specific instruction tailored to their specialty areas. “We prioritize hiring individuals who are not only part of the community but also have lived experiences that align with the needs of the patients they will serve,” Dr. Solano said. This approach ensures that CHWs have both the cultural competence and personal insights necessary to effectively address specific health challenges or barriers.
For formal certification, Sam Rodgers partners with local community colleges and health councils, often covering training costs and providing time for education. That investment in training is complemented by ongoing professional development and mentorship, which Dr. Solano emphasizes as crucial for evolving the roles of CHWs and enhancing their impact on health outcomes.
Defining the Scope of CHW Services
One of the first challenges Sam Rodgers faced was defending the scope of services for CHWs. Dr. Solano recounts that early on, there was a need to clarify what CHWs could and could not do, particularly when some providers expected them to take on clinical roles. “CHWs are not nurses, clinical providers, or interpreters. They can assist with finding appointments or connecting patients to resources, but they are not there to provide clinical care,” he said. This distinction was essential in establishing the CHW’s role in supporting, rather than replacing, clinical care.
When integrating CHWs into the care continuum, it’s crucial to clearly define their roles and responsibilities and address potential misconceptions. Sam Rodgers quickly learned that simply providing theoretical information through presentations also proved to be insufficient. It’s essential to involve CHW champions or those who can highlight the positive impact of CHWs and address concerns about role displacement and even job security.
Recruiting champion providers who demonstrate the value of CHWs is instrumental in fostering adoption and understanding. The champion mentors other providers, shares best practices, and addresses concerns related to integrating a CHW into the care team. By actively involving providers and addressing training issues, organizations can ensure a smooth onboarding process and create a supportive environment for CHWs to thrive.
Initially, Sam Rodgers explored the possibility of having CHWs available for patient support without requiring their physical presence. However, they quickly learned that the approach was not effective. Providers with heavy patient loads struggled to connect with CHWs, and care coordination became stressful and ineffective. This led Sam Rodgers to reconsider the role of CHWs and implement a model that emphasizes their direct interaction with patients and providers. By ensuring CHWs are readily accessible and physically present, Sam Rodgers has been able to address communication gaps and improve overall patient health outcomes.
Integration into the care continuum required careful alignment with population health goals. CHWs work closely with the clinical team to support patient-centered medical homes, particularly for patients with chronic conditions who are not seeing expected improvements. By using appropriate assessment tools, CHWs identify barriers to care, such as lack of transportation or housing instability, and work to resolve them, thereby improving overall health outcomes.
Leveraging Technology Enhances CHW Efficiency
Technology plays a crucial role in enhancing the efficiency and impact of its CHW program. One of the most important tools is the electronic health record (EHR) software, which allows CHWs to document their interactions and interventions directly within the clinical workflow. This integration helps prevent the inefficiencies and errors associated with duplicating records, a challenge the program initially faced.
In the past, CHWs were often required to maintain separate records, leading to discrepancies, incomplete dates, and wasted time re-entering information. Recognizing this, they worked closely with its IT and tech departments to build the right workflow within the EHR system. The adjustment has been key to ensuring accurate documentation, streamlined communication with other health care providers, and effective reporting and billing.
“Having the right workflows within our EHR system is key to our success,” Dr. Solano states, highlighting that effective data collection and reporting are critical for demonstrating the value of the CHW program. This technology not only aids in service delivery but also plays a crucial role in reporting and billing, ensuring that the program remains financially sustainable.
Demonstrating Return on Investment – A Crucial Ingredient to Policy Change
A standout feature of the CHW program at Sam Rodgers is its dedicated perinatal CHW initiative, which supports pregnant people from conception through the first month of postpartum. Dr. Solano emphasizes the importance of this program in addressing maternal health disparities, noting that the perinatal CHWs work closely with the Women’s Health program and local hospitals to provide targeted support. “The data on maternal mortality and other key indicators guide the work of our perinatal CHWs, ensuring that pregnant people receive the comprehensive care they need,” he explains.
Sam Rodgers also collects its own data. Evaluating the impact of the CHW program is a priority for the FQHC. Dr. Solano explains that the program’s success is measured against state-mandated quality measures, focusing on improving outcomes in areas like chronic disease management and depression remission. “We track specific metrics that are tied to our program outcomes, ensuring that we are meeting our goals and demonstrating the value of our CHWs,” he says.
Financially, the CHW program at Sam Rodgers shows a strong return on investment. Missouri’s funding framework allows for partial reimbursement of CHW services, with the remaining costs covered by grants, philanthropy, and partnerships with organizations like the Health Department and the Department of Mental Health. Dr. Solano points out that this funding structure not only sustains the program but also underscores the value of CHWs in providing cost-effective, community-based care.
The women’s health program often receives substantial funding from state agencies like the Department of Mental Health (DMH). Screening services can also generate revenue, albeit at a lower rate.
Despite the many successes, integrating CHWs into health care systems has not been without challenges. Dr. Solano notes that one of the significant barriers has been navigating the policy landscape, particularly around reimbursement for the CHW services. “We continue to advocate for policy changes that recognize the value of CHWs, pushing the expanded billing codes and more consistent funding streams,” he explains.
Looking ahead, Sam Rodgers aims to continue evolving its CHW program, leveraging its position as a pioneer in the field to drive further innovation and share its model with other FQHCs. The goal is not only to sustain the program but to expand it, ensuring that the benefits of CHWs are accessible to all communities in need.
“In health care, the CHW is helping us to go back to the basics, which is prevention rather than intervention. That’s the real return on investment,” Dr. Solano said.
