By Amanda Clarke, Director of Programs, California Health Care Safety Net Institute; Zoe So, Program Coordinator, California Health Care Safety Net Institute
Community health workers (CHWs) and peer support specialists (peers) are vital members of complex care teams. They draw on their personal experiences and close community ties to develop trusting relationships with clients and serve as a bridge to the care delivery system.
In California, CHWs play an essential role in Whole Person Care, a statewide program that brings together public health care systems, behavioral health providers, Medi-Cal managed care health plans, and social service organizations to coordinate care and improve outcomes for people with complex health and social needs. Nearly all of the twenty-five regional coalitions or “pilots” participating in Whole Person Care have identified CHWs and peers as foundational to the success of the program.
In February 2020, the California Association of Public Hospitals and Health Systems/Safety Net Institute (CAPH/SNI) partnered with the National Center for Complex Health and Social Needs to organize a regional convening of more than 100 CHWs, peers, and Whole Person Care leaders from across California.
At the convening, participants learned from successful local and national CHW and peer models, shared promising practices across pilot sites, and contributed ideas for sustaining the CHW and peer workforce beyond Whole Person Care, which is set to expire at the end of 2021. Pilots learned from one another, as well as from complex care experts from the Transitions Clinic Network, UCSF Women’s HIV Clinic, and the Camden Coalition.
The following compendium of resources offers practical tools, shared by Whole Person Care pilots, for organizations working with CHWs and peers. They have been developed and refined based on the experiences of California’s 25 Whole Person Care pilots and include tools for hiring and training CHWs and peers, developing integrated care teams, and implementing organizational processes that support trauma-informed care.
Additional partners involved in the convening included an advisory group of CHWs and peers, the California Health Care Foundation, and the county associations: the County Health Executives Association of California, County Behavioral Health Directors Association of California, County Welfare Directors Association of California, and California State Association of Counties.
Learn how California’s CHWs and peers formed an integral part of CA counties’ COVID-19 response in an accompanying blog post here.
Tools and resources for integrating CHWs and peers into complex care teams
The skills that qualify CHWs and peers for their unique role, such as empathy and shared experience, are not typically found on a resume. Whole Person Care pilots had to develop creative recruitment and hiring practices to identify candidates with the right skill set. At the convening, speakers from Whole Person Care Santa Cruz, Whole Person Care San Mateo, and the Camden Coalition shared strategies such as posting to community boards (online and in local businesses) and recruiting by “word-of-mouth” through CHWs and peers. The Camden Coalition described their phased hiring process, which involves case studies and shadowing care teams in the field.
Onboarding and regular training is critical to equip CHWs and peers with the interpersonal and technical skills to succeed. At the convening, the Camden Coalition described the RELATE model, a training framework to help CHWs build authentic healing relationships with clients. Whole Person Care Ventura emphasized the importance of feedback loops for CHWs and peers to receive constructive feedback from supervisors. Whole Person Care Los Angeles discussed their approach to developing and facilitating trainings that are both skills-based (e.g., motivational interviewing, mental health first aid) and population-focused (e.g., LGBTQ2I+, justice-involved).
As CHWs and peers were hired through Whole Person Care, pilots found that clinical staff were often unfamiliar with the new role and needed additional guidance to work as effective, integrated teams. Participants at the convening discussed the importance of educating staff about CHWs’ and peers’ scope of work and unique position as cultural brokers, as well as strategies to avoid “medicalizing” the CHW and peer workforce. Participants also shared how they adjusted care team schedules so that CHWs and peers could balance their time in the clinic with time spent in the community engaging clients.
Many of the clients served by CHWs and peers have experienced significant trauma in their lives and continue to face extreme challenges, such as homelessness, severe mental illness, and involvement in the criminal justice system. CHWs and peers need the tools and resources to adequately address clients’ trauma, as well as to manage the secondary trauma that may arise as they are reminded of their own similar experiences in the past. To support CHWs and peers in this way, many Whole Person Care pilots implemented trauma-informed care, “a model for organizational change…that promotes resilience in staff and patients.” (SAMHSA) Participants at the Whole Person Care convening learned strategies to develop trainings, meetings, and hiring practices that account for staff’s physical and psychological safety, as well as techniques to develop safe and supportive relationships between CHWs and peers and their supervisors.
The California Association of Public Hospitals and Health Systems (CAPH) represents California’s 21 public health care systems, which include county-affiliated systems and the five University of California academic medical centers. Together, these systems form the core of the state’s health care safety net.
The California Health Care Safety Net Institute (SNI) is the performance improvement affiliate of CAPH and supports California’s 21 public health care systems by informing and shaping statewide and national health care policy, providing performance measurement and reporting expertise, and accelerating decision-making and learning across systems.