Community Health Workers and Their Value to Social Work
Spencer, Michael S., Gunter, Kathryn E., Palmisano, Gloria, Social Work
The use of community health workers (CHWs) as social justice and health advocates has a long and upstanding history both internationally and domestically in disenfranchised communities and in the public health, nursing, and biomedical literature (for example, Eng & Young, 1992; Israel, 1985; Lewin et al., 2005; Navarro et al., 1998; Norris et al., 2006; Swider, 2002;Two Feathers et al., 2005; Witmer, Seifer, Funocchio, Leslie, & O'Neil, 1995). CHWs have become vital to linking underserved populations to health and social service systems. Indeed, national priorities focused on eliminating health disparities, such as Healthy People 2010, call for innovative and effective approaches that address social determinants of health, with CHW interventions emerging as a promising approach in health care settings .Their value and potential role in the social work practice and research literature has been largely absent. Yet social workers and CHWs share a common value base of social justice; client and community empowerment; and commitment to culturally appropriate, effective, and sustained change. Thus, the purpose of this integrative review is to discuss the role of CHWs in promoting social justice and their utility in enhancing the work of social workers in community settings.
CHWs go by many names, including lay health advocates, promotores(as) de salud, family health advocates, community health advisors, outreach educators, peer health promoters, peer health educators, community health representatives in Native American Nations, and natural helpers, to name a few. Although there are various definitions of what a CHW is, the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions (HHS, HRSA, BHP, 2007) defined CHWs as
lay members of communities who work either for pay or as volunteers in association with the local health care system in both urban and rural environments and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve.
Similarly, the CHW Special Primary Interest Group of the American Public Health Association (2006) added the following: "A [CHW] is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served." CHWs often work in partnership with states and health care systems. Rather than replace health care and social service providers, CHWs complement services delivered through formal systems by enhancing the range of comprehensive and supportive services, generally in a cost-efficient and effective way (Goodwin & Tobler, 2008).
THE ROLE OF CHWS
Although there is a multitude of roles and responsibilities of CHWs, seven core roles were identified by Rosenthal et al. (1998) in their National Community Health Advisor Study: (1) providing cultural mediation between communities and health and human services systems, (2) providing informal counseling and social support, (3) providing culturally appropriate health education and information, (4) advocating for individual and community needs, (5) ensuring that people obtain necessary services, (6) building individual and community capacity, and (7) providing basic screen services.
A primary function of CHWs is to link community residents and vital health care and social services, acting as a bridge between individuals and families with significant needs and the institutions and organizations that provide assistance and care (Love, Gardner, & Legion, 1997; McElmurry, Park, & Buseh, 2003; Satterfield, Burd, Valdez, Hosey, & Eagle Shield, 2002). CHWs increase access to services by serving as navigators through the complex systems of care. CHWs also provide other services, from case management, referrals, other direct services, such as first aid, to interpretation and translation services (HHS, HRSA, BHP, 2007). …