To Strengthen The Public Health Response To COVID-19, We Need Community Health Workers
The public health system is a critical firewall to reduce community spread of COVID-19 and to relieve the unsustainable pressure the US health care system is experiencing as a result of the pandemic. Community health workers (CHWs)—frontline public health staff who conduct outreach and build trust with vulnerable populations in federally qualified health centers (FQHCs), hospitals, public health agencies, and through community-based organizations—have a particularly important role to play.
On March 19, 2020, the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency issued a memorandum on identification of essential critical infrastructure workers during the COVID-19 pandemic. The memo included CHWs in the list of “essential critical infrastructure workers who are imperative during the response to the COVID-19 emergency for both public health and safety as well as community well-being.”
While there have been a few reports of state efforts to collaborate with organizations that employ CHWs and engage CHWs in COVID-19 contract tracing, this workforce is being underused in the nationwide fight against the pandemic. A recent informal member poll by the National Association of Community Health Workers (NACHW) revealed that instead of mobilizing this critical human resource, community-based organizations in many states have opted to lay off CHWs. According to respondents, some CHWs working in clinical settings such as FQHCs have been instructed to simply “find something to do” while their supervisors are occupied with patient care.
CHWs can be a tremendous asset to community-based COVID-19 emergency response teams. The missed opportunity to leverage CHWs’ potential is costing thousands of lives. Health systems, local governments, and state public health officials should immediately engage CHWs in community-based strategies to protect vulnerable populations during the pandemic.
We Need To Leverage CHWs’ Communications Skills And Community Connections
At a time when misinformation and lack of understanding can have devastating consequences in low-income communities, CHWs’ expertise is urgently needed.
CHWs can provide a critical communications link. Based on their unique experiences and community connections, CHWs can share insights with state and local decision makers on the most effective ways to provide vital resources to vulnerable populations such as individuals who use injection drugs, are experiencing homelessness, engage in sex work, or have recently been released from incarceration. CHWs can likewise serve as community messengers for critical public health and social service information, to inform these populations about where to access COVID-19 testing, health services, food pantries, diaper banks, and hardship funds. CHWs may use tools such group texts and email, social media, shared electronic forms such as GoogleDocs, or daily conference calls to provide their communities with real-time updates.
State and local authorities should ensure that CHWs have the resources they need (for example, phones, videoconferencing technology, high-speed internet access) for remote communication. Providing these resources also can help CHWs maintain continuity of support services for patients with chronic conditions who participate in group or individual disease management coaching. Remote check-ins can be used to help patients access medications, adhere to treatment and exercise regimens, and maintain healthy diets. These support services are critical to reduce preventable hospitalizations at a time when health care system capacity is extremely constrained.
CHWs can develop and distribute culturally appropriate health education materials. CHWs across the country have reported difficulty in finding COVID-19 materials to meet the unique needs of populations they serve, including those with limited literacy. The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care highlight multi-media materials as an effective way to convey health-related messages in culturally diverse communities. Given their experiences and understanding of communication needs and preferences in their communities, CHWs can play an important role in efforts to develop and disseminate culturally sensitive health education materials.
Bi- and multi-lingual CHWs can translate written materials and provide interpreter services remotely. Individuals with limited English proficiency (LEP) may be at increased risk for COVID-19 infection due to their living conditions, jobs, and lack of paid sick leave. To improve access to care for LEP populations, CHWs can be employed to provide interpreter services for remote medical appointments and translate information offered through COVID-19 testing sites, information lines, food banks, and other resource distribution centers.
CHWs Can Boost Public Health And Safety-Net Provider Capacity In Low-Income Neighborhoods
As they ramp up efforts to combat the spread of COVID-19 among vulnerable populations and provide financial assistance to those most in need, communities should call on CHWs to fill workforce gaps in public health and social service agencies.
CHWs can expand the capacity of homeless shelters, food pantries, and local agencies providing assistance with public benefit applications. Many CHWs have experience staffing shelters and emergency food distribution centers and know which individuals, families, and elderly residents in their neighborhoods are most in need of social support and resources such as food, medical supplies, and diapers. Based on their knowledge and experience, CHWs can help people apply for unemployment and disability benefits, as well as the Supplemental Nutrition Assistance Program, the Special Supplemental Nutrition Program for Women, Infants and Children, and utility assistance programs. CHWs also have the background needed to mobilize volunteers at these facilities.
CHWs can be hired and trained to conduct COVID-19 contact tracing. CHWs have the outreach skills needed for contact tracing. Health departments should hire and train CHWs to interview people with confirmed cases of COVID-19 by phone to identify their contacts and reach out with information on how to prevent COVID-19 transmission and where to access testing. Training should include clear, evidence-based guidance on how to support screening and referral of individuals with COVID-19 symptoms.
CHWs can provide COVID-19-related support for Medicaid members. Some Medicaid managed care organizations employ CHWs to support members with chronic conditions, and some states have supported CHW activities through Medicaid 1115 waivers. States should leverage opportunities in their Medicaid programs, along with Medicaid emergency authorities and waivers approved for the pandemic, to support engagement of CHWs in COVID-19-response activities. For example, CHWs could support isolated Medicaid members with COVID-19 symptoms by coordinating food and medication delivery and conducting phone or video visits to monitor symptoms and help combat social isolation.
Additional Efforts Are Needed To Protect The Well-Being Of Community Health Workers
CHWs often work in hourly positions that pay less than a living wage. As state and local leaders turn to CHWs to fill gaps in community-based pandemic response efforts, they need to provide adequate compensation. Boosting the wages of CHWs can help them overcome challenges with transportation, food security, and other barriers that inhibit their ability to thrive and help others.
Communities also need to protect the health of CHWs during the pandemic, for example, by allowing them to opt out of activities such as staffing shelters that may put them at high risk. Finally, employers should encourage CHWs to prioritize and use a range of resources to promote self-care, including tools related to mindfulness, stress management, and mental health.
These recommendations are grounded in the models of community-centered CHW work developed by the National Association of Community Health Representatives and a nationally recognized organization of promotores, and confirmed by evidence of CHW effectiveness published by the Community Preventive Services Task Force and the Association of State and Territorial Health Officials.
Prior to the pandemic, a number of states had enacted legislation recognizing CHWs as part of a vital public health workforce and acknowledging their unique roles, qualities, and competencies. Implementation of these recommendations can increase state, local, and health system capacity to implement COVID-19 emergency response. Many CHWs are needed immediately to help address this crisis.