WEBINAR Sustaining CHW Programs in the HIV Response: Lessons Learned from the United States
Sustaining CHW Programs in the HIV Response: Lessons Learned from the United States
Wednesday, 30 November 2016
9-10:30am EST / 1-2:30pm GMT
In the United States, community health workers (CHWs) are culturally diverse and work in underserved areas, much like the communities served by CHWs globally. This webinar on November 30th featured a lively panel discussion with CHW leaders and organizers from California, Florida, Massachusetts, and Wisconsin to draw out lessons about how CHWs in the US have organized and formalized their roles to maximize impact and sustainability of community-based or lay cadre programs and how these experiences inform the global HIV response.
The Sustaining CHW Programs in the HIV Response webinar was sponsored by USAID, the USAID ASSIST Project, and CHW Central, with funding support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
Webinar Moderators: Donna Bjerregaard, Initiatives Inc. and CHW Central, and Shayanne Martin, USAID Global Health Bureau Office of HIV/AIDS
- Maria Lemus, Vision y Compromiso, California
- Ana Paula Soares Lynch and Joelisa Castillo, United Voices, Wisconsin
- Brendaly Rodriguez, CHW Coalition, Inc., Florida
- Rachel Weidenfeld, Justice Resource Institute, Massachusetts
A short summary of the webinar discussion and the slides used in the webinar may be downloaded below. Also downloadable below as file attachments are three resources from Vision y Compromiso.
Questions posed by webinar participants and responses from panelists:
Audience question: As CHWs are often working with vulnerable families with complex issues - how do you equip them to deal with psychosocial component of CHWs work? What competencies are needed and have they themselves identified psychosocial support competencies as a need for their training?
Ana Paula Soares Lynch: Close mentorship is important so that CHWs—who are often dealing with very difficult issues in the community—feel supported and feel like they can connect people with resources. In Wisconsin, we also encourage peer support—CHWs talk with each other, support each other. Self-care is also important—we have a self-care series where we talk about stress reduction and mental health. The consistency of supervision is also very important—having the supervisor in touch every week, every month is important for CHWs to feel supported—they have a “home” they can come back to.
Audience question: With formalization of CHW roles and increased integration into the health system, CHWs tend to show more allegiance to the system that pays their salary and supports them at the expense of the community they support. Is that the case in the US? If so, how have you been able to sustain commitment to the community or population they support?
Brendaly Rodriguez: Sometimes that is the case also in the US. What we at University of Miami and at the Florida CHW Coalition have encouraged is that CHWs become part of already established, or help set up, community advisory boards/committees (names vary) with specific geographic area and/or population focus (Hialeah= Established Cubans/Hispanics, Little Haiti= Haitians, Little Havana= Cubans and recently-arrived Central American Hispanics, Overtown=African Americans), with representatives from a diverse mix of organizations, NGOs, local government, local health departments, academic/research institutions, hospice/end-of-life and disease-specific management or survivorship support organizations, school board members, federally qualified health centers and community centers/clinics, etc. That way the CHW still is involved and linking to the community throughout the years, no matter if they are volunteer or paid, or change jobs/organizations/programs along the way. We do that in south Florida in our community-academic partnerships for research and community health assessments and it’s worked for diabetes, cervical/colon cancer, HIV and stroke/cardiovascular disease programs, for example.
Audience question: It would be interesting to hear the speakers talk about how they engage with the community members and leaders to identify local needs and priorities and how these shape program planning and implementation.
Brendaly Rodriguez: [By having an] ongoing presence and [providing] support to non-health-related events, so trust and rapport are cultivated.
Audience question: I know this is an ongoing debate, but I'd love to hear your comments: What is your take on working with CHWs as part of the system (paid) vs volunteer CHWs (unpaid)?
Brendaly Rodriguez: Both have pros and cons and, at least in Florida, we try to bridge the gaps and mobilize both groups, because of the mobility factor. Today you may be a volunteer but because of that experience, when a paid position opens, many times it goes to CHWs who have volunteered beforehand [because of the] shorter learning curve. Other times, CHWs that are now paid workforce, may find themselves out of a job for a period of time after their program ends, so by keeping them engaged in leadership positions, informal professional networking and information exchange opportunities, the Florida CHW Coalition supports and brings together both the paid and volunteer CHW experiences.
Audience question: Can the panel share experience on CHW program in urban areas. In Sub-Saharan Africa, most CHW programs focus on rural and peri-urban areas.
Rachel Weidenfeld: There are different challenges in urban areas. It can be time-consuming to find clients even though it’s in a geographically concentrated areas. Resources are more available, which for us has meant that we need to make sure we are aware of and connecting with all of the available resources in the area, and that we keep those contacts current, so that when there is turnover in medical care providers, we establish a contact with the new person. This helps the CHW make referrals, even accompanying the client to see a particular person the CHW knows who can help. I would say the bigger challenge in urban areas is confidentiality. We often hear from clients that they don’t want to go to that health facility because they know someone who works there, and they don’t want to disclose their status. Our CHWs have the conversation with clients, “Who do you want me to say I am if asked by a neighbor?” It’s also important for our CHWs to be dressed in regular clothes and that they don’t have anything on them that identifies them as an HIV worker. They carry identification as working with a human services organization.
Audience question: As CHWs are often working with vulnerable families with complex issues - how do you equip them to deal with psychosocial component of CHWs work? What competencies are needed and have they themselves identified psychosocial support competencies as a need for their training? Can they share their psychosocial support materials/ curriculum? This is a real gap in other curricula globally.
Rachel Weidenfeld: This link provides a curriculum for CHWs to address behavioral health/substance use related issues with clients: https://www.pcdc.org/resources/healthy-conversations-supporting-patients-mental-health-substance-abuse-issues/
Additional Resources Suggested by the Panelists:
Stress and CHWs
Haq Z, Iqbal Z, Rahman A. Job stress among community health workers: a multi-method study from Pakistan. International Journal of Mental Health Systems. 2008; 2:15. Available at: https://ijmhs.biomedcentral.com/articles/10.1186/1752-4458-2-15
Chibanda D, Mesu P, Kajawu L, Cowan F, Araya R, Abas MA. Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. 2011. Available at: http://www.chwcentral.org/problem-solving-therapy-depression-and-common-mental-disorders-zimbabwe-piloting-task-shifting-0.
Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. 2015. Cochrane Database of Systematic Reviews. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002892.pub5/full
Curriculum for CHWs to address behavioral health/substance use related issues with clients
Strengthening CHW Program Functions
Crigler L, Hill K, Furth R, Bjerregaard D. 2013. Community Health Worker Assessment and Improvement Matrix (CHW AIM): A Toolkit for Improving CHW Programs and Services. Revised Version. Available at: http://www.chwcentral.org/community-health-worker-assessment-and-improvement-matrix-chw-aim-toolkit-improving-chw-programs-a-0
Engaging CHWs in HIV Services
Kenya S, Okoro I, Wallace K, Carrasquillo O, Prado G. Strategies to Improve HIV Testing in African Americans. J Assoc Nurses AIDS Care. 2015 Jul-Aug; 26(4): 357–367. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489406/
Visión y Compromiso (PDFs available below as file attachments)
- The National Network of Promotoras and Community Health Workers
- The Promotor Model: A Model for Building Healthy Communities. Framing Paper
- A Landscape Analysis of the Promotor Model in Boyle Heights
Resources from the Florida CHW Coalition
Florida CHW Voices: This short video describes how CHWs in Florida participated in clinical research on cervical cancer prevention led by the University of Miami. Available at: https://www.dropbox.com/s/4vhsvyqrbetk512/CHW_APHA_final2.mp4?dl=0
Working with CHWs on Chronic Disease Management: Lebron C, Alonzo Y, Reyes-Arrechea E, Castillo A, Carrasquillo O, Kenya S, Rodríguez B. From One CHW to Another: A Community Health Worker's Guide. 2015. CES4Health.info: Community-Campus Partnerships for Health. This guide provides information about the tools used to deliver the Cariño program through which CHWs in Florida provided Hispanics/Latinos with type II diabetes with the necessary skills to make healthy lifestyle changes. Although the focus is on Hispanics/Latinos, many of the CHW approaches are applicable to other populations. This guide provides information about the tools used to deliver the program, CHWs’ experiences when working with patients, and the barriers CHWs encountered. Available at: http://ces4health.info/find-products/view-product.aspx?code=K6GJYM8G
Working with CHWs on emergent public health issues: Rodriguez B. “Working with community health workers to reinforce the mosquito bite prevention message during the threat of Zika.” US. Department of Health and Human Services Office of Minority Health Blog posted on August 10, 2016.
eLearning for CHWs in English and Spanish on chronic disease prevention and health promotion: “Promoting Healthy Choices and Community Changes: an E-learning Program for Promotores de Salud.” This eLearning Program, developed for the U.S. Department of Health and Human Services, can be accessed at: https://promotores.thinkculturalhealth.hhs.gov/default_en.asp. Registration is required to view the program. A webinar presented by Brendaly Rodriguez in Spanish discussing how this e-learning program can help promotores de salud talk to community members about chronic disease management is available through this link: