Primary Submission Category: Health care/services
Clinical integration of CHWs in New York State: Preliminary findings from a community-driven qualitative study
Authors: Meghan Armocida, Kayla Fennelly, Dina Pimenova, Denise Navarrete, Amy Freeman,
Presenting Author: Meghan Armocida*
Increasing evidence demonstrates that Community Health Workers (CHWs) improve population health outcomes and inequities by bridging gaps in care and addressing social determinants in culturally responsive ways. Understanding organizational capacity to integrate CHWs into clinical teams is becoming increasingly important as recent Medicare and Medicaid policy changes provide reimbursement for CHW services. This qualitative study aimed to identify facilitators and barriers to clinical integration of CHWs across New York State in order to understand how to better support this workforce and the organizations in which they are embedded. We recruited participants using a community-based convenience sampling approach and conducted focus groups with CHWs, clinical and community-based providers, and consumers to explore domains such as role clarity, team integration, documentation, organizational support, and sustainability. To date, we have completed 7 of 11 planned focus groups and will use rapid analysis to identify key themes. Preliminary findings framed using the Consolidated Framework for Implementation Research highlight inner setting factors such as supervisor engagement, reporting structures, and workplace resources (e.g. office space). Lack of role clarity creates tension between CHWs and clinical teams while clear role definitions, thorough orientation, ongoing training, and recognition of CHWs’ work aid in integration. Outer setting challenges include lack of reliable funding, lack of social service resources, and potential inadequacy of reimbursement mechanisms. Perceptions about the utility of formal CHW certification were mixed. In further analysis we will compare themes across settings and with consumers. Barriers should be addressed to enable effective partnership between CHWs and clinical settings. Similarly, facilitators can be strengthened and shared as best practices. The need for greater funding stability and recognition of the CHW workforce persists.