Evaluating community health worker (CHW) programs can be difficult. Many of the outcomes that we care about, such as patients’ capacity to live healthier lives, can be difficult to measure and take time to manifest. I have been fortunate to be part of a five-year research partnership with the KC Care Health Center that was funded by the Health Forward Foundation. Our evaluation team worked closely with program staff to evaluate and improve an already established and well-run program. The program now embeds many aspects of our evaluation. What started off with a narrow evaluation of cost that was described in an earlier post, has now resulted in a toolkit geared towards the evaluation of CHW programs designed to be used by organizations.
Measuring Value
Talking to CHWs and hearing their stories of the differences they have made in people’s lives is valuable. Success stories and case studies can be great ways to show the depth of impact of working with people one-on-one to improve the material, social, and emotional aspects of their lives. CHWs connect people to resources and help them advocate for themselves. In the words of one CHW we interviewed:
Community health workers also give hope to people. When you think that you have somebody that can help you […] You say, “Okay. Let’s work together. I’ll see if I—if we can find something that can help you.” They have that feeling of hope […] as I told you before, this lady that she had cataracts on both eyes, and she didn’t know how bad her vision was until she got them removed for free […] She looked more energetic just because she was happy that she could [see]—she said “Thank you.” I was like, Well, I didn’t perform the surgery or anything like that. But I gave her the path for where she could go. I helped her. […] But the look on her face. That’s what you take, you know? You take home that, and that fills your heart and your spirit and that give you more, like, energy to help others. That’s priceless.
With the increasing interest in the use of CHWs in many areas of healthcare, though not all, coupled with increased pressure to demonstrate results, being able to describe the value of such programs is essential for their financial sustainability. As a team, we looked through many ways to measure outcomes. We settled on a mix of qualitative data collected from semi-structured interviews and focus groups and quantitative data from the case management system.
Our Toolkit
We reviewed many of the excellent toolkits that already exist. After the review, we choose areas that were of interest to the joint research team and that seemed to be missed in other resources. As a result, the toolkit has four main sections:
- Workforce professionalization and training
- Outcomes measures
- Process Improvement
- Workflow development
Each section contains best practices from our own work and the academic literature, examples, and online resources. The goal is to give programs information they can use to improve without being overly prescriptive. The toolkit has a lot of suggestions and advice for how to choose among the many options.
The section on outcomes breaks down measures related to social determinants of health. Additionally, we discuss how evaluations can have different perspectives: client, CHW, program, payer, and community. We then go on to give examples of how you might measure outcomes from these different perspectives. Importantly, we also talk about how to choose and test specific measures. Check out the toolkit to learn more.
Additional resources
There are lots of great CHW toolkits out there, all geared towards different types of programs and different parts of a program lifecycle. I’ve listed a few here but if you have others, please name them in the comments!
- The National Association of Community Health Workers has an excellent resource center.
- The Penn Center for Community Health Workers is a national center of excellence. Learn more about the IMPaCT model at the website.
- Healthforce Center at UCSF is a research collaboration producing some great knowledge.
- Northern Arizona University’s Center for Health Equity Research is another research-CHW collaboration with online webinars.
- The Arizona Community Health Workers Association has great online training, programs, and advocacy resources.
- A toolkit from the American Hospital Association [PDF] discusses CHWs in hospital settings. They have some great resources on role definition in the hospital setting and key stakeholders.
- The Minnesota Community Health Worker Alliance toolkit [PDF] is geared towards potential health and social care employers starting a CHW program.
- The Mid-America Regional Council has excellent resources for professional training.
- The Rural Health Information Hub has a great online toolkit focusing on CHWs in rural areas.
- The CDC has a nice technical assistance guide [PDF] geared towards states who want to improve diabetes, heart disease, and obesity.
- For info on the roles of CHWs and financing in different states, check out the National Academy for State Health Policy.
The Community Health Worker section of the American Public Health Association is a great place to learn more and meet people.
What comes next?
In an interview, a representative from the Center for Public Health Initiatives asked what I hoped would happen in the field over the next 10 years. In the next 10 years, I want CHWs to be paid more than a living wage and have access to critical benefits, such as health insurance. Also, I hope the workforce will be much much larger than today’s workforce. I hope that professionalization and sustainability work in the interests of CHWs and clients. I hope that the profession is still open and remains an accessible job. Communities can derive incredible benefits from individuals becoming CHWs, getting training, making professional connections, and continuing their careers (even if outside the CHW role). What do you want to see?
Jess Williams