Community health workers (CHWs) are trusted frontline health workers who often live in or come from the communities they serve. These community connections allow CHWs to provide support for hard-to-engage populations by liaising between patients and providers, in addition to advocating for patients’ needs. Prior studies emphasize the importance of these providers in improving physical health outcomes and lowering healthcare costs for their patients, yet there is limited research on the roles CHWs fill in behavioral health care. The increasing investment and implementation of the Certified Community Behavioral Health Clinic (CCBHC) model across the country presents opportunities to utilize CHWs to broaden behavioral health service availability.
Study Aims/Research Questions
The aim of this study is to understand how CCBHCs in the 10 demonstration states of Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Michigan, and Kentucky may employ CHWs to assist in connecting patients with integrated physical and behavioral services. For locations at which CCBHCs currently employ CHWs, this study will describe the populations they serve, services they provide, and how their role impacts demand for behavioral health services (e.g., whether behavioral health specialists are able to increase caseloads when CHWs are part of care teams). Study findings may illuminate opportunities to employ CHWs in behavioral health settings and funding mechanisms for integrating CHWs into behavioral health care teams.
- To what extent are CCBHCs currently employing and utilizing CHWs?
- How could employing CHWs impact the reach of CCBHCs and their behavioral health workforce?
Through interviews with stakeholders in eight of the ten CCBHC demonstration states, the key finding from this study is that CHWs are not currently commonly employed in the CCBHC setting. In several interviews, CCBHC staff were unfamiliar with the term CHW, and were unclear about the roles and qualifications of this workforce. All interviewed CCBHC staff noted that the role of peer support workers, and at times, case managers or care coordinators, may serve some similar or overlapping functions to the kinds of support CHWs would provide, but that none of their staff were certified CHWs. One CCBHC in Michigan reported that they did have one staff member with a CHW certification, but that individual was not employed as a CHW, or working in that capacity in their role at the CCBHC.
Additional findings were categorized into relevant themes that included: staffing challenges faced by CCBHCs, the use and impact of telehealth, underemployment or dissatisfaction among CHWs in behavioral health settings, issues of reimbursement, CCBHC requirements regarding staffing, and how CHWs may play a role in the CCBHC setting.