CORE Insights: How community health workers strengthen care coordination relationships

Monday, September 5, 2022

Care coordination requires strong organizational relationships. Community Health Workers can help.

Supporting people with complex health and social needs often requires coordination between healthcare, social services, housing agencies, community-based organizations, and other service providers and entities. This collaboration is essential to effective care coordination. It’s also often complicated, requiring trust and information sharing between departments and organizations, and across traditionally siloed systems.

So, how can service providers build strong relationships within and between organizations, while helping those they serve navigate these systems? Based on research by our team at the Center for Outcomes Research and Education (CORE), Community Health Workers (CHWs) can play a vital role.

Three ways CHWs support multidimensional organizational relationships

CHWs are frontline public health workers who are trusted members of and/or have an exceptionally close understanding of the community served. Researchers have often cited CHWs’ unique ability to build trust with community members and break down barriers to navigating the complex web of health, social services, and other systems. However, our research of a care coordination program in Southwest Washington highlights another distinct area where CHWs can play a major role: developing the organizational relationships on which care coordination efforts depend. Through interviews with CHWs, their supervisors, and leadership participating in this regional care coordination program, our team at CORE identified three key areas where CHWs can build and strengthen the relationships needed to support their clients’ complex and varied needs.

1. Building relationships with external organizations

Relationship building with external organizations empowers CHWs to address clients’ varied needs, according to the staff we interviewed. CHWs, supervisors, and leadership explained that CHWs can be effective at both initiating new relationships and strengthening existing ones through their day-to-day work, which in this case included educating other organizations about the care coordination program and exploring ways their organizations could work together. Outreach created more trust and communication with other organizations, and that led to increased referrals into the program as well as referrals to other organizations based on their areas of expertise.

“It takes a little bit of time to get outside community partners to really trust the program, but I think it took off as expected, where it took a few referrals before people really understood how helpful it can be. Now, I don't think we have a problem getting referrals. We definitely have some community partners that are referring quite regularly” – Care coordination program supervisor

Staff also emphasized that building relationships requires a significant amount of time and energy. Because of this, agencies should allocate time and support for CHWs’ relationship building efforts and treat this as a core job duty.

2. Strengthening relationships within organizations

CHWs can also help improve relationships within their organizations. Staff reported that CHWs supported increased communication across departments at individual agencies. This was particularly true in organizations with many departments or locations. Through participation in morning huddles and ongoing conversations, CHWs helped build interdepartmental relationships and increase awareness of the care coordination program among medical and social service providers. This also helped improve staff understanding of client needs and other services those clients received.

“Making ourselves known in our particular clinic and attending those [morning meetings] is something huge, because people start their day with the information of like, “Hey, remember, the [Care Coordination] Program.” Sometimes our supervisor hops on with the provider, they kind of let them know about the program. Just word of mouth literally within the clinic about the program has been also a big one.” – Community Health Worker

Furthermore, staff reported that internal relationship building benefitted their organizations by allowing providers and specialists with more extensive professional training to focus on their areas of expertise while CHWs took the lead on care coordination.

3. Maintaining relationships amidst challenges

Despite various challenges faced by CHWs during the study period, including the COVID-19 pandemic, barriers posed by working in rural settings, and staffing shortages, these workers played a fundamental role in relationship building within and across organizations.

During the resource-scarce environment created by the pandemic and in isolated geographic settings, staff reported working even more closely with other organizations and departments to ensure client needs were met. Staffing shortages led to greater awareness of the value created by CHWs. These factors were also associated with an increased focus on providing CHWs with adequate pay and emotional support.

These findings further underscore the key role that CHWs can play in promoting organizational resilience in times of uncertainty.

Lessons for other care coordination programs

CHWs’ ability to build organizational relationships proved essential to making this care coordination program function as envisioned. While this study focused on just one program, based on our research and other studies, CHWs are best positioned for success when their organizations provide them with support in a variety of areas, including:

Setting aside scheduled time for outreach
Providing them with appropriate compensation
Ensuring adequate program funding
Delivering training to support core competency development in areas like relationship building
Providing supportive supervision
Ensuring access to shared data systems, including internal electronic health records and community health records
Providing access to other resources, such as local and national professional networks

As explained by other research in this area, these considerations are especially important in times of crises, such as the COVID-19 pandemic ^{(Peretz et al., 2020;}^{Rahman et al., 2021)}, when health disparities deepen and organizations increasingly rely on CHWs for continued community outreach and care coordination.

To learn more, read our manuscript in the Journal of Ambulatory Care Management.

For more CHW insights from CORE, read our blog post on The Impact of Traditional Health Workers.