Social Worker Perspectives on Managing Community Health Worker Programs

Background: Community Health Workers (CHWs) are frontline workers who are often members of the communities they serve. They often share the same lived experience, language, culture, and socioeconomic needs of their clients. Social workers tend to take upon managerial roles within CHW programs. While many studies examine CHW work experiences, there are no studies that focus on leadership and upper management’s perceived expectations of CHWs; many of whom are social workers. Our study examines the perspectives of CHW program Executive Directors (EDs) and supervisors of CHWs scope of practice, strengths and challenges faced by CHW in their work, and identifies individual, organizational, and policy-level supports needed for them to fulfill their work.

Methods: We conducted two separate focus groups; one with the supervisors (n=6) and one with EDs (n=7). The purpose of the focus groups was to solicit perspectives on the nature of CHW work, their ability to support CHWs, and ongoing policy-level changes that may impact the sustainability of CHW programs. All focus groups were audio-recorded and transcribed verbatim. Thematic analysis was used to identify salient themes relevant to the overarching research questions of the study.

Results: All participants (n=13) were females. The racial breakdown of our sample was: White (ED = 6; supervisors =3); Black or African American (ED = 1; supervisors =3). Two EDs had Doctoral degrees, and five had Master’s Degrees; all of the EDs were trained in social work. Two supervisors had their Bachelor’s degree and four had their Master’s Degrees in social work. EDs and supervisors reported that CHWs are valuable in linking families with basic survival skills. EDs perceived that CHWs strengths lie in the fact that they tend to be from within the community and share lived experiences as clients in addition to having an established relationship with community members. Supervisors also noted the ability to engage/connect with the target population and their capacity to develop a working alliance with clients as strengths. Challenges identified by EDs included both individual (poverty, lack of professionalism, trauma) and structural (low salaries, high turnover rates, recruiting CHWs, lack of trainings, limited or inactive referral networks, lack of observational aspects of CHWs evaluations) issues. Supervisors noted similar individual (trauma, lack of ability to maintain professional boundaries) and systemic (negative public perceptions, high turnover rates) challenges that influence CHWs abilities to work.

Implications: Our study sheds light on social workers’ managerial role in supervising and leading CHW programs. Our study offers recommendations to social workers in terms of considering professional development areas for CHWs, such as such as regular CHW performance review developmentally appropriate in-service/targeted trainings; and structured supervision incorporating evidence-based techniques that enhance skill acquisition and uptake. At the organizational level, data-driven referral processes and referral network management systems should be implemented within CHW programs to improve and monitor referral making processes and outcomes. At the policy level, we suggest continued advocacy at the state level to ensure that adequate resources (funding) are made available to further expand CHW programs.