CHW Best Practices

Recommendations and Best Practices:

A) Best Practices to assist integration into Behavioral Health services

  • Define CHW role, scope of practice and tasks, as well as other staff roles
  • Create a shared language by
    1. Providing CHW behavioral health trainings
    2. Training behavioral health team on the role of CHWs broadly and in behavioral health specifically
  • Co-locate CHWs in behavioral health departments or embed them on BH teams
  • Include CHWs in huddles, team meetings and clinical case consults
  • Create a supportive supervision structure that provides CHWs what they need to work with BH clients

B) Facilitators of CHW integration into Behavioral Health care teams Supervisors and CHWs, alike, described a number of factors that facilitate integration. These included having a shared language as well as opportunities for consistent, multidisciplinary communication. Similarly, opportunities for collaboration and teamwork were seen as important facilitators. Communication and opportunities for collaboration were seen as strengthening teamwork and contributing to ongoing coordination. Examples of where this occurred included huddles, case conferences and clinical meetings. Co-location of CHWs and other providers  also strengthened opportunities for communication and collaborations. Further, having a clear understanding of the role of the CHW as well as CHW strengths and what they bring to the care team was seen as a facilitator of communication collaboration which were seen as necessary for integration. Role clarity has also been discussed in the literature related to CHW integration in primary care. Implementation studies suggest that successful integration requires clearly defined roles. In the case of the CHW our qualitative interviews revealed that their roles and expertise are not always clear. We, like others, learned that their integration is dependent upon other providers understanding and valuing their role. Participants were from a variety of different practice settings. Those who worked in settings with a behavioral health department and with behavioral health teams reported having a structure in place with regular meetings and touch points facilitated their integration. Other perceived facilitators of integration included supervision and multidisciplinary support for CHWs. In some cases we learned that CHW supervision was provided by an administrator not a clinician, this was seen as a barrier to integration. CHWs supervised by senior CHWs or social workers were described as critical if CHWs were to be fully integrated. 

The challenges of developing a training curriculum with a racial equity lens brought up additional recommendations.  As noted above in the section Training Model, the ABCD project team felt that it was essential to not only have a mixed race training team but also a majority people of color advisory council. Our goal was to include professional expertise and lived experience to develop and deliver our training curricula. Dynamics of white privilege and power surfaced as we discussed multiple drafts of our training materials. It was challenging and at times uncomfortable for team members to raise their concerns and for others to acknowledge the areas that needed changes. However, it is crucial to prepare for this likelihood based on the historical context of racism in healthcare and other institutions in our society.

Finally, CHWs and their supervisors both spoke to the need for additional behavioral health training for CHWs who were more often than not, working with people with both physical and behavioral health needs but simply were not provided with sufficient and appropriate training on these topics.