CHW Training Model
Training Model
Training Curriculum: ABCD project staff released an informal RFP to explore existing training curricula for CHWs and their Supervisors that addressed mental Illness, substance use, and strategies to integrate CHWs into care teams. The team hired Jules Patigian, LMHC from Sameboat Consulting to adapt a curriculum that they had co-developed several years before. This curriculum is called Healthy Conversations and it was developed specifically for CHWs to use with patients who have mental health or substance use challenges: Healthy Conversations: Supporting Patients with Mental Health and Substance Abuse Issues
Together, the ABCD project team, Jules Patigian, and the Advisory Council adapted the training curriculum to fit the CBIP goals. The project team then developed and designed the Trainer’s guide, slides, and activity handouts (see addendum) with input from the trainers.
Additionally, the project aims to understand and improve the partnership between CHWs and social workers, a relationship that historically has been challenging and can be competitive as CHWs grow into the social determinants of health and the mental health spaces. Both the CHW and supervisor training curricula explore this tension and initiate discussions amongst the participants to think through strategies to decrease competition and increase collaboration with social workers, other mental health clinicians and CHWs. In addition, each training engages two co-trainers, a CHW and a social worker, to model a healthy collaboration between the two disciplines and to have representation of the two fields of expertise. The trainers all have worked in primary care and integrated behavioral health settings and have significant informative experience being a part of a multidisciplinary team.
Racial Equity and Training Experience: ABCD facilitated several curriculum adaptation meetings and train the trainer sessions. It is important to include in this report the challenges that occurred in these two components of the planning process that relate to race and racism. ABCD intentionally hired a mix of CHWs and social workers of color and white social workers. There is a significant section in each training that addresses racial equity in mental health as well as access in health care settings and the planning team agree that it is essential to have balanced and diverse racial representation of the trainers themselves. Both the advisory council members and the trainers critiqued and edited the training material to ensure its content was educational and antiracist. This feedback process became uncomfortable and at times confrontational. Importantly, the project team remained open to the critique and made changes in the training materials based on the recommendations of the trainers of color and advisory council members. Although this process was not always comfortable, it was an essential part of creating a training curriculum that honored both the trainer’s lived experiences of racism and corrected content, vocabulary and emphasis.
Training participants: ABCD successfully recruited CHWs and their supervisors as participants who work in community health centers (CHCs), hospitals, and community based organizations (CBOs) throughout Massachusetts that serve people of color who may be living in poverty. The people they serve have high rates of mental illness and substance use in addition to complex medical conditions including diabetes, respiratory disease, stroke, and cardiovascular disease.
Of the 88 CHWs who completed the baseline survey only 11% reported rarely or never coordinating behavioral health services. The vast majority of CHWs we trained reported navigating behavioral health care referrals for their patients in addition to addressing patient social needs to support chronic disease management. Moreover, most described their motivation to participate in the training as stemming from a mismatch between the extent of time they spend navigating behavioral health and the amount of behavioral health training they have received. For most this was their first formal behavioral health training. Below are quotes from trainees expressing their motivation in registering for this training.
“To prepare for the uptick going on in mental health with patients. CHWs caseloads will be increasing with more than usual behavioral health cases.”
“I would like to know more about mental health so I can assist the patient with this issue:
“I work with a population with complex behavioral health needs. I work alongside a social worker who is GREAT in difficult situations– however I’d like to gain more skills when it comes to handling a tough behavioral health case.”
“I believe all CHW’s could use more training in Behavioral Health and think participating in these training can help when working with patients.”
Toolkit Framework
A) Purpose of the Toolkit The purpose of this toolkit is to share training materials and research-based insights that might benefit employers of CHWs and other health professionals, training organizations, payers, community health worker programs, and policy makers. It will assist organizational planners, program managers, supervisors and other stakeholders in successfully integrating CHWs into the behavioral health services at their health setting. The materials in the toolkit are meant to be adapted as needed and all of the materials are open source.
B) Who should use the Toolkit This toolkit is designed for several types of stakeholders including employers of CHWs and behavioral health clinicians including programmatic staff and CHW supervisors, training organizations, payers, and CHW programs and statewide networks.
C) How to use the Toolkit
- Employers of CHWs and behavioral health clinicians:
- The toolkit can suggest strategic improvements to serve patients with comorbid physical and mental health issues by equipping staff with training materials to use with CHWs and their supervisors.
- CHW teams can access the Healthy Conversations Curriculum and use any of its many hundreds of activities, tools, and assessments to use with their clients. Healthy Conversations: Supporting Patients with Mental Health and Substance Abuse Issues
2. Training organizations: these open source materials can be adapted to add important content to an existing CHW training program as can the recommendations about trainer recruitment.
3. Payers: the evaluation insights can inform payers and recommend programmatic design to improve the integration of CHWs and behavioral health care teams and services.
4. CHW Programs and Networks:
- The evaluation outcomes and recommendations can be added to the evidence that CHW Networks need to advocate for more Behavioral health training for CHWs as well as more supervisor training.
- CHW Networks can disseminate these resources to other statewide CHWs networks or National CHW organizations such as the National Association of CHWs (NACHW).
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