[SPEAKER]
Although generalizing about distinctions between CHWs and other occupations may be difficult, some observations can be made. CHWs generally do not design clinical interventions autonomously. A CHW may, however, be involved in design as a member of a clinical team and contribute her understanding of the patient’s or family’s context and of the larger community.
Distinctions between the CHW and other occupations become more significant when other professionals supervise CHWs. In these instances, supervisors need to know where their responsibilities end and those of the CHW begin. Clarifying boundaries and a distinct scope of practice for CHWs is also important in establishing state policy.
When establishing a scope of practice, it’s useful to remember that CHWs are commonly relied on for their knowledge of the community, rather than for particular clinical expertise. In the community, however, the CHW is looked upon as an authority on how “the system” works.
Another distinction is in accountability. CHWs are considered to be operating in support of other members of the clinical team and are generally not held accountable for the clinical outcomes of individual patients. They generally do not carry professional liability or malpractice insurance. Even so, they often have a sense of emotional accountability for the results of individual patients or their families.
Nonetheless, because of the limited clinical training provided to CHWs, stakeholders are frequently concerned about the quality of services CHWs provide. Quality of service is a sensitive issue, even in the act of providing health information, and is an important area of responsibility for the CHW supervisor. Good CHW training and supervision includes instilling a clear understanding of quality assurance and negotiating strategies to assure accountability for delivering accurate information.
