Tightly Focused Interventions Limit Flexibility

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Earlier, we discussed the tendency to fund CHW services in narrowly focused interventions on specific health issues, a practice that runs against the natural tendency of CHWs to move fluidly between roles in their interactions with community members.

Tightly focused interventions limit flexibility in the CHW workforce as:

CHWs play multiple roles and move fluidly among them
There is a need for flexibility: CHWs tend to “do whatever it takes”
Limiting CHW roles can undermine their credibility
CHWs often spend extra time per client/patient

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Earlier, we discussed the tendency to fund CHW services in narrowly focused interventions on specific health issues, a practice that runs against the natural tendency of CHWs to move fluidly between roles in their interactions with community members. CHWs are often involved in population-based outreach, but they also follow up with individuals or families identified in the course of this outreach, applying a somewhat different skill set.

Further, as noted in Session 1, a CHW usually responds to the entire range of needs of an individual or family, doing “whatever it takes” to meet those needs. This tendency carries over to outreach programs. To develop the credibility necessary to deliver her outreach message, a CHW may need to help people meet other, more immediate needs first. One example of this occurred in an outreach program to promote well-child exams under Medicaid, the Early Periodic Screening, Diagnosis, and Treatment Program, or EPSDT. CHWs working for one community-based organization complained that they were only allowed to talk to families about the EPSDT program, when it was clear that the families had other needs with which the CHWs could assist. Another group of CHWs asked to help enroll children in Medicaid responded, “don’t limit us to talking about Medicaid; they will look at us like salespeople.”

One possible reason for CHWs’ effectiveness is the fact that they often are able to spend more time with an individual or family than other health professionals can. Research on health literacy and health education has shown that effective communication often takes time and patience, particularly in stressful situations. Also, differences in perceived status and power between a medical professional and patient may limit the patient’s willingness to be fully candid about his or her situation. Time and trust can allow a CHW the opportunity for more complete communication with the patient or client. The limitations of a tightly focused intervention may limit CHWs’ ability to capitalize on this strength.