The Community Health Worker Ecosystem in Texas
Who are Community Health Workers?
Community health workers (CHWs) are frontline health workers worldwide who are trusted members of their communities and are instrumental in reducing disparities and promoting health equity.
The dedication and service of Community Health Workers inspire hope and pave the way for a healthier, more equitable future. Yet, CHWs often need to be more appreciated, equitably paid, and better understood by the health systems that depend upon them.
What CHallenges face Community Health Workers?
PHOTO: Team members from UTHealth Center for Health Equity with participants in a community health worker mapping session in Houston on March 30, 2023
In 2022, The Health Equity Collective (HEC), a multi-sector systems-level collective impact coalition in the Greater Houston region, partnered with the City of Houston Health Department to launch a two-year effort to implement a comprehensive approach towards strengthening the CHW workforce infrastructure to advance equity.
UTHealth Houston — one of the most comprehensive academic health science centers in the United States — conducted a study to understand better the ecosystem of need, support, training, and deployment of CHWs in Texas.
This included promoting parity in living wages, providing a career pipeline for further advancement, recruiting from ethnically and racially diverse communities, and offering full-time employment opportunities with benefits.
The researchers’ baseline assessment findings show the challenges CHWs face, such as being underpaid, experiencing burnout, variability in job definitions, and lack of pathways and support for career development from the systems they are hired within. These issues and challenges stress the need for better support systems for these essential health workers.
The Center for Health Equity research team engaged Alphachimp to help facilitate, document, and visualize the CHW journey.
What did The Journey Mapping Process look like?
This multi-stage visualization process resulted in several iterations of “journey maps” through interviews, brainstorming workshops, and an iterative design process.
ABOVE: Screenshots showing the multiple versions and iterations of journey maps, including photos of the flipcharts and Post-It Notes from the first workshops, Miro Boards from online work sessions, sketches, and the final script and storyboard for the final explainer video.
The various maps all included the pathways that brought the participants to pursue a CHW career path, their journey through CHW training, personal development, fieldwork, and certification, and how they obtained their jobs, part-time or full-time. They also highlight many challenges, including:
unclear role definition
insufficient systems support
billing for services unavailable
supervisors are rarely CHWs themselves
lack of investment in career pathways and professional development
lack of systems crisis response
overwork, low wages, and underemployment
Conversely, the research identified many opportunities to empower CHWs through community engagement, building trust between the community and healthcare systems, service areas, listening to others, storytelling, peer training, and knowledge distribution.
CHW Explainer Video
The final explainer video, a product of the core research team's extensive two-year qualitative and quantitative research, is a testament to the team’s commitment to thoroughness and credibility.
The video's goal and primary usage is as a briefing or introduction tool, used both online and in live presentations to level-set audiences on the personal and professional needs of CHWs.
The team did not want an anonymous voice but a trusted messenger, so the video was narrated by Rosalia Guerrero, who has worked with community health workers for over 20 years throughout Texas, including urban, rural, and border communities.
She serves as Director of Vulnerable Populations for the Texas Epidemic Public Health Institute (TEPHI) at the UTHealth School of Public Health (UTSPH) in Houston and as adjunct faculty at Texas Southern University, College of Pharmacy and Health Sciences.
Conclusions
An upcoming academic paper (under review as of 10/1/24) outlines the journey mapping process and the collective impact approach to strengthening the CHW workforce across the Greater Houston region. Strategies and priorities were developed based on CHW voices and engaging stakeholders across all efforts.
These collaborative efforts have contributed to promising systems and policy changes on the local and state levels. The effort has also identified a historical lack of power-sharing and mistrust across CHW stakeholders that needs time and investment and more equitable systems to heal.
Disclaimer
This article is meant for educational purposes only. It is about the collaborative design process and does not represent the views of UTHealth, its faculty, departments, institutions, or government agencies.
Acknowledgments
I want to express profound gratitude to Dr. Shreela Sharma, Heidi M. Hagen McPherson, Rosalia Guerrero, Naomi Tice, Sisan Tennyson, Dr. Jemima John, Deborah Banerjee, Nadia Siddiqui, Sheila Savannah, members of the Health Equity Collective and the CHWs for their invaluable participation and guidance in this research.
The authors also thank the City of Houston Health Department for its crucial role in this process.
Additionally, acknowledgment is extended to UTHealth. Their support and fostering of an environment that enabled this systems change have been invaluable.
And to my bud Jody Lentz for connecting me when I moved to Houston during The Covid Times!
Learn more about CHWs and their important work in communities. https://sph.uth.edu/research/centers/che/community-health-workers/
