Washington state program helps community health workers reach clients coping with behavioral health issues

Lacy M. Fehrenbach, MPH, CPH
Washington State Title V Director
Office of Family and Community Health Improvement, Washington Department of Health

It was clear that “Sam” needed medical attention. He had cellulitis on both legs, a knee injury that had been hurting him for years and was experiencing challenges related to his mental illness. The staff at the clinic in Everett, Wash., wanted to help, but Sam, who was homeless, was becoming demanding and abusive. His behavior was frightening some staff and likely to get him restricted from the center.

Analisa Hall (pictured), a community health worker at the Community Health Center of Snohomish County, was determined to help Sam receive medical attention and break from the cycle of illness and homelessness.

“Most people did not realize that he was hurting and frustrated,” Hall said. “I wanted him to see my face every single time he came in, to know that I would be that one constant thing in his life that was committed to actively trying to change it.”

The Critical Role of CHWs

Community health workers (CHWs) play a vital role for thousands of families in Washington state. While their job titles may be outreach worker, health educator, patient advocate, or some other appellation, the work typically involves serving as connectors to state or community-based resources and shepherding people through complex systems. By being accessible and nonjudgmental, they often have a powerful influence in their communities to promote positive health choices.

As trusted members of their community, CHWs are essential to Washington goals to provide whole-person care and help people live longer, healthier lives in healthy families and communities.

The Washington Department of Health (DOH) has long recognized the value of providing information and resources to further empower CHWs. Its statewide training program launched in October 2012 and has since seen 1,800 people complete its eight-week core training. The first day of training is conducted in a classroom, followed by six weeks of online learning and a final in-person half day of training. CHWs can return and take any of 29 additional health-specific modules available online, six of which are in Spanish.

“Every day community health workers in our state make a meaningful difference in the lives of people with the greatest needs,” said Anne Farrell-Sheffer, manager of the Community Healthcare Improvement and Linkages team at DOH.

“Community health workers are advocates for their clients. They often come from the same communities or have similar life experiences to those they are seeking to support. This shared understanding, and a true commitment to meeting people where they are can, over time, build a trusting relationship with clients. Community health workers, through their strong community partnerships, can be effective at connecting clients to resources such as housing, food pantries, and job training that may have been long standing barriers to health.”

Training Improves Services

At Eastside Family Support Center in Tacoma, Coordinator Shannon Butt doesn’t directly support services for clients in need of behavioral health but participated in the state’s behavioral health module to “have a better understanding or discernment when someone comes through the door.”

Najja Brown, executive director of Yield to the King Ministry in Seattle, said the training enhanced her ability to assist community programs.

When she goes to shelters to feed the homeless, Brown works with staff to observe clients who may be in need of behavioral health referrals.

“I provide feedback based on my training,” Brown said. “Sometimes the organization invites me in to help the paid staff navigate the situation so the client can get the behavioral health services they need. I don’t provide any diagnosis, but I help connect the person to services.”

Often CHWs find they need both the training and a deep well of empathy to help clients.

After assisting Sam over several months, Hall began to make progress. She negotiated with law enforcement, the housing department, and health care providers to assist him.

Sam was admitted for medical treatment and an apartment had been found for him. But, worried about his possessions still out on the street, Sam checked himself out of the hospital against medical advice.

“I spoke with him and wanted him to know just how much was being done for him and how close he was to being housed,” Hall said. “I really wanted him to understand that I never gave up and followed through with what I told him I would do. He was very quiet and thoughtful, and it seemed to sink in at that moment that he was actually finally going to get off the street.” Analisa continues to work with him and has a team of professionals to help Sam stay off the street. Because he now has housing, he can access transportation services – and specialists for his knee. They are trying to get Sam into behavioral health services. “Now that he has housing, the work really begins,” she concluded.”

For more information please contact us at chwts@doh.wa.gov or visit our web page.