Best Practice

PASOs Health Connections

State/Jurisdiction: South Carolina
Setting: Clinical Community
Population: Children Families & Caregivers Infant Women & Maternal
Topic Area: Access to Quality Healthcare Equity & Anti-Racism
NPMs: NPM 6: Developmental Screening NPM 11: Medical Home

The PASOs Health Connections model involves PASOs’ trained Community Health Workers (CHWs) who work closely with members of Latino households including women, men, and children in a variety of settings including clinics and community-based locations. Because they are bilingual and are themselves Latino/a, the CHWs are able to build trust with immigrant families, even those who may otherwise be distrustful of institutions. From that position of trust, the CHW conducts intake screening, which includes health needs as well as social determinants, to determine the needs of the participant or family. Based on this intake, the CHW helps participants select an appropriate goal that works toward addressing the need with their support. Goals might include establish a primary care provider, apply for or renew health insurance including Medicaid, receive a chosen birth control method, learn how to use public transportation to get to work/school/appointments, receive food or clothing, connect with specialty care for a health need, and many more. Depending on the needs of the participant, and their level of urgency, CHWs will first educate them on the issue, inform them of available resources that they are eligible for, and work to refer and connect them with the resources they need to achieve their goal(s). The CHW follows-up with the participant to determine the outcome of the goal and whether the referrals made were successful.

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Implementation Handout

Maria Martin
(845) 283-9444
Practice Website