At Baylor Scott & White Health System, community health workers (CHWs) are members of interdisciplinary teams that include social workers, nurses, pharmacists, physicians, and sometimes chaplains. Teams are dedicated to subcategories of patients, including Medicare beneficiaries, individuals with chronic conditions, and individuals encountering social needs. CHWs work with patients to navigate the healthcare system, facilitate self-management of chronic diseases, and connect patients to primary care homes. They enhance care coordination by providing direct patient engagement and support, addressing barriers to care through social resource connections, & provide education to help strengthen care.
CHWs have the ability to meet patients where they are (physically and emotionally) as a trusted peer, often with lived experience. CHWs are viewed as fellow members of the community with whom patients can be open and honest. Typically, CHWs wear plain-clothes, even in a clinical environment – this helps the patients to see CHWs like themselves. Some CHWs conduct home visits to physically meet the patients where they are – this helps to further address any unidentified social needs that patients may have. Their cultural humility and competence allow them greater understanding through high-touch, low-volume interaction with patients who may not seek out or continue with complex care or treatment. This is in contrast to physicians who may operate at a high-volume, low-touch clinical pace. CHWs often follow-up through phone calls or other outreach for patients to confide in them their struggles, misunderstandings, and any confusion about their complex and chronic health issues. Bi-lingual support can be critical to patients that may be fluent enough in English to answer questions with a simple yes or no, but may not be fluent not enough to ask questions of their own or have health literacy issues that have not been identified by other care team members