Care Coordination

Supporting CHWs as they Support the Community
By Tanikka Price, Director of Education, Central Ohio Pathways HUB

Technical Assistance support may conjure images of someone walking through how to use a computer program, or how to input data entry. Technical Assistance (TA) with Community Health Workers (CHWs) and their Supervisors in the Central Ohio Pathways HUB is so much more than that. HUB Director of Education, I approach every TA session armed with the knowledge that CHWs have a huge turnover rate, and that the assistance I provide may make the difference between this CHW remaining employed or not. General issues that CHWs face include burnout, time management challenges, unclear expectations and overwhelming personal issues.

Burnout
For most CHWs the opportunity to serve clients in their community is exciting. During Onboarding with the HUB, CHWs are warned of burnout in a session called “Self-care.” Meditation, exercise, a balanced diet, and boundaries with clients are explored as ways to manage the challenging work that is ahead of them as CHWs. They are trained to model and coach clients to a point of self-sufficiency, enabling the clients to advocate and do for themselves eventually as the relationship progresses. However, for some CHWs, they begin making appointments for clients, getting food for clients at the local food bank, picking up diapers and wipes from local agencies, and that gets taxing over time. So these CHWs are more likely to experience burnout. In our TA session, we work with setting boundaries and working smarter, not harder. We roll play talking directly to clients, not in a way that hurts their feelings, but in a way that garners respect and understanding.

Time Management Challenges
A calendar is a must for CHWs. Time must be managed. It is so easy to get derailed by an emergency call from a frantic client which takes up the entire day. In our TA session we discuss keeping a calendar which includes having time for breakfast, lunch and dinner (you’d be surprised how many CHWs don’t make time to eat during the workday). We also discuss building in time for time in Care Coordination Systems (CCS) our data system and time to reflect. For CHWs with a history of trauma or adverse childhood experiences, it is important to build in time to journal or, when necessary, therapy. Working with clients from similar backgrounds may be triggering, and it may be even more challenging to establish boundaries with a client who is struggling through something you can remember struggling through.

Unclear Expectations
Sometimes there is nothing more than a caseload and a data system and CHWs have to figure out on their own how to prioritize the work. In this case, our TA session may incorporate finding out what the CHW is unclear on and then meeting with the Supervisor to make sure we are all on the same page. A good example of this is- a CHW may think that being efficient at work is checking all the emails in a day, while the Supervisor may have an expectation that she contacts clients every day. Communication and clear expectations are the key to making sure that the CHWs work is aligned with the expectations of the agency.

Overwhelming personal issues
Sometimes life situations come up that feels unmanageable. It happens to us all. In our TA sessions, sometimes the CHW just needs a trusting ear with which to vent. There is no therapy that happens during TA sessions, but there are suggestions made regarding time management, self-care, and communication with administration that are helpful to CHWs during a time when personal issues threaten their employment. CHWs are strong and resilient and that is what makes them so effective. Sometimes they just need to hear that everything is going to be okay, and to be reminded that they have made it through before and they will again. In those situations where personal issues are so overwhelming that they are not able to fulfill their responsibilities as a CHW, they are coached in a way that they can always come back to gainful employment when the time arises. When appropriate, they are referred to mental health agencies, or other social service agencies. During one TA session, I noticed the CHW squinting to read the notes on the computer and immediately referred him to Divine Family Eyecare where he was able to get an appointment and get new glasses to perform his job more effectively! In other words, sometimes we have to be a CHW to the CHW.
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Reducing turnover with CHWs begins the day they decide to do the work of a CHW. At the Central Ohio Pathways HUB, we take our mission seriously: we cannot serve the community without ensuring that the needs of our CHWs are fulfilled. We do that by providing TA sessions that can empower and encourage CHWs to continue on their path.