Blog Post

Community health workers: A prescription for healing

This blog post is by Khmer Health Advocates. The organization provides health care and support for survivors of torture. 

Long before there were doctors, nurses, dentists, and pharmacists, there were community health workers (CHWs). These workers are trusted members of the community who understand the words their community members use to describe their pain and sickness. They know the experiences of their community and the fears that come from those experiences. 

Called many different names in different cultures, CHWs share an appreciation for the beliefs and history of their community and an understanding of their community’s current needs. Most importantly, they know what resources for healing are available within their community.  

Many communities suffer from trauma. Wounds that break connections between our heart and our mind, our body and emotions, our relationships with our families and community, and the links between our past and our today. These wounds come from sickness that claimed many lives like the pandemic, wars, violence that causes people to become refugees, victims of sexual abuse, natural disasters and other events that shatter our sense of being whole. 

Trauma is always about loss. The loss of loved ones, loss of country, property, jobs, inherited wealth, access to resources and most of all the loss of a sense of who we are and where we belong. In times of hardship and distress, people develop skills to survive. Nevertheless, without healing, survival becomes the path to chronic illness. That could be post-traumatic stress disorder, depression, anxiety disorders, diabetes, heart disease, stroke, and various other conditions stemming from stress.

The road to healing cannot be taken alone. Healing happens in community. The CHW begins as a guide and supporter and grows into the role of leader who can help people advocate for their own needs. The CHW is a communicator who knows the words that can comfort, educate, and help their community members develop a strategy for healing. The job of the CHW is to remove the obstacles and build resources for healing, knowing that it will take time and caring. 

Modern medicine cares for the here and now. Healing traditions look to the past to guide a community to a healthier future. Tradition comes from the Latin word for “handing over,” handing over the wisdom that comes from caring for our sick and wounded. Healing from massive trauma does not take weeks and months, but rather decades and centuries. The burden of trauma is handed down to the children and caregivers of those who survived.

The CHW is the link between the past and the future, the modern and the traditional, the individual and community. It is essentially the “missing link” in our health care system.

The Community CARES Tradition

Keeping the community in community health workers

The art of the community health worker is not only linking clinical health care to the community, but also engaging members in building a healing community.  We know that medical care contributes approximately 20% to health outcomes in a community. The social determinants of health contribute the remaining 80%. They include health behaviors, socio-economic and environmental factors, which are the realm of the community health worker. 

The Community CARES Tradition is an example of a model of care that focuses on the social determinants of health. It offers structure and language that creates a bridge between community health workers and health care providers. 

The model has two goals, removing obstacles and building resources for healing. It requires community health workers to master skills in five domains: communications, access, resources, education, and strategies, utilizing four actions—connecting, deconstructing, circling, and sharing. These actions happen in a circle rather than a straight line and help the CHW meet their community members where they are at now.  

Connecting requires the CHW to “be in the community” doing home visits and attending community events. Deconstructing problems is a process of collecting information and seeking wisdom to understand what the community needs. Circling is a practice of returning over and over to a problem or need until it is solved, or the need is met. Sharing engages the community and the clinical health care providers in a “give and take” that builds a bond between all members of the group. 

The structure of the Community CARES Tradition can help marginalized communities identify and explain their priorities for health equity. Evidence-based programs prove that CHWs can effectively engage their members in collecting data for research outcome studies. 

There is a mental health crisis in the United States and social isolation and traumatic distress are the root of many physical and mental disorders. Communities inherit the negative consequences of this crisis. Now, more than ever, community health workers are essential to healing individuals, families, communities and our country.