Adding Value to our Health Care Teams: Nevada’s Community Health Workers

WHAT IS A CHW?A Community Health Worker (CHW) is a frontline public health worker who is a trusted

member of and/or has an unusually close understanding of the community served. This

trusting relationship enables CHWs to serve as a liaison, link, or intermediary between

health & social services and the community to facilitate access to services and improve the

quality and cultural competence of service delivery. 1

In other words, CHWs serve as bridges between clients and resources. Nevada’s

communities benefit through improved health outcomes, yet funding sources are rarely

tied to the savings that CHWs have demonstrated can be realized when ER and

urgent care visits are not used as a first choice for accessing healthcare.

[1] APHA Definition in: Mason, T., Rush, C. and Wilkinson, G. (June 2017). Promoting Community Health Workers: Workforce Definition and Credentialing—Issues and Options for State Departments. ASTHO Technical Assistance Presentation. Multi-State Learning Community.

Here in Nevada CHWs work under many job titles, the primary ones being:

• Community Health Worker• Care Coordinator• Case Manager• Resource Coordinator or Resource Liaison• Community Health Educator/Outreach Educator

• Outreach/Enrollment Worker or Patient Navigator• Health Advocate• Peer Advocate or Peer Leader• Youth Outreach Worker• Family Advocate

• Family Support Worker• Community Health Representative• Promotores de salud (Healthcare Promoters)

To date, much of the CHW workforce has been developed through local,

grassroots efforts—community by community—and with our growing state-

wide Nevada Community Health Worker Association, we are ready to build

upon and sustain CHWs as a viable member of the healthcare workforce.

What is needed in Nevada NOW to take the CHW Workforce to the next level?

LOCAL HEALTH STRATEGIESIn Nevada those who identify themselves as a Community Health Worker, with the full array of titles noted above, are already working in our state as members of our health and human services teams.

CHWs were formally recognized by the American Public Health Association in 2001, when they adopted Policy Statement 2001-15, “Recognition and Support for Community Health Workers’ Contributions to Meeting Our Nation’s Health Care Needs.” The Community Health Worker National Workforce Study, published in 2007, estimated that as of 2005, there were approximately 121,000 Community Health Workers in the United States. At that time, the number was growing at over 7 percent annually (C.H Rush, personal communica-tion, May 15, 2009).

With the appropriate resources, training and support, Community Health Workers improve the health of their communities by linking their neighbors to health care and social services, by educating their peers about disease and injury prevention, by working to make available services more accessible and by mobilizing their communi-ties to create positive change.

In Nevada, CHWs are locally-grown health providers with deep roots in the community. They have emerged as voices and health supports for many diverse communities of people of which they are members: communities of color, LGBTQ community, people living in poverty or, as with our FASTT and MOST programs, people who are incarcerated and transitioning back into their communities.

BELOW ARE SOME EXAMPLES:

• In Community Health Centers across the state, CHWs are employed to educate

patients on the importance of health screenings such as for colorectal cancer,

provide warm hand-offs to community resources and make follow-up calls to

ensure referrals to outside providers are completed.

• In Southern Nevada, barbershop workers are being trained to screen for high

blood pressure in their customers. This program puts a focus on communicating

the importance of heart health, specifically to Black men, a group that is less

likely to seek out preventive care.

• In Rural Northern Nevada, Home Visitors recruited locally are trained as CHWs

and provide in-home supports to families with children prenatally through five

years. They visit weekly or biweekly and support parents as the first teachers of

their children, while also linking families to primary care and other community

resources that will enable them to sustain the well-being of their families through

job training, community support, and parenting skills training and modeling.

MORE EXAMPLES:

• CHWs working in Mineral and Storey counties with inmates, some

of whom are struggling with addictions, are able to expedite the

transition to community and make sure that the required paper-

work to access community resources and support is completed and

that they have a peer to walk alongside them as they navigate their

return to daily living.

• In another rural county, Douglas County Social Services (DCSS)

works with inmates in the jail who are about to be released. DCSS

has a program coordinated by CHWs who also train inmates in CPR

before they are released. They added a Naloxone training for in-

mates and give them Naloxone kits to serve as peer helpers when

they are back in community.

What impact can CHWs have on our goal of promoting healthy lifestyles?

The work of CHWs is based in some fundamental

assumptions and consistent observations of how

their services have affected the lives of community

members and strengthened the work and results of

their team members and partner agencies:

• Preventive work equals preventive measures to

intervene earlier and link people with existing

resources (activities, classes, basic needs), all at a

lower cost than traditional health care, while increasing

healthy lifestyles, which also saves our state money.

• We’ll never “grow” the number of medical and

mental health professionals we think we need: BUT

if we change how we think and invest in its people, we

can reverse the numbers and ratios to reflect more

community members per CHW and fewer needing

professional health providers.

• CHWs are a much less expensive means of growing

the workforce than some of our other capacity-building

efforts.

• CHWs working as Safe School Professionals or

“Resource Coordinators” in our rural counties

(2014-18) contributed significantly to students’

mental health through coordinating referrals and

follow-up. This support enabled students to continue

to attend and participate in school, thereby ensuring

uninterrupted learning and they were able to stay on

track academically.

The results from the University of Nevada’s ROI Study

also indicate that there is a decrease in ER visits (14%)

urgent care (6%), acute admits (18%) and repeat

hospital visits (20%). 2

CHWs working on MOST teams are estimated to

produce county savings for people diverted from

jails. Approximately three days of reduced jail time

is estimated when people who are in jail are paired

with CHWs prior to, upon and following release.

At approximately $400/day that is a $1,200/per

person savings.

When CHWs are added to a clinical team providing health and medical services in Nevada, this resulted in a return of nearly $2 for every $1 spent.

[2] Elizabeth Christiansen and Kelly Morning (2017). Community Health Worker Return on Investment Study Final Report. Center for Program Evaluation, School of Community Health Sciences, University of Nevada, Reno.

WHAT ARE THE CORE COMPETENCIES THAT NEVADA’S CHWS POSSESS TO DO THE WORK THEY DO IN COMMUNITIES?Community Health Workers are typically empathetic,

resourceful and willing to help others. Such qualities are

personal characteristics that can be enhanced, but not

necessarily taught. CHWs who are trained in Nevada also

receive specific skill enhancement in the following areas:

1. Communication Skills 6. Education and Facilitation Skills2. Interpersonal and Relationship -Building Skills

7. Individual and Community Assessment Skills8. Outreach Skills

8. Professional Skills and Conduct

8. Evaluation and Research Skills

8. Knowledge Base

3. Service Coordination and Navigation Skills4. Capacity Building Skills5. Advocacy Skills

WHAT VALUE DO CHWS BRING TO NEVADA’S COMMUNITIES?

WHY IS IT IMPORTANT THAT WE INVEST IN CHWS IN NEVADA’S COMMUNITIES?

Their competencies position them to build individ-

ual and community capacity for residents to thrive

by increasing health knowledge and self-sufficiency

through a range of activities such as outreach, com-

munity education, informal counseling, social support

and advocacy. Their expertise is based on shared life

experience and (usually) cultural background with the

population served. They spend most of their time with

people in their homes, communities, and clinics. They

address social determinants of health.

CHWs build trusting relationships based on shared

power and “Three C’s” of community: Connectedness,

Credibility, Commitment. Their core values are based in

equality, justice, empathy.3

There’s a chronic professional healthcare workforce

shortage: a significant contribution CHWs make is get-

ting people to get the “right care” when they need it and

to take better care of themselves as part of their daily

lives. This results in decreased utilization of ER (14%)

and urgent care clinics (6%), systemwide cost savings,

and more focused time for mental and medical health

professionals to do what they do best while a member

of their team handles the non-clinical aspects of medi-

cal and mental health needs of community members.4

[3] IBID. Callaghan, T.H., et al. (November 2019). Southwest Rural Health Research Center, Texas A&M School of Public Health.

[4] See “What is the Return On Investment (ROI) for employing CHWs?” section of this document for more results achieved through use of CHWs.

The figure below demonstrates, Nevada’s CHWs already work in di-

verse settings—from treatment facilities to health clinics, to schools

and out in the community at-large—and have expressed an interest

or intention in continuing to work in these settings.

WHERE DO CHWS WORK? HOW DO THEY REACH OUT TO NEVADA’S MOST VULNERABLE POPULATIONS?CHWs add value to the sustainability of the integra-

tive Medical/Behavioral Health model. They serve as

allies to community members and take a systemic

approach to how they support their clients. Whether

in schools, health clinics or community settings, they

address the systems that community members need

to negotiate to get and stay healthy. They do so by

assessing their clients’ needs, setting up action plans,

and in some cases providing side-by-side support.

They can handle many of the non-clinical aspects of

mental health professionals’ caseloads, including

those that fall into preventive health care/education

and monitoring of patient outcomes and follow-up in

medical patient caseloads.

Treatment Facility | 20.2%

Community | 40.1%Clinic | 20.2%

School | 13%

Unsure | 6%

The results represent 391 responses from CHWs to an ongoing survey conducted by the Nevada Community Health Worker Association between December 5, 2017 through October 28, 2019.

SCHOOLS• Case management

• Set up on campus counseling

• Referrals to Human Services

• Mental Health Referrals

• Vision referrals and vouchers

• Drives - solicit donations for food, school

supplies, hygiene, clothing and distribution

• Recruit and Oversee student volunteers

working with senior citizens

• Facilitate student clubs - Girl Scouts after

school, Student Study Teams

• Attendance / Participation at: Achievement

Conferences, trainings, community meetings,

Family involvement Committee, and School

Progress Plan

• Reporting for grants

• Supervise Americorps Members

• Run clothes closet, food backpack programs

at elementary and middle schools

• Playground and Lunch Duty

• Encourage Parent Involvement through Coffee

Klatsch, etc.

• Develop community partnerships with Human

Services, DCFS, JPO and businesses

• Co-facilitate classes

• Conduct hygiene lessons with PE Teachers or

Read to kindergarten classes

CHW OUTREACH SERVICES

“I have SO enjoyed working with you; It’s been my total privelege

to enjoy your passion and dedication to all the kids and their

families; they are blessed to have you in their corner!”

“Miss Patty is magic!”

-A school counselor

- Students say

HEALTH SETTINGS• Connect a client to any and all resources.

• Make sure clients make doctors’ appointments

with primary and specialty physicians.

• Help schedule and meet clients at clinic / office

to help them understand what is being said.

• Contact patients to ensure outside referrals

are met.

• Secure resources for clients, such as eye

glasses, hearing aids, vaccinations, mental

health services.

• Make sure they have Medicaid and Food

Stamps, if qualified.

• Connect inmates to resources to prevent reoffending

• Set up MTM rides.

• Meet clients at wound care.

• Make sure clients have coats and shoes.

• Set up medication calendars so clients remember

to take their medications.

• Connect ER patients to primary care physicians.

• Take housing applications to homeless patients.

• Make sure those experiencing homelessness had

clothes, toiletries, and basic needs met.

• Help clients with Social Security information.

• Check on sick, elderly homebound patients for MOST.

• Provide basic health education, i.e., nutrition, general

chronic disease care.

• Inform policies, procedures and practices within the

healthcare setting.

“I would never have made it to this appointment without you.”“The doctor treats me so different when you are here.”“Thank you so much, I didn’t hear the doctor say that.”“I have never had anyone care like you do.”

“I would be dead if it wasn’t for you.”

“I know this is your job but I can tell I really matter to you,I bet you don’t do this for everyone?”

“We have the opportunity to see the person as they live and that’s something your doctor doesn’t get to see.”

Patie

nts

say

-A CHW

COMMUNITY SETTINGS

HOW THEY DO THIS:

OVERARCHING SERVICES:

• Bridging cultural mediation between communities

and the health care system.

• Providing culturally appropriate and accessible

health education and information.

• Ensuring that people get the services they need.

• Providing informal counseling and social support.

• Advocating for individuals and communities.

• Building individual and community capacity.

• Providing direct services (such as basic first aid)

and administering health screening tests.

• Conducting brief screenings.

• Conduct brief screenings for diabetes, substance use,

suicide, mental health, tobacco, and nutrition.

• Participate in community events to provide health

information and resources.

• Conduct classes / trainings on topics such as

nutrition, diabetes, tobacco cesstation, mental health,

and substance use.

• Coordinate pain management cohorts utilizing

Mindfulness, Yoga, Qigong techniques.

• Assist with navigating systems via completing

paperwork, attending appointments with clients,

and translation services.

• Engage with social service agencies to develop

systems to better serve clients.

• Participate in community collaborations representing

the Community Health Worker Field.

“CHWs are working diligently and quickly to help inmates

obtain long-term rehabilitation followed by residential

treatment programs.”

Mineral County Detention Center Staff

“CHWS are like the immune system of our

communities - they’re antibodies that help

keep community members healthy.”

Community Chest, Inc. Leadership

What is the potential for a locally-grown Health and Human Services Workforce?

Nevada’s Community Health Workers’ (CHW) typically are home-grown,

locally-based and see their role as a step toward a career as a Health or

Human Services provider. Ninety-two (92%) percent reported that they

were interested in developing their skillsets and continuing their

education, with a specific interest in pursuing a career in health/

human services.

• 50% of CHWs, who were also AmeriCorps members and served Nevada’s com-

munities from 2017 to 2019, reported that they were advancing in the healthcare

and human services field and continuing their education, with the intention of

staying in the community while doing so.

• 23% pursued higher education and 27% secured employment in a related field.

Combined, this path reflects a much less expensive means of growing the work-

force than some of our state’s other capacity-building efforts.

Based on an ongoing survey conducted by the

Nevada Community Health Worker Association with

each training cadre, CHWs are working in eleven of

Nevada’s seventeen counties. The figure below shows

the distribution of CHWs. The growing percentages of

CHWs in rural communities reflects their utilization

of CHWs’ skills and demonstrates the communities’

support and reliance on them as a backbone of their

health workforce. They are an active and capable

and growing workforce that can be tapped as our

future needs for Health and Human Services

professionals grows.

The results represent 137 CHWs’ responses to an ongoing survey conducted by the Nevada Community Health Worker Association between December 5, 2017 through October 28, 2019.

Where do CHWs fit in the Workforce Pipeline?

As the figure on the right illustrates, the Community

Health Workers’ advancement along their career path-

way is based on foundational and specialized training

and in some cases certification. In Nevada, there are

two levels of certifications available, CHW I and CHW II.

The process for applying can be found at 

https://nevadacertboard.org/.

The State Office of Rural Health at the University of

Nevada, Reno’s School of Medicine, is supportive and

committed to the development and utilization of CHWs

as a viable workforce in rural Nevada through their

Rural Residency program. 

The Area Health Education Centers (AHEC) also

supports the potential of CHWs as the beginning point

in the pipeline for professional health careers. 

In particular, Nevada’s Federally Qualified Health Cen-

ters and Rural Health Centers are interested in employ-

ing CHWs –as an entry position onto health care teams—

and as a first step for many on their career pathway.

The Rural Nevada Health Network (RNHN), a group of

public and private agencies committed to improving

access to high quality, affordable healthcare for Rural

Nevadans, has actively advocated for the inclusion and

support of CHWs as members of healthcare teams.

Community Health Worker career pathway

Individual as aCommunity Health Worker

Volunteer Position(Possible Stipend)

Entry Level PaidPosition

(Training & SupervisonRequired)

Specialized CHW(Positioned in 1

or more of 3 settings)

Another Healthcare Position

Another HumanServices

(or related profession)Continue as aSpecialized CHWContinue as a CHW

Americorps(Living Allowance)

Continue as a volunteer

Level 1 Level 2 Level 3Level 4

Further Advancement

Who employs CHWs?

• Community Health Centers

• Managed Care Organizations

• Specialty Vendors to States:

o Medicaid Enrollment

o Chronic Disease Management

• Community Coalitions and other Community-

based organizations

• Family Planning

• Family Resource Centers

• Early Childhood Education (Head Start and

Home Visiting Programs)

• Local School Districts

• Services for formerly incarcerated individuals

and families affected

• Employee benefits programs in large companies

or institutions

• FASTT/MOST Teams

• Local governmental health districts and human

services agencies

• Hospitals

• Opioid Treatment Center and other Treatment Centers

• Certified Community Behavioral Health Organizations

Where can I get additional information on CHWs?

Nevada Community Health Worker Association

Email- nvchwa@gmail.com

Website- nvchwa.org

This product was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under grant # G25RH32417. The information, conclusions and opinions expressed in this product are those of the authors and no endorsement by FORHP, HRSA, or HHS is intended or should be inferred.