The positive impact of Community Health Workers (CHWs) has become clearer in the last decade. As CHWs join more diverse workspaces, including churches, nonprofits, and school systems, the demand for these frontline public health workers continues to grow. But for many organizations adding CHWs to their team, there are a few challenges. One organization facing these challenges is Integrated Services of Kalamazoo (ISK).
ISK provides clinical mental health care as well as programming and prevention for mental health conditions. ISK’s mission is to “promote and provide mental health, intellectual/developmental disability, and substance use disorder resources that empower people to succeed.” In 2020, ISK received a grant to hire and utilize two CHWs focused on suicide prevention.
The goal for the CHWs was to address the social determinants of health that keep individuals from getting care for mental health and substance use disorder conditions. These CHWs provided support to individuals who didn’t need a full case management team but did need additional support to bridge the gaps in their care.
Initially, two CHWs had been hired for the grant, then four more were quickly added through grant funding. Two were assigned to the Youth & Family department and four to the department for Adults with Mental Illness. Jon Klok, licensed professional counselor and nationally certified counselor, had been working for ISK as an emergency mental health clinician inside the local jail. He transitioned from his previous role into a position supervising CHWs on the adult side. Because of Klok’s prior experience as a crisis and 211 worker, along with previous supervisory and clinical experience, Klok was an ideal candidate for leading the new CHW positions.
“We attempt to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) during each initial contact in order to check in to see how our individuals served are doing. We work to refer individuals to mental health services when appropriate. We also do pre-planning for our psychiatric clinic. We call and prep the patients for the actual treatment plan,” he explains. This involves helping prepare consumers with what questions/concerns/needs they might have for their care team before the treatment planning process begins. The CHWs also attempt to assess any barriers to attending the scheduled treatment plan, while also ensuring the person has the right address, date, and time of the appointment.
While the ISK team was excited to add CHWs to their group, there were roadblocks. “We were starting from scratch,” Klok says. “Our agency had no history of having a CHW program and we had no protocols in place yet. We didn’t know exactly how we’d operate and how we’d get referrals."
Klok and the supervisor of the Youth & Family CHWs knew that tackling this first challenge was vital to getting the CHWs integrated onto the team and into their community. How could they make this an established program? How could the team make sure people really used it? Many people in the community didn’t know the CHW service was available, which meant community members weren’t yet aware of the program and organizations weren’t referring individuals to it.
“My biggest thing when I started in this position was to build the program and make partnerships in the community. We empowered and entrusted our CHWs to help assist in this process and have a sense of ownership within the program. It was a lot of networking, a lot of consulting with other staff and case managers. Many organizations are now working with us. ISK’s CHWs accept referrals from agencies across Kalamazoo County.” There’s a duality to these partnerships: The partners refer their clients to ISK, and ISK refers their clients to other relevant partners as necessary.
While both program supervisors and the CHWs educated the community about their roles, the community educated them, too. “When the program first started, the persons we serve would often teach our CHWs things. People struggling to find resources would know more about how to obtain these resources than us at times, because some may have had prior experiences searching for them themselves in the past.” A system was set up to accept direct referrals from individuals in need, while also promoting an intake line and email that providers use to refer their clients.
While Klok and his team began integrating with the community, he began to see the strength of CHWs. “I think there’s a lot of success in having people who are tied to the community and know the resources. It’s refreshing for community members to meet with someone who focuses on social determinants of health. Anything we’re asked to help with, we’ll try.”
One such need was for an individual who struggled with loneliness. This person confided in one of ISK’s CHWs, noting that their loneliness was exacerbating issues with their mental health. This person knew what could help: a companion. Klok’s team got to work finding a dog at the animal shelter. They helped that person select the perfect companion and go through the adoption process.
“Being able to have a CHW program at Integrated Services of Kalamazoo has uplifted individuals in outpatient therapy,” Klok notes that it can be helpful to address social determinants of health and work with specialists on these needs, while having existing clinical supports working to improve mental health outcomes. “If you’re homeless or need food assistance and clothing, the last thing on your mind is getting to an appointment. Our program has really helped keep people in services and the success rate for treatment has been going up based on people getting those needs met.”
Addressing more challenges, inside and outside of the team
Since receiving the initial grant, more CHWs have been added to the ISK team. CHWs are now being added to ISK’s corrections unit and emergency mental health team, as well as assisting one of their homeless outreach programs. As they’ve joined, Klok identified other challenges for the program. One such issue was that of job descriptions.
“The initial job description was vague and didn’t quite provide people a good picture of what CHWs do,” Klok explains. So he began working with other departments and Shannon Lijewski of Everyday Life Consulting to create a clear and structured description. “We made it more detailed, more specific so that people know what the defined roles are. Since we started using that new framework, we’ve had people in the interviews demonstrate an understanding of the position a bit more.”
Understanding the CHW position at ISK was especially important as the team grew. “Other departments will use their CHWs differently depending on need.” Klok has his CHW team staffed at ISK’s clinic to assist their same-day access team for intakes and notes that they established an office located at the psychiatric clinic to expand their outreach. “We’re able to have a rotating schedule at this office and have different individuals staffed on different days,” Klok explains.
To support the CHWs and enhance their sense of connection between departments, Klok and the other CHW supervisors began working together to host multi-department meetings. They also began cross training all CHWs to better understand the different roles within the organization. Another tactic was creating the orientation checklist.
“An employee [who transitioned from the CHW position to another role at ISK] developed an orientation checklist to help the next person navigate the role better on their own. Other departments hiring CHWs were provided the checklist to edit and tailor specifically to their own CHWs and have shared that this has been helpful,” Klok says. “Someone can come in, sit down, view this document, and find various protocols, resources, and other things relevant to building knowledge about the position. There are links to videos detailing what CHWs do nationwide. It outlines where our resources are and how to navigate the resource bank.” This has helped across teams.
In addition to integrating CHWs from different teams, another challenge Klok faced was integrating his CHWs with the clinical teams. ISK’s electronic health record (EHR) system had primarily been used by the clinical associates. When Klok’s team began using the EHR system to document their time and services with clients in the contact note section, there were issues. “It doesn’t capture time. We still don’t know the duration of the phone calls or meetings. We’re a free service, so we’re not billing for our services,” Klok says. But understanding the time his CHWs spend with clients is essential to not only quantify their work, but also to coordinate the clients’ care.
Klok began problem-solving with his team. They assessed what it was they needed to know, how they could document it, and who should be involved. “We’re transitioning EHRs. One thing we have done is work with our IT people to have our notes populate in the clinical notes section. We also decided that the person’s primary clinician (if enrolled in another service) gets attached to our notes so that they are up to date on what the CHWs are assisting with.”
These problem-solving tactics have helped Klok and his CHW team thrive at ISK. The CHWs are able to connect clients to the resources they need, which in turn helps the clients prioritize their mental health and treatment. And Klok has been enhancing his own role as a supervisor.
“I go through every referral that’s emailed to us. We sort out which department gets what referral. I attempt to distribute these referrals evenly amongst my staff. I kind of function in somewhat of a dispatch-type role,” Klok explains. “I also make sure everyone knows how to document their contacts correctly and what the expectations are when we reach out to people. Part of my role is to audit the records and look for instances in which we said we’d follow up and still need to. Our follow-up rate is getting better due to the audits, and I receive help with these from ISK staff overseeing the grant as well.”
He also uses his previous experience and licensure as a professional counselor to provide even more value to his team of CHWs. “I provide some clinical oversight in areas my staff may not be as well-versed in,” he says. Because of his clinical education and experience in treating mental health and substance use disorders, he is able to lend that extra knowledge to his team.
Ultimately, the impact of the CHWs at ISK is already clear, even in the early stages of the program’s implementation. And with Klok’s guidance and his team’s desire to meet people where they’re at, they’ll continue to make a positive impact in their community.