Staffing Model: Community Health Workers vs Nurses

What was the reasoning for using CHWs in the Tennessee program? Did you encounter any resistance to using CHWs instead of nurses and how did you overcome that? Are there any challenges/drawbacks to using CHWs and how do you mitigate for that? What are best practices in recruiting- and retaining- CHWs?

CHAMP has 3 Community Health Educators, 1 RN, and 1 RT. Certainly the RN and RT are critical to our operation, but the CHEs are the persons who take the message to the homes and deal with families in their environments. First and foremost, the CHE’s strongly identify with the families they serve and have great success in engaging these families, understanding and respecting the cultural issues. (Understand where the “family is” and work with it.)  CHEs earn the right to say what needs to be said and still maintain the relationship with the family.  They are very well trained by our medical staff to “talk the language of asthma” in the same manner as a well-informed parent.    We require them to demonstrate competencies (asthma “basics) annually.  They understand the “mechanics” of an asthma exacerbation (restriction, swelling, mucous) and can explain in simple terms why daily controllers are so important.   They administer the ACT and most importantly, they know what they DON’T know, making excellent use of the medical team which is only a phone call away.   When the grant was first written, the Physicians who worked on the concept suggested that CHAMP utilize a team of RTs in the field. One of the first changes that CMS asked us to make in the model was to consider the community workers rather than RTs or RNs. We took their advice and feel like we made the best possible decision on this.   Important to note - CHAMP has a strong medical component, programs that are not directly linked to clinicians and do not have ready access to them might not have the same experience we have had.