Today’s complex health care and social services landscape causes many individuals and communities to struggle to access resources and support that can improve well-being. Community health workers are trained professionals who serve as a link across communities and health care and social service systems.
They are often members of the communities they serve, possessing an understanding of cultures and local needs, and can help people address social determinants of health (such as housing stability, neighborhood safety, and mental health care) that greatly influence health outcomes. For example, they may help connect people to an interpreter or transportation to get to appointments, or walk someone through insurance enrollment and advocate for them to receive culturally responsive health care.
Many organizations, including the Iowa Department of Health and Human Services (IHHS), are training individuals to work or volunteer in capacities that utilize community health worker skills. While expanding the number of positions that have community health worker responsibilities recognizes the benefits of the model, the patchwork approach within government, nonprofit, and health care programs and organizations can lead to challenges, including fragmented resources and services, a lack of collaboration, and inconsistent standards.
Taking a system approach to community health work is not a new idea in our state. Multiple cross-system needs assessments and strategic plan initiatives call for a systemic solution for accessing services to address community and individual needs. Recommendations include streamlining screening and aligning services with needs, maximizing access to community-based services, and addressing social determinants of health. Additionally, recommendations aim to increase access to mental health providers, develop a statewide resource for health care providers, and strengthen postpartum follow-up.
Working at the intersection of health care and social services with a broad reach to individuals who most need support, IHHS is uniquely positioned to take the lead in this system approach. It also aligns with the Department's stated goals and guiding principles for alignment of:
As the former Executive Director of Prevent Child Abuse Iowa, I especially saw how a systemic solution could help strengthen families by better connecting them to resources and supports before reaching crisis. Through conversations with various stakeholders as a part of my HealthConnect Fellowship, I’ve identified several benefits of supporting a community health worker model within IHHS. Here is why I believe this systems approach would have greater impact:
In a siloed approach, community health resources and services are often fragmented, with multiple organizations and initiatives operating independently. This fragmentation can result in inefficiencies, duplication of efforts, and gaps in coverage. A statewide system could improve collaboration between community health workers, health care providers, and community-based organizations providing services. By working together, these stakeholders could develop comprehensive strategies to identify and address the specific needs of individuals and communities, allocate resources effectively, and improve health outcomes on a broader scale.
Community health worker roles can provide individuals with pathways to enter the health care field, particularly for those who may face barriers to traditional health care professions. By investing in the training and professional development of community health workers, health care organizations and IHHS could contribute to the economic growth and empowerment of local communities. Because community health workers are often from diverse and marginalized communities, investing in their work could also build a more representative employee pool at IHHS.
A more representative health care workforce, including community health workers, brings diverse perspectives and experiences to decision-making processes. Community health workers’ insights and firsthand knowledge of community needs contribute to more informed and culturally responsive health care policies, programs, and service delivery. Involving community health workers in health care planning and policy discussions ensures that the voices of marginalized communities are heard and considered.
Employing community health workers within IHHS could help align programs and initiatives within the department and meet various goals by having people who make connections across programs and services. They could also tap into existing infrastructure, data systems, and partnerships established by IHHS, enhancing their ability to connect individuals to necessary resources and support. IHHS could also leverage its relationships with other government agencies and community stakeholders to address systemic barriers and drive community-level change.
Having community health workers as part of state health and human services departments could provide stability and sustainability to their roles. Community organizations may experience funding challenges or fluctuations, which impact the availability and continuity of community health worker positions. By employing community health workers directly, IHHS could ensure a more consistent presence of these valuable health care professionals, providing stability to both the workforce and the communities they serve and allowing community health organizations to focus on service provision.
Siloed approaches may result in variations in training, certification, and supervision protocols, leading to an inconsistency in the quality of services provided. IHHS has infrastructure and resources to offer comprehensive training, supervision, and ongoing professional development for community health workers. This could ensure that workers have the necessary knowledge, skills, and support to effectively carry out their roles. IHHS could also provide opportunities for community health workers to collaborate with other public health professionals, facilitating knowledge exchange and enhancing their professional growth.
IHHS already provides some training for community health workers in partnership with the Iowa Chronic Care Consortium that could be expanded. The training course provided focuses on developing and building skills of new and seasoned community health workers and other front-line professionals committed to advancing community health.
Siloed approaches often result in fragmented data collection and evaluation systems. This lack of integration leads to challenges in assessing the impact and effectiveness of community health interventions comprehensively. By implementing a statewide system of community health workers, data collection and evaluation efforts could be harmonized, providing a more holistic understanding of health outcomes, identifying trends, and informing evidence-based practices.
A statewide approach to community health work can ensure our state is designing its systems based on how people access and utilize services, rather than by individual programs and positions. By integrating community health workers into the fabric of IHHS, we could maximize the impact on improving health outcomes and promote health equity for Iowans.
Iowa Chronic Care Consortium offers information about the profession and training opportunities.
Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.