Community health workers aim to bridge gaps

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A Midlands mother of four had a good job and provided for her children. But when she learned she needed a hysterectomy and didn’t have insurance, she found herself out of work.

After exhausting her options, with an outstanding medical bill, unable to get surgery and finding it difficult to feed her children, she was at her wit’s end.

Then she turned to a community health worker: Julie Smithwick.

“She had this constant bleeding and couldn’t work. She didn’t know what to do,” Smithwick said.

Smithwick was able to help the mother navigate the often-complicated world of health care and public assistance to help her find a food source, a payment plan for her medical bill and a low-cost program for the surgery she needed.

“She was able to pay off these bills and go back to work after the surgery to provide for her family,” Smithwick said. “She wanted to go back to being a productive citizen, and she couldn’t because of these health issues. She didn’t want to be on public assistance if she could help it. She kept trying to do it on her own, but it’s frustrating even for people not dealing with what she was going through.”

The Midlands mom’s illness was also potentially hurting the economy, with an able-bodied worker out of a job and having to go to the emergency room, Smithwick said. She needed a helping hand she could trust.

Community health workers are meant to be that helping hand, Smithwick said, stepping up in their communities as leaders to educate neighbors on healthy living, help connect them to health care providers and even help get them to their doctor’s appointments.

Smithwick, formerly the director of PASOs, an organization of community health workers and providers charged with creating healthier Latino communities in South Carolina, is now the director of a newly formed program aimed at establishing a statewide network of community health workers. The Community Health Worker Institute at the University of South Carolina’s Arnold School of Public Health, funded in part by Blue Cross and Blue Shield of South Carolina, launched March 1.

Community health workers are not necessarily highly trained or educated medical professionals, though they can be, said Lee Pearson, associate dean of operations and accreditation at the Arnold School. They’re often people from marginalized communities who already have a trusting relationship with their neighbors who can help in a more organic way than a health care provider might.

“We have a large number of South Carolinians of limited means and lower health,” Pearson said. “The more people stay healthy, the more money we could save. These community health workers could help improve healthy behaviors and connectivity to health services, making us a healthier state. This could give South Carolina a chance to be a national model and shake off that reputation. Wouldn’t that be great?”

Community health care workers can also be advocates for their communities, said Smithwick, who was trained and served as a community health worker beginning in 1997 before founding PASOs in 2005.

“Think about when you have a problem,” Smithwick said. “You might turn to your friends and family, or someone in your church or your circle, before you go to your doctor, if you have a doctor. People need someone approachable and on their level who they trust implicitly. The first person people think of isn’t always their doctor.”

Community health care workers have the opportunity to be an integral part of a new emerging health care model, Pearson said.

“There’s a significant shift in health care right now in moving from volume-based care to value-based care,” Pearson said. “Rather than rewarding or reimbursing health care providers for the number of tests of patients they see, reimbursement models are shifting to improved health, holding health systems or providers accountable for improving outcomes.

“This makes providers, doctors, nurses and health care systems realize that improving overall health requires operating outside the walls of their clinic or hospitals and having an extension in the community, because the best solutions come from those who are closest to the problem.”

Often, that means community health workers, Smithwick and Pearson said.

Community health workers can provide education about health care or healthy living, spend extra time helping people understand their diagnosis, help navigate complicated medical care networks and processes, provide guidance on financial assistance, or connect people with resources for healthy food, transportation and other services.

“They are trusted resources in their communities,” Pearson said.

The USC institute intends to provide a central hub for training new and existing community health workers.

“Right now, those that operate may be self-taught or limited in training, or some may have advanced training, but there’s no common denominator of experience or training for these people in our state,” Pearson said. “This creates the opportunity for a one-stop shop to serve them and grow the ranks of community health workers across the state, especially in high-need areas.”

The institute hopes to create a pipeline of community health workers, which Smithwick said is an emerging profession lacking formal training and development to help people “be the best community health workers they can be” and provide a network to hire and support those workers in sustainable jobs.

Many of PASOs’ community health workers are funded by grants, but Smithwick said she wants to use the institute to develop a more sustainable model for workers so they can be paid and recognized for their work.

“When a grant goes away, that community health worker goes away, and then everybody suffers,” she said.

Community health workers can also help address aspects of health care that are not necessarily clinical but can affect well-being.

“Sometimes it’s stress, or responsibilities at home, lack of access to healthy foods, no transportation to the doctor. But community health workers can help with all of that,” Smithwick said. “Even those of us with high literacy, who speak English fluently and have some privilege, can sometimes find it difficult to navigate our way to better health.”

This story first appeared in the March 25 print edition of the Columbia Regional Business Report.