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Julie St. John, the associate dean for the Graduate School of Biomedical Sciences at Texas Tech University Health Sciences Center (TTUHSC) as well as an associate professor at the Julia Jones Matthews Department of Public Health in Abilene, has an extensive background training and equipping future Community Health Workers (CHWs) for the essential—often overlooked—career ahead of them.
A certified Community Health Worker instructor since 2009, St. John served on the Texas CHW Advisory Committee for nearly 10 years, currently serves on the Board of Directors for the Texas Association of Promotores and Community Health workers, and has worked with CHWs for more than two decades.
“Community Health Workers serve as integral members of health care and public health teams,” said St. John, who defines CHWs as “indigenous members from a community who love their community and want to see people’s health and lives improve, so they unselfishly give their time and energy—often with no or little pay—not because it’s a job, but because it’s a work of love for them.”
Covering the scope of practice for Community Health Workers
In 2015, Springer Publishing company and the CHW section of the American Public Health Association (APHA) joined together to discuss the need for a book written by CHWs, detailing the important roles they play in improving population and community health.
With St. John as lead editor and around 80 years of combined experience from the editorial team, 10 core CHW roles were chosen as the framework for the book, providing insight and instruction through real stories from each role. Each of these 10 core roles gets a chapter of the textbook, allowing for in-depth, realistic views of the positions. Finally, the book concludes by addressing the National CHW Association and the future of Community Health Workers.
Titled Promoting the Health of the Community: Community Health Workers Describing Their Roles, Competencies, and Practice, the book is the first of its kind and an exciting new resource for employers interested in the CHW model, as well as those who seek a future as a Community Health Worker.
CHWs are different from other health care jobs
“CHWs are different from other health care and public health jobs in that they are usually a part of the community they serve—reflecting and sharing values, culture, language, etc.,” said St. John, clarifying that a CHW’s role is essentially to solve problems and to lessen or remove barriers to any basic needs or health resources and services the community might need. CHWs also facilitate changes in behavior for the individual and the community through modeling and through education—empowering people to take ownership and responsibility for their health.
“CHWs are not typically trained as much in direct health care services, but rather they are the bridge between the community resident and the health care, public health, and social service fields—taking the initiative and time to listen to felt and demonstrated needs and assisting in solution-finding through sustainable action steps,” said St. John.
Since this is such an essential element of health care, St. John explained that TTUHSC engages with community health, as well as the CHW model, on multiple levels. West Texas Area Health Education Centers (AHEC), housed in the The F. Marie Hall Institute of Rural Health, has a Texas certified CHW training program (as does the School of Nursing’s Larry Combest Community Health and Wellness Center in Lubbock). Various research projects also employ CHWs as part of the research team, and several other TTUHSC departments engage CHWs in practice, training and research.
“CHWs do everything from holding hands when someone is sick to calling thirty agencies to assist a resident with a particular need,” said St. John.
While CHWs are not recognized as often or paid as much as other positions in health care, the recent COVID-19 pandemic has placed a particular spotlight on how important CHWs are within a community, and how their presence and work can impact the health of a population.
Community Health Workers and COVID-19
“CHWs were and continue to be vitally important during the pandemic because they often serve the most vulnerable, hard-to-reach communities that were hit hard by COVID-19—communities that desperately need services and resources,” observed St. John. She also pointed out that CHWs can relay information that may not otherwise be easily communicated or received.
“CHWs are trusted members of the community, thus if they share with their community the need for testing and the importance of vaccination, they are far more likely to achieve success in helping their communities,” said St. John.
Additionally, St. John explained how the pandemic has demonstrated that CHWs need to be a key strategy in emergency planning and response.
“They have the unique ability to mobilize vulnerable communities much more quickly and efficiently—primarily through their trusted relationships, social capital, and social networks,” she said.
There is a specific chapter of Promoting the Health of the Community that addresses COVID-19, relaying a story of CHWs—or, more specifically, promotores, or CHWs for minority health—in Chicago.
“They advocated on behalf of their primarily Latino community, who suffered disproportionate numbers of cases and deaths from COVID-19 compared to other ethnic groups in Chicago,” said St. John. This chapter, like the others in this book, showcases how CHWs fulfill their roles, accept challenges, grow from successes and learn lessons.
“CHWs see and hear what’s going on in their communities and then seek out solutions, often serving as the advocate and spokesperson for communities who cannot speak out or do not yet have their own voice,” St. John said.
Lessons from the pandemic
According to St. John, the future role of CHWs might shift and change due to COVID-19.
“The future of CHWs will focus more on scope of practice, reimbursement strategies for CHW services, and their role in emergency planning, response and management,” she said.
Even though the virus has caused immeasurable grief and cost many lives, St. John pointed out that this pandemic has reemphasized how valuable togetherness within a community can be.
“The COVID-19 virus has reminded us of the value and importance of community once again,” said St. John, recalling the many ways in which communities joined forces to combat this threat, including donating and creating PPE, volunteering to screen those who were potentially ill, and supporting those on the front line with signs, gift bags, letters and more.
“COVID-19 has taught us that we are resilient, creative, innovative and collaborative,” said St. John. “We can achieve great things together.”
The other emphasis the virus has provided is that people need togetherness and a sense of community in order to thrive.
“We need each other,” St. John said simply. “Isolation because of COVID-19 has taught us to check up on each other, that being alone breeds depression and loneliness, and that we need to be together—whatever that may look like: on a screen or six feet apart with a mask.”
The new book, published this year, is called Promoting the Health of the Community: Community Health Workers Describing Their Roles, Competencies, and Practice.