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Considerations for Recruiting, Hiring Community Health Workers

Community health workers are playing a bigger role in patient care and social determinants of health work, prompting organizations to consider recruitment and hiring best practices.

As team-based care becomes more common in medical practice, healthcare organizations are considering how they invest in non-clinician personnel, like recruiting and hiring community health workers.

A community health worker is “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served,” according to the American Public Health Association (APHA). “This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.”

The role of the community health worker has become more prominent in recent years, as more healthcare organizations recognize the impact social determinants of health can have on patient wellness. As a result, some clinics and hospitals have recruited and hired community health workers to help patients navigate the social services that can address those SDOH, improve overall health, and improve quality of life.

But although the community health worker profession is gaining recognition, the recruitment and hiring process isn’t always clear, especially for organizations hiring their first community health worker staff.

Identifying community health worker recruits

Dominique Francis, MPH, is an expert at this. As the training manager for the Community Health Worker Institute (CWHI), a part of both South Carolina’s Arnold School of Public Health and the Center for Community Health Alignment, Francis has a lot of experience identifying individuals who would make a good community health worker—and it’s not all about the credentials or educational experience.

Rather, Francis said he leans on principles espoused by the C3 Project, or the Community Health Worker Core Consensus Project. Per the C3 Project, being a trusted member of a community is fundamental to being a community health worker and something Francis looks for when seeking new recruits.

“Some of those specific things you're going to look for in the recruitment of community health workers is first and foremost that they are from the community that they are serving or that they are a trusted ally of the community that they're serving,” Francis told PatientEngagementHIT in an interview.

“Now, that's an ideal world,” he added as a caveat. “Does it always happen? Not necessarily, but that is the aim.”

Francis, whose organization doesn’t necessarily recruit CHWs for hire but instead for its renowned training program, said recruiters or hiring managers should look for an X factor that signals an individual is invested in becoming a part of the community he or she will eventually serve.

“They need to have a demonstrated investment in gaining that trusted member status. They need investment, not just for the sake of the job, but by the operation,” Francis advised. “You can tell who is a community health worker, even if they're not at their place of work, because everywhere is a place of work.”

Recruiting someone with deep inroads, or the ability to build those inroads, is essential because of the core function of a community health worker. CHWs need to be able to help patients navigate both the medical and the social resources available to improve overall wellness, Francis said, and being well-resourced is the key tool CHWs have to do that.

Beyond that trusted status in the community, Francis said he looks for potential community health worker recruits who have a very specific disposition.

“We're also going to want someone who is patient, who is compassionate, someone who can serve and has served, or is willing to serve as this community bridge, that connector between resources that are needed and those desires of community members,” he said.

Identifying that individual isn’t always easy, Francis acknowledged, because hiring managers cannot entirely lean on a list of core competencies during the CWH recruitment process. This is a holistic approach that looks at the whole person, not just a list of qualifications or skills.

“Oftentimes, when interviewing for a position, our minds go to skills,” Francis pointed out. “And rightfully so, because there are some positions that are very hard-skill-oriented. For community health workers, on the other end, instead of focusing on skills, we first go to those qualities.”

It may be helpful for healthcare organizations to stay mindful of the job function of a community health worker, or the exact missions for which the organization plans to employ the CHW. According to the C3 Project, the 10 core parts of the community health worker role include:

  • Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems
  • Providing Culturally Appropriate Health Education and Information
  • Care Coordination, Case Management, and System Navigation
  • Providing Coaching and Social Support
  • Advocating for Individuals and Communities
  • Building Individual and Community Capacity
  • Providing Direct Service
  • Implementing Individual and Community Assessments
  • Conducting Outreach
  • Participating in Evaluation and Research

Starting with those 10 CWH roles, healthcare organizations can better determine the specific personality traits—not necessarily skills or accreditations—critical for community health worker recruits.

Considerations for hiring community health workers

Francis said most healthcare organizations will want to consider those same personality traits during the community health worker hiring process.

“But then the question becomes, how do I do that in a 30-minute or an hour-long interview?” he mused.

That means healthcare organizations need to get creative and may not be able to rely on the traditional hiring process. Generally, there are a handful of strategies organizations can employ to hire a community health worker:

  • Recruitment at community events
  • Group hiring events
  • Structured interviews with situation-based questioning
  • Assessment of prior community-facing experience

For example, one of Francis’ colleagues opens up community support and group education sessions to community members.

“After doing that for several weeks, they might identify someone in that group facilitation and say, ‘I love the way you interact with your peers,’” Francis said. “’I love the way that you communicate this information. Would you be interested in working with us, even if not full-time, could we get you part-time? If not part-time, could we get you as a volunteer?’”

Offering a group hiring event could also be effective.

“They look to see how folks maneuver the room. And they look for that person who isn't just running up to the CEO or running up to the person with the suit or the name tag,” Francis shared.

“Instead, they look for the person who is talking to another quiet individual in the corner, or who gives that extra smile to someone who looks like maybe they're having a rough day, and how they're mingling, who they're communicating with, what their conversations are like.”

In a more formal interview setting, hiring managers should ask applicants situational questions to understand how an applicant might handle difficult circumstances.

“It is not a bad idea to ask some of those situation-based behavioral questions when interviewing someone to see if they are being culturally humble,” or culturally responsive, Francis suggested. “Or asking what resources in the community are they aware of? What experiences do you have connecting people to those?”

The applicant resume could also give some answers, Francis added. If the applicant has held other community-facing roles, like a little league coach or a food pantry volunteer, a hiring manager may conclude that person has both a commitment to community as well as knowledge about community resources.

Supporting a community health worker staff

Once complete with the hiring process, healthcare organizations need to close the loop and provide ample support to its community health worker staff. According to Francis, this comes with a number of tangible resources.

Take, for example, the technology the CHW will use to do her job. As the CHW role is largely out within the community, it makes most sense to give her a laptop or a tablet that will be easy to carry around. A separate work cell phone will help promote work/life balance, too.

Organizations don’t need to devote the biggest office space to community health workers, Francis added, but it would be helpful to provide a home base with a set of cubicles—a true, full set of cubicles to accommodate a multi-person CHW team, he emphasized. That will allow the organizations to more fully meet community needs through a diverse workforce.

“In any given community, folks are going to need different levels of expertise,” he said.

A Black man will have different expertise than a Hispanic woman, and both perspectives are important for reaching the whole community. This approach also prevents one worker from taking on all community issues.

“When I say diverse, I mean diverse in a number of ways,” Francis added. “They could both be from the community, but you could have a Black individual and a Hispanic individual. You could have a man and a woman. You could have cis-heterosexual person and a trans or non-binary person.”

And to that end, organizations should support their community health workers by ensuring the entire clinic or hospital understands the job function. As noted, CHWs do a lot of their work away from their desks and they must spend a lot of time on their phones. An outside observer might perceive CHWs as distracted, but through organization communication and education, coworkers can understand this is the CHW job function.

As healthcare organizations onboard new community health worker teams, Francis advised they consider the following:

  • Creating boundaries; not funneling CHWs other busywork
  • Letting the rest of the team know CHW expectation and job role
  • Give community health workers the resources they need

Finally, Francis urged healthcare organizations to treat their community health worker staff with compassion and understanding.

“Because community health workers come from the community that they're serving in an ideal world, there's going to be a lot of passion there,” he concluded.

“And sometimes tension is caused because there are certain actions that a community health worker wants to take, or they might even be verbal about, an employer might go, well, why are they so touchy or sensitive or hotheaded? Remember this person is coming from that community. And so it's going to be magnified even that much more.”

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