Montefiore’s Community Health Worker Role a Bridge to Medical Workforce

At Montefiore Medical Center, the Community Health Worker Institute (CHWI) is a pipeline to the healthcare workforce.

Sure, the actual “community health worker,” or CHW, title is an entry-level job, but it’s a key starting point for a health system working to support patients while also serving as an anchor institution and jobs creator.

“We don't anticipate having lifelong CHWs in our health system,” Kevin Fiori, MD, MPH, MS, the director of CHWI and a pediatrician and researcher at Montefiore Health System and Albert Einstein College of Medicine, told PatientEngagementHIT in an interview. “We don't actually want that. We want someone who is motivated and talented, to come in and bring lots of community expertise into our health system, and then have that opportunity to move up.”

The community health worker job has grown in the past several years, with the US Bureau of Labor Statistics predicting to have seen a 14 percent bump in the role from 2022 to 2023.

CHWs are critical as more healthcare organizations set their sights on better population and public health and services addressing social determinants of health. These goals can’t be achieved inside the clinic alone and require strong community engagement and a sense of trust on the part of the patient.

That’s where CHWs come in.

Community health workers are folks who live in or have close ties with a given community and serves as a liaison between the community, social services, and healthcare services. CHWs could help connect a community member with a provider or help a patient screening positive for certain SDOH access a social service.

These non-medical professionals are also often tasked with more public health types of services, like increasing individual or community health knowledge.

But beyond that, the job description for a CHW can vary from facility to facility based upon individual organizational needs and resources, plus the needs of the community. While that level of flexibility is essential, it can introduce some challenges in terms of training and potentially credentialing community health workers.

Many healthcare organizations are rising to the challenge by implementing their own CHW training curricula and hiring standards, and the Montefiore CHWI is working to serve as a model for that.

Established in 2021, the CHWI provides a built-out description for aspiring community health workers, which helps folks who work at Montefiore identify people who might be a good fit, according to Renee Whiskey-LaLanne, MPH, MCHES, AE-C, the associate director of the CHWI.

“For us, it's really important that our community health workers are from The Bronx,” said Whiskey-LaLanne, who’s also the director of Community Partnerships in the department of Family and Social Medicine at Montefiore and Einstein.

“We want our CHWs to speak the various languages of The Bronx,” she added. “We want them to have shared life experiences. This way, we have a keen understanding of the challenges our community members face and services they are looking for and trying to navigate.”

Once Montefiore has hired a community health worker, they spend four weeks training before they engage with patients. This helps Montefiore leaders outline the organization’s community and population health goals and helps CHWs get acclimated to the ins and outs of the healthcare system.

“We go over everything from who's on the care team, what kind of care team you will be on, the different roles, and how you interact with the different people on the team,” Whiskey-LaLanne explained. “We then focus on actionable items CHWs are responsible for and what patient engagement looks like. We share the types of stories they are going to hear and what will be requested to help our patients.”

Once on the job, CHWs are set up with resources that help them complete their jobs. Fiori described the system’s Intranet Hub, where CHWI reposts all of its trainings. Other CHWs can also post resources they’ve encountered while on the job to help their colleagues.

“Another thing to think about in community health worker roles is the importance of supportive supervision,” Whiskey-LaLanne added. “What we mean by that is a collaboration between our management team and our CHW about how to solve problems.”

The CHWI leverages peer support and training, too, Fiori added. For example, the Institute previously hosted a training featuring one CHW who developed the organization’s gold standard for scheduling within the EHR.

“The idea is putting the CHWs in the role of teaching each other,” Fiori said. “We want to create that environment and that culture.”

In addition to job training, Montefiore has stressed the importance of physician champions and provider education to eliminate the impact of power hierarchies in the team setting. The job also includes a pipeline to membership to 1199, the largest healthcare union in the country.

What sets the CHWI apart is the Institute’s commitment to job growth, Fiori emphasized. In recognition of the role hospitals and health systems play as anchor institutions, Montefiore acknowledged that being a job creator is, in and of itself, part of its community health work. After all, employment is a key social determinant of health.

“Montefiore is the largest healthcare provider in Bronx County, but it's also the largest employer,” Fiori stated. “We see the workforce development piece of the Community Health Worker Institute at Montefiore as being just as important as the services that the CHWs are providing.”

To be clear, community health worker is usually someone’s first job, so it will require both on-the-job training and resources for continuing education to see that job growth. According to Whiskey-LaLanne, the Montefiore model considers both.

Through a partnership with Hostos Community College, CHWs at Montefiore can complete college-level coursework as part of the Hostos Community Health Worker Apprenticeship Training Program. This includes a seven-month didactic piece, during which CHWs meet with professors to complete the coursework. While on the job, participants complete separate training around navigating social needs, which go toward apprenticeship hours.

Those hours can also be submitted to the Department of Labor, allowing Montefiore CHWs to qualify for an apprenticeship certificate from New York State. Whiskey-LaLanne stressed that this is an important resume-builder that can help CHWs move onto the next step of their careers in healthcare and public health.

As a complement, career development benefits also support the hospital’s work as an anchor institution, which is critical as organizations continue to eye health equity. Improving community health will require health systems like Montefiore to look inward and their own practices and workforce benefits.