The Duke Endowment Funds Important New Community Health Grant

March 8th, 2021

Since its inception a decade ago, AccessHealth Spartanburg has worked to elevate the role of the Community Health Worker (CHW). The results have been notable: data shows people who are connected to a CHW through AccessHealth utilize the emergency room for non-emergent needs less frequently than they did prior to enrollment.

To be sure, many factors play a role in reducing emergency room utilization. AHS connects its clients to a suite of wraparound services and utilizes a complex case management system to help its clients access the care they need, improve their health and ultimately build resilience and self-sufficiency.

Now, Spartanburg Regional Healthcare System, the Northside Development Group and AHS are playing a leading role in expanding the presence and impact of community health workers across Spartanburg, Union and Cherokee counties. SRHS recently took the lead in securing a three-year grant worth more than $320,000 from The Duke Endowment that will help underwrite the effort. The grant funds will be held at the Spartanburg Regional Foundation.

The grant — titled “Achieving Health Equity: The Role of Community Health Workers” — will in the near term fund two new community health worker positions, one in the Northside and one in the Highland community. In year three of the grant, a third community health worker will be hired in Union County to support the Union Medical Center for OB/GYN patients and families.

The three new positions may be the immediate headlines of the grant, but an education and analytical component could potentially reshape community health strategy and funding decisions for years to come.

“Part of this grant is adding community health workers in some of our census tracts with the highest need,” explained Carey Rothschild, SRHS’ Director of Community Health Policy and Strategy. “The other part is about elevating the role of community health workers overall. That will involve collecting some baseline data in our surrounding community, how many community health workers we have, whether they are employed or not, whether they are called a community health worker or not, and then increasing that number.

“We will also be looking at how many organizations employ these roles and we will be trying to increase that number. So we want to increase the total number of community health workers and also increase the number of employers who understand the importance of hiring them.”

What is a community health worker?

Indeed, that quote from Rothschild underscores just how novel the role of community health workers remains in some health care circles, not to mention in the general public. AccessHealth Spartanburg has truly been a pioneer in recognizing and championing the vital role of community health workers (as well as employing them). In fact, AHS was named the Community Health Worker Group of the Year by the American Public Health Association in 2019.

The South Carolina Community Health Worker Association's definition of a community health worker is:

Although CHWs may have diverse job titles, they are trusted members of the community they are serving and/or have a thorough understanding of the community, and are committed to addressing the health needs of the individuals with whom they are working. This trusting relationship permits CHWs to connect individuals to health care and social service resources in the community and to improve the quality and cultural competence of service delivery. CHWs have the capability to address social determinants of health in order to improve health outcomes of the individuals they are serving. CHWs build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach to individuals in their environment, community education, counseling, social support and advocacy.

Indeed, though a community health worker may or may not have any specific health care clinical training, they are often trusted by patients more than clinicians.

“We are seeing more and more evidence that people with lived experience and connection to specific populations — whether geographic or through the language they speak or the shared medical condition — are able to build relationships that are equally important if not sometimes more important than the relationship between a patient and a medical provider,” Rothschild said. “There are some things patients will doubt, or information they need to double check, but they might not ask a provider those types of questions. They will, however, ask their community health worker. The benefit of that relationship-building and trust is difficult to measure, but it is significant. And that comes naturally to a community health worker.”

So what makes a great community health worker?

“For a lot of careers, we can train people to do just about anything — but we really cannot train someone on relationship-building, trust-building and lived experience,” Rothschild said. “Those are things people generally either have or don’t. People who really excel in this role have a deep understanding or knowledge of the local community and issues that the population they're working with is experiencing. They also have strong critical thinking skills and an understanding of community resources and how to navigate systems. We can train on that, but relationships, strong communication, being good at building relationships and gaining trust quickly are all paramount. Community health workers are high performing and compassionate people and critical thinkers.”

For Rothschild, elevating community health workers also carries a powerful equity component.

“We need to find a way to value with dollars that lived experience,” she said. “There are really two key parts to this effort: elevating the role of community health workers into a viable, appealing and well-paid career choice, and benefitting from the relationship-building, communication and engagement that community health workers bring to the table — particularly when working with individuals with complex needs, medical or otherwise. I think too often people who thrive in these roles are bypassed for opportunities because they don't have a bachelor’s degree or some sort of education that might be attractive. We don't yet have a way to recognize and value lived experience — at least it has not traditionally been valued based on where you grew up, how you grew up, what you know and how you communicate. But it should be.”

Thanks to The Duke Endowment’s belief in SRHS and this vision, that day is coming. And hundreds of under-resourced people here — and by extension, the entire community — will benefit.