TOPEKA — As a deaf-blind interpreter in Spain, Ton Miras Neira found a need for more health workers focused on empowering and understanding underrepresented communities.
So when Neira came to the United States in 2012, he began a career as a community health worker — frontline public health workers who are either trusted community members or have an unusually close understanding of those they serve. Miras embedded himself within hospitals, working in the emergency room, but he would also spend time with patients in their homes, building a rapport and developing more competent care plans.
Neira, who works as a community health worker project manager at the University of Kansas Medical Center, said this can ensure treatments are successful where they otherwise might fall short.
“Sometimes it’s like (doctors) don’t understand why their client is being compliant with the medication for diabetes but the outcomes are not good, and as the community health worker, you go to the house and you see that they are still drinking sodas or they are not working,” Neira said. “No provider or no staff, medical staff that is inside the hospital or clinic, is going out in the community to do that.”
This year, the Kansas Department of Health and Environment announced a new certification for these health workers, the first in the state to recognize the role they play in linking communities to health and social services. Development of the certification involved more than 40 members of the Kansas Community Health Worker Coalition and lasted five years.
“Having a certification process for CHWs is key to expanded career options and future opportunities,” said Stefanie Olson, KDHE CHW section director, when announcing the certification.
KDHE said a Certification Task Force was created out of the need to investigate paths for certification and started in the coalition’s Sustainability Committee.
To be eligible, residents must have a high school diploma or equivalent, although some exceptions may be made. They must also complete one of two pathways — an education pathway involving the completion of a KDHE-approved training program and a work experience pathway demonstrating 8,000 hours over three years of volunteer experience.
“As we see validation of CHWs through the certification process, more groups like the Governor’s Commission on Racial Equity and Justice will recognize the role that community health workers can play in addressing long-standing health disparities and improving health equity, and improving access to education and economics,” said David Jordan, president of United Methodist Health Ministry Fund.
Jordan said community health workers have been used since the 1960s, so they are not a new provider, but they’ve been used in different ways at the community level.
Treva Smith, a care coordinator for KC CARE Health Center, touted the move as a major step in bringing Kansas to the forefront of this issue of culturally competent care.
“The certification and education piece are huge, and so I’m very proud to say that Kansas is right up there in the top five, at least 10 for sure, of states that are making headway with the community health workforce,” Smith said.
Cultural competency and financial benefits
Smith saw firsthand the benefits of culturally competent care in a previous role with the Kansas Breastfeeding Coalition. In some cultures, people do not even consider breastfeeding, she said.
“Introducing something that is fairly simple for women and has such huge health benefits is magnificent,” Smith said. “Safe Sleep is another one. We just do what we’ve always done or what we’ve seen done, but when you can talk to someone and really take that time with them, help them understand and provide them the resources that they need to get it done, that is a game changer.”
By embedding in local hospitals and health centers, community health workers can connect the dots and address dilemmas of culture, bridging the gap between the health system and clients, Smith said.
Neira said ensuring proper representation among CHWs is the first step he and his team take at KU Med, where they have almost 60 health workers across Kansas. Before they hire anyone, they check the demographics of different countries and conduct interviews based on the uniqueness of the community they are looking to serve.
“We have one CSW in Finney County who comes from the Afghanistan community, and we have CHWs who are Latino, and we have CHW representing the African American community,” Neira said. “If you don’t have that, you are not addressing the cultural barrier.”
Beyond cultural benefits, community health workers can also provide financial relief for the state by taking pressure off emergency systems, providing increased primary and preventive care and better chronic disease management. A 2020 University of Penn study found for every dollar invested in community health workers has a return on investment of $2.47.
“They’re also saving individual providers money because they’re able to make sure that they provide that really important community level connection to patients that don’t exist within the four walls of their clinic or their hospital, which is really what’s driving the fact that Americans are so dissatisfied with the health system,” Jordan said.