We need strong, diverse health teams — not just CHWs — to address complex health and social needs in our communities
We are two licensed practical nurses (LPNs) who have been at the Camden Coalition for nine years collectively, and we could not do our work without our community health worker (CHW) teammates. We have noticed that there are a lot of new initiatives around CHWs recently — CHW legislation, CHW institutes, etc. — which is great, and we need more of it. However, we worry that some of these efforts are missing (or, at least not emphasizing) the importance of strong, diverse teams and, in some cases, perhaps inadvertently undervaluing other members of the broader health workforce, including medical assistants (MAs), doulas and LPNs, who are also critical to the work of complex care.
Like CHWs — and the two writers of this blog post — these healthcare workers are often people who come from the communities where our clients live. We understand intimately the systemic racism and other barriers that make everyday living hard on the best days, and impossible on others. As we hear more about the value and need for CHWs, we urge public health and healthcare leaders to connect this call with the need for strong, diverse public health and healthcare workforce teams. It has been our experience that strong teams not only benefit our clients, but provide team members with much-needed support as we strive toward our shared goal of improving the health and well-being of those we care for.
We consider ourselves incredibly lucky to have worked as LPNs at the Camden Coalition in care teams that partner a nurse (an LPN or RN) with a CHW as well as a social worker and, more recently, an attorney from our Medical-Legal Partnership who is also embedded in our care team. Jointly, and alongside our regional care partners, we work to provide community-based, person-centered care management that focuses on our clients’ complex health and social needs: what they want to prioritize to feel better, and what individual and systemic barriers are limiting their ability to do that. Our work on the ground includes partnering not just with clinicians but with the receptionists who squeeze our clients in, the medical assistants who go the extra mile to have medications approved by insurance, and the primary care providers who spend time at appointments trying to gain a whole-person perspective. Many of these roles have been around far longer than CHWs, but they are still undervalued and often neglected even though, like the CHW role, they are critical to care-planning.
As LPNs, we have experienced tremendous neglect and bias from the healthcare field outside of our own care teams at the Camden Coalition. There have been instances when, upon being introduced to providers, payers, and leaders as a licensed practical nurse, there is a noticeable shift in attention and body language. Sometimes we are outright dismissed. The comment “Oh, you’re just an LPN,” is one we are way too familiar with. The conversation that often follows often includes questions like, “Why the LPN route?” and one of our favorites, “When are you going back for your RN?” While we are sure that these comments typically come from a place of curiosity, the cumulative weight of them can leave us feeling lesser than over time. This is why teams are so important — we buoy each other to confront issues of racism, classism, and unconscious bias — not just for our clients, but for ourselves.
Which brings us back to our CHW teammates. We could not do our work at the Camden Coalition without them. In our training as licensed practical nurses, we are taught to focus on the management of symptoms. This means ensuring that our patients have the right medications and are taking them as prescribed, that they are getting the proper treatment for physical and mental health conditions, and are connected to the right providers. Having a CHW as part of the team allows the LPNs time to focus on those medical complexities and management, while also having a valuable and knowledgeable teammate who can connect with the patient on a personal level, provide care coordination, and engage with community-based organizations to help the patient accomplish the goals and priorities that are most important to them.
Our CHWs are not only champions in building authentic healing relationships with our participants; they are equally as influential when it comes to interorganizational relationship building. Those established relationships have helped us as LPNs countless times when trying to make the appropriate connections that eventually improve the quality of life of the individuals we work with. The Camden Core Model is built on the complementary strengths of both the CHW and LPN roles. We rely on each other’s knowledge and experiences to be able to improve health outcomes and use a person-centered approach when interacting with complex systems.
The truth is, when it comes to working with individuals with complex medical and social needs, it takes not only the nurse-social worker-CHW care team who work together at the Camden Coalition, but a teaming mindset toward all of the people and organizations involved in our patients’ care — from physicians to social service case managers to the clients themselves.
As the role of CHWs and the resources for CHWs expand, we encourage a team focus that truly values the experiences, training, and strengths of all members of the care team. Outside of the CHW role, there are other roles — including LPNs and MAs, as well as peer recovery specialists, navigators, case workers/case managers, pharmacists, probation/parole officers, and more — that are often filled by individuals from the community and are critical to the development of meaningful, person-centered interventions. These roles should be getting the same level of attention and resources as the CHW role. We recommend that initiatives that are focused on the development of the healthcare workforce take a broader, interprofessional approach to empowering and supporting all historically under-valued roles, rather than focusing narrowly on CHWs. Team-based care takes all of us.