1. Michigan Community Health Worker Alliance
In coordination with the Curtis Center Program Evaluation Group at
the University of Michigan School of Social Work
Linkages Project Evaluation:
CHW Baseline Interview Results
December 4, 2015
For the Michigan Primary Care Association, with funding from the Michigan Health
Endowment Fund
For questions about this report, please contact MiCHWA Project Director Katie Mitchell
(mitchkl@umich.edu) or Lead Evaluation Staff Abby Anderson (ybbaand@umich.edu).

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BACKGROUND
The Michigan Primary Care Association (MPCA) works to promote, support, and develop comprehensive,
accessible, and affordable community-based health care services for everyone in Michigan. Enriching Michigan's
health workforce policies is an ongoing strategic focus of the Association which has led to an integral partnership
with the Michigan Community Health Worker Alliance (MiCHWA). A School of Social Work project, MiCHWA
works to promote and sustain the integration of community health workers (CHWs) into Michigan’s health and
human service systems through coordinated changes in policy and workforce development.
MPCA is the recipient of an award from the Michigan Health Endowment Fund. With this award, MPCA launched
a statewide project called Linking Clinical Care with Community Supports (LC3S, or Linkages). MiCHWA will
evaluate elements of the project, including the sustainability of CHWs and the training and integration of CHWs
into care teams at participating federally qualified health centers in Michigan. Evaluation activities include
conducting pre-post CHW training assessments, conducting post-training interviews with CHWs and employers,
and identifying CHW continuing education needs. MiCHWA will also evaluate the role of CHWs in patient care
planning, assess CHW and non-CHW care team member perspectives on the role of the CHW in patient care, and
identify barriers and strategies for successful CHW integration into the care team. This report focuses on the
integration of the CHW into the patient care team, specifically the perspective of CHW care team members.
Purpose of the Report
Interviews were conducted over the phone with CHWs (n=27) about their experience on the patient care team,
especially regarding their role and integration into the team. This report will provide a summary of the baseline
results captured by these interviews.
Methodology
The Evaluation in Social Work course (SW 683) taught by Sue Ann Savas, Director of the Curtis Center Evaluation
Group, conducted the interviews as part of their coursework. The students, under the supervision of Sue Ann Savas
(professor), Dr. Edie Kieffer (PI) and Katie Mitchell (Project Director), developed a key informant interview
protocol. They used this protocol to conduct key informant interviews to document the integration of CHWs into 16
care teams across Michigan-based health centers, including successful strategies and barriers to integration. The
interviews also included information regarding the interviewees and their health clinics used to track responses. This
information, however, was not tied to the responses in analysis to ensure the confidentiality of the interviewees.
CHWs were emailed a recruitment letter through MPCA and asked to sign up for an interview slot on a shared
Google Doc. A student interviewer and notetaker was then assigned to each CHW who signed up. Confirmation
emails were sent participating CHWs, and student pairs then contacted each individual at the designated interview
time. Interviews were recorded for accuracy with interviewee permission. After each interview was conducted, the
interview responses were added to a shared master document for analysis. This document allowed each interviewer
to enter the pertinent information from each of the questions into one document, along with any additional
comments or insight the interviewer had.
To analyze the data, the students examined all of the responses for each question to identify common themes. These
themes were then recorded into the same master document. The research team looked over the themes and made
needed adjustments and additions. Data and themes from this analysis were verified by a student research assistant
with the Curtis Center Program Evaluation Group, and results are presented below.

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RESULTS
Q1 What are the roles and responsibilities of the community health worker on the patient
care team?
Probe: What do you do on the patient care team?
The results below demonstrate the CHWs’ various roles in supporting health clinics and patients in the identified
populations. Identified challenges include lack of clarity in the CHW role and lack of CHW participation on the care
team.
Identify and enroll patients that fit their patient specialty
Provide resources (sometimes community resources)
Act as liaisons between patients and providers, including sharing social
issues/information with patient care team
Act as advocates for the patients
Act as patient point of contact and support: identifying barriers to health care
and encouraging compliance, conducting home visits
Administrative tasks, primarily involving scheduling
Lack of clarity of role
Not participating on team
Q2 What is unique about your role on the patient care team?
a. What do you do with the patient that is different from other team members?
i. Probe: how or why is what you do different?
b. Do you see any overlap among team members and their roles in patient care, including
your role?
The CHW plays an important role in building relationships with patients, enabling then to advocate on patients’
behalf. The CHW also facilitates patient care and connects patients with community resources.
Build a strong relationship and rapport
As a member of community, uses a familiar language
Makes patient feel comfortable
Patient may share information they don't share with provider/nurse
Advocates on patients' behalf
Encourages patient
When role as
CHW known
Challenges
Relationship
with patients
Patient education
and empowerment

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Helps with goal setting
Have more time to spend with patients; patient doesn't feel rushed; answers
questions pts don't ask providers; able to visit patients' homes; helps meet non-
medical needs that provider doesn't address; allows medical staff to focus on
medical needs; patient follow-up to engage no show/non-compliant patients
Able to go into community to connect patient with resources
Addresses social needs
Finds out information additional, pertinent patient information
Not allowed to do outreach
Role overlaps, potentially with nurse, care manager, BHS and/or SW
Lack of CHW understanding of unique role in patient care - feels engagement is
slowing patient down
Lack of participation in care team
Q3 We’re really interested in how your team is collaborating. Can you share a brief example
or story of how your team has collaborated in patient care so far? What role did you play?
a. Thinking about your team-based care training, has your team identified any challenges to
address or strategies to overcome challenges?
b. Based on you experience so far, do you as a CHW expect any challenges in your integration into
the patient care team?
CHWs collaborate with the care team to address patient needs, both supporting the engagement of other care team
members and providing non-medical patient care. Barriers to effective CHW engagement occur when there is a lack
of support within the health care clinic and/or patient care team, when there is high incidence of turnover, and when
there is CHW isolation due to few referrals or lack of clarity regarding the CHW’s role.
Huddles
Collaboration to meet non-clinical needs - care team members refer to CHW if
non-clinical needs are identified
Integration naturally occurs – CHW widely accepted on teams
Team members use each other as resources according to their expertise
Communication regarding patient information from all members of team to
inform the other PCT members' work
CHW follows up with patient to ensure information was conveyed well and
understood by patient
CHW reduces no-shows by doing reminder calls and reducing barriers to arriving
Patient care
Collaboration
present
Community
connections
Challenges

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Disconnection/lack of support from upper management
Finding time for full huddle participation
Care-team member turnover is a possible challenge as new members do not
have the training
Buy-in/support from other members of patient care team (especially the
provider)
Lack of knowledge regarding the role of the CHW on patient care team
Recognizing that all patient care roles are equally important
Lack of patients/cases where CHW collaboration is requested
Isolation from PCTs and patients
Q4. At this point in time and from your perspective, why is it important to integrate the CHW
into the patient care team?
a. Probe: What, if anything, do you see changing about patient care once you’re fully integrated
into the team?
CHWs are an important asset to the patient care team in that they have access to information about the patients that
other members of the patient care team may not. They are able to support the patient in ways that will in turn
improve the overall wellbeing of the patient.
Patients may provide information to CHW that they do not share with provider
– this is shared with the team to broaden the understanding of all members of
the patient care team
Helps engage patient in their own care
Helps patients feel comfortable
Have knowledge and time to connect patients to resources
to improve their lives
CHWs have time to listen to social needs that affect the medical condition of
patient as well
Contributes this information to the patient care team and in huddle
Challenges to
collaboration
Complements the
patient care team
Social support/
resource referral
Addresses social
determinants of
health

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Q5. When addressing patient care, which team members do you, as a CHW, interact with
directly?
CHWs interact with many individuals within the health centers, but most frequently with nurses and providers.
Huddles and other in-person contact are the most frequent reported forms of communication.
Most common interactions are with nurses and providers, followed by medical
assistants.
Additional interactions are with behavioral specialists, care managers, front
desk staff, pharmacists, supervisors, outreach coordinator, social workers, other
CHW's.
Interviewer notes indicated variability in amount of contact between CHWs and
teams.
Primary communication methods are…
- in person/face-to-face
- in huddles
- messaging through the Electronic Health Record
- email
- phone
Huddles seem to be primary method of communication between the various
team members
Q6. What is your health center doing to support your role on the team?
The health centers provide support to CHWs through both interpersonal and material means. The challenges to
health centers’ support vary between sites, but include lack of clarity regarding protocol for CHW engagement, lack
of onsite supervision, and delayed access to necessary software.
Time for training and webinars
Answer questions
Provide access to resources
Provide ideas regarding how to help the patient
Weekly meetings
Generally supportive team – encouragement and excitement regarding CHW
role
Introduce CHW to staff and to patients
Monthly site meetings about different topics
Care management meetings
Providers show support by making referrals
Patient care
team
interactions
Communication
methods
Health centers’
supports

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Delays in hiring
Delay in getting needed software
No onsite supervision
Lack of clarity regarding roles and responsibilities
Lack of knowledge regarding role by Health Center/care team
NEXT STEPS
The MiCHWA evaluation team will meet with the MPCA Linkages team to review results to date and identify next
steps. This will include a review of strategies and barriers to CHW integration. This will also include strategies for
improved evaluation in year two of the Linkages project.
Challenges to
health centers’
support