Mecklenburg County Health Department

Community Health Worker Initiative

The Mecklenburg County Health Department’s Community Health Worker Initiative is building a network of community health workers, organizations, and other interested stakeholders to improve health equity.
Partners for Impact is providing evaluation services to ensure that this community change initiative is achieving the following three  goals:
  1. Convene key decision makers in a collaborative forum to contribute to organizational  planning, development, and direction. 
  2. Develop a collaborative plan that involves mentorship and training for CHWs in Mecklenburg County. 
  3. Develop a shared data governance plan to better align initiatives and programs to demonstrate CHW impact in Mecklenburg County.

 

IMPACT: Individuals and households who traditionally do not have equitable access to health information and services improve their health outcomes with the assistance of Community Health Workers. 

Theory of Change

Community health workers increase their skills, abilities and access to resources that improve community, household, and individual social determinants of health.

Organizations employing community health workers provide long-term investments and the support necessary for community health workers to sustain their employment within the profession/agency.

Mecklenburg County’s network of health providers maximize the resources available for community health workers to improve population health.

-Community health workers have the technical skills and support to provide quality interventions. 

-Community health workers have the resources necessary to improve a household’s unique social determinants of their health.

-Community health workers have the ability to understand and manage potential burnout.

-Community health workers have the leadership and self-advocacy skills to improve institutional settings.

-Community Health Workers assist in the data collection and management of the Common Indicators used in measuring health improvements. 

-Community health workers are leading local initiatives to meet their community needs.

 

-Health serving organizations develop, implement, evaluate, and continuously improve their CHW programs.

-Health serving organizations implement strategies designed to onboard CHWs (including the 10 roles of a CHW), and increase the skills, support and incentives needed to retain CHWs.

-Health serving organizations have culturally competent workplace policies that support the diversity, inclusion and equity of CHWs; especially in decision that directly impact CHWs and the people they serve. 

-The unique values and experiences of CHWs along with their expertise on Social Determinants of Health are integrated as a valued addition to the organizational/institutional health care team.

-Network members work together to provide efficient and comprehensive community coverage to the diverse communities in Mecklenburg County.

-Network members develop processes to identify resource gaps that can be used to develop strategic advocacy partnerships.

-Network members create and implement plans that decrease inequities between Mecklenburg County’s CBO’s and large HSO.

-Network members develop and implement plans that streamline information sharing, including the sharing of patient resources and minimizing the number of separate data platforms.

 

Client:

Mecklenburg County Health Department

Services Provided:

Evaluation

The Problem/Challenge:

Partners for Impact was brought on to evaluate whether the Community Health Worker Initiative was meeting its primary goals.

 

Case:

The Mecklenburg County Health Department’s Community Health Worker Initiative is building a network of community health workers, organizations, and other interested stakeholders to improve health equity. The project has three components

  • Mecklenburg County’s Community Health Worker Program which oversees “ A Guided Journey” and other internal Community Health Worker Projects, and also provides backbone support for the community-wide initiative;
  • Queen City (QC) Community Connect Coalition is an association of community health workers practicing in Mecklenburg County; and
  • The Stakeholder Advisory Collaborative which is composed of organizational representatives from across the County who deploy Community Health Workers, including direct supervisors and program directors
Partners for Impact is providing evaluation services to ensure that this community change initiative is achieving the following three  goals

  1. Convene key decision makers in a collaborative forum to contribute to organizational  planning, development, and direction. 
  2. Develop a collaborative plan that involves mentorship and training for CHWs in Mecklenburg County. 
  3. Develop a shared data governance plan to better align initiatives and programs to demonstrate CHW impact in Mecklenburg County. 
The current intervention is designed to improve patient health outcomes and reduce health inequities by focusing on elements of the system that are not solely based on the patient and the provider. The CHWI considers other system level factors, especially the Community Health Worker workforce/profession, organizations that hire and use CHWs and the systems that influence these organizations. It acknowledges the role Social Determinants of Health play in patient health outcomes. This community level intervention also acknowledges that systemic forces are at play that perpetuate health inequities, and that solutions to these inequities must be at the organizational and system level. To believe that a community health worker is the “magic bullet” disproportionately places the burden of success/impact solely on community health workers and their patients and does not hold organizations or the larger healthcare systems accountable for success/impact. The evaluation team’s experience suggests that to design interventions solely at the patient and provider level may improve some health outcomes, but it runs the risk of perpetuating systems that still create the underlying inequities and disparities. 
Measuring systems change can be challenging. However, the CHWI project has been using the conditions of Collective Impact to structure the work of this community change initiative. Collective Impact also provides a natural evaluation framework which is useful in tracking systems change efforts. The framework is designed to move a community towards change and consists of five conditions: Creating a Common Agenda, Shared Measurement, Mutually Reinforcing Activities, Continuous Communication, and Backbone Support. In addition, the eight Principles of Practice for Collective Impact  can also help build an evaluation framework for this initiative. These principles are: 

  1. Design and implement with a priority placed on equity
  2. Include community members in the collaborative
  3. Recruit and co-create with cross sector partners
  4. Use data to continuously learn, adapt and improve
  5. Cultivate leaders with unique system leadership skills
  6. Focus on program and system strategies
  7. Build a culture that fosters relationships, trust, and respect across participants
  8. Customize to the local context
Background Report
Evaluation Report
Year 1 Report