'You're a bridge. You are the community.'

Jessica Carter worked as a chef for 15 years before becoming a community health worker (CHW) in Southeast Ohio. After completing her coursework in Ohio University’s CHW program , Carter works closely with new mothers, helping them focus on the importance of good nutrition. When an issue arose in a client’s kitchen, she knew just what to do. 

“I had a couple of clients who didn’t know what to do with a whole chicken,” Carter explains. “And I was like, I didn’t even think about that. I didn’t even think that you wouldn’t know how to cook a whole chicken.” 

The job description might not include cooking expertise, but the ability to draw on life experience and community connections to solve problems is a crucial skill for all CHWs. And then there is what Carter said next to her clients. 

“Let’s walk through it together. We’ll do it right now,” she recalls telling them. And that’s exactly what she did.

Walking through it together

Community health workers may be employed by public or private organizations and their job descriptions vary widely, but one thing is true of all CHWs: their work focuses on bridging the gap between healthcare and people. 

The CHW title is newer than the job itself. Associate Professor Kerri Shaw, community health worker lead for the OHIO Alliance for Population Health , says that similar roles—local healthcare liaisons and advocates—have been around for hundreds of years. The significance of such work is not always recognized; nor has it always had a name.

“This is a new term in the United States to some degree, but really, they’ve been naturally in communities around the world for a long, long time,” says Shaw. “The people who kind of established this title in the United States, they were physicians who went up to Alaska and found these really rural Alaskan communities that all had local health leaders who were very trusted.” 

Increased recognition of the role’s importance from the larger healthcare community has brought increased demand for CHWs. This recognition led to the creation of Ohio University’s training program in 2015. In 2019 the Appalachian Regional Commission offered a $1 million grant, which allowed the University to expand the program to help fight the opioid crisis. The program has also been adapted to train lay community members in Ukraine to support their communities. 

CHWs often work closely with their own communities, which makes them better able to advocate for their patients because they understand them on a deeper level and may share similar experiences with them.

“It’s pretty integral to the position that they look and talk like and have lived experience that is really similar to the people they’re working with, which is unique in the healthcare world,” says Shaw. “I think that having that voice, that community voice, in healthcare is a game changer because you get to advocate from a first-person experience.”

Carter, the former chef, now works as a certified community health worker and a state-certified peer recovery supporter. She works with patients from Jackson, Gallia and Meigs counties, driving an average 200 miles a day delivering food and other necessities to her patients.

“I was able to help one of my clients get a vehicle and it was a life-changing moment for them,” Carter says. “It’s something so very basic, just having transportation, and she cried and was just so appreciative. It’s the little things like that.” 

Each CHW brings a different set of life experiences to the role, and they’re encouraged to let those experiences inform their practice. Carter often uses her experience as a chef to educate her clients about making the most of the food she delivers.

“If they don’t know how to maybe prepare some of the things that are in their food boxes, they can call me and we can work on recipes together,” Carter says.

A single mom, April Krape finished her CHW training recently and is in the process of completing her field hours at her current job. She spends her days working with families in Washington Courthouse.  

“I was just recently able to help someone get a new washer because it’s a household of seven and their washer quit,” Krape says. “On that same day I was able to deliver Thanksgiving food. It’s challenging sometimes, but very rewarding.” 

Better health outcomes

Ohio University’s Community Health Worker training is one of the few free CHW training programs offered in the state. The course is extensive and covers 100 hours of coursework. The majority takes place online, with three in-person classes. The in-person classes include CPR certification and training in basic medical tasks such as taking vitals and motivational interviewing, a conversational approach to patient intake that helps CHWs understand their clients’ behaviors and assess how motivated they are to make changes.

“After students complete the 100 hours in the classroom or doing didactic activities, they will then complete 130 hours in a community-based setting, practicing community health work,” says Shaw.

During this time, students work closely with a supervisor and complete journals reflecting on how they apply their classroom learning to what they are doing in the field. Students are eligible for certification through the Ohio Board of Nursing after completing the required field hours.

Christopher Johnson graduated from Ohio University in 2018 with a degree in stage management. Johnson lives in Logan, where he works at Health Recovery Services as a case manager while completing the CHW coursework. He counsels clients who face addiction and mental health issues. Johnson said his experience with the CHW training has not only had a positive impact in his work, but also in his personal life.

“The training is fun,” says Johnson. “I’ve found it more and more helpful, not just in my work life, but in my personal life. I have high blood pressure, so going to classes and hearing that high blood pressure can be catastrophic and can be deadly really inspired me to watch over my own health more.”

Olivia Degitz is another alumna of OHIO’s CHW program. Her background is in social work and public affairs; she even studied neuroscience as an undergraduate.

“It’s a very accessible course to folks,” Degitz explains. “We had a really diverse group of people in our class which I loved. It was all women, and we had women from all over the state with various backgrounds, various ages, and I thought that was really cool. I learned a lot from my classmates.

Degitz recently moved back to Athens, where she works at the Athens City-County Health Department as the Friendship Bench program manager. The program offers free and confidential appointments with staff trained to lend a listening ear.

“The training is more accessible than you might think,” Degitz adds. “It is more useful and more helpful than people realize. Folks who are community health workers play a huge role in the health and wellbeing of our communities, and in helping folks have better health outcomes in general.” 

"You're a bridge."

Appropriate healthcare is vastly important for everyone, but not everyone has the same access to it.

“We get to really be addressing health inequities in a new way,” Shaw says. “We shouldn’t be saying that people are non-compliant because they don’t have transportation to their doctor’s appointment.”

No matter the specifics of their day-to-day jobs, all CHWs work to bring healthcare to communities in an accessible way.

“The training is really easy for the people that set out to do this type of work with very little bias,” Carter says. “You can walk into someone’s house knowing that they have bed bugs and you treat them like they’re a human being. That’s what it is. It’s compassion and empathy and actually treating people like they’re human beings.”

Building trust is vital for a good healthcare experience, but trust is difficult to establish when there is little to no common ground between patient and doctor.

“Especially here in Appalachia, where we are not very trusting people, we don’t trust our doctors,” Carter says. “We’re not going to go because we have the cold or a flu, we’re not going to the doctor. I think it’s important for our role as CHWs to actually gain that trust and that rapport with our clients so that they might be a little more apt to actually listen to us.

Shanika Frazier has worked as a CHW for five years. Previously, she spent fifteen years working in child welfare, and was a foster parent for six years. After completing her CHW training and becoming certified, she got a job with United Healthcare.

“When they say community healthcare, you’re a bridge. You are the community,” Frazier says. “Because you bridge that gap and then the health workers are your peers, the people that you work with. And we’re all working for one goal. And that is that: every person, we meet them where they are and we get them what meets their needs.” 

Looking forward

“I love being able to look at the people in my classroom and know that they are going to be treated with dignity and respect and that they’re getting jobs,” Shaw says. “That’s what we need in our region.”

The first cohort had three students. Now the program enrolls between 40 and 60 CHWs each semester. Community health work is a growing field, one that is based on empathy, trust, and care.

“You know,” Frazier says, “I don’t think I’ll ever stop doing work in the community to help people bridge the gap.”

Individuals interested in Ohio University’s Community Health Worker Program can apply online. The program is offered each semester at different Ohio University campuses.