Supervising and Supporting Community Health Workers

Defining Roles and Responsibilities

CHWs most often work as part of a team. Whether a CHW is a participant in a new or an existing program, it is important to clarify the specific roles, responsibilities, and expectations of the CHW. Clarifying a CHW's role and expectations will help ensure successful implementation. In addition to clarifying the role and expectations for the CHWs, it is necessary to educate other team members and program staff about the roles and responsibilities of CHWs. This can help build buy-in across the CHW's team and organization, and minimize confusion and conflict among staff.

For more information about CHW roles, see Roles of Community Health Workers in this toolkit.

Supervising

Providing ongoing, supportive supervision to CHWs is critical and can improve CHW motivation and engagement. A supervisor's role is to be regularly available, provide supportive and trauma-informed supervision, prioritize safety, and offer monitoring and coaching to CHWs.

Programs should identify an individual who can be responsible for supervising CHWs. This can be an individual with a social work or public health background, a healthcare provider, an experienced CHW, or another individual. Supervisors should receive training on the history of CHWs, CHW roles and responsibilities, communication, and effective supervision strategies so that they can support CHWs.

Supervisory tools, such as guides, logs, and checklists, can facilitate supervision. It is also essential that the supervisor has sufficient time to dedicate to CHW supervision. Having a supportive manager for the supervisor can help ensure that the supervisor's workload can accommodate their duties for supervising and mentoring CHWs.

Supervision can consist of one-on-one and group supervision. Group supervision provides an opportunity for CHWs to support and learn from each other, while one-on-one supervision allows the CHW to discuss topics in a private environment. In rural areas, it may be necessary to conduct supervision meetings via phone or video conference. Prior to conducting remote meetings, the supervisor should ensure that both they and the CHWs can connect to and are comfortable with the technology required for remote supervision.

According to MHP Salud's Supervision Manual for Promotor(a) de Salud Programs, it can be beneficial to schedule regular supervision meetings to:

Check in with CHWs and discuss activities and workload
Conduct team-building exercises
Review documentation and data
Provide feedback on progress and performance
Identify training and resource needs
Discuss and address issues or challenges, such as burnout
Commend accomplishments

Outside of regular meetings, supervision can also entail ongoing encouragement of self-care activities or overseeing annual performance reviews.

Mentoring

While supervisors can provide mentorship to CHWs, some programs provide peer mentoring opportunities by empowering CHWs with more experience to support and guide CHWs with less experience. One strategy to provide peer mentoring is to organize CHWs into teams with a range of experience. Ongoing mentorship can support CHWs on an ongoing basis, while some programs have implemented mentoring programs for specific processes, such as quality improvement, that include less frequent mentoring sessions. Mentors may provide training, convene group discussions, review patient cases, help CHWs solve problems and communicate with other team members, and connect CHWs to resources to support their work.

Retaining

CHWs may also experience challenges that make it difficult to continue to work with the program. Retention challenges for CHWs may include difficulty finding transportation, lack of child care, inadequate pay, limited options for advancement, difficulty completing all required job duties, low morale or job satisfaction, and feeling overwhelmed or burned out. Program leadership and staff should anticipate these barriers and attempt to address them to support job satisfaction and retention. Strategies for addressing retention barriers can include offering benefits and incentives to CHWs such as health insurance, retirement plans, paid leave, performance-based recognition and rewards, childcare, competitive wages, professional development opportunities, gym memberships, and reimbursement for job-related expenses, such as transportation, or continuing education.

Resources to Learn More

Best Practice Guidelines for Implementing and Evaluating Community Health Worker Programs in Health Care Settings
Document
Offers healthcare administrators, providers, and others guidance and recommendations when developing CHW programs. Addresses hiring, training, supervision, evaluation, and integration of CHWs into healthcare systems.
Author(s): Kapheim, M.G. & Campbell, J.
Organization(s): Sinai Urban Health Institute
Date: 1/2014

Community Health Worker (CHW) Toolkit
Website
Provides employers in clinical settings guidance for CHW program planning and practice integration. Includes information on CHW education and training opportunities, services provided by CHWs, billing and reimbursement, and more.
Organization(s): Minnesota Department of Health, Office of Rural Health and Primary Care

Community Health Workers: Part of the Solution
Document
Traces how two states, Massachusetts and Minnesota, initiated comprehensive policies to foster the utilization of CHWs and, in the case of Minnesota, to make their services reimbursable under Medicaid.
Author(s): Rosenthal, E.L., Brownstein, J.N., Rush, C.H., et al.
Citation: Health Affairs, 29(7), 1338-1342
Date: 7/2010

Supervision Manual for Promotor(a) de Salud Programs
Document
Highlights considerations for supervising promotores, including recruiting and hiring, orientation and training, supervision, and common challenges.
Organization(s): MHP Salud
Date: 1/2016

Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings
Document
Discusses the integration of CHWs into programs and teams, and offers considerations for building a CHW program, including hiring, training, and supervision.
Author(s): Brown, O., Kangovi, S., Wiggins, N. & Alvarado, C.S.
Organization(s): National Academy of Medicine
Date: 3/2020