Understanding Facilitators and Barriers of Community Health Worker (CHW) Adoption, Integration and Sustainability Within and Across Organizations Participating in the One Lawndale Community Health Collective

Despite decades of concentrated investment into the reduction and elimination of health disparities in the United States, they persist. Community Health Workers (CHWs), who are trusted members of the communities they serve, can be effective bridges of trust into minoritized and disinvested communities and thus have the potential to impact health inequities if appropriately implemented. CHW interventions have been shown effective in improving chronic disease prevention and management, addressing social determinants of health, navigating systems, and connecting organizations to the communities they serve. The Affordable Care Act (ACA) and transition to value-based care provides healthcare systems and payers with a business case for integrating CHWs into interdisciplinary teams. The implementation of the ACA, along with the need to quickly leverage a local workforce of trusted members in the COVID-19 response, federal investments towards the COVID-19 emergency, passing of legislation in Illinois opening the door to Medicaid reimbursement for CHWs, and multimillion-dollar investments in Illinois by Medicaid towards healthcare transformation collaboratives (many of which engage CHWs), have led to the rapid expansion of the workforce. However, to be effective, CHWs need to be employed by organizations that are ready for them, trained effectively, be networked to other CHWs and/or organizations, and have opportunities for growth. As the public health emergency officially ended in May 2023, many organizations are grappling with how best to transition CHWs to longer-term public health challenges, and with building the infrastructure needed to fully integrate and sustain CHWs. Enhancing understanding of which organizational, community, and system-level characteristics facilitate and impede CHW uptake, integration, and sustainability, and how those align and differ by organization type, can support more effective CHW implementation towards health equity.

The One Lawndale Community Health Collective (OLCHC) is a community-specific co-development approach towards enhancing adoption, integration, and sustainability of CHWs within organizations serving Lawndale, a predominantly non-Hispanic Black and Latinx, over-burdened and under-resourced west side Chicago community. The initiative aims to improve networking and coordination of CHWs and the organizations that employ them towards efficiency and collective impact. The OLCHC therefore offered a single significant case within which to assess the phenomenon of interest in a community system, particularly the impact of organizational factors, community factors, partnership, and capacity-building investments on enhancing integration and sustainability of CHWs within and across organizations serving the Lawndale community. Via a three-phased qualitative multi-method single case study with nested cases, the research: (1) assessed the current state of CHW adoption, integration, and sustainability within and across organizations serving Chicago’s Lawndale Community; (2) sought to understand enabling factors both internal and external to organizations in supporting CHW adoption, integration, and sustainability; (3) considered how collaboratives, such as the OLCHC, might inform the future state of CHW adoption, integration, and sustainability including the capacity-building investments and community enabling environment important to optimizing workforce impact.