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Population Health Spotlight: “Rhetoric to Reality” of Community Health Workers


November 12, 2015

On November 11, the Dornsife SPH welcomed its second speaker for the Population Health Spotlight Speaker Series, Shreya Kangovi, MD, MS. Dr. Kangovi is the founding Executive Director at the Penn Center for Community Health Workers, and lead developer of the IMPaCT model, which has been implemented by over 450 organizations nationally and globally.

Kangovi’s research draws on a long history of using community health workers (CHWs) —lay people trained to work with patients—to improve health outcomes in high risk populations from low income communities. Dr. Kangovi cited that CHWs have long been used in developing countries to address common health care trends: people of low socioeconomic status are hit harder by disasters and epidemics, drivers of health are largely outside of health care walls, and the cost of care is bankrupting poor countries. These experiences can be easily compared to current chronic diseases epidemic trends in the United States.

History has shown that CHWs have great promise in the United States, but have mixed success becoming an effective, sustainable part of the community.  After studying the challenges facing CHW programs, Kangovi and her team, which consists of trained community members, academics, and healthcare providers, developed the IMPaCTTM (Individualized Management towards Patient-Centered Targets) model to try and circumvent the problems that previous CHW programs faced. 

“There was a huge sense of disconnect from traditional healthcare personnel—people who had a different lived experience—and patients wished for support from someone to whom they can relate,” Dr. Kangovi said as she described the design of the program. At the inception of the IMPaCT program, the team was unsure if CHWs would work in terms of addressing this problem, and used qualitative methods to identify needs directly from the community members. Based on community member feedback, the Penn Center hires and trains workers from the community who have traits and skills that will allow them to bridge this disconnect.

Kangovi’s program addresses head-on the major issues that CHW programs have historically found challenging: hiring of CHW staff, training and supervision, defining the work practice, integration with clinicians, using a patient-centered approach, and drawing on an evidence base for interventions.  As a result, the program has expanded sustainably since its start in 2010. Over 1500 patients are impacted annually, with measured improvements in outcomes such as hospital readmissions, mental health status, and health activation. The Penn program is funded by operational dollars rather than grants and has grown to a team of more than 40 employees in five years, with no employee turnover. In addition, the team has developed manuals and provides training support for groups interested in replicating the IMPaCT model to improve health outcomes and solve various population health problems.

The main question the IMPaCT program tries to address with the patients it serves, “what do you think you need to improve your health?” is powerful in many ways. This question not only creates an individualized plan of action for both patients and the CHWs to follow, but also enables the patients to actively participate in their recovery and health, rather than being dictated what to do.

“There are good people out there,” Dr. Kangovi added about the CHWs, and programs like this help provide them with the space and capacity to make a difference in their community.