Supervision Strategies and Community Health Worker Effectiveness in Health Care Settings

Shifts in health care toward value-based payment (i.e.,payment based on outcomes rather than units of service) have drawn increasing attention to health-related social needs and social determinants of health. As trusted community members, Community HealthWorkers (CHWs) are well positioned to support marginalized patients in addressing unmet social needs, navigating the health care system, informing health behaviors, and supporting communities in addressing the underlying causes of health inequities. The recent changes in the administration of health care services in the United States have also shifted discussions around the CHW workforce from fundamental considerations such as CHW acknowledgment, inclusion, and remuneration to more sophisticated human resource management issues such as inclusion into reimbursement mechanisms, training, job satisfaction, engagement, and supervision methodologies. As the CHW workforce is formally integrated into health care systems of different configurations across the globe and in the U.S., (e.g., facilitated by structural, systematized payment mechanisms), issues about human resource management have risen and matured to the extent that research and evaluation on these issues have been called for by the World Health Organization. Tools have been developed and research has been conducted to assess these issues in the international arena, particularly in low- and middle-income settings. For example, the Community Health Worker Assessment and Improvement Matrix toolkit seeks to support the efforts of those assessing, planning, implementing, and managing CHW programs. The toolkit includes programmatic components that address workforce issues like recruitment, roles, training, supervision, performance evaluation, incentives, and advancement opportunities. Another example is the Perceived Supervision Scale, which is an internationally validated tool that measures supervisory experience from the CHW perspective. Specifically concerning the supervision of CHWs, the concept of supportive supervision has been applied to bolster this unique workforce. Supportive supervision emphasizes joint problem-solving, mentoring, and two-way communication between supervisors and those being supervised. In the United States, supportive supervision is crucial to the effective integration of CHWs into institutional workflows, which is in turn fundamental to achieving the mission of health care and public health organizations. The integration of CHWs is a nuanced and contextualized endeavor in both public health and health care settings, and so too must be their supervision to optimize their contributions. During a 2019 workshop at the National Academies of Sciences, Engineering, and Medicine’s Roundtable on Population Health Improvement, a panel of CHWs, trainers, supervisors, academics, and payment-mechanism specialists pointed out that across the different contexts in which CHWs work, organizations must be ready to accommodate and support the ways in which CHWs carryout their work and be willing to rethink the manner in which they are supervised, which requires changes to traditional or historical modes of supervision in healthcare.

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