Firehouse Model Community Health Worker Teams 

Robert Marlin

Why did we start?
Massachusetts is preparing to certify community health workers (CHWs) for the first time and is developing regulations that would allow for reimbursement for the work completed by CHWs under a licensed clinician. At the same time, Cambridge Health Alliance (CHA) needs to expand the number of patients it cares for within its catchment area, including among vulnerable populations, while maintaining its current patient base. This project aimed to create CHW teams from among existing CHA Volunteer Health Advisors (VHAs) and mal-employed foreign-trained health professionals (FTHPs) to engage with a diverse, multilingual, vulnerable immigrant population on issues of health and healthcare and help link them to care at CHA.

What did we do?
After identifying the CHW teams, we established ourselves in locations in the CHA catchment area and at regular times that were convenient for the target population. We then made ourselves available to anyone at these locations and offered blood pressure screenings, information on signing up for health insurance/coverage, obtaining and retaining a primary care physician/team, preventive health information, and answers to general questions about healthcare. For those without insurance/coverage or primary care, we attempted to link them to services at CHA that could provide both of these.

What did we find?
In order for individual clinicians/care teams and vulnerable immigrant patients to be able to co-produce health, CHA as an institution first needs to engage with vulnerable immigrant populations at the level of the community. For this to happen, the communities we serve and CHA leadership, clinicians and staff must see the institution as belonging to and being part of the community, rather than simply serving it.

What does it mean (and what do we intend to do next)?
While the Firehouse Model CHW teams will not continue at CHA, the institution needs to re-orient its efforts at community health engagement towards having a regular physical presence in the community and our team will work with CHA to help effect this in the Department of Community Health Improvement and other divisions.