Community health workers in the clinical setting: Are we ready to take a leap?

The implementation of the Affordable Care Act will lead to a large influx of previously uninsured patients into an already stressed healthcare system resulting in concerns over the system's readiness to handle the additional strain. In the Inland Valleys of Southern California, as many as 300,000+ people are expected to gain access to healthcare by 2014, many from health-disparities groups. Studies show that Community Health Workers (CHWs) can improve the health outcomes of patients due to their unique knowledge of their community's culture and language - possibly allowing them to play a pivotal role in alleviating the increased pressure on the healthcare system. Guided by theories of organizational readiness, formative research was conducted to evaluate clinics' organizational capacity and institutional readiness for the inclusion of CHWs in their healthcare delivery. Qualitative data (key informant interviews and validation focus groups) examined clinic personnel's positions about the inclusion of CHWs in their healthcare treatment groups. Following the qualitative inquiry all healthcare teams were surveyed. Results point to language, culture and other contextual barriers to providing optimal care given existing resources, and a general openness (with some reservations) for professional clinic staff to partner with CHWs in order overcome these barriers and effectively begin to address currently observed health disparities. Our findings will inform the development and implementation of interventions aimed to integrate CHWs into the continuum of care in this changing system.