Community Health Workers Keep Patients Connected to Critical Resources During the Pandemic

When the coronavirus outbreak first spread across New York City last spring, the challenges that so many families face in normal times — lack of access to healthcare and technology, financial and food insecurity — were exacerbated by the pandemic.

This came as no surprise to Patricia Peretz, MPH, and Dr. Adriana Matiz of the Center for Community Health Navigation at NewYork-Presbyterian. Established more than 15 years ago, the center was created to improve the health and well-being of patients through culturally sensitive, peer-based support offered by community members serving as community health workers.

In a recent article in the New England Journal of Medicine, Peretz, who leads the center, and Dr. Matiz, its medical director, explain how community health workers were poised to step in and quickly address the healthcare and practical needs of patients suddenly facing this new crisis.

We spoke with Peretz and Dr. Matiz, who is also a pediatrician in the NewYork-Presbyterian Ambulatory Care Network and a professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, to learn about what community health workers do and the essential role they have played during the pandemic.

What is a community health worker?
Community health workers are peers of our patients. They live in the same community, speak the same language, and build trust with those whom they support. Serving as a bridge between the community and the hospital, community health workers are able to quickly connect patients to the clinical and social services they need while also empowering them to navigate and access care in the long term. At NewYork-Presbyterian, they are members of our healthcare teams, integrated into inpatient and outpatient settings, but are based in community organizations that offer the social services and support patients need most.

Why are community health workers so important?
They are proven community connectors who often are already playing a formal or informal leadership role in their neighborhood. They may be a leader in their church or active in their local school or a former patient or caregiver who has learned how to navigate the health and social service landscape and wants to share this knowledge with others. They are accustomed to facing barriers and know how to move past them. Community health workers are passionate about empowering others to improve their health and to help them effectively connect to local resources. They have positive energy; they build trust.

How did the community health workers program begin at NewYork-Presbyterian?
In 2005 we collaborated with four community-based organizations in northern Manhattan to create the WIN for Asthma Program to improve outcomes for children with poorly controlled asthma. We quickly learned that to help families, we had to first gain their trust and to help them address other challenges that stand in the way.

With that understanding, we created a model in which community health workers were employed by the local community-based organizations and co-supervised by the organization and NewYork-Presbyterian. It didn’t take long to show that the asthma program reduced preventable emergency room visits and hospitalizations and increased families’ confidence in their ability to manage their children’s health. Soon, the program was expanded to support adult patients, and in 2008 we created an emergency department-based patient navigator program to help patients effectively navigate the healthcare system and connect to follow-up care. Community health workers and patient navigators are now at five NewYork-Presbyterian campuses.

How are community health workers providing support during the pandemic?
Community health workers began proactively reaching out to patients. We wanted to see how our patients were doing and find out what they needed — not just connect them to the medical system, but also find out what they needed in terms of educational support for their children, access to food stamp benefits, unemployment benefits, housing necessities, and even basic needs such as diapers.

Many of our patients were facing extreme challenges because their income only allows them to live day to day. Many who were restaurant workers suddenly found themselves unemployed. These patients and their families needed food assistance and connection to food pantries with a level of urgency. Community health workers helped with each need that was uncovered. When patients ran out of their medication, community health workers connected patients to their provider to get prescriptions filled. When patients needed food, community health workers connected them to free, healthy-food resources, including NewYork-Presbyterian’s food distribution programs.

They also provided COVID-specific information to our patients and provided education about when to call their physician and where to find testing sites. Through these phone calls from a trusted source, we made sure that people were receiving accurate information about COVID-19, even while they were cut off from other resources.

By early summer, community health workers started offering video visits, which gave us a whole new way to connect with our patients.

Since late March, the community health workers have conducted nearly 12,000 wellness calls to patients, completed more than 2,000 virtual social service referrals, and, along with their patient navigator colleagues, helped to enroll more than 5,000 patients onto NewYork-Presbyterian’s patient portal so they stayed connected to the care they needed. Most importantly, in many cases community health workers were the only people reaching out to isolated patients, providing the essential support and reassurance that they otherwise would not have received.

What role did community health workers play in reducing the digital divide during the pandemic?
We found that many patients were not prepared for the rapid evolution that required all of us to suddenly have the necessary hardware, internet access, and knowledge to interact with digital healthcare, social services, and education systems. And who best to help with that but a community health worker?

Community health workers played a critical role in helping patients adapt. They helped many people create their first email account and enroll in the patient portal, where they could access their health information, communicate with their provider, and participate in telehealth visits. Without our community health workers, these families would not have had the access to care that they were able to obtain.

How did they help caregivers with children being taught virtually?
In the spring, our pediatric program focused on finding out what devices children have at home and then connected caregivers to parent coordinators in the schools to help them receive needed equipment. We also connected caregivers to the utility companies that were offering special rates or programs for those who could not afford Wi-Fi or pay their phone bill. We were successful in connecting a large number of caregivers with these important resources.

What has the pandemic taught us about the role of community health workers?
There is substantial evidence supporting the role of community health workers to improve the health and well-being of those whom they support, and this pandemic showed how they are uniquely able to build trust and to support those in need during times of crises. Their ability to quickly and effectively navigate complex and evolving systems of care, combined with their determination and passion to help others, enables them to quickly resolve challenges patients face. These are critical team members who are needed to help reduce disparities and address the digital divide. We are hopeful that the community health worker workforce will grow across our nation.