Insights: The impacts of traditional health workers

As health systems, community-based organizations and other changemakers work toward healthier, more equitable communities, many are exploring the impacts of integrating Traditional Health Workers (THWs) into their programs. THW is an umbrella term being used in Oregon to encompass roles like Community Health Workers, Doulas, and Peer Support Specialists, to name a few. While their specific titles reflect key differences, all THWs work as trusted community members who walk alongside others facing barriers to good health to promote healthy behaviors, connect them to services, and help coordinate care.

At CORE we’re engaged in a variety of research, evaluation, and cross-sector coalition building efforts that place THWs at the center of new care models and innovative programs. These projects illustrate some of the ways THWs are improving outcomes, building trust, and shaping policy. 

Below we’ve summarized several of our key findings, and a few examples from a growing body of work here at CORE. For more info, get in touch!

Improving Outcomes 

As organizations consider integrating THWs into their programs, the question for many decision-makers is whether this approach can measurably improve outcomes. Measuring THW impact can be tricky, as they often work within multifaceted programs. And sample sizes in pilot or early stage programs are often small. However, despite these limitations, in the programs evaluated by CORE, we saw promising results.

For example, in Kaiser Permanente’s Housing for Health Initiative, which served roughly 400 clients with THWs, we observed a 51% reduction in the likelihood of sleeping on the street, in a car, campsite, or similar space, and a 49% increased likelihood of not going without food. In another project, where 240 pregnant individuals with substance use disorder received support from peer mentors trained as doulas, participants had a 70% reduction in the odds of having a pre-term birth compared to non-participants.

Building Trust

THWs often share similar backgrounds, experiences, language, and culture with those they serve. These factors are key to their ability to build trust and address clients’ experiences of stigma within health care and social service settings. This also allows THWs to break down barriers and connect community members to care and services, because they have navigated those very systems in their own lives.

Plus, that trust goes both ways, as systems and organizations are increasingly turning to THWs to engage and support their clients in ways they can’t.

Informing and Improving Policy

CORE’s research and evaluations have found that THWs are natural researchers who can elevate community needs and drive meaningful policy and system change. Their lived experience and experience interacting with the populations they serve empowers them to identify the barriers that individuals and populations face – from inequities, to cost, to access to quality care – and propose solutions. The implications for organizational and public policy are significant.

Take, for example, the Rose Village Community Health Worker team in Southwest Washington State. Through testimony, advocacy, and outreach, this neighborhood-based team influenced a number of impactful policies ranging from tenant protections to local public transportation. And in other projects, we observed THWs advocating for internal policy changes and improvements to existing programs and  interventions.

“To have people like (THWs) who care about social justice, health, and anti-poverty issues and are willing to go and talk to lawmakers… it’s huge”  – Community Partner