Defining the Duality of CHWs: Communities to Clinics

2 Jan, 2026

Defining the Duality of CHWs: Communities to Clinics

CHW News, CHW Professional Development, CHWs, Health Equity

Community Health Workers (CHWs) continue to strengthen the connection between community life and healthcare systems by bringing cultural context, empathy, and lived experience into environments that often operate far from the realities people face every day. As CHW roles expand across Mecklenburg County, it is essential to understand how their responsibilities both shift and remain consistent across community and clinical settings.

This blog focuses on ORG 4.2, from the Community Health Worker Initiative’s (CHWI) Cultivating Community Change Together Plan, which calls for members, partners, and organizations to deepen their understanding of the different responsibilities CHWs hold across settings. Recent CHWI baseline data and organizational partner insights offer a clearer picture of how CHWs are supervised, integrated, and supported throughout the county.

CHW Supervision: A Crucial Support Structure

According to the CHWI’s baseline data, supervision emerged as one of the strongest predictors of CHW success and well-being. CHWs reported a clear need for support in managing burnout, with 25 citing the use of self-assessments, 22 identifying strategies for burnout recovery, and 19 emphasizing the importance of ongoing training recommendations.

💡 ORG STRATEGY 4.2 Members, partners and other organizations ensure that organizations understand the different responsibilities CHWs have in clinical and community settings.

Organizational data reflects strong alignment in this area:

100% of participating organizations provided formal onboarding, including hands-on shadowing and role-specific training.
All CHW supervisors received training in both the CHW model and best-practice supervision.

These findings reflect a growing understanding that CHW supervision requires more than traditional clinical oversight. Supervisors must understand the relational foundation of the CHW model to effectively support staff working at the intersection of community-based work and institutional expectations.

CHW Integration Across Systems

While CHW integration varies across organizations, several common themes emerged in the CHWI’s baseline findings. CHWs identified key barriers affecting their work, including language and cultural barriers (9), referral process challenges (8), and limited resource availability (6). These challenges highlight how CHWs navigate frontline realities while attempting to bridge systems that are not always fully aligned with community needs.

From the organizational perspective:

84 CHWs were employed across 20 partner agencies at the start of FY25.
20 new CHWs were hired and 11 separated, underscoring the importance of ongoing integration and retention strategies.
80% of organizations implemented formal policies supporting cultural competence and diversity, equity, and inclusion, helping CHWs operate effectively within clinical environments while honoring community expertise.

When CHWs are fully integrated, participating in interdisciplinary teams, contributing to data collection, and shaping program direction, organizations report clearer workflows, stronger client engagement, and improved continuity of care.

💡 ORG ACTIVITY 4.2.3 Integrate CHWs into clinical and/or community settings based on their ability to adapt to either setting.

CHW Core Roles Across Settings

Recent baseline data demonstrate that CHWs consistently emphasized C3-aligned responsibilities across both community and clinical environments. Among the 44 CHW respondents, many reported training in behavioral and mental health (29), community violence prevention (22), and housing (22), core areas central to both community outreach and clinical coordination.

As CHWI Intern Balkirat emphasized, CHWs are effective because they meet people where they are, whether in a clinic, community space, shelter, or neighborhood. Evidence consistently shows the value of CHWs in clinical environments, including reduced hospital readmissions, shorter hospital stays, and increased patient confidence in navigating care ¹. In community settings, CHWs advance public health by connecting individuals to social and medical resources, delivering culturally grounded education, and addressing gaps that contribute to persistent inequities. Systematic reviews show CHWs improve access to preventive services, support chronic disease management, and promote more equitable outcomes across diverse populations ².

💡 ORG ACTIVITY 4.2.1 Understand the different roles and responsibilities that CHWs have in clinical and community settings.

Organizational data reinforces this consistency: 80–100% of partner organizations included CHW Core Roles, including health education, care coordination, advocacy, outreach, and assessment, within job descriptions. This alignment ensures CHWs can move between community and clinical environments without losing the foundational elements of their role.

Conclusion

Recognizing the duality of Community Health Workers, across both community and clinical settings, is essential to strengthening systems and outcomes. Baseline data confirms that CHWs are already applying data-informed approaches, including interviews, surveys, and focus groups, to shape programs and guide decision-making. Their ability to translate lived experience into actionable insight bridges gaps that traditional systems often miss. When organizations intentionally align supervision, integration, and infrastructure with the CHW model, they enable more effective care coordination, cultural responsiveness, and trust. Ultimately, acknowledging the full scope of CHW work, from communities to clinics, reinforces the public health system and advances more equitable outcomes across Mecklenburg County.

References

Kangovi, S., Mitra, N., Norton, L., Harte, R., Zhao, X., Carter, T., Grande, D., & Long, J. A. (2018). Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: A randomized clinical trial. JAMA Internal Medicine, 178(12), 1635–1643. https://doi.org/10.1001/jamainternmed.2018.4630
Glenton, C., Colvin, C. J., Carlsen, B., Swartz, A., Lewin, S., Noyes, J., & Rashidian, A. (2013). Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: Qualitative evidence synthesis. Cochrane Database of Systematic Reviews, 2013(10), CD010414. https://doi.org/10.1002/14651858.CD010414.pub2