By Corina Pinto
When I first heard Dr. Thea James speak, I felt vindicated. She said, “it’s not about filling the gaps, it’s about eliminating them.” Finally, a physician articulated the way I have always viewed community health work and advocacy. Community health workers (CHWs) strive to eliminate gaps in healthcare, not simply providing a temporary fix. I had the honor of interviewing Dr. James, a senior leader at one of the largest accountable care organizations (ACOs) in Massachusetts, who is leading the way for integrating CHWs into healthcare teams. Conference participants will have a chance to hear her speak on May 3rd but let’s learn more about her first…
How can CHWs help in removing gaps and not just filling them?
Dr. James: For CHWs to remove gaps, the system requires a paradigm shift in the way that health outcomes are achieved. The biggest barrier CHWs have to eliminate gaps is the mindset of the current system. If the system’s interpretation of health care delivery is based on episodes and not about the root causes, the impact of CHWs will be limited. The goals of our current health care system and the goals of our patients are misaligned. Healthcare needs to understand what people want.
Also, CHWs do great work in simply engaging people, which has a huge impact. CHWs ask the question, “What matters to you? What’s important to you?” Those questions make a difference in patient’s lives.
Where does that misalignment between the goals of the health care system and the goals of patients/community stem from?
Dr. James: It stems from how we [physicians] are educated and trained. We are trained to function based on episodes not root causes. Now, new interns who are coming in to be trained at BMC receive a social determinants of health training where they go through a real case study and have to find the root causes to illness instead of just pushing medications and moving on.
Have you worked with CHWs before?
Dr. James: In 2006, the Mayor of Boston asked us to start a violence prevention program. We began to look at other models and saw that the measure of success was based on things like re-injury, incarceration and I thought why are we setting such low bars for people? In designing our program, we decided to set high bars and expectations for not only our patients but also our community health advocates (CHWs). We started off with just two community health advocates and now we have nine. One of the best outcomes we’ve had is with a community health advocate that we hired. He was 23 years old, shot a couple of times and was previously incarcerated. Five years later he had an MBA.
Why do you use the title “community health advocates” instead of “community health workers”?
Dr. James: We chose the name because we did not want the employees to be seen as a social service worker. We want them to be advocates first in all areas that they find themselves in, whether that be in navigating a housing situation or finding any resource. We did not want to title to limit what the advocates did.
Do you have any words of wisdom or advice for CHWs to be successful in the new ACO landscape?
Dr. James: Yes, you will have to wait and see. That will be the topic of my address during the CHW Conference on May 3rd!