Jefferson Health looks to community health workers to improve health outcomes and build trust

A patient who recently received a liver transplant was struggling to find transportation to his twice-weekly checkups with Jefferson Health doctors in Center City. He lived two and a half hours away in Carbon County. Unable to work during his recovery, he couldn’t afford to keep paying drivers.

This worried Lydia King, the community health worker assigned to his case.

“If they are too inconsistent with coming to their appointments and their medical care, we start to run the risk of losing the transplanted organ,” she said.

King was tasked with helping the liver transplant patient as part of her training in Jefferson Health’s Community Health Worker Academy, a 13-month program that teaches community members to become front-line public health workers. Their expertise in the communities in which they live and serve can help address non-medical needs like access to transportation that affect health outcomes.

Through a bit of research and “a lot” of calls and emails, King secured a shuttle bus for the patient to take free of charge through Carbon County’s Medical Assistance Transportation Program. It was a resource the patient wouldn’t otherwise have known to use.

“Knowing how overwhelmed he was by the whole process of being transplanted, not being able to work, and having a family that he needed to provide for, it was very fulfilling to help just bridge such a small gap,” King said.

King, 25, graduated late May as part of the academy’s second cohort. She brings to her role experience living in the Logan area, and she previously worked at Dedicated Senior Medical Center, helping patients navigate insurance, social services, and access to food. Becoming a community health worker seemed like a natural progression.

Launched in April 2023, the program seeks to tackle health disparities in Philadelphia’s most underserved communities by integrating community members into care teams. All eleven graduates of this year’s cohort received return offers to continue working as community health workers at Jefferson.

Jefferson’s academy recruiters look for two things when selecting the next cohort of community health workers: a community connection and a desire to help people.

Community health workers use their lived experiences as community members to bridge gaps between patients and the medical system. It’s a plus if someone has interacted with the healthcare system in the past and can use that experience to empathize with patients.

“Healthcare systems realize that there needs to be these individuals who can speak directly to patients,” said Keith Leaphart, chief health equity and community impact officer at Jefferson. (Leaphart serves on the board of The Lenfest Institute, which owns The Inquirer.)

He noted that people who come from the same communities as the patients “can help to build trust in a way that is unique to them.”

Program participants receive basic health education on chronic conditions such as high blood pressure and diabetes.

But in their role, understanding the socio-economic and environmental factors that affect a person’s health is more important than medical expertise. Their access to transportation, social support, housing, and food extends beyond the health system, but can determine health outcomes.

Knowing how to navigate the resources available in the community is key to meeting these needs.

The academy teaches participants to build relationships with community partners, whether it’s a church, school, food pantry, mosque, or housing organization, Leaphart said. This makes it easier to consult these partners for help with patients.

“When we’re making referrals and making a phone call to an organization, they serve as a bridge,” he said.

Participants in the academy are trained in classrooms and in the field at Jefferson. Most of the community health workers are placed in clinics and outpatient facilities, rather than inside hospitals. There, they work with the nursing and social work teams to identify patients who need assistance.

King’s first placement was working with the transplant team. That’s how she was connected with the liver transplant patient in his 30s.

This case tested King’s ability to address multiple needs. Though the patient’s primary issue had involved transportation, he also told King that he was worried about the financial stability of his family. The sole breadwinner for his wife and young child, he had been unable to work since falling sick.

King offered a solution to help: She applied for Supplemental Nutrition Assistance Program benefits on the man’s behalf and secured $600 a month for his household. It was another resource that the man would not otherwise have known to seek out.

That patient is now recovering and will hopefully return to work soon, King said.

“I’m hoping that it creates some stability for him and his family to be able to build upon and keep moving forward,” she said.