O3261: Community Health Workers’ Perspectives on Integrating into School Settings to Support Student Health

Background: Children with chronic health conditions, especially those of vulnerable populations, are more likely to experience lower educational achievement and increased morbidity in comparison to healthy, privileged peers. Schools represent key venues for monitoring student health and delivering health services; however, limited staffing and resources constrain the impact of schools. Community health workers (CHWs) in schools may help reduce such gaps, but their potential is underexplored. This study gathers perspectives of experienced CHWs to describe how CHWs can best be applied in school settings to support student health.

Methods: This qualitative study was conducted through an existing community-academic partnership in Chicago. Semi-structured interviews were conducted between January and April 2022 with individuals who held positions that aligned with the CHW scope of work. Questions focused on the implementation of CHWs into schools. De-identified transcripts were analyzed using inductive reasoning. Codes were organized into domains and themes.

Results: Fourteen individuals participated in the study. Seven domains about the implementation of CHWs in schools emerged: roles and responsibilities, collaborations to support work, key steps for integration, characteristics of successful CHWs, training, assessment of impact, and potential challenges.

Participants shared various potential responsibilities of school-based CHWs, including health education, addressing social determinants of health, and supporting students’ chronic disease management. To effectively provide such services and overall support the school community, CHWs must build trusting relationships with school staff, students, and families. Collaborations were identified as integral to the success of school-based CHWs. For instance, participants described how CHWs can coordinate student care with school staff and parents, as well as acquire resources from community partners.

To integrate CHWs successfully into schools, participants indicated CHWs and schools should together determine CHWs’ responsibilities, familiarize CHWs with the school environment, introduce CHWs to the school community, and establish support systems for CHWs. Familiarity with the broader community was identified as a key characteristic that CHWs should possess to be successful, along with relevant work experience, essential professional skills, and specific personal qualities. Additionally, participants emphasized the importance of training on CHW core skills and health topics to effectively prepare CHWs to work in schools to assess CHWs’ impact, participants proposed utilizing evaluation tools, documenting CHWs’ interactions with students, and observing indicators of success within the school community. For challenges, participants anticipated that CHWs need to overcome pushback from the school community and difficulties related to their scope of work.

Conclusion: This study is the first to describe the perspectives of experienced CHWs on considerations for implementing CHWs into schools. CHWs play a valuable role in the healthcare system and have the potential to support student health by enhancing school-based health services. These findings can help inform models to integrate CHWs to ensure healthy environments within schools.