The Benefits of Social Support From Community Health Workers: A Qualitative Study of a Local CHW Program for People Experiencing Homelessness

Abstract

Purpose: This report describes findings from a qualitative evaluation of a Community Health Worker (CHW) program: Hospital to Housing, a grant-funded program run by the Massachusetts Housing and Shelter Alliance and the Massachusetts Behavioral Health Partnership/Beacon Health Options. Beyond evaluating the role of CHWs in this specific program, this project aims to contribute to a broader understanding of how CHWs can address the needs of marginalized, medically and socially complex populations. Methods: This program evaluation was a qualitative, descriptive study with the purpose of program evaluation. Twenty-six semi-structured interviews were conducted with the CHWs (n = 4), a selection of their clients (n = 15), and both current and prior program leaders (n = 7) to explore stakeholder perspectives on the CHW role. Clients were sampled until a point of saturation was reached – when no new concepts emerged from additional interviews. To analyze the interview transcripts, a grounded theory approach was used to inductively develop and assign codes. Results: Five key CHW roles were identified: relationship-building, social support, system navigation for housing, system navigation for health care and community engagement. Program strengths included therapeutic relationships between the CHWs and their clients, the program’s outreach-based approach, and the flexibility of the CHW role. Program challenges included variability among the CHWs, inadequate supervision and support, and a lack of affordable housing options. Conclusions: The findings from this evaluation demonstrate the potential for CHW programs to incrementally yet meaningfully impact well-being and engagement with services among chronically homeless populations. These findings also suggest that the effectiveness of CHW programs depends on both individual CHW efficacy as well as program design. Lessons learned include that social support is a crucial component of the CHW role and that hands-on, client-centered supervision is essential in order to balance CHW flexibility and consistency.