"Meet Them Where They Are": Achieving Health Equity for People Experiencing Homelessness with Community Health Workers

Abstract

In the United States, it is estimated that about 14 million Americans will experience homelessness in their lifetime (Coldwell & Bender, 2007). While it is well documented that people experiencing homelessness suffer a disproportionate burden of disease compared to housed individuals, medical interventions that are specifically tailored to their vulnerabilities are insufficient (Fazel et al., 2014; Geddes & Fazel, 2011; Somerville, 2013). Some authors argue that a cultural approach is needed to ameliorate the disproportionate suffering and burden of disease that this community faces (Somerville, 2013). A health-care model that is highly effective in bridging cultural barriers and providing health care to underserved populations is the Community Health Worker (CHW) model. CHWs are lay persons who serve as liaisons between their communities and the health-care system (Arvey & Fernandez, 2012; Koenig et al., 2010; Mukherjee & Eustache, 2007; Olaniran et. al., 2017; Raviola et al., 2012; Walton et al., 2004). CHWs provide culturally informed services to their communities and facilitate a bi-directional flow of knowledge between their community and the health-care system (Arvey & Fernandez, 2012; Mukherjee & Eustache, 2007; Olaniran et al., 2017). This knowledge flow helps level power asymmetries and thus can limit the ways that clinical medicine perpetuates structural violence against vulnerable communities (Farmer et al., 2006; Mukherjee & Eustache, 2007). This study used qualitative research methods to assess the potential for CHWs to bridge the gap between people experiencing homelessness and the health-care system in the United States. Semi-structured interviews were conducted with two pools of experts: (1) professionals in organizations that provide services to people experiencing homelessness, and (2) professionals in organizations that provide CHW services. Interviews were recorded and transcribed. Thematic analyses were conducted to identify major trends, assess areas of overlap, and evaluate the potential strengths and challenges of such programming. Based on these findings and research from the literature, a framework for the implementation of a CHW program for people experiencing homelessness is proposed.