Table 3:

Clinician perspectives on the current role of CHW and desired changes in CHW training

	Perceived roles and strengths of CHW
	Summary Points	Representative Quotes
4M’s	CHW play a minimal role in helping patients with medications or advance planning However, CHW can bring concerns about medication non-compliance, fall risk in a patient’s home, or sudden cognitive changes to a provider’s attention	“If there was an issue where someone realized like, someone’s out of medication or there was an adverse reaction, I don’t doubt that [the CHW] wouldn’t bring it to us.” “If mobility comes up, [the CHW] would probably talk about it, but … they’re not having deliberate conversations about mobility.” “[The CHW] is not necessarily focused on helping manage mood, but more kind of noticing if mood may be factoring into an issue, then she’ll highlight it to the social service team.”
Resource navigation	Most clinicians we spoke to felt that the most important role of CHW is working with patients to obtain social services	“We have community health workers who can help patients navigate Pace and homemaker services and things that are a bit time consuming for us [social workers].”
In-home interaction	CHW are uniquely positioned to make observations about a patient’s home environment and social needs	“We’re dealing with patients who are in and out of the hospital a lot because they’re complicated, and so just having yet another way to give them support and to understand what they’re dealing with at home and how that has an impact on their health, I think is pretty invaluable.”
Cultural bridging	CHW can bring cultural awareness and sensitivity to their relationships with patients	“I do feel like a lot of consumers relate to CHW’s more than they do to social workers or any other profession, just because they’re sort of like the bridge between the hospital and the community. They trust them in a different way.”
	Desired changes in CHW training
	Summary Points	Representative Quotes
Medications	Most clinicians said that CHW involvement in medications should be minimal and limited to helping patients with organization	“Right now the role of CHW is not so much focused on medication, but could there be more push on home visits and then checking with the patient in-person in the home to see if they are taking their medication.”
Mobility	Some clinicians said that CHW need formal training on specific mobility hazards to look out for in patient homes	“It would be relatively easy to teach the information that was needed for them to be able to then intervene. And I think that would be great, because they’re already asking lots of questions about the patient’s living situation.”
Mentation	Most clinicians said that CHW would require formal training on cognitive decline in older adults in order to screen for them	“We’ve trained the CHW’s in how to escalate things like suicidality and homicidality, but not general concerns about memory impairment.” “One gap that I’ve noticed is in the memory piece of things. I think that’s not something that [the CHW] is particularly well versed at assessing.”
What Matters	Most clinicians said that CHW involvement in advance care planning should be minimal and limited to informal conversations around care goals	“As long as they have the communication skills that can help to facilitate the goals of care discussion, it doesn’t have to necessarily be a goals of care discussion – just maybe a conversation about what’s important to a patient.”