Table 2.

Community health worker responses to training program

Themes	Quotations
What did CHWs think of the training and materials?
Informative	“Training was well done, well put together, very informative and educational for those who wouldn't have as much knowledge on a particular subject.”
	“The role-playing on how to deal with difficult clients was very interesting.”
What components are CHWs using?
PHQ-2 and PHQ-9: Strategies for use of screening and referral resources	“Several of our workers have used the PHQ-2.”
	“Paraphrasing (screening items), so we could understand each other.”
	“I suggest they go to a clinic because I don't want them to say I said they have ‘such and such.’ When they come back I ask about the visit and then ask the questions and present the options.”
Confidentiality tools	“Confidentiality materials were helpful, especially HIPAA laws”
Behavioral activation	“Elderly man who develops a plan to get off bus one block early to return to exercise, feels better; then gets off 2 blocks early and runs into a friend.”
How can CHW training and support materials be improved?
Case registry	“The form is too long, break it down. Some questions need to be eliminated.”
Cultural competence	“Spanish version or simplified version for folks with low education.”
	“Would like a more community-oriented approach and language.”
More role playing	“People need more practice and a practice session is very helpful.”
More relationship building	“Needs to be a greater effort to get them all to talk. Have everybody exchange phone numbers and have some conversations.”
Therapy for CHWs	“Having recently trained counselor run support group for outreach workers.”
Integrate with counseling skills	“You created an artificial distinction between counseling and outreach piece, that didn't work (for our needs in mental health agency).”
What are the challenges associated with implementing the CHW role?
Community infrastructure	“Reluctance to call police because of the way they handle it sometimes.”
	“Limited hospital services.”
	“Long wait for buses.”
Client resistance and denial	“We get the ‘I'm not crazy.’”
	“Denial issues.”
	“People don't want to go to care.”
	“When we try to get people to accept some responsibility, people get upset with us and report us to the front office.”
Hard-to-reach clients and clients with complex issues	“‘Catch me if you can’ clients.”
	“When I called her the following week, have not been able to get through.”
	“Try to reach family to follow-up with elderly.”
	“Clients dealing with multiple issues—health is last.”
	“Problems on top of problems.”
Job conditions	“Work force too small, pay too little.”
	“Management is not on the same page.”
Agency relationships and provider collaboration	“Don't have the interrelationships within and between agencies.”
	“Still trying to collaborate (to find a) place we can refer our clients.”
	“Outreach workers could work more closely with providers, churches.”
What is the early impact?
Hope	“It gives us all hope...It's good that you started that process.”
Networking	“The most important thing is that we stay in touch to make sure we are working on the same basis so we can all help each other.”
	“We increased ease of getting help for clients, working with other agencies.”
	“Do a resource network of mental health and rehabilitation providers. That would be a great service you could do.”
Certification	“Our agency pre-Katrina, failed Joint Commission because we did not do this. They will look to see if you have things like this in your program.”
Improved quality and funding	“Helps set our own standards, better opportunity to shine, clarify ourselves, and get more money.”
Perception of providers	“First time realized these providers want to do well.”