National Health Outreach and Engagement Conference 2024

Martinez, E, Johannes, E, and Kiss, E.
Community health workers (CHWs) are “frontline public health workers” who are naturally
embedded in the communities they serve. CHWs “serve as a liaison/link/intermediary between
health/social services and the community to facilitate access to services and improve the quality
and cultural competence of service delivery” (APHA, 2024). The scope of practice of CHWs
includes, but is not limited to (Kansas Community Health Worker Coalition, 2024):
• Client support
• Care coordination
• Healthcare liaison
• Health education
• Advocacy

Much like Extension professionals, CHWs work to build individual and community capacity
via outreach and education but complement Extension’s role via a unique connection to health
care providers and expanded scope of practice. Additionally, CHWs are uniquely connected to
health care in ways that Extension is not via both requirements and opportunity. That is, to be
recognized and reimbursed by Medicaid, Medicare, and other third-party payors, CHWs must
be supervised, at least in part, by an individual or organization with an associated National
Provider Identification Number, or NPI. An individual with an NPI is a health care provider and
might include a physician or nurse practitioner, physical therapist, or clinical social worker.
This requirement presents the practical opportunity to have a joint hire between Extension and
direct-care providers. Furthermore, one of many opportunities is developing, or joining, a
closed-loop referral system that significantly improves patient and community health. To
illustrate: Patient A visits Provider B because they suspect they have diabetes. After a diagnosis,
Provider B then supplies the necessary medical treatment, but also enters the patient into a
closed-loop referral system. This means that Patient A could be referred to Extension for a
Dining with Diabetes course and other healthy living programming, as well as a CHW who can
help the patient secure a blood sugar monitor, learn how to interpret their blood sugar, check-in
regularly, and explore insurance benefits. This simplistic example begins to highlight how the
work of Extension professionals and CHWs are both complementary and effective for the
individuals being served. By following a joint-hiring model and employing CHWs within local
Extension offices, there is an even greater natural opportunity for collaboration, reduced
duplication of services, expanding the services both entities provide, and improving the health
of our nation. This is Health Extension.

As of the writing of this proposal, funding has been secured and hiring of CHWs within
Extension offices has begun. There has been an incredible journey to building the foundation on
which this is moving forward, and this session will describe that path. This will include
developing initial partnerships with CHWs in the state, certification requirements, funding
possibilities, a visual model of Extension and CHW’s overlapping and unique scopes of
practice, and other hiring considerations. The status of the initiative and lessons learned will be
shared. Then, future opportunities, including additional hiring, partnerships, and insurance
reimbursement will be discussed.

Innovative initiatives such as this directly contribute to the pursuit of health equity, serving
populations that are underserved and victim of discriminatory practices, and meeting the call to
diversify Extension’s workforce