The Missing Link
By Jessica Rosencrans on
Many healthcare positions are tried and true. Dentists, nurses, and surgeons are just a few examples of positions that need little explanation. However, a new healthcare position has surfaced in recent years, one that often flies under the radar: community health workers.
A community health worker, also known as a community health representative within tribal communities, is a frontline public health position who generally helps connect people with community resources. However, a community health worker's responsibilities might vary widely between communities and organizations.
Country Community Health Center group
photo left to right: Vicky Schantz, RN;
Kylee Schmiesing, CHW; and Anna
Anderson, LBSW.
Kylee Schmiesing is a community health worker at Coal Country Community Health Center (CCCHC) in Beulah, a position she has held since October 2023. Schmiesing is not only the sole community health worker at CCCHC, she's also the first person to ever hold the role at the organization. She works as part of the Medicare Chronic Care Management program, assisting residents who utilize CCCHC in Beulah, Hazen, Center, and Killdeer with conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure, hypertension, diabetes, and chronic kidney disease.
Much of her workday involves making phone calls to patients, checking in and seeing if they have any areas of concern. Schmiesing also drives out around the county and visits patients in their homes, alleviating the need for them to travel to CCCHC to have access to care.
Schmiesing works with a team of two other people, a nurse and a social worker, to assist the 150 patients in the program. "There's a lot of patients living on a fixed income who need assistance with different programs, so I help with applications to Medicaid, low-income housing, or the Supplemental Nutrition Assistance Program (SNAP)," she said. "If someone needs food or help caring for their home, I can help them contact the local food pantry and get them set up with a homemaker to help with cleaning and care."
Addressing Social Determinants of Health
Kaylee Caspers is a community health worker based at Altru in Grand Forks. Like Schmiesing, Caspers is the only community health worker at her location. However, Caspers' role is more of a resource connector for Altru patients. If a patient is flagged on the entry survey, they are referred to Caspers, where she informs them of a variety of Altru- or community-based resources available to help them meet their needs. She works to assist patients in Grand Forks in applying for housing, transportation services, and food supplements like food pantries and SNAP.
The goal is to find a solution that will work for that person in the long-term.
"Most of the work I do relates to social determinants of health," said Caspers. "The goal is to find a solution that will work for that person in the long-term."
Like Schmiesing, Caspers is also the first community health worker at Altru. She has been in the role for about a year, working alongside pursuing a master's degree in social work.
Creativity in Connecting
Sanford Hillsboro Medical Center, a Critical Access Hospital in Hillsboro, North Dakota, also boasts a solitary community health worker: Melissa Stern. Stern receives referrals on people who could benefit from community resources and connects them with the best fit for their situation. Her main areas of focus fall under social determinants of health, where she has used unique approaches to help address needs in her community. To address food insecurity, she planted a garden next to the clinic and offered vegetables to patients who were food insecure or diabetic.
Health Workers.
One area of particular focus for Stern is transportation. Without a reliable mode of transportation to appointments, healthcare can become inaccessible. Relying on family members or friends isn't ways an option, and road conditions can easily become treacherous in the North Dakota winters. Stern started a transportation project in Traill County to help provide rides to appointments for people in need.
She also set up a program to allow residents to check out transportation-related equipment for free. Currently, this library offers items such as transfer boards, car and seat assists, leg lifters, and swivel seats. By utilizing these items, community members can retain some of their independence and not rely on senior transportation, freeing up the bus for others who need it.
As part of the Chronic Care Management program, Schmiesing also helps patients get access to needed equipment. Some of her referrals include connecting patients to organizations like Community Action Partnership of North Dakota, which serves all 53 counties in North Dakota. These partnerships have resulted in Schmiesing's patients receiving a walk-in shower and other life-changing appliances free of charge.
A Piece of the Puzzle
Although the community health worker position is relatively new in North Dakota, efforts surrounding certification and reimbursement mechanisms related to the role have been in the works for nearly a decade. In 2023, the North Dakota Legislature established a taskforce to develop recommendations for North Dakota Health and Human Services in creating guidelines for community health workers and the services they provide. Rebecca Quinn, associate director at the Center for Rural Health, located within the University of North Dakota School of Medicine & Health Sciences, is part of this task force.
Community health workers are trusted members of the community who serve as a bridge to healthcare.
"Community health workers are trusted members of the community who serve as a bridge to healthcare," Quinn stated. "Often, they provide services outside of our brick-and-mortar system. For rural communities, this can be vital to extending the reach of healthcare, improving access for individuals."
When asked if people they interact with in their social lives tend to know what a community health worker is by title, both Caspers and Schmiesing laughed. "Oh no, I always have to explain what my job is," said Caspers.
Although their jobs might look different, all three community health workers agree that the best part of the job is helping people in their communities. "I love working with the patients," said Caspers. "I love building relationships with people and seeing the progress that they make and see how far they've come."
Schmiesing shares a similar sentiment. "When I visit with the patients and see the smiles on their faces, that's the best part of my job. It's a great feeling to know that I am helping to improve their lives."
Ultimately, community health workers act as a bridge between patients, community resources, and healthcare providers. Their work can be particularly impactful in rural communities, where there are unique challenges in providing adequate transportation and limited resources to go around. Although some referrals with community health workers become a regularly scheduled check-in while others are a one-time deal, knowing that someone is out there who has the knowledge and capability to help can mean a great deal to patients.
Stern loves in the role she holds in Hillsboro and takes every opportunity to share her work with others. "I believe that community health workers are a very important part of the health system. We do such a variety of things, anywhere from assisting with applications to finding transportation for residents to get to appointments and getting people access to equipment," she said with pride. "We are the people who put the pieces of the puzzle together to make it whole."
is the communication specialist with the Center for Rural
Health at the University of North Dakota School of
Medicine & Health Sciences in Grand Forks.
