Hey, Neighbor!

Person to person, community health workers provide critical support for people navigating the health care system — and the broader forces of health.

Joshua Collier didn’t set out to work in health care. At Austin’s Casa Marianella in the early 2000s, he helped displaced immigrants navigate challenges like securing housing or finding work. 

But Collier routinely found himself in clinical spaces, accompanying clients to the ER or spending hours at primary care appointments to ensure their needs were met.

“‘Health care system’ is a misnomer; it’s a series of disconnected systems,” Collier says. “It’s challenging to navigate getting care, even for people who had the privilege of education or familiarity with the health care system.”

Collier’s role now? Community health worker at Lone Star Circle of Care at Collinfield, where he partners with faculty and staff of Lone Star and Dell Medical School at The University of Texas at Austin to help patients navigate systems, with an eye toward integrating assistance with social determinants of health into mainstream care.

“Health is so much more than what happens inside the clinic or hospital,” says Carmen Valdez, Ph.D., chief of the Division of Community Engagement and Health Equity in Dell Med’s Department of Population Health. Together with the Division of Global Health, it acts as a hub for initiatives that support community health work. “Having individuals who deeply understand their communities’ and neighbors’ needs is necessary to help people get access to care in a way that’s appropriate for their lives and goals.”

A Day in the Life

Community health workers don’t come in one shape or size. They might work at a traditional clinic like Collier, acting as a bridge between patient and provider and helping individuals navigate all the issues standing in the way of a healthier lifestyle — food access, language barriers, transportation and more.

We look at health in very broad terms — food, parks, access to transportation and more.

Ricardo Garay, Program Manager

But these health workers, who are members of the communities they serve, are just as likely to be with a local organization focused on issue advocacy, a nonprofit dedicated to supporting a particular group of people or an academic institution closely studying the area.

“We look at health in very broad terms — food, parks, access to transportation and more,” says Ricardo Garay, program manager in the Division of Community Engagement and Health Equity and a certified community health worker instructor. “You need to be adaptive to patients’ needs as individuals, and that’s not always as categorical as the health care system wants it to be.”

Collier, for example, spends a lot of his time at the clinic meeting with patients before or after they see a health care provider. He’s looking to understand each patient’s specific challenges to health, beyond a condition or illness. Collier then takes that information and tries to find useful resources nearby — perhaps a food bank to address food insecurity, or a rental assistance program for those needing housing. Ideally, within two weeks of a consultation, Collier follows up by phone to hear how things are going.

Brandon Altillo, M.D., is a primary care provider at Lone Star Circle of Care at Collinfield, where Collier works. “The idea that we as a health care system need to address social determinants of health has really gained steam nationwide in the last few years, but I’m so happy to be part of a team that is really leading the charge and investing in that promise right now,” he says. “I’ve seen firsthand how much of a difference it can make when our community health workers help someone with resources such as food access, school system support or rent assistance, especially during the pandemic.”

Now With COVID

Opportunity — and demand — for community health work grew last year, as COVID-19 plagued Latinx, Black and indigenous communities. On June 1, 2020 — amid the upswing of the pandemic’s summer wave — the weekly average of people hospitalized in the Austin metro area was more than four times higher for Hispanics than white, non-Hispanic people, the second most-hospitalized racial or ethnic group. And the Centers for Disease Control and Prevention, adjusting for age differences, estimates that Latinx, Black and Native American people are 2 to 3 times more likely than white people to die of COVID-19.

Brenda Garza is a community health worker assigned to COVID-19 response, hired by Dell Med to provide services to Latinx patients hospitalized at Dell Seton Medical Center at The University of Texas. Dell Seton, operated by the Ascension Seton health care system, is the primary teaching hospital of the medical school and a cornerstone of community health in Austin.

Garza helps patients with a huge range of needs, from communicating effectively with physicians and other health care providers to arranging transportation to getting vaccinated. In recent days, she’s been focused on referring the son of an older patient to job training programs. When the patient is discharged, he’s going to be reliant on his son for housing support. To provide it, the son needs a better-paying job, so he asked Garza for help. That’s often how it happens.

I have worked with whole communities because someone had COVID and ended up in the hospital, then they shared the knowledge of what I do with the people around them.

Brenda Garza, Community Health Worker

“The reality is, my work doesn’t stop at the doors of the clinic,” she says. “Many times, in helping a patient, I help the family. Then they talk about what I did for them, neighbor to neighbor to neighbor. I have worked with whole communities because someone had COVID and ended up in the hospital, then they shared the knowledge of what I do with the people around them.”

It’s relationships that fuel community health work, says Tim Mercer, M.D., chief of the Division of Global Health at Dell Med — one of the two divisions that acts as a hub for community health services. Throughout the pandemic, Mercer has worked collaboratively with Austin’s largest federally qualified health center network, CommUnityCare Health Centers, and its Health Care for the Homeless program to help people experiencing homelessness get tested, safely isolate and get vaccinated. He’s joined by Richard Johnson, a Dell Med community health worker who focuses on the homeless population, building trust by helping people with simple, immediate needs like making a phone call or picking up medication. Most weeks, Mercer or a Dell Med community health worker like Johnson can be found at a mobile food pantry in Austin’s Rundberg neighborhood.

“I think the real success story is the person who’s come back to that pantry week after week and the same worker has talked to them as they went from a hard no to wanting more information and then eventually getting the vaccine and then bringing their whole family to be vaccinated,” Mercer says. “It’s that time and that trust and that connection that is some of the real power of community health work.”