Provide care with the community health worker program

The Community Translational Research Institute (CTRI) Community Health Worker (CHW) Program helps extend care beyond the clinic by supporting individuals and families in navigating healthcare and community resources.

Through the IEHP Community Health Worker benefit, CTRI provides community-based support that addresses the social and environmental factors that influence health outcomes. Because clinics typically do not hold CHW service contracts, CTRI works as a community partner to help bridge the gap between healthcare systems and the communities they serve.

Community Health Workers provide support to patients and families by helping them connect to healthcare services and community resources that promote health and well-being.

CHW support includes:

• Post-visit follow-up
• Patient navigation and resource connection
• Health education and coaching
• Housing, food, and transportation support
• Family and caregiver engagement
• Care coordination and community support services

CTRI Community Health Workers also support individuals enrolled in Enhanced Care Management (ECM) programs, as well as family members and community members who may benefit from additional support navigating services. CHWs help individuals access resources, address social barriers, and stay connected to care.

By working closely with clinics, community organizations, and families, CTRI helps strengthen coordination between healthcare providers and community-based services. Community Health Workers serve as a bridge between healthcare systems and the community, helping individuals overcome challenges related to housing, transportation, food access, and other social determinants of health.

Community members may also receive assistance connecting to services such as healthcare navigation, community programs, family support services, and health education resources that promote overall well-being.

Clinics and community partners can refer individuals to the CTRI Community Health Worker Program for additional support. Once connected, CHWs work with patients to identify needs, connect them to appropriate services, and coordinate with clinics and community partners when needed.

Referral pathway:
Clinic or Community Partner → CTRI Community Health Worker → Community Support Services → Coordination with Healthcare Providers

The CTRI Community Health Worker Program works collaboratively with clinics, community organizations, and partners across the region to improve health outcomes and strengthen access to care beyond the clinical setting.

Get involved

Clinics, community organizations, and community members interested in learning more or partnering with the CTRI Community Health Worker Program are encouraged to reach out.

Community Translational Research Institute (CTRI)

Reach out to get involved: Contact — Community Translational Research Institute