Community Health Workers and Social Proximity: Implementation of a Parenting Program in Urban Poverty

Community health workers (CHWs) offer many advantages for effective dissemination of mental health interventions, and thus a potential means through which to mitigate the many barriers to treatment faced by minority youth and their families. However, studies using CHWs have mainly focused on whether interventions implemented by this workforce are effective, while leaving much unknown about the nature of CHWs’ role and the key elements that make them effective. The primary aim of the present study was to better understand one of the central components defining the CHW role: their shared community membership with the population served. We used the term social proximity to refer to this closeness to the population served, and to encapsulate the shared characteristics, background, and experiences that could comprise defining features of community membership. In order to better characterize and understand social proximity, we interviewed 16 CHWs (called Student-Family Liaisons, or SFLs) implementing a school-based early intervention program (Partners Achieving Student Success, or PASS) in Latino and African American communities of urban poverty. The program targeted promoting child and parent engagement in schooling as a protective factor for children’s mental health. SFLs were interviewed about the strategies, characteristics, and elements of their role that they leveraged in connecting with and engaging families. Thematic analyses of semi-structured interviews revealed four main themes defining social proximity for this CHW workforce: (1) experiences of parenthood or caring for children, (2) knowledge and understanding of practices or experiences related to ethnicity/race, (3) familiarity with and understanding of the neighborhood community, and (4) experiences of life hardships and struggles. These elements of social proximity were featured most prominently in the engagement strategy of relating. SFLs’ accounts illustrated how their experience of social proximity was informed by specific typologies of similarities (experiential and deep-level), contextually relevant similarities, and program-based similarities. Additionally, these accounts highlight the need for supporting, promoting, and celebrating the natural traits and lived experiences of CHWs, for these are the defining features that make this workforce unique and also what CHWs consistently draw upon when connecting with community members during service delivery.