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Community Health Workers in the Veterans Administration: Exploring Opportunities and Barriers to Integration for
Katlin Harker1, Teresa Howard1, Battista Smith1
1Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC.
Background:
Rural Veterans and caregivers face challenges related to health care access, care coordination, and institutional trust-areas where Community Health Workers (CHWs) are well positioned to make an impact. Despite their potential, CHW integration into complex federal systems such as the US Department of Veterans Affairs (VA) remains limited. CHWs represent a promising strategy to enhance access and care continuity for rural Veterans and caregivers.
Objectives:
To examine perceptions of community and institutional partners regarding integration of CHWs into the VA to support rural Veterans and their family caregivers.
Methods:
We conducted virtual, semistructured interviews with 24 key informants from community organizations and VA-affiliated institutions (October 2024 to February 2025). Interviews explored key informant views on CHW roles, responsibilities, training needs, and implementation considerations. A community advisory board of CHWs guided all aspects of the project.
Results:
Four themes emerged: (1) CHW scope of work, (2) barriers and facilitators to CHW implementation, (3) CHW support needs, and (4) training and requisite knowledge.
Conclusions:
Effective CHW integration into the VA will require role clarity, robust support systems, and context-specific training tailored to this population. To ensure sustainability, VA leadership will need to standardize role definitions across clinical and community domains. A strong business case-demonstrating improved care coordination, reduced emergency department use, and enhanced screening for social determinants of health-will be critical to secure funding and supportive policy. CHW integration could also offset staff burden within the VA.
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