Ascension Illinois Foundation
Community Health Workers Link Patients with Help
If someone is struggling to put food on the table and pay the bills, impacted by trauma in their family or community, or does not speak English, they likely will have a harder time accessing health and social services. Community health workers have a particularly close understanding of the communities they serve and are there to help.
Ascension Illinois secured grant funding from Molina Healthcare in 2021 for community health workers to meet people living with prediabetes or diabetes in their communities and help link them with services to address their unmet needs. At five Chicago-based primary care clinics serving diverse and underserved populations, these workers meet with patients to identify their needs and risk factors; provide diabetes education; and refer them to community and diabetes resources to improve their health and overall well-being. The program is currently funded through June 2024, and the goal is to secure funding to continue beyond that date.
“This work is really rewarding,” said Jessica Bustamante, who has been a community health worker at the Cicero Avenue Primary Care clinic since September 2021. “Some patients have a lot going on that they don’t always disclose to the doctor.”
Building connection and trust
Across all five clinic sites, more than 4,800 patients have been screened since July 2021 to assess how they are doing in terms of housing and food security, basic safety, utility costs, transportation access, education, and job and financial stability. Food and housing are two of the biggest challenges that screened patients are dealing with. Bustamante said her clinic serves a high-need population. Many patients have diabetes, are Spanish-speaking, and come from low-income households that rely on Medicaid or don’t have insurance coverage.
One patient, who was a domestic violence survivor, was living on the streets and needed a phone. Their community health worker helped them apply for one and for food assistance, and helped them find a safe place to live. Another patient had suffered a heart attack and been staying with friends, without a home of their own. With help from their community health worker, they secured housing and furnishing, along with medication management and diabetes education to bring their diabetes under control.
“No una. Muchas gracias.”
When another patient, Adan, met Bustamante, his blood sugar as measured by his A1C level was a dangerous 14%. He was feeling weak, dizzy, was struggling to sleep at night and had very little energy. Over time, Bustamante helped him learn new ways to manage his diabetes. Through conversations with Adan, Bustamante also identified that he was struggling with food insecurity and helped him secure food assistance. Adan is following his treatment, eating better and taking his medication. On a recent visit, his A1C level was down to 6%.
“I feel happy whenever I speak with her. Especially when I am at home and she gives me a call, I feel better knowing that she is attentive to my health and knowing that she is here as an extra support,” Adan said. “She’s truly needed here. It’s not just one thank you, but many thanks for all of her contributions to me and to the clinic.”