title: Strategies to Improve the Integration of Community Health Workers Into Health Care Teams: "A Little Fish in a Big Pond".
abstract: BACKGROUND
  The Patient Protection and Affordable Care Act acknowledges the value of community health workers (CHWs) as frontline public health workers. Consequently, growing attention has been placed on promoting CHWs as legitimate partners to provide support to health care teams and patients in the prevention, management, and control of chronic disease, particularly among diverse populations and high-need individuals.
  
  
  METHODS
  Using a mixed-methods research approach, we investigated the integration of CHWs into health care teams from the CHW perspective. We conducted a survey of 265 CHWs and interviews with 23 CHWs to better understand and describe their experience and their perceived opportunities and challenges regarding their integration within the context of health care reform.
  
  
  RESULTS
  Feelings of organizational support were positively correlated with the number of CHWs in the organization. CHWs reported the following facilitators to integration: having team meetings (73.7%), training inside (70.4%) and outside of the organization (81.6%), access to electronic health records, and ability for CHWs to stay connected to the community.
  
  
  CONCLUSIONS
  The perspectives of CHWs on their positive and negative experiences offer useful and innovative insight into ways of maximizing their impact on the health care team, patients, and their role as key emissaries between clinical services and community resources.
authors.affiliation: Emory University, Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA 30322. Email: caallen89@gmail.com.
authors.forename: Caitlin G
authors.initials: CG
authors.lastname: Allen
authors.affiliation: Emory University, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Cam
authors.initials: C
authors.lastname: Escoffery
authors.affiliation: Emory University, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Anamika
authors.initials: A
authors.lastname: Satsangi
authors.affiliation: Emory University, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: J Nell
authors.initials: JN
authors.lastname: Brownstein
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000517:prevention & control* / Q000628:therapy; D003150:Community Health Workers / Q000523:psychology* / Q000706:statistics & numerical data; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D019468:Disease Management; D004522:Educational Status; D057286:Electronic Health Records; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010344:Patient Advocacy / Q000523:psychology / Q000706:statistics & numerical data; D010348:Patient Care Team; D010353:Patient Education as Topic; D024382:Professional Role; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods; D012944:Social Support; D011795:Surveys and Questionnaires; D014481:United States; D035862:Vulnerable Populations