Community health workers (CHWs) work on the front lines of public health, helping patients at home, in their communities, and in the hospital to navigate the health care system and the day-to-day tasks that form the practice of wellness. CHWs increase patient knowledge and self-sufficiency through outreach, community education, informal counseling, social support and advocacy. Some CHWs are trained to offer help for specific conditions, such as teaching patients with diabetes how to check their blood sugar levels and improve their diets. Others help connect patients in need to resources such as food stamps and housing assistance. “It’s a very flexible role, tailored to the needs of the patient,” says Lauren Mitchell, MD, MS, a 2025 graduate of the CDRP PITCH fellowship, whose research focuses on how CHWs help communities and how to implement and support CHW programs to provide social care within the healthcare system.
Mitchell first observed how CHWs can play a unique role in improving health while working with social justice organization Partners In Health, which had established a CHW program to help treat tuberculosis in Peru. Treatment for tuberculosis can be lengthy, sometimes requiring patients to take medications and endure their side effects for over a year. As a result, many do not finish the treatment. While some programs require patients to come to a center to receive medications, Partners In Health’s CHWs went to patients’ homes, not only ensuring that patients take their medication, but also providing many other forms of support. “The workers ran emotional support groups for people with TB, helped with microfinance and employment support, and offered general economic assistance,” she recalls. “TB treatment often makes it difficult for people to work, so that kind of support is crucial.”
The CHWs she met had a powerful impact on the communities they served–and on Mitchell. “It became a much more supportive and human-centered approach,” she says. “I saw firsthand how deeply they were trusted by the community, how much they were able to do, and how effectively they reached people living in remote areas.” The program not only improved how many people stuck to their treatments, it also demonstrated that CHW support was cost-effective for treating the disease. As a result, the Peruvian government eventually incorporated this model into its national health plan.
While in medical school at Harvard, Mitchell spent a year working in India on another CHW project that involved training CHWs to deliver a short form of talk therapy for patients with depression. “It’s empowering for CHWs to be able to support their own communities,” she says. “They’re incredibly effective at reaching people who might otherwise be left out of the health system. Many of them came from the same communities they served, and you could really see the impact they were having—not just on public health outcomes, but on the lives of individuals and families.”
The United States has also developed many CHW programs, especially since the COVID-19 pandemic, when contact tracing and outreach efforts for testing and vaccination highlighted the value of community-based approaches. However, US CHW programs are often specific to the individual universities, hospitals, and nonprofits that host them. “I’ve become increasingly interested in how these programs should be organized,” says Mitchell. “There are important policy questions about funding, standardization, and certification: should CHWs be standardized nationally or remain more flexible and localized? Those logistical and structural issues are areas I’m interested in exploring further.”
As a PITCH fellow, Mitchell analyzed Bureau of Labor Statistics data to assess whether certification and Medicaid reimbursement impacted CHW wages and employment settings. “Medicaid reimbursement does improve CHW wages—but primarily for those employed by hospitals, likely because hospitals are better equipped to bill Medicaid,” she says. “This work highlighted the need for stronger connections and support between healthcare systems and community-based organizations, which also serve Medicaid populations but face more administrative barriers.”
She also worked with the CHW program in the Chicago Department of Public Health, which conducts community outreach events focused on health education and resource provision. Through interviews with leadership at local organizations and a geospatial analysis of outreach event locations, she is analyzing how CHWs are allocated and how they improve health in specific communities.
“Community organizations are using tools like the Chicago Health Atlas to identify where there are higher rates of smoking or more Medicaid beneficiaries,” she says. “Some coordinate with local aldermen or police departments to decide where to hold events. It really showed me how important both data and social networks are in planning effective public health outreach.”
With changes to Medicaid budgets on the horizon, the future of funding for CHWs is uncertain, yet their contributions to the health and well-being of all Americans. “CHW programs improve health broadly,” she says. “They help patients manage chronic conditions, navigate the healthcare system, apply for food stamps, or get their heating bills paid. They’re flexible and deeply connected to the communities they serve.”
Despite the challenges of launching a research career during a time of financial uncertainty in academia, Mitchell remains motivated to continue. “In some ways, it’s affirming. The fact that I still want to do this work, even though it’s harder now, tells me how important it is to me.”
The PITCH fellowship enabled Mitchell to immerse herself in her research and gain necessary skills and mentorship. “Having protected time for research is invaluable. Trying to do research during residency was difficult. Having time specifically set aside for research during the fellowship made a huge difference,” she says. “The program also provides a strong foundation in research methods and statistics, which has been directly applicable to my work. I’ve also had wonderful mentorship with Elbert Huang, Marcia Tan, Betsy Cliff, Mary Kate Wagner, and others. The environment at the University of Chicago is very supportive, especially for work focused on chronic diseases in the community. I felt surrounded by people with similar interests, which made it easy to bounce around ideas and build collaborations.”
Now a Pathways instructor at the University of Chicago, she continues to see patients while finishing her CDPH project and planning for the future. “I’m hoping to apply for a K award in the next year or two. I want to keep working on how we integrate social care into healthcare delivery.”
The HRSA T32 Primary care Investigators Training in Chronic disease & Health disparities (PITCH) Fellowship trains the next generation of primary care clinical investigators to improve health outcomes and care delivery for patients with chronic diseases — learn more and apply HERE