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Background: Community health workers (CHWs) are tasked with connecting clients to care and resources, yet the success of these referrals depends on a complex web of factors. This study aims to disentangle the process by which CHWs connect clients to resources and create a process model to guide effective CHW referral systems.

Methods: We conducted a qualitative study guided by the social-ecological model to characterize actions by CHWs to overcome barriers and facilitate successful referrals. We conducted semi-structured interviews with CHWs from two community health organizations. Interviews were transcribed and coded inductively and deductively with Dedoose, with a focus on process coding for the actions occurring during the referral process. CHWs and their supervisor collaborated on the interview guide and recruitment process (two are co-authors).

Results: Interviews (n=16) revealed actions taken by CHW and clients that made referrals successful, including assisting with assessing social needs; eligibility assessment, paperwork, and scheduling; actively communicating with resource organizations; arranging/educating on transportation; accompanying some clients to appointments; following-up; and identifying opportunities to address other health disparities. Themes emerged related to referral facilitators and barriers for client and CHW characteristics, including cultural/language congruency, needs of special populations (e.g., refugees & asylum seekers), coping/stress management, personal relationships with community partners, as well as structural/institutional factors (including efficiency of technology systems, strength of partnership network, availability of resources, and legal/insurance considerations). Mapping the CHW referral processes revealed other actions (e.g., supporting client self-sufficiency, interpreting, & providing emotional support) that CHWs take above and beyond the established processes to facilitate successful referrals. Member checking clarified how these key actions occur throughout the referral process and tied everything together to build trust between the clients and the CHWs.

Lessons Learned: CHWs often take actions above and beyond established processes to make client referrals successful. Enhanced, formalized support of these critical actions will help inform replicable structures to facilitate efficient and effective referral processes.

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Mapping CHW Community Resource Referral Processes: A Qualitative Study