Visibility Beyond Fidelity Well-timed and Well-situated Community Health Worker Support for Mental Health

Abstract

We here present the implementation of three instructional modules developed by and for community health workers (CHWs) to support mental health groups as a component of broader resource and support activities in their communities. The innovative conceptual framing is presented in an extended introduction, with a focus on the distinction between academic and community perspectives and a ground for visibility into community dynamics that comes from providing and tracking responsive support. CHWs have drawn considerable academic attention as potential agents of change, but we believe they are limited by top-down insistence on fidelity to expert opinion. We highlight the specific framing of their activities in terms of engaged support that generates its own type of visibility beyond compliance and fidelity. Section 2 details the development of the modules and the methods that were applied to drive the design of the encompassing interventions. The modules were used to help form 10 mental health support groups, within the larger context of individual resource navigation support, and we report some of the responses to those activities in section 3. The CHWs were embedded in their communities as part of a long-term research project designed to describe the capacity and impact of self-directed and empowered CHWs. The final discussion in section 4 ties the evidence of the stories back to the conceptual framing and proposes a responsive framing of expertise within the community setting that would allow creative engagement with individuals to guide the emerging understanding of the social dynamics. Section 5 concludes our presentation.