Foundation of Trust: How Community Health Workers Address the Social Determinants of Health

The best patient care is built on a foundation of trust. At every point of care, a patient needs to trust that the person providing their care is knowledgeable and has their best interests in mind.

Doctors build trust through their bedside manner and medical expertise. Community health workers (CHWs) build trust as peers, through intimate knowledge of the patient’s community.

Guidance from community health workers is key for Maria, mother to 11-year-old Alex. Alex has chronic asthma which is exacerbated by their living conditions. Maria is unemployed, battling leukemia and going through a divorce.

A CHECK participant (not the participant mentioned in this case study) during a visit with a community health worker.

CHECK, a program at University of Illinois at Chicago Health System, coordinates care for Alex and other youth with complex health conditions. In addition to helping Maria and Alex manage their medical care, CHWs connect them with community resources that address their social determinants of health.

For Maria and Alex, the commitment of their CHWs was key. During a home visit, the CHWs listened to Maria’s story and used Purple Binder to find food pantries, legal assistance, and counseling services in their neighborhood. They called Maria a few days later to follow up and discuss housing recommendations.

Google Isn’t Enough — CHWs Build Trust Through Community Knowledge

“Before Purple Binder, Google was the only way that we were making referrals… The information wasn’t verified and sometimes lacked details.”

A CHECK community health worker, on his way to a home visit.

By connecting patients with resources that they need, the CHWs aren’t just giving patients information. The CHWs’ accurate, local guidance builds trust with patients, showing that they are acting in the patient’s best interests and are committed to their health.

It wasn’t always easy for the CHWs to provide this local guidance.

“Before Purple Binder, Google was the only way that we were making referrals,” Monika Marko-Holguin, Director of Technology and Compliance, explained. CHWs would compile resources they found through Google searches, but the information wasn’t verified and sometimes lacked details.

Sometimes, patients ended up finding out for themselves that the place they were referred to no longer offered a service that they needed. There was a clear need for a verified, easy-to-use source for community referrals. This need led the CHECK team to Purple Binder.

Purple Binder helps CHECK community health workers streamline their care coordination process.

Matching People with the Resources They Need

In explaining why she chose to work with Purple Binder, Monika noted its ease-of-use.

“Now, just by getting your gender, age, and zip code, we can find all of the services that you have in your area. It doesn’t have to be limited to whatever you need in the moment, it can be everything that’s around you,” Monika said.

By providing a verified, searchable database of a wide variety of community services, Purple Binder helps CHECK streamline their care coordination process.

CHWs have had a positive reaction to Purple Binder so far.

“Community health workers use Purple Binder for everything from disease-specific support groups, to food pantries and low-income housing.”

“The idea is definitely something that they’re fascinated with, because it’s so simple,” Monika said. “It makes it a lot easier for them to do their jobs.” CHWs use Purple Binder for everything from disease-specific support groups, to food pantries and low-income housing.

By providing patients with accurate information, CHECK’s CHWs demonstrate not only that there are ways to overcome barriers to health, but also that they are committed to the patient’s health.

Whatever Happened to Alex and Maria?

Maria had been responsive to the CHWs after their initial home visit. Unfortunately, when CHWs called Maria for a second follow-up, her number was disconnected. Maria and Alex missed their appointments and were designated “hard to reach.”

Several months later, the CHWs finally reached Maria. She reported that both she and Alex were attending counseling, and she had received legal assistance to finalize her divorce. She was moving herself and her son to a better living environment. Alex’s school attendance had even improved. Maria noted that she could not have done it without the resources that CHECK’s community health workers provided during their home visit.

Faced with a challenging situation, the CHWs developed a foundation of trust with Maria and Alex by helping them access the resources they needed to address their social determinants of health.

Trust lays the groundwork for healthier individuals, families, and communities. CHECK’s community health workers build trust with their patients in order to help them thrive.

The project described herein was supported by Grant Number 1C1CMS331342 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Patient names have been changed to protect privacy.

Photos by Michelle Kanaar.

For more information about CHECK, please see