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Several years ago, a community health worker with Saint Alphonsus Medical Center–Baker City in Oregon was assisting a child with health and social service needs when it became necessary to coordinate with the child's school. Through conversations between the health worker and the school district, the school's director saw the true value of a community health worker's services.

That director told the community health worker, Kathie Pointer: "We need you here at the school," and even offered to give her office space. That conversation spurred Pointer to investigate the level of need at the school and convinced her to approach leadership of Saint Alphonsus Health System's Community Health & Well-Being division about the school's request.

After months of coordination, in fall 2021 Pointer became an embedded community health worker at the Baker School District in northeast Oregon's Baker City. Pointer calls the arrangement "a beautiful collaboration" between the hospital and school district.

Pent up demand
Pointer, whose title is community health worker supervisor with the Community Health & Well-Being department of Saint Alphonsus in Baker City, provides services to everyone at no cost to them, whether or not they are patients of Saint Alphonsus.

Her role is to connect with students and their families, assess their needs and then guide them to the health and social services they require, including connecting them with providers and helping with transportation needs. Pointer says upon her arrival, word spread quickly about how she could help people and "it kind of blew up from there." Demand for her services escalated quickly.

Vanessa Haggett is principal of Eagle Cap Innovative High School and Baker Virtual Academy, two schools within Baker School District. She says in the district, many students and families "are dealing with extensive life traumas, and often do not have the time, money, or connections to deal with a major life setback like a serious illness. When they let us know, we connect them to Kathie."

Engaging Pointer in this way increases "the feeling of belonging families have at our school, as they know we are here to support them however we can," says Haggett.

'Cowboy community'
Baker City is a community of nearly 11,000 people that is about 130 miles northwest of Boise, Idaho. The 25-bed Baker City hospital's parent, Saint Alphonsus Health System, is based in Boise. Saint Alphonsus is part of Trinity Health.

Baker City is remote and faces challenges with economic disparities similar to other rural communities, says Pointer. About 13.8% of the population is in poverty, according to the U.S. Census Bureau. Baker School District has about 1,700 students across six elementary schools, one middle school, a high school, the innovative high school that provides alternative paths to a diploma, and the virtual school. According to district statistics, 59% of students qualify for the free or reduced-price lunch program. Haggett says in the innovative school for students who do not thrive in the traditional high school 89% of students qualify for the free lunch program and 32% are homeless.

Torie Andrews, a counselor for the innovative school, says "families are struggling and hurting. Often it seems that students and their families don't understand what resources are available to them or they don't know where to start looking." Often, school counselors and nurses are ill-equipped to help students and families navigate local health care and social service systems, say Andrews and Pointer.

Pointer adds that in many respects, Baker City is "a cowboy community, where people don't always want to accept help." She says the fact that she lives and raised her kids there helps her establish trusting relationships and convince fellow residents to accept help.

Visible presence
While many of the students and families Pointer serves have been referred to her by district staff, many come to know her through her outreach. She frequently visits the district's schools to interact with staff and students and families. She participates in school activities. It's becoming a tradition for her to bring ornaments and help students decorate the school for Christmas. She attends parent nights. Sometimes she'll do presentations, alerting families to the services she can offer or highlighting important public health issues. For instance, when there was a local increase in accidental infant deaths, she presented on infant safety.

Out and about in the schools, she becomes aware of numerous needs. She learned of a family who had fallen on hard times after the father's diagnosis with a terminal condition. They were storing food in the snow because they couldn't afford a refrigerator. She helped figure out how to get them one at no cost. Another time, she learned about a student who was dying and reliant on wheelchair. He wanted to have some normalcy by attending school, but the school's available transportation was not workable for his family. Pointer arranged for volunteers who had the needed wheelchair-accessible van to transport him.

Pointer has arranged toiletry supply drives and other collections to add to the school's food pantry. Saint Alphonsus staff have responded enthusiastically. She's also collected donations of art supplies for an art therapy program that has greatly benefited students dealing with trauma.

"She understands the importance of relationships and being seen," says Andrews.

Firsthand knowledge
Pointer is one of 14 community health workers employed by Saint Alphonsus. Rebecca Lemmons, Saint Alphonsus regional director of Community Health & Well-Being and Community Benefit, says no other Saint Alphonsus community health workers are embedded in schools.

Lemmons notes that one reason Pointer's arrangement has worked out so well is that "the best community work happens organically," as this setup did. "We are going where the people are," she adds.

She says Saint Alphonsus has gotten more in tune with Baker City through the arrangement. Pointer has gained firsthand, comprehensive knowledge of the needs and gaps. Her insights have proven very valuable when Saint Alphonsus is completing community health needs assessments and community benefit plans, Lemmons says.

Lemmons adds that Pointer's presence also builds goodwill for Saint Alphonsus. "She's a trusted face in the community," she says. "And those relationships are everything."

Pointer says being such a part of the school district community has been very meaningful for her, especially when she is able to help people in deep need. "I see the brokenness of some of these kids, and that has ignited a love in me for them," she says. "This work has become a passion for me."

Haggett says the support Pointer provides is essential to the students. "If you are hungry, in pain or feeling unsafe, you are not going to be able to learn," she says. "Kathie has helped families to get medical care and meet their basic needs."

Andrews says, "Kathie often goes above and beyond to find every avenue of help or system that could potentially be used. … Just knowing that there's a community health worker, with their boots on the ground, who has a vast knowledge of local and state support, has been critical."

She adds, "Community health workers have such a unique opportunity to bring light to situations that often seem bleak."