Community Health Workers build on their lived experience to offer intensive supports for new Mainer families in Lewiston-Auburn

Like many of the Afghan families she visits, Laila Navid knows firsthand the challenges of building a new life in Maine. Not long ago, she too was learning to navigate unfamiliar healthcare and education systems while providing for her family’s needs after arriving from Afghanistan.

Now, as a Community Health Worker with Maine Community Integration in Lewiston-Auburn, Navid uses that experience to help other immigrant families thrive. “As a new Mainer, I can understand these families because I’ve had the same problems,” she explains.

This dual fluency – in both the culture of newly arrived families and in the systems of their new community – is at the heart of a promising initiative to improve outcomes for immigrant families with young children in Lewiston-Auburn.

Support from a Trusted Source

Maine Community Integration (MCI) has been a longtime leader in providing health education and outreach to new Mainer families. Under Executive Director Fowsia Musse’s leadership, the organization has trained trusted community members as Community Health Workers (CHWs) to bridge the gap between health professionals and individuals. This approach proved particularly effective in sharing public health information during the COVID-19 pandemic.

With funding from the John T. Gorman Foundation and Maine Department of Health and Human Services, MCI has now adapted the CHW model to address urgent issues facing children and families in the Lewiston area.

In Lewiston, the childhood poverty rate is 24% — 10 points higher than the statewide average. At the same time, the city qualifies as a Medically Underserved Area with poor health outcomes and too few primary care providers. Addressing these issues is especially challenging due to barriers that prevent the delivery of adequate, culturally responsive care to the city’s immigrant and refugee families.

Last year, MCI hired and trained six new CHWs to work intensively with a total of 30 families with young children over two years. Each CHW shares a common language and culture with the five families they serve, and has extensive knowledge of local healthcare, education, and other systems. They are also trained to assess children’s developmental milestones and needs.

“They are a lifeline for families,” Musse said. The CHWs connect with families weekly in their homes, help them address basic needs such as housing, accompany them on medical appointments, drive them to services, and problem-solve daily challenges. Navid, for example, has helped families find English language classes with childcare, obtain medicine for a sick child, and access urgent medical care.

More Than Interpreters

During medical appointments, CHW Abdi Abdalla says his role is much more than an interpreter for the Somali families he works with. At times, he is an advocate – like when hospital staff delivered a meal containing pork to a mother who couldn’t eat it for religious reasons. Often, he is the “middle person” who helps the family access services while delivering the healthcare provider’s message in a way parents can understand and be willing to consider.

These are delicate conversations, the CHWs stressed. Parents want what’s best for their children, but may have a different understanding of healthy child development than their doctor. They may also face cultural taboos around mental health, be unfamiliar with diagnoses like autism, or hesitate to accept recommended treatments. Mindful of these cultural differences, the CHW works to help parents make informed decisions without stepping on their beliefs.

Originally from Chad, CHW Ashta Azrak said they are uniquely positioned to build this kind of trust with families. “They’re more likely to tell me what’s going on because they don’t view me as a stranger,” she said. “They don’t want strangers to know their business.”

While other organizations also use CHWs to support immigrant families, Musse said MCI’s focus on a defined set of families is unique. The limited caseload allows the CHWs to form deeper relationships with families, offer more intensive supports, and track families’ progress. By the end of two years, CHWs hope the families can achieve independence, advocate for themselves, and be fully integrated in the community.

“By helping them, then they can help others,” said Abdalla.