Esteem HealthCHW Certification Training
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Module 4: CHW in PracticeLesson 4.2 · 8 sections · ~40 min

Home Visits and Field Work

Learning Objectives
  • Explain the importance and advantages of home visits.
  • Describe the main steps for each stage of a home visit: preparing, conducting, and following up.
  • Identify the components of a client-centered referral.
  • Describe appropriate attire and footwear for conducting a home visit.
  • List strategies for ensuring your own safety during a home visit.

Home visits

Conducting home visits is a crucial aspect of CHW work. These visits enable CHWs to establish connections with patients in a non-medical setting, offering valuable insights into their environment and daily routines.

By visiting patients in their own environments, you observe living conditions, available resources, support systems, and challenges firsthand. This allows you to tailor care to each patient's specific needs.

Every home visit has three fundamental stages: preparation, conducting the visit, and follow-up.

What can go wrong

Before we walk through best practices, here's what happens without them.

Historical Case Study
Samantha · New CHW · A cautionary tale
Situation

Samantha was eager to conduct her first home visit with Mrs. Johnson, an elderly patient with diabetes. She was excited — but she cut corners on preparation.

What the CHW Did
  1. Skipped the confirmation call, dismissing it as "a mere formality"
  2. Only skimmed Mrs. Johnson's file before the visit
  3. Didn't set any objectives — assumed the visit would "unfold naturally"
  4. Couldn't find parking on arrival; ended up parking in a tow-away zone
  5. Knocked on the door — greeted by a barking dog she wasn't aware of (Mrs. Johnson scrambled to restrain it)
  6. Forgot her notepad and patient forms at the office
  7. Tried to take notes on her phone — the visit felt disorganized
  8. Missed key details about Mrs. Johnson's living conditions and medication management
  9. Felt too ashamed afterward to debrief with her supervisor or document properly
  10. Failed to schedule a follow-up visit
Outcome

**A week later, Mrs. Johnson was hospitalized due to a fall at home — a hazard Samantha had overlooked during her visit.** Her medication issues had escalated too. Each shortcut Samantha took multiplied. Preparation isn't a 'mere formality' — it's the visit.

Warning
The rest of this lesson is everything Samantha should have done.

Stage 1: Preparation

Make a confirmation call

Provide important details (purpose, duration) and ask about specific instructions or safety concerns. Good questions to get answered first:

Confirmation call questions

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Location
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Is there a particular place I should park? What entrance should I use?
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Get organized

Pull together what you already know

Background and demographics
Support structure (family and caregivers)
Screening tools
Assessments
Progress notes

Watch: Preparing for a home visit

How a CHW prepares for home visits
Reflection Prompts

According to the CHW in the video, why is being prepared for a home visit important?

The CHW mentions some people may not be comfortable allowing a stranger into their home. How does he address this?

Where in your community could you recommend meeting clients who aren't comfortable with home visits?

Stage 2: Conducting the Visit

Your main goal during the visit is to gather information. There are three modes:

Targeted, open-ended questions

Use targeted, open-ended questions and follow-ups so people can share from their own perspective. Example: "Last time we talked, you mentioned a lot of pain. How have you been managing it in the last week?" Follow up: "When you say you struggled with pain last week, how many days were difficult?" Use assessment tools, questionnaires, and scales to guide the conversation and track progress.

Stage 3: Follow up

Step 1: Documentation

  • Create or update an action plan
  • Write progress notes summarizing findings, topics discussed, progress, barriers, and action plan updates
  • Submit notes to the care team
  • Log visit data into other databases as required

Step 2: Follow-up Activities

  • Phone calls (doctors, case managers, caregivers, resource providers)
  • Submit referrals; follow up on processing
  • Research specialists, resources, and health education materials
Note
For older adults or adults with limited mobility, consider a home safety evaluation by an occupational or physical therapist. They check for missing safety features (grab bars, appropriate chair/toilet height) so patients can move safely in their own homes.

Step 3: Prepare for Next Visit

  • Identify anticipated objectives
  • Determine if any assessments are required based on current needs
  • Review and address follow-up topics from the action plan
Knowledge Check

Samantha skipped the confirmation call because she thought it was "a mere formality." Which problems during her visit could a confirmation call most directly have prevented?

AForgetting her notepad and patient forms at the office
BNot knowing about the barking dog and not knowing where to park
CFailing to debrief with her supervisor afterward
DNot scheduling a follow-up visit
Knowledge Check — Matching

Match each home-visit activity to the stage it belongs to.

Terms
Making a confirmation call
Asking open-ended questions and observing the environment
Writing progress notes and submitting referrals
Developing 1–3 key objectives
Definitions
Follow-up
Preparation
Preparation
Conducting the visit

Making client-centered referrals

Referrals work when they're tailored to individual needs and preferences — aligned with the patient's specific health conditions, lifestyle, and personal circumstances.

Watch these two videos. Pay attention to the difference in how each CHW handles the client's priorities.

Client-centered referral — example 1
Client-centered referral — example 2
Reflection Prompts

In the first video, the CHW immediately suggests a support group and mentions a personal connection to the facilitator. In the second, the CHW takes a more exploratory approach. How important is it for CHWs to actively listen to clients and address their individual concerns?

What impact can client-centered care have on the effectiveness of referrals?

Dressing for the field

The way you dress during a home visit affects trust, comfort, and safety. A professional and appropriate appearance establishes credibility, while respectful and culturally appropriate dress strengthens connection. Five things to keep in mind:

Dressing for the field

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First Impressions
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Create a positive first impression and establish trust by dressing professionally and appropriately.
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Staying safe in the field

CHWs often work in diverse environments, some of which may pose risks (crime, poverty, instability). Stay vigilant and take proactive measures.

Before going to the home

Notify your supervisor of the home visit time and location
Ensure your car has enough fuel for the round trip
Avoid scheduling visits after regular working hours
Knowledge Check — Select all that apply

Which of the following are recommended field-work safety practices during a home visit? Select all that apply.

Choose a seating location that allows a direct exit and know alternative exits
When touring the home, walk behind the client
Leave your keys and ID in the car so your hands are free
Refrain from providing services if anyone appears under the influence of drugs or alcohol
Share your personal phone number so the client can reach you anytime
Lesson Takeaways

🌟 Lesson takeaways

Home visits give CHWs context — what patients live with, who supports them, and what their day-to-day actually looks like. The three stages (prepare, conduct, follow up) all matter, because cut corners cascade — Samantha's tale shows what one missed confirmation call can lead to. A client-centered referral aligns services with the patient's own conditions, lifestyle, and circumstances. Dressing thoughtfully builds trust without going to extremes, and safety strategies protect you so you can keep doing the work.

🎉Great work!
📅
Coming up

At the end of this module, you'll join a live discussion with your cohort and an instructor. Great work — we'll see you there.