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Session 3
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There is a wide range of professionals and non-professional workers who play a role in community-oriented health care. These roles differ in the degree of contact with the patient or the community and in the level of responsibility involved for patient care and community health. In an interdisciplinary collaborative health care team, the levels and areas of responsibility must be clearly established. It is critical for members of the team understand the education, core competencies and scope of practice of different members of the health care team. What follows is a brief description of the role and preparation of team members encountered in a community-oriented primary care setting.

Community Health Worker Nutritionist
Dentist Pharmacists
Health Educators Physician (MD)
Interpreters Physician Assistant (PA)
Mental Health Provider Social Worker
Nurses Volunteers
Registered Nurse (RN) Other Team Members
Vocational or practical nurses  

Once you have reviewed the descriptions of the health care team members, Reread the Interdisciplinary Team Case. Answer the questions posed at the end of the case presentation.

How do your responses to the case differ from your initial reading?

Community Health Worker:

Community Health Workers (CHW) can be broadly defined as individuals who connect health care consumers and providers, promoting health particularly among groups who have traditionally lacked access to care. The CHW is a member of the community and play an important role in identifying a community’s problems and in developing solutions. Examples of successful uses of the CHW include: using ex-addicts to educate intravenous drug users about AIDS risks and increasing breast, cervical, and colon cancer screening in minority communities. CHWs may play critical roles in improving community health status by providing cultural and technical linkages between community members, primary care providers, and the health care delivery system. Training may range from weeks to months and may combine lectures with supervised field experience. There is neither a licensure mechanism nor scope of practice laws specific to CHWs.

For more information on community health workers read:
"Community Health Workers: Integral Yet Often Overlooked Members of the Health Care Workforce." Pew Health Professions Commission (1995)



The general dentist (DMD or DDS) is a primary care professional for patients in all age groups. Dentists take responsibility for the diagnosis, treatment management and overall coordination of services to meet the oral health needs of patients. Most dental schools have a four-year postgraduate program followed by a hands-on state board examination to receive licensure. Specialty practices such as orthodontics, pediatrics or oral surgery etc. require 2-6 years of additional education. The dentist is required to have licensure in the state in which they practice.

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Health Educators:

Health educators teach clients, both individually and in groups, about various health topics. Although all members of the healthcare team are charged with client education, health educators are focused on providing adequate information to the client to assure understanding of the medical problem and treatment plan. These individuals may focus their educational efforts in health promotion and disease prevention activities that reduce the burden of disease in the community. Some health educators are utilized to provide in-depth instruction to clients about specific illnesses after being diagnosed. Many health educators have bachelors or masters degrees in health education or health promotion. There are no mandatory education or certification requirements for health educators.



Interpreters are invaluable members of the healthcare team that assist other healthcare professionals in communicating with the patients in their native language. These individuals make the patient comfortable in the medical setting as well as allowing the patient to communicate with the healthcare team. Interpreters also assist the healthcare team members in explaining information about medical conditions and treatments. There is no formal licensing or accreditation process for health care interpreters. Many receive training in medical terminology in order to interpret in a health care setting. Often, untrained native speakers are employed or recruited as volunteer translators for the sake of convenience and cost.

For more information on Interpreters read:
Putsch Robert W (1985) Cross-cultural communication the special case of interpreters in health care. JAMA, 254 (23) 3334-3348


Mental Health Provider

Professional training for individuals who provide mental health services in community health settings varies widely. They include psychiatrists (a physician who completes a residency in psychiatry); clinical psychologists (doctoral preparation in clinical psychology followed by a clinical internship); licensed clinical social workers (see above); psychiatric clinical nurse specialists (master’s prepared nurse with clinical training in individual and family counseling); licensed counselors with a master’s degree in counseling, or an individual with no formal training. In the District of Columbia only the psychiatrist and psychiatric clinical nurse specialist have prescriptive authority.



Advanced Practice Nurses (APN) today are required to have a Master’s degree.

The term APN is a descriptor that includes nurse practitioner (NP), clinical nurse specialist (CNS), certified nurse-midwife (CNM), or certified registered nurse anesthetist (CRNA). APNs must hold current RN/APN licensure in the state in which they practice. In 29 states, APNs must pass a national certification examination to practice. State Nurse Practice Acts detail legal authority, reimbursement, and prescriptive authority under which APNs practice. In DC, APNs have full prescriptive authority and may practice without any required collaborative agreement with a physician. Specialty areas for NPs include: family, adult, pediatric, gerontologic, women’s health, school/college health, occupational health, mental health, emergency and acute care. The NP serves as a primary care provider for individuals, families, and communities in ambulatory settings.

The curriculum includes core content such as research, health care policy, ethics, and health promotion and disease prevention. Advanced practice content considered essential for all advanced practice students includes pharmacology, physiology, pathophysiology, advanced physical assessment and specialty content specific to specialization. Intensive, supervised clinical experiences are part of the educational preparation.


Registered Nurse (RN):

Registered nurses (RN) may be educated at the diploma (hospital-based), associate or bachelor’s level. Today, most RNs are prepared through associate and baccalaureate degree programs. Most associate degree programs are at community colleges and can be completed within 2-3 years. Bachelor’s prepared nurses complete a four-year university-based degree program, typically with the first two years of course work devoted to the sciences and the last two years to nursing courses and clinical preparation. Upon graduation, all nurses must pass a national licensing examination, known as the National Council Licensing Examination (NCLEX). Successful passing of this examination is necessary for state licensure as a RN. RNs are prepared as generalists with their educational preparation providing theory and practice in areas such as – medicine, surgery, pediatrics, obstetrics, psychiatry, and public health. RNs play an integral role in community clinics, ranging from providing essential services to the provision of home-based services through the public health department and private agencies.


Vocational or practical nurses:

These nurses usually receive up to 12 months of basic nursing skills training. They practice under the supervision of a registered nurse or physician. They must practice a national licensing examination to become a licensed vocational nurse (LPN) and must obtain a license in a state to practice.

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The Registered Dietitian (R.D.) is a health care professional trained in the single specialty of nutrition science. Their goal is to promote health and fight illness by fostering the practice of proper nutrition to individuals and groups. A RD has both theoretical and practical experience, including a minimum of a bachelor’s degree in food and nutrition from an accredited university plus an extensive professional internship under expert supervision. The RD must pass a comprehensive examination for certification and continuing education is required to maintain certification. Twenty-seven of the 41 states with statutory laws governing the practice of dietetics plus the District of Columbia require licensure. Thirteen states require certification.



Pharmacists dispense drugs and medications prescribed by physicians, physician assistants, nurse practitioners, and dentists. They also advise healthcare professionals and patients on the use and proper dosage of medications, as well as expected side effects and interactions with other prescription and nonprescription medicines. These professionals also order and maintain supplies of medications and various medical supplies required for use in the clinical setting.

Pharmacists usually possess a bachelor’s degree and are required to graduate from an accredited school of pharmacy. Many continue to study to obtain advanced degrees in pharmacy or business. All states and the District of Columbia require a license to practice pharmacy, which may require an internship under the supervision of the registered pharmacist.

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Physician (MD):

Physician training begins with a bachelor’s degree from a four-year college or university. Medical school typically consists of two years of course work followed by two years of clinical experience. Course work emphasizes pathophysiology, recognition of signs and symptoms of disease, and application of scientific method to the understanding of disease. Classes also include training in history taking and in physical examination.

The clinical years include required clerkships in internal medicine, pediatrics, surgery, obstetrics/gynecology, psychiatry, neurology, and family medicine. Elective clerkships are available in other areas of specialization. Clerkships are primarily hospital-based. Today, there is an increasing interest in providing medical students with ambulatory care experience and in the community.

After graduation from medical school, physicians enroll in intensive post-graduate residency training in a particular specialty, which lasts at least three years. License to practice medicine in an individual state is regulated by the State Board of Medicine. Licensure is generally available after one year of post-graduate training. Board certification in a specialty is an elective process that requires a minimum number of years of residency in the specialty and successful completion of oral and/or written examinations.

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Physician Assistant (PA):

Physician Assistants practice medicine with the supervision of a licensed physician. As members of the health care team, PAs provide a broad range of medical services. They are educated in one of the 107 specially designed 2-year programs located at medical colleges and universities, teaching hospitals, and through the Armed Forces. The first year is based on classroom learning of the basic medical sciences, while the second year is spent predominately in clinical rotations. The typical PA student has a bachelor’s degree and over 4 years of health care experience prior to admission to the PA program. After graduation, PA’s must pass a national certifying examination.

Physician Assistants must be licensed in the state in which they practice. In the District of Columbia, PA authority is derived from the physician and requires agreement with a physician-collaborator to obtain licensure. PAs have prescriptive authority under this agreement and may be directly reimbursed under Medicaid. PA’s have limited ability to apply for reimbursement under Medicare. Board Certification examinations are available in Primary Care and/or Surgery. Not all states require board certification for licensure. Recertification requires 100 continuing education hours every two years and by written examination every 6 years.

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Social Worker:

Training for professional social workers is at minimum a bachelor’s degree in social work (BSW). Most social workers possess a master ’s degree in social work (MSW). They provide counseling, and enable individuals, families, and communities to obtain social services. They work with clients on issues of unemployment, illness, disability, housing, abuse, and financial problems. Social workers specializing in providing mental health services and counseling are called Clinical Social Workers. In the community, they may be active in organizing communities to improve health and social services. Social workers often assist families in crisis situations and during periods of transitions.

Master’s prepared social workers may become licensed clinical social workers (LCSW) after completing 3200 supervised hours of work experience and completion of coursework in the areas of individual and family counseling, child abuse, sexuality, and chemical dependency. LCSW’s may provide individual and family counseling services. Licensure is at the state level and occurs after completion of a written and oral exam. Licensing permits social workers to bill insurance companies for their services. All states and the District of Columbia have licensing and certification requirements for practice. Clinical social workers require additional education, training, and certification.

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Volunteers are individuals that that provide services in the clinical setting with no monetary payment. They may be retired healthcare practitioners or citizens with a strong desire to provide public service to the community. Many clinics utilize these volunteers to perform a variety of jobs, such as interpreters, filing, answering telephones, or more patient oriented services, such as taking vital signs, assisting patients in completing forms, and assisting other health care team members. To serve as a volunteer requires no certification or license, just a strong willingness to serve the community and assist in helping provide health services to others.


Other Team Members:

Other members of the interdisciplinary health care team may include: Physical therapists, occupational therapists, speech and language therapists, and art or music therapists. The availability of these additional members of the health care team depends on the community served and the health care services offered.