Community Health Worker Training in Higher Education for Addressing Social Determinants of Health

Community Health Worker Training in Higher Education for Addressing Social Determinants of Health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Community Health Worker Training in Higher Education for Addressing Social Determinants of Health Jen K. Molloy, Carrie Jo Riordan, Heather Otremba, Mackenzie Petersen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8272882/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: The aim of the research was to explore the ways campus-based Wellness Program peer supports, applied learnings from a Community Health Worker Training Program (CHWTP) to address the Social Determinants of Health (SDOH) of students. Participants : Fourteen campus-based, embedded peer supports titled Wellbeing Support Coordinators (WBSCs) enrolled in the CHWTP. Methods : WBSCs participated in three focus groups and collected data on peer meetings. Results : Findings indicate that WBSCs applied knowledge and skills learned from the CHWTP to address SDOH among students in myriad ways and in ways that aligned with typical CHW roles and referrals (e.g., social-emotional support and advocacy). CHW training content tailored to the specific needs and challenges of college students was recommended. Conclusions : Embedding CHWs in college campuses could provide the support needed to ensure that universities are equipped to address the SDOH of students. Community health worker higher education social determinants of health peer support college student health Introduction Social determinants of health (SDOH), as defined by the U.S. Department of Health and Human Services (HHS) are, “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (2024, para. 1). SDOH fall into five domains: economic stability, health care access and quality, neighborhood and built environment, social and community context, and education access and quality (HHS, 2024). While access to higher education can lead to improved health and well-being, considerations related to the other four SODH domains can hinder or support degree attainment (HHS, 2024). To create a healthier society and address health equity, we must consider the unique challenges of college students' SDOH. When looking at SDOH among college students, the research highlights the extreme economic insecurity they face. As a whole, students are characterized as low income, with 36% considered food insecure, 36% having unstable housing, 9% being unhoused, and 65% of those who graduate having an average of $29,200 in loan debt (Reppond, 2019). Although college-aged young adults are no less likely to get sick than any other population, 17.1% lack health insurance (Henry et al., 2018), which is twice the national average (Keisler-Starkey & Bunch, 2024). This often leads to a lack of routine care, with 40% of students reporting that they needed to see a doctor but were unable to due to the costs (Koon et al., 2024). Furthermore, college students across the country are experiencing a mental health crisis which impacts their ability to attend class and complete course work. The national Heathy Minds Study (HMS), a cross-sectional survey that examined mental health in students from 133 four-year universities, found that 55% of those surveyed met criteria for one or more mental health issues (e.g., depression, anxiety, disordered eating, or suicidal ideation). Of the 95,711 students who took the survey, 78% reported that their academic performance was negatively affected by their mental health (Lipson et al., 2021). Students are at a higher risk than other population groups for experiencing loneliness and accompanying feelings of stress, anxiety, and depression – all of which have been associated with loss of sleep and suicidal ideations (Ellard et al., 2023). Research suggests that feelings of loneliness can negatively impact a student’s grades in a multitude of ways including decreases in self-efficacy, increased physical and emotional exhaustion, and negative feelings about their learning environment; resulting in loneliness being associated with higher rates of attrition (Hopp et al., 2022). When considering SDOH and student loneliness, both the social and community context and the campus neighborhood and built environment play a role. Loneliness is associated with mental health struggles, decreased campus engagement, and a loss of positive social relationships, thereby creating a cycle where students declining wellbeing leads to increased isolation (Lyons et al., 2023). Considering ways to further support student’s attainment of the SDOH needs to be a priority in higher education. Without adequate attention to the conditions necessary to generally thrive, many students are unable to thrive academically. Addressing SDOH in a university setting can ensure that students have their basic needs met, which can address barriers to student success and lead to greater retention and degree attainment. Research shows recruiting one student costs four to five times more than retaining them (Aderholdt et al., 2019). As Lipson et al. (2021) reported: Given the link between student mental health and academic outcomes, including college graduation, there is a strong economic case for federal, state, and local investments in the mental health of college students through programs and services aimed at treatment and prevention and for social support services. (p. 1131) Further, research commissioned by the California State University system, the largest US institution of public higher education, revealed high rates of housing and food insecurity among its students (AASCU, 2023). Based on these results, Stanislaus State created a Basic Needs department to provide a holistic student support system including a food pantry, emergency housing and financial assistance, food kits and live meal prep demonstrations, and case management referral services for on- and off-campus nonclinical support and resources. First-year students who accessed Basic Needs services surveyed in 2021-22 were retained at higher rates than those who did not and a majority of students reported services positively impacted their mental and physical health, and improved stress levels (AASCU, 2023). Community Health Workers Address SDOH Given the needs of college-age students related to SDOH, higher education needs to consider ways to offer support and resources beyond what is currently available. Many institutions have specific offices addressing these needs and they are often not utilized by students (Lyons et al., 2023). Whether due to a lack of awareness, availability of services, or help-seeking stigma, addressing SDOH must be prioritized. One way to do so is looking to other disciplines and settings for innovative ideas (Guzman et al., 2022). One workforce that has a long history of connecting community members with support and resources related to SDOH are Community Health Workers (CHWs). In 2009, the American Public Health Association (APHA) adopted a definition for CHWs that many states have fully adopted or edited to suit their needs, stating: Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. CHWs play a vital role in addressing healthcare disparities and improving healthcare outcomes (National Heart, Lung, and Blood Institute, 2024). The scope of practice for CHWs outlines their activities; however, there are differences in the level of detail, focus, breadth, and roles depending on the community (Haywood et al., 2017). CHW models have proven to be a cost-effective means of delivering care—especially among underserved, lower-income, minority communities (McCarvill et al., 2024). Largely due to their trusted roles within the community, CHWs can be especially helpful in increasing an individual’s engagement in their own care, ultimately creating better overall health outcomes (Haywood et al., 2016). Given their unique potential to support community members in addressing SDOH and to generate positive health outcomes, CHWs are being further embedded into healthcare, justice, and K-12 education systems (Yao et al., 2023). Our review of available literature indicates CHWs have yet to be utilized to support college students, although the skills and roles of CHWs are applicable and there is untapped potential to embed them on college campuses. Higher Education and Student Needs Many institutions of higher education are attempting to meet growing student mental health needs, with limited attention to other SDOHs. Acknowledging gaps in mental health services, many universities are considering services that extend beyond traditional counseling departments (e.g. mindfulness courses and mental health awareness campaigns). These methods, however, are often not cost-effective and fail to meet the individual needs of students (Terrell et al., 2023). One approach to addressing student needs that has proved promising is the incorporation of Peer Support Models. Peer Support Models are an evidence-based approach (Mental Health America, 2019) which include a range of activities and interactions between people with similar experiences - such as a behavioral health condition or a shared identity. On campuses, peer support increases “access to support for students in settings where staffing shortages, lack of cultural responsiveness and representation among providers, isolation, or distrust of mental health services are in play” (Davis et al., 2023, p. 5). Peer support enables fellow students to relate to one another, generating feelings of belonging and connectedness which have been linked to improved mental health and academic success (Caporale-Berkowitz, 2022). Research found these to be cost-effective and successful at delivering prevention materials (Stice et al., 2023) and in helping address the equity gap that other interventions may miss (Tucker et al., 2020). While the CHW literature includes reference to Peer Support Models (Malcarney et al., 2017), we found no research or reference to preparing student peers to serve other students using the knowledge and skills associated with CHWs. As noted above, CHWs are trusted community members and/or have an unusually close understanding of the community. In the context of campuses students supporting other students would naturally be those trusted community members. The aim of the research presented here was to explore the ways campus-based peer support services, offered through a campus-based Wellness Program, applied learnings from a CHW training program. CHWs Role on College Campuses This article provides an overview of one university’s efforts to leverage the knowledge and skills of CHWs to address student SDOH. In Fall 2023, the Wellbeing Support Program, offered by the University of Montana Health Center, enrolled Wellbeing Support Coordinators (WBSCs) utilizing a Peer Support Model in a CHW training program (CHWTP) with the intention of further developing the WBSCs skills to bridge gaps in student supports and resources. Wellbeing Support Coordinators In Fall 2022, WBSCs were introduced to the University of Montana campus. The aim of the Wellbeing Support Program is to proactively reach out to enrolled students who may be struggling to offer support and additional resources before they require urgent, higher levels of sustained care. WBSCs function in a non-clinical capacity, as they are not licensed mental health providers, however, they do receive clinical supervision. In 2017, 25% of students in Montana who enrolled and attended a public four-year university within the state did not return for their second year (Aderholdt et al., 2019). According to the University of Montana Fall 2023 Census Enrollment Report, there were 10,327 enrolled students with the following demographics: 67% white, 8% multiracial, 7% American Indian or Alaska Native, 5% Asian, 4.98 % Hispanic, 1% Black, with 4% “No Response.” Additionally, 14% of students had a documented disability, 23% were first generation students, and 19% were offered a PELL grant (University of Montana, 2023). By increasing overall student wellbeing, the program intends to impact academic success and retention rates. The program employed 11 WBSCs who were embedded in every college, housing, and the Native American Center on campus. In their role, WBSCs provide individualized wellbeing support sessions for students; training and support for faculty/staff on student wellbeing; and assist students in accessing resources on and off campus. WBSCs advocate for and with students to address challenges and offer a variety of outreach events. Community Health Worker Training Program The University of Montana Center for Children, Families, and Workforce Development, through a Health Resources and Services Administration grant, began offering a CHWTP in Fall 2023. The CHWTP is a 10-week, free, asynchronous training for new and existing CHWs. The curriculum includes five core Modules each with four lessons (see Table 1). Each Module includes case studies, a variety of content delivery methods to accommodate different learning styles, and quizzes to assess learning. For three months post-training completion WBSCs were required to enter peer client data for those served in an online encounter form. WBSCs receive a stipend for participation in the CHWTP. Table 1: CHWTP Curriculum Overview Module Topic Lessons Module 1: Introduction to CHW and Cultural Humility History of CHW CHW Ethics and Values Professional Communication Cultural Awareness Module 2: CHW Foundations Public Health and Social Determinants of Health Community Health Needs Assessment CHW Across the Lifespan Maternal and Child Health Module 3: Working with Clients Documentation and Interviewing Motivational Interviewing Community Outreach and Engagement Advanced CHW Communication Skills Module 4: System Navigation and Coordination Skills Service Coordination and Referrals Housing Navigation Healthcare, benefits, and system navigation System Navigation Module 5: Behavioral Health in Montana Introduction to Behavioral Health in Montana Behavioral Health Systems Behavioral Health: Suicide Prevention Self-care in CHW The research question was: In what ways do WBSCs apply the knowledge and skills learned in the CHWTP with peers? With sub-questions related to the applicability of the specific topics covered and additional training topics recommended to address SDOH of a student population. Methods Fourteen WBSCs participated in the CHWTP, with 11 serving in the role at the University of Montana and three on affiliated campuses. Data were collected through focus groups and encounter forms completed by WBSCs after each peer meeting, in MyCap platform (Harris et al., 2022 ). Focus Groups Three focus groups were conducted with WBSCs who participated in the CHWTP as part of a larger program evaluation. Participants were recruited by email and provided verbal informed consent. All methods were carried out in accordance with relevant guidelines and regulations, and the program evaluation was determined exempt by the University of Montana Institutional Review Board. The researchers developed a semi-structured guide for the initial focus group covering topics related to overall satisfaction with the CHWTP and the application of knowledge and skills with peers. Questions for following groups were developed iteratively, with questions created based on previous responses, time since training completion, and emerging queries. Questions were related to most and least relevant knowledge and skills gained, application of knowledge and skills in work, and additional training needs. Data Collection and Analysis Focus groups were held at the end of the training, two months post-CHWTP completion (mid-semester), and four months post-CHWTP completion (end-of-semester). Each group lasted 60 minutes and was recorded, transcribed and a note taker was present to capture key themes. WBSC participation varied with N = 9 in group one, N = 12 in group two, and N = 11 in group three. Specific demographics of WBSC in each group were not collected; however, Table 2 provides those of the WBSCs who participated in the CHWTP. Table 2 Demographics of WBSC Enrolled in CHWTP Number (N) Percent (%) Age 20–29 6 43% 30–39 6 43% 40–49 2 14% Race American Indian 1 7% White 13 93% Gender Male 1 7% Female 12 86% Genderqueer/Gender Non-conforming 1 7% After conducting all focus groups, two of the authors analyzed transcripts and notes using strategies for rigor identified by Milne and Oberele’s (2005) to ensure (a) authenticity to the purpose of the research; (b) credibility or trustworthiness of results; and (c) intentional decision-making processes. To ensure integrity a participant was included in the data analysis process as a form of member checking. Authenticity was encouraged through ongoing examination of potential bias and peer review by co-authors. Data was analyzed using a method of focused and open coding, which combined deductive and inductive analysis (Emerson, Fretz, & Shaw, 1995; Mayring, 2014). Deductive codes were established through a review of notes from focus groups. Two authors individually reviewed the transcripts using the deductive codes and each added codes that emerged from the data. The authors met to review codes generated inductively and to clarify meaning and interpretation of findings and to collaboratively generate the themes. Salient quotes representative of the themes were identified, without reference to specific WBSC to maintain anonymity. Encounter Forms Encounter data from WBSC peer meetings provide an understanding of the quantity and type of peer needs being addressed (see Table 3 ). Nine of the 14 WBSC trainees completed encounter forms. Table 3 Encounter Form Data Peer Meetings (N = 145) Number of Meetings (n) Percent of Meetings (%) New Peer Meetings 87 60% Follow-up Peer Meetings 58 40% Peer Demographics*(n = 87) LGBTQ 11 13% Disability 21 24% Low Income 21 24% *WBSCs entered demographics for new peers served and only when peers openly shared facets of their identity. Students may have identified as belonging to more than one The Encounter Form asked what, if any, health concerns were addressed during the peer meeting. Eighty-four peer meetings (58%) addressed a health concern (see Table 4 ). Table 4 Health Concerns Addressed by WBSC Health Concerns Addressed (n = 84) Number (#) Percent of Peer Meetings with Health Concern Addressed (%) Other (n = 4, Disordered eating; n = 1, nutrition; n = 4, seizures and medication management) 8 6% Maternal and Child Health 9 6% Physical Activity (i.e., working out) 32 22% Activities of Daily Living (i.e., hygiene and personal grooming) 35 24% Mental Health 72 50% Mental health was the most prevalent identified concern, appearing in 50% of peer meetings. To provide an understanding of how WBSCs engaged and supported peers, and the type of services required to address SDOH, the Encounter Form included questions related to specific CHW roles used (see Table 5 ) and referrals (see Table 6 ). Table 5: CHW Role or Strategy Used by WBSC Role or Strategy Used [i] (N = 145) Number (n) Percent of Total Peer Meetings (%) Health Services 9 6% Providing Culturally Appropriate Services 13 9% Navigation or Care Coordination or Case Management 18 12% Advocacy for Individuals 43 30% Education for Individuals 52 36% Social-emotional Support 139 96% [1] Less than 6% of peer meetings utilized outreach, enrollment in services and/or benefits, emergency response and recovery, building community capacity, community assessment, and advocacy for communities. No peer meetings required evaluation and research, and education for communities. Table 6: Referral Type Made by WBSC Referral Type [i] (n = 58) Number (n) Percent of Peer Meetings with Referral Type (%) Heath Insurance/Health Coverage 6 4% Income Assistance 8 6% Crisis Services 10 7% Food Assistance 10 7% Education 14 10% Disability Services 17 12% Behavioral Health 19 13% [i] Less than 4% of referrals were made for child care, employment, public health, transportation, housing support, legal services, and healthcare. No referrals were made for translation services. Referrals were made in 40% (n = 58) of encounters and are provided to demonstrate the type of services required to address SDOH. Findings The overall themes identified throughout the three focus groups were related to (1) CHWTP relevance and applicability; and (2) CHWTP content needed for campus-based programs. While WBCSs identified areas of the CHWTP requiring tailoring or increased content relevant to specific concerns of peers, overall, they found the training to be engaging and applicable to their work. The CHWTP content provided information that accompanied, further developed, or supplemented training they received as part of their onboarding as WBSCs. CHWTP Relevance and Applicability WBSCs were specifically asked to reflect on the CHWTP to identify what knowledge and skills, and course features were beneficial to their work with peers. Within this theme sub-themes included relevant content, course structure, and CHW roles and referrals. Relevant Content When speaking about the CHWTP overall, one WBSC, acknowledging that they were new to working one-on-one with students, said that the training was, “really helpful for me just getting that foundational knowledge…that has helped in this role.” Another WBSC further explained that the training was, “applicable to broader systems…where we are mostly operating within the university system.” WBSCs also identified numerous content areas they found particularly applicable in their role which are highlighted below. Motivational Interviewing (MI). WBSCs talked extensively about how the MI content complemented the MI training they received during onboarding. They found the videos showing MI skills used in different scenarios helpful and appreciated their ongoing accessibility, allowing them to revisit the content. One WBSC found it particularly helpful in talking with peers whose primary reason for meeting was a general feeling of overwhelm—echoing trends other WBSC consistently noted. MI was helpful in, “navigating the sessions, and what [students] they want, and why they’re there because…they come in and they’re like, ‘honestly, I don’t know what I need. I’m just overwhelmed. I don’t know where to start.’” In alignment with the student-centered and -directed approach of the program, learning MI reminded them to ask open-ended questions and “really being intentional” with pausing, allowing the students to direct the session. Another WBSC spoke about utilizing MI to assess for SDOH saying, “After going through this training, I kind of made it a goal to check in with every student on those basic needs.” They asked questions like, “What is your housing like? How is that going for you? Do you feel safe there?” They shared how students will often meet for a specific reason, but when asked questions that assessed for SDOH, information would come to light that allowed for more holistic care in addressing stressors that may contribute to their initial concern. Resource Mapping. A primary service offered by WBSCs is to connect students to available resources. During onboarding WBSC learn about on-campus resources available for students, but the Resource Mapping content elicited a more comprehensive understanding of community resources they could refer students to as well. For example, one WBSC spoke about resource mapping with a student who was unhoused saying, “I thought I knew about some of the resources in Missoula but it was useful to understand how to sort of access more of them…knowing how to connect him with some other resources.” They utilized resource mapping to ensure that their peer had a plan in place and had support. Grief at Client Loss. CHWTP content on grief did not initially seem particularly relevant, yet, upon further discussion, many WBSC described their experiences working with peers who had recently experienced a loss or with someone experiencing feelings of grief from an older loss. One WBSC insisted that the section on grief, “belongs because you just don’t know what kind of client is going to come through your door. I have also had students who are grieving the loss of a grandparent…they saw their decline.” Another WBSC noted, “quite a few of us have worked with students who’ve lost someone in their life, so they’re dealing with grief…because I think for a lot of people it’s been sudden…and they’re dealing with a recent loss.” Grieving is not linear, and the content provided was periodically drawn on while working with peers who had, perhaps, come to a WBSC seeking support for something seemingly unrelated. Navigating Healthcare Systems and Self-care. WBSC while assessing for SDOH, found that some students share concerns that are potentially symptomatic of a larger health issue. Noting that many of the student meetings are with freshman and sophomores, one WBSC made it routine to ask questions like, “Do you know how to make a [doctors] appointment? Do you know how to get primary care?” and they will then refer them to medical care. The learnings from the training allowed WBSC to support peers’ in addressing broader healthcare needs. Relatedly, one WBSC noted that, in addition to generally assessing for SDOH, they used the self-care assessment from the CHWTP with peers to expand their understanding of what self-care can actually look like in practice. They used the assessment to identify whether peers’ notions of self-care included things like, “making it to the dentist, going to the doctor when you’re actually sick.” This allowed them to help peers identify and understand what areas they’re already doing well in and where there is room for growth. Systems and Community Advocacy. Reflecting on the Systems Advocacy Module, several WBSCs noted their appreciation of the distinction between general outreach and more targeted outreach it provided. One WBSC noted the module reframed their thinking on outreach and encouraged them to modify their outreach efforts, saying, “When I do my flyers, I think I’m going to…move where I put information about me and…highlight the most relevant stuff in a different way…going off of what the course was saying was a good idea.” Another WBSC valued an assignment where they created a systems advocacy brief. It caused them to rethink how they created marketing materials including their “phrasing, how it looks, what’s on it” and the benefit of providing relevant statistics and information. The example brief provided an accessible and functional layout for creating outreach materials that specifically targeted peers whose needs WBSC could assist. Course Structure WBSC reported the structure of the course to be engaging and accessible. In particular, the case studies with associated activities and varied presentation of information (i.e., text, visuals, podcasts, videos) accommodated for diverse learning styles. One WBSC noted it is always “helpful to have different ways of receiving information and different ways of being presented information and…the modules did a really good job of that.” The accessibility and ability to continue to revisit modules as frequently as needed, even post-training, consistently came up. The CHWTP proved to be an ongoing resource, with one WBSC saying, “I really appreciate that we can go back…look back and remind ourselves. I really appreciate that it’s still open to us. That’s really, really helpful.” WBSCs also frequently noted utilizing the PDF module summary handouts, saying they were “very, very succinctly made” and served as ongoing reference materials. CHW Roles and Referrals WBSCs shared numerous ways they applied learnings from the CHWTP with peers that aligned with typical CHW roles and referrals. Overall, when the APHA CHW definition was shared, participants generally agreed that it represented their understanding of the WBSC role. One WBSC shared, “It feels very relatable and kind of exactly what we do on a small scale. We’re like a University Health Worker.” They went on to share how so much of the daily work WBSCs do involves outreach and being a liaison within the university system to support students and increase their knowledge base and self-sufficiency, mirroring the work of a CHW. Many of the roles associated with CHWs coincide with WBSCs established role as a supportive resource for students, which was confirmed in encounter data identifying social-emotional support, education, and advocacy as primary roles used with peers. Social-emotional Support and Education. Given the priority of WBSCs is to support student wellbeing and 96% of encounters were identified as using this role, not surprisingly, the social-emotional support provided was described throughout all of the focus groups by multiple participants. One WBSC spoke about peers who expressed a lot of stigma around seeking counseling and other services such as Office for Disability Equity (ODE) accommodations. Education was needed to address peers social-emotional needs and involved, “talking about the stigma and kind of demystifying it…talking about misconceptions…and fears around it and what it could imply for certain individuals.” Another WBSC reported, “I think the hope is to connect students…work with students on the stigma around getting support with those more difficult kind of personal mental health issues, and then we can help them with…general wellbeing.” This kind of de-stigmatizing education surrounding mental health and the services available was also import for faculty, who at times are not as open to acknowledging the mental health struggles of students. Many WBSCs spoke about the stress and feelings of overwhelm students reported. One WBSC said that hearing, “I’m just stressed and overwhelmed” were the two things that most peers talked about. Another WBSC added, “overwhelming stress are the main things that I end up talking with students about…students are stressed, and they don’t always know how to deal with that.” Yet another WBSC spoke about listening to peers feeling overwhelmed and “not just overwhelmed with the current but really overwhelmed with the future.” As one WBSC said regarding social-emotional support, “sometimes they [peers] come in, and they’re like, ‘honestly…I don’t know what I need. I’m just overwhelmed. I don’t know where to start.’” One WBSC acknowledged that social emotional support was almost always needed because “everything is interconnected…The way that we operate in the world impacts our mental health, and our mental health impacts the way that we operate in the world.” Advocacy for Individuals. WBSC shared many examples of other advocacy efforts where they worked to empower students to advocate for themselves within the University system. For instance, one WBSC worked with a student trying to change his major who was receiving immense pushback from his advisor who wanted him to stay within the department and talked him out of changing his major. To support their peer, the WBSC explored possible majors and helped him identify and schedule meetings with advisors for majors he was interested in. As a result of this advocacy, the student changed his major to one he was excited about. Similarly, a few WBSCs worked with peers, with and without accommodations from ODE, to draft emails to their professors asking for extensions on assignments. Another WBSC, shared the experience of working with a student athlete who had four concussions in a three-month timespan and had received accommodations from ODE. However, one of the student’s professors had failed them before the end of the class. The WBSC was able to partner with the student’s advisor to advocate for a grade change and ensure that their accommodations were recognized and followed. These examples highlight the range of advocacy and support provided to individual students based on their specific needs and circumstances. CHWTP Content Needed for Campus-Based Programming WBSCs identified additional content that would be useful to include in a campus-based CHW training specific to the student population. Topics included navigating interpersonal relationships, prevention of substance use, and knowledge related to disordered eating. It is important to note that, while the training emphasized adults, the specific developmental needs of young adults should be considered in implementing campus-based CHW programming. Navigation of Interpersonal Relationships WBSC noted student needs related to interpersonal relationships – both creating and navigating them. Given many students are in their late teens and early twenties, living away from home for their first time, they report experiencing social isolation and loneliness. One WBSC noted this experience is more prevalent at this time since “a lot of students missed out on a lot of social skills because of the pandemic and are stuck in a rut.” That WBSC went on to discuss how they’ve been helping peers learn how to “just talk” to other people in hopes of “reducing feelings of loneliness, depression, and anxiety, but that that work has been challenging”. Another WBSC noted they had been encountering peers who, “feel lonely, and they don’t know where to find people…they just kind of end up staying up in their dorm rooms…not going out and not knowing how to get started building a social network.” The CHWTP did not specifically discuss social isolation and its importance when addressing SDOH. Healthy relationships and boundaries, both setting and respecting them, was another pattern in peers seeking support and an area where additional content could be helpful. One WBSC recommended that, “a section on understanding what personal and professional boundaries are, and then how to go about setting them in a way that feels comfortable” could be helpful for campus-based CHW training because they’re seeing students who are struggling with their relationships and navigating things like, “how can I set a boundary and still have my partner know that I care about them?”. It was also noted that some peers find it rather easy to set a boundary for themselves, but noted that it was, “really hard to accept somebody else’s boundary…it’s kind of personal sometimes.” Another WBSC added a student they were working with who had many encounters with campus police for stalking and was really interested and motivated to learn about boundaries to develop an understanding of them from both sides. Students who are new adults and still feeling the social impacts of the pandemic are struggling within their interpersonal relationships or are lacking the skills/support to seek out connection with others. Harm Reduction or Substance Use Education and Supports Harm reduction as an overarching umbrella was another area WBSCs thought additional training on would be beneficial; Specifically, ways to decrease stigma associated with Narcan training and its accessibility, and how to have discussions about marijuana use. WBSCs noted how challenging talking with peers about substance use can be. One WBSC shared, “I have had some unique conversations with students, especially around marijuana…a lot of students are using it as coping mechanisms for various reasons.” They went on to say that, when talking about their usage of marijuana, students are specifically naming it as a way to sleep and de-stress. Overall, harm reduction and its many applications to the variety of concerns students were having was an area of interest for WBSCs. Knowledge and Services for Disordered Eating Disordered eating was a common area of concern in peers and an area where WBSCs thought additional content was needed. WBSCs shared how delicate a topic it is and where knowledge of services to refer students too, would allow them to feel more confident approaching the conversations. One WBSC talked about working with students “wanting some support in nutrition or eating…or that comes up as something their struggling with…and I’m always cautious that I don’t want to cause harm by giving nutrition advice…or what conversations are helpful for them.” Another WBSC added that they’ve interacted with peers seeking support in nutrition and exercise, but with a stated weight loss goal, and that “feels a little touchy.” There was an acknowledgment that WBSCs wanted to have the knowledge and skills to talk to students about these things in ways that are supportive and are not going to create harm. Limitations The main limitation of the study is that WBSCs may have had preexisting knowledge and skills, received through WBSC onboard training or Master of Social Work classes, which may have impacted their assessment of the CHWTP. Yet, findings regarding the relevance and applicability of the CHWTP were likely unaffected. Though focus groups are used frequently in program evaluations, other studies might consider individual interviews to elicit different or diverging opinions and ensure quieter individuals have their views heard. The research design also was limited to reflections during one semester and additional time to reflect could lead to new insights. Future research could benefit from including the perspective of peers served through the program. Additionally, the number of WBSCs utilizing the Encounter Form limited the data collected on peers served and it is unknown whether all encounters were tracked. While this research does not allow for outcomes related to retention and graduation rates, data considering both should be tracked moving forward. Discussion The findings indicate WBSCs applied knowledge and skills learned in the CHWTP in numerous ways in their roles as active supports for peers to address SDOH. Specifically, WBSCs identified content within the MI module to be useful when assessing for SDOH, as well as the Resource Mapping, Grief at Client Loss, Navigating Healthcare Systems and Self-care, and Systems and Community Advocacy Modules. Content included in these modules was particularly relevant for WBSCs in addressing student concerns for which they were initially seeking support and mirror survey data obtained by the American College Health Association (ACHA, 2024). Each semester, the ACHA conducts a National College Health Assessment (NCHA) survey of students from universities across the country on health and wellbeing issues that impact their mental health and academic performance. In Spring of 2024, over 79,000 undergraduate students from 154 universities participated in the NCHA and having challenges similar or adjacent to the topics addressed in the CHWTP, including finances, career, academics, procrastination, personal appearance, the health of someone close to them, and the death of someone close to them (ACHA, 2024). This final listed challenge reiterates the WBSCs assessment of the importance of the Grief at Client Loss module within the CHWTP. WBSCs drew several parallels between their roles and responsibilities and those typically associated with CHWs. While WBSCs primarily provided social-emotional support and de-stigmatizing education to students, they often acted as a liaison within the university system, working with peers to empower them to advocate for their needs. WBSCs also noted how the CHWTP curriculum, particularly the resource mapping, helped them expand their role in engaging with the broader community to support peers. The literature is clear in acknowledging that institutions of higher education are failing to meet the growing basic and mental health needs of their students. These needs are shown to exceed the infrastructure and capacity of most university systems as they currently function (Lyons et al., 2023). Including CHW training into existing campus-based staff training is an innovative approach to address student needs. WBSCs included in this study deemed the overall training to be valuable as it provided the necessary knowledge and skills to effectively meet student needs and increased their understanding of resources and services available in the community that could be leveraged when student needs exceeded their scope or the university’s support services. These findings highlight the need for additional CHW training content tailored to the specific needs and challenges associated with SDOH of students. The WBSCs identified and recommended the inclusion of modules addressing how to navigate interpersonal relationships, harm reduction and/or substance use education and supports, and specific content on disordered eating. The data from the NCHA echoes the sentiments of the WBSCs, with 36% of students surveyed having experienced challenges with intimate relationships over the last 12 months, 42% of students reported having drank alcohol within the last two weeks and 17% reported having used marijuana within that same timeframe, and over 55% of students reported having challenges with their personal appearance (ACHA, 2024). According to the WBSCs, these were areas where they could have used extra training to effectively support students. The CHWTP was a grant funded program, and CHWs are typically also funded by grants. Because that funding does not lead to long-term sustainability of programs and ongoing training of peers is needed as students graduate, we recommend embedding CHW training with supervision into existing campus offices and student groups focused on student wellness. The CHWTP provided modules with specialized content intersecting in ways that address SDOH. Addressing SDOH among students promotes health equity, which is interconnected with educational equity for students. Given how important it is to address SDOH among students to promote health and wellbeing and academic success, it is the responsibility of higher education to prioritize health equity in unison with educational equity. This Wellbeing Support Program leveraged the specialized knowledge and skills provided by the CHWTP to address student needs and this research lends insight into the promising and emerging use of CHWs. Declarations Disclosure statement The authors report there are no competing interests to declare. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of University of Montana. Additional information Funding This work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award # 6 T29HP46745‐01‐01. References Aderholdt, D., Oliveri, C., Clark, J., & Seifert, T. (2019). Informal Peer Mentorship: Listening to the Everyday Student. Strategic Enrollment Management Quarterly, 7 (3), 5-14. American Association of State Colleges and Universities. (2023). Increasing graduation rates by meeting students’ basic needs . AASCU: Telling our story. Retrieved [2024], from https://www.aascutellingourstory.org/promising-practice/increasing-graduation-rates-by-meeting-students-basic-needs/. American Public Health Association. Community health workers. Retrieved [2024], from https://www.apha.org/apha-communities/member-sections/community-health-workers Bailey, C. P., Sharma, S., Economos, C. D., Hennessy, E., Simon, C., & Hatfield, D. P. (2020). College campuses’ influence on student weight and related behaviors: A review of observational and intervention research. Obesity Science & Practice, 6 (6), 694-707. https://doi.org/10.1002/osp4.445 Caporale-Berkowitz, N.A. (2022). Let’s teach peer support skills to all college students: Here’s how and why. Journal of American College Health, 70 (7), 1921-1925. https://doi.org/10.1080/07448481.2020.1841775 Davis, K., Dettmer, A., Salzer, M., Federici, M., Brusilovskiy, E., Tempesco, R., Baker, K. (2023) OR Mental Health America?? Peer support in mental health initiatives: Learning from the peer support movement. 2023. https://mhanational.org/sites/default/files/reports/College-Peer-Support-Report-2023.pdf Ellard, O. B., Dennison, C., & Tuomainen, H. (2023). Review: Interventions addressing loneliness amongst university students: a systematic review. Child and Adolescent Mental Health, 28 (4), 512-523. doi:10.1111/camh.12614 Guzman, P. G., Lange, J. E., & McClain, A. C. (2022). The association between food security status and psychological distress and loneliness among full-time undergraduate students at a minority-serving institution. International Journal of Environmental Research and Public Health, 19 (15245), 1-13. https://doi.org/10.3390/ijerph192215245 Harris, P. A., Swafford, J., Serdoz, E. S., Eidenmuller, J., Delacqua, G., Jagtap, V., Taylor, R. J., Gelbard, A., Cheng, A. C, Duda, S. N. (2022). MyCap: a flexible and configurable platform for mobilizing the participant voice. JAMIA Open, 5 (2). https://doi.org/10.1093/jamiaopen/ooac047 Haywood, M., Garman, A., Johnson, T., Chrisopher, B-A M., Walker III, R. (2016). Advancing community health workers through higher education: Lessons learned from a basic certificate program implementation. Pedagogy in Health Promotion, 3 (4), 228-233. https://doi.org/10.1177/2373379916671957 Henry, B., Cormier, C., Hebert, E., Naquin, M., & Wood, R. (2018). Health and health care issues among upper-level college students and relationships to age, race, gender, and living arrangements. College Student Journal, 52 , 1, 7-20. Hopp, M. D. S., Händel, M., Bedenlier, S., Glaeser-Zikuda, M., Kammerl, R., Kopp, B., & Ziegler, A. (2022). The structure of social networks and its link to higher education students’ socio-emotional loneliness during COVID-19. Frontiers in Psychology, 12 (733867), 1-15. doi: 10.3389/fpsyg.2021.733867 Keisler-Starkey, K. & Bunch, L. N. (2024). U.S. Census Bureau, Current Population Reports, P60-284, Health Insurance Coverage in the United States: 2023, U.S. Government Publishing Office, Washington, DC. Koon, K., Wettergreen, S., Hemstreet, B. A., Fink, R. M. (2024). Identification of social determinants of education among pharmacy students: results from a single-institution survey. American Journal of Pharmaceutical Education, 88 (5), 1-5. https://doi.org/10.1016/j.ajpe.2024.100691 Lipson, S.K., Phillips, M.V., Winquist, N., Eisenberg, D., & Lattie, E.G. (2021). Mental Health Conditions Among Community College Students: A National Study of Prevalence and Use of Treatment Services. Psychiatric Services, 72 (10), 1126-1133. Lyons, K., Magsayo, M., Maheshwari, R. (2023). Loneliness & college students: A needs assessment regarding georgetown student experiences in a post-virtual world. Georgetown Scientific Research Journal, 3 (2), 41-49. https://doi.org/10.48091/gsr.v3i2.70 Malcarney, M-B., Pittman, P., Quigley, L., Horton, K., Seiler, N. (2017). The changing roles of community health workers. Health Services Research, 51 (1), 360-382. doi: 10.1111/1475-6773.12657 McAfee, N. W., Schumacher, J. A., Carpenter, R. K., & Ahmad, Z. (2023). College student mental health, treatment utilization, and reduced enrollment: Findings across a state university system during the COVID-19 pandemic. Journal of American College Health, 71 (6), 1-11. https://doi.org/10.1080/07448481.2023.2248495 McCarville, E., Martin, M. A., Pratap, P., Pinsker, E., Seweryn, S. M., & Peters, K. E. (2024). Understanding critical factors associated with integration of community health workers into health and hospital systems. Journal of Interprofessional Care, 38 (3), 507-516. https://doi.org/10.1080/13561820.2023.2183183 Mental Health America (2019). The State of Mental Health in America . https://mhanational.org/sites/default/files/2019-09/2019%20MH%20in%20America%20Final.pdf National Heart, Lung, and Blood Institute. Role of community health workers. Retrieved [2024], from https://www.nhlbi.nih.gov/education/heart-truth/CHW/Role Reppond, H. (2019, December). Many college students struggle to have their basic needs met. The SES Indicator . http://www.apa.org/pi/ses/resources/indicator/2019/12/college-students-needs Stice, E., Rohde, P., Gau, J.M., Bearman, S.K., Shaw, H. (2023). An Experimental Test of Increasing Implementation Support for College Peer Educators Delivering an Evidence-Based Prevention Program. Journal of Consulting and Clinical Psychology, 91 (4), 208-220. https://doi.org/10.1037/ccp0000806 Terrell, K. R., Boggs, C., Adelstein, D., Hamadi, H. Y., Kulikov, E., Martinez, V., & Borreca, M. (2023). Mental health initiatives: Providing stress management, wellness, and mindfulness workshops on college campuses. Journal of American College Health , 1-8. https://doi.org/10.1080/07448481.2023.2222830 Tinto, V. (1993). Leaving college: Rethinking the causes and cures of student attrition (2 nd ed.). University of Chicago Press. Tucker, K., Sharp, G., Qingmin, S., Scinta, T., & Thanki, S. (2020). Fostering Historically Underserved Students’ Success: An Embedded Peer Support Model that Merges Non-Cognitive Principles with Proven Academic Support Practices. The Review of Higher Education, 43 (3), 861-885. https://doi.org/10.1353/rhe.2020.0010 University of Montana (2023, July). Census Enrollment Numbers . Institutional Research. https://www.umt.edu/institutional-research/enrollment/census-enrollment.php University of Montana (2023). University of Montana Fall 2023 Census Enrollment Report. Retrieved from https://www.umt.edu/institutional-research/documents/census-reports-accessible/202370_census.pdf U.S. Department of Health and Human Services. Healthy people 2030. Retrieved [2024], from https://health.gov/healthypeople/priority-areas/social-determinants-health Yao, N., Kowalczyk, M., Gregory, L., Cheatham, J., DeClemente, T., Fox, K., Ignoffo, S., and Volerman, A. (2023). Community health workers' perspectives on integrating into school settings to support student health. Frontiers in Public Health, 21 (11), https://doi.org/ 10.3389/fpubh.2023.1187855. Yang, M., & Chau, A. W. L. (2011). Social involvement and development as a response to the campus student culture. Asian Pacific Education Review, 12 (3), 393-402. https://:doi.org/10.1007/s12564-011-9149-x Yang, M., & Chau, A.W. L. (2011). Social involvement and development as a response to the campus student culture. Asia Pacific Education Review, 12 , 393–402. https://doi.org/10.1007/s12564-011-9149-x Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8272882","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":570993724,"identity":"d9d28d0d-7fb4-45d0-b0e2-b9787738a2d9","order_by":0,"name":"Jen K. Molloy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYBACxgYwZSHDwMB8ACHMQ1iLBFANWwJEiI2AFigAaeExIE4Lc3vvAaYbFRI8/BI5Xzf+qGBIXDu/gfHB2zY8Dus5l8Ccc0aCR3JG7rbbPGcYErcdY2A2nItPy4wcA+bcNgkegxtALYxtYC1s0rz4tMx/A9OS8+zmT4gW9t94tczggWthu8ELtYUZr5aeHIPDYL/0PDMD+kXCeNuxxGbJOedwazFsP2P4OKfCRo6fPfnZzR8VNrLbDh8++OFNGR4tDQwMB8AsgQQQKcEAj15cQB7O4j+AV+EoGAWjYBSMYAAA3ctOrBsCbU0AAAAASUVORK5CYII=","orcid":"","institution":"University of Montana","correspondingAuthor":true,"prefix":"","firstName":"Jen","middleName":"K.","lastName":"Molloy","suffix":""},{"id":570993731,"identity":"06ae2e9d-0efa-4418-b21e-0915e2dc8cf3","order_by":1,"name":"Carrie Jo Riordan","email":"","orcid":"","institution":"Center for Children, Families, and Workforce Development, University of Montana","correspondingAuthor":false,"prefix":"","firstName":"Carrie","middleName":"Jo","lastName":"Riordan","suffix":""},{"id":570993733,"identity":"2273e658-2e3e-4070-bdb0-837b5b3b8bf4","order_by":2,"name":"Heather Otremba","email":"","orcid":"","institution":"University of Montana","correspondingAuthor":false,"prefix":"","firstName":"Heather","middleName":"","lastName":"Otremba","suffix":""},{"id":570993734,"identity":"e89eb5fb-fcbb-420b-bb81-478e7caec5b7","order_by":3,"name":"Mackenzie Petersen","email":"","orcid":"","institution":"Center for Children, Families, and Workforce Development, University of Montana","correspondingAuthor":false,"prefix":"","firstName":"Mackenzie","middleName":"","lastName":"Petersen","suffix":""},{"id":570993741,"identity":"c7c08670-56db-4cdb-a95d-d459ba2f8708","order_by":4,"name":"Kim Spurzem","email":"","orcid":"","institution":"Center for Children, Families, and Workforce Development, University of Montana","correspondingAuthor":false,"prefix":"","firstName":"Kim","middleName":"","lastName":"Spurzem","suffix":""},{"id":570993743,"identity":"4a6099b0-c61d-4457-b628-1b7b4b4cf519","order_by":5,"name":"Jessica Liddell","email":"","orcid":"","institution":"University of Montana","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Liddell","suffix":""}],"badges":[],"createdAt":"2025-12-03 17:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8272882/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8272882/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99811620,"identity":"7765be7c-edbe-4f8b-8140-34df0567c10a","added_by":"auto","created_at":"2026-01-08 14:34:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60912,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscriptwithauthordetailsRevised12.15.25.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/ef837b6bcd03a202e3fd8470.docx"},{"id":99811449,"identity":"4c1649c1-4e36-459c-a499-d9f0ff7fbec5","added_by":"auto","created_at":"2026-01-08 14:33:53","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6946,"visible":true,"origin":"","legend":"","description":"","filename":"563b42d15d544804be6861626c1de21a.json","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/0f70a4261935356cd63ab2df.json"},{"id":99811703,"identity":"4aadb992-7045-4c91-9727-4e4b2fc96560","added_by":"auto","created_at":"2026-01-08 14:34:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16211,"visible":true,"origin":"","legend":"","description":"","filename":"Table1CHWTPCurriculumOverviewFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/4b853ecae7c1f1cdc3fe7dc5.docx"},{"id":99811590,"identity":"e2f182d6-70c8-4193-8902-80b2bb508272","added_by":"auto","created_at":"2026-01-08 14:34:10","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15213,"visible":true,"origin":"","legend":"","description":"","filename":"Table2DemographicsofWBSCEnrolledinCHWTPFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/481d74496e82c07324fe27c6.docx"},{"id":99811612,"identity":"e71866f8-b715-4762-acf6-5278d6a739e4","added_by":"auto","created_at":"2026-01-08 14:34:17","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18651,"visible":true,"origin":"","legend":"","description":"","filename":"Table3EncounterFormData.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/d3d06ee36f17356726785120.docx"},{"id":99811352,"identity":"1e4d8ec0-e55d-4005-8894-5e8875a9aba3","added_by":"auto","created_at":"2026-01-08 14:33:51","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18766,"visible":true,"origin":"","legend":"","description":"","filename":"Table4HealthConcernsAddressedbyWBSCsFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/ca8901c4eeae25080d287de8.docx"},{"id":99811447,"identity":"8f408c0b-da42-4379-ab3b-eb9628e76af2","added_by":"auto","created_at":"2026-01-08 14:33:53","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18483,"visible":true,"origin":"","legend":"","description":"","filename":"Table5CHWRoleorStrategyUsedbyWBSCFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/851c370dc2eca4480276396a.docx"},{"id":99811613,"identity":"271f5bee-4044-4f74-9134-680146fe41b4","added_by":"auto","created_at":"2026-01-08 14:34:17","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18495,"visible":true,"origin":"","legend":"","description":"","filename":"Table6ReferralTypeMadebyWBSCFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/2b127a5a22b45de05850dfd7.docx"},{"id":99811466,"identity":"9a8e96db-b78d-4cee-b15e-b1da82b90a02","added_by":"auto","created_at":"2026-01-08 14:34:00","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":115565,"visible":true,"origin":"","legend":"","description":"","filename":"563b42d15d544804be6861626c1de21a1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/cb33cc8785a5646a99efd67c.xml"},{"id":99811529,"identity":"26fd8cf8-df55-47d9-a32a-f43edd0d7b78","added_by":"auto","created_at":"2026-01-08 14:34:04","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1036,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/0643e703ca4fe230f81947c9.png"},{"id":99811533,"identity":"bf9c0666-fb95-4eda-99ad-8c26f7e8a8c0","added_by":"auto","created_at":"2026-01-08 14:34:05","extension":"png","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1036,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/55286dd0a61f7f4b3d10fbe7.png"},{"id":99811701,"identity":"7a780136-fcf6-4259-a8bd-dbaa968ef58b","added_by":"auto","created_at":"2026-01-08 14:34:33","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":856,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/ae65634a530fb885fa999b3d.png"},{"id":99811662,"identity":"8743c7f0-2b54-4eed-8f1b-cfb15e677df2","added_by":"auto","created_at":"2026-01-08 14:34:30","extension":"png","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":856,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/c6a8f678bc674c5b5c19d75d.png"},{"id":99811718,"identity":"d4559617-d6eb-4b26-9f21-152d7ce71685","added_by":"auto","created_at":"2026-01-08 14:34:37","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110136,"visible":true,"origin":"","legend":"","description":"","filename":"563b42d15d544804be6861626c1de21a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/661a6e98dff6ac3bf875b472.xml"},{"id":99811631,"identity":"2701ddcc-ac7e-4194-bb11-fe1c63853bc3","added_by":"auto","created_at":"2026-01-08 14:34:22","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":123450,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/f9afd2f6f02bf90635bda7c0.html"},{"id":103395891,"identity":"80d4bde6-9606-46dc-9d3d-a3cfe7dec5d4","added_by":"auto","created_at":"2026-02-25 08:42:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1030412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8272882/v1/284ef189-877d-48b2-bb2a-659cbb88d7b1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Health Worker Training in Higher Education for Addressing Social Determinants of Health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSocial determinants of health (SDOH), as defined by the U.S. Department of Health and Human Services (HHS) are, \u0026ldquo;the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks\u0026rdquo; (2024, para. 1). SDOH fall into five domains: economic stability, health care access and quality, neighborhood and built environment, social and community context, and education access and quality (HHS, 2024). While access to higher education can lead to improved health and well-being, considerations related to the other four SODH domains can hinder or support degree attainment (HHS, 2024). To create a healthier society and address health equity, we must consider the unique challenges of college students\u0026apos; SDOH.\u003c/p\u003e\n\u003cp\u003eWhen looking at SDOH among college students, the research highlights the extreme economic insecurity they face. As a whole, students are characterized as low income, with 36% considered food insecure, 36% having unstable housing, 9% being unhoused, and 65% of those who graduate having an average of $29,200 in loan debt (Reppond, 2019). Although college-aged young adults are no less likely to get sick than any other population, 17.1% lack health insurance (Henry et al., 2018), which is twice the national average (Keisler-Starkey \u0026amp; Bunch, 2024). This often leads to a lack of routine care, with 40% of students reporting that they needed to see a doctor but were unable to due to the costs (Koon et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, college students across the country are experiencing a mental health crisis which impacts their ability to attend class and complete course work. The national Heathy Minds Study (HMS), a cross-sectional survey that examined mental health in students from 133 four-year universities, found that 55% of those surveyed met criteria for one or more mental health issues (e.g., depression, anxiety, disordered eating, or suicidal ideation). Of the 95,711 students who took the survey, 78% reported that their academic performance was negatively affected by their mental health (Lipson et al., 2021). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudents are at a higher risk than other population groups for experiencing loneliness and accompanying feelings of stress, anxiety, and depression \u0026ndash; all of which have been associated with loss of sleep and suicidal ideations (Ellard et al., 2023). Research suggests that feelings of loneliness can negatively impact a student\u0026rsquo;s grades in a multitude of ways including decreases in self-efficacy, increased physical and emotional exhaustion, and negative feelings about their learning environment; resulting in loneliness being associated with higher rates of attrition (Hopp et al., 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen considering SDOH and student loneliness, both the social and community context and the campus neighborhood and built environment play a role. Loneliness is associated with mental health struggles, decreased campus engagement, and a loss of positive social relationships, thereby creating a cycle where students declining wellbeing leads to increased isolation (Lyons et al., 2023). Considering ways to further support student\u0026rsquo;s attainment of the SDOH needs to be a priority in higher education. Without adequate attention to the conditions necessary to generally thrive, many students are unable to thrive academically.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAddressing SDOH in a university setting can ensure that students have their basic needs met, which can address barriers to student success and lead to greater retention and degree attainment. Research shows recruiting one student costs four to five times \u003cem\u003emore\u003c/em\u003e than retaining them (Aderholdt et al., 2019). As Lipson et al. (2021) reported:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGiven the link between student mental health and academic outcomes, including college graduation, there is a strong economic case for federal, state, and local investments in the mental health of college students through programs and services aimed at treatment and prevention and for social support services. (p. 1131)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurther, research commissioned by the California State University system, the largest US institution of public higher education, revealed high rates of housing and food insecurity among its students (AASCU, 2023). Based on these results, Stanislaus State created a Basic Needs department to provide a holistic student support system including a food pantry, emergency housing and financial assistance, food kits and live meal prep demonstrations, and case management referral services for on- and off-campus nonclinical support and resources. First-year students who accessed Basic Needs services surveyed in 2021-22 were retained at higher rates than those who did not and a majority of students reported services positively impacted their mental and physical health, and improved stress levels (AASCU, 2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity Health Workers Address SDOH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven the needs of college-age students related to SDOH, higher education needs to consider ways to offer support and resources beyond what is currently available. Many institutions have specific offices addressing these needs and they are often not utilized by students (Lyons et al., 2023). Whether due to a lack of awareness, availability of services, or help-seeking stigma, addressing SDOH must be prioritized. One way to do so is looking to other disciplines and settings for innovative ideas (Guzman et al., 2022). One workforce that has a long history of connecting community members with support and resources related to SDOH are Community Health Workers (CHWs). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2009, the American Public Health Association (APHA) adopted a definition for CHWs that many states have fully adopted or edited to suit their needs, stating:\u003c/p\u003e\n\u003cp\u003eCommunity Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.\u003c/p\u003e\n\u003cp\u003eCHWs play a vital role in addressing healthcare disparities and improving healthcare outcomes (National Heart, Lung, and Blood Institute, 2024). The scope of practice for CHWs outlines their activities; however, there are differences in the level of detail, focus, breadth, and roles depending on the community (Haywood et al., 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCHW models have proven to be a cost-effective means of delivering care\u0026mdash;especially among underserved, lower-income, minority communities (McCarvill et al., 2024). Largely due to their trusted roles within the community, CHWs can be especially helpful in increasing an individual\u0026rsquo;s engagement in their own care, ultimately creating better overall health outcomes (Haywood et al., 2016). Given their unique potential to support community members in addressing SDOH and to generate positive health outcomes, CHWs are being further embedded into healthcare, justice, and K-12 education systems (Yao et al., 2023). Our review of available literature indicates CHWs have yet to be utilized to support college students, although the skills and roles of CHWs are applicable and there is untapped potential to embed them on college campuses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigher Education and Student Needs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany institutions of higher education are attempting to meet growing student mental health needs, with limited attention to other SDOHs. Acknowledging gaps in mental health services, many universities are considering services that extend beyond traditional counseling departments (e.g. mindfulness courses and mental health awareness campaigns). These methods, however, are often not cost-effective and fail to meet the individual needs of students (Terrell et al., 2023). One approach to addressing student needs that has proved promising is the incorporation of Peer Support Models.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePeer Support Models are an evidence-based approach (Mental Health America, 2019) which include a range of activities and interactions between people with similar experiences - such as a behavioral health condition or a shared identity. On campuses, peer support increases \u0026ldquo;access to support for students in settings where staffing shortages, lack of cultural responsiveness and representation among providers, isolation, or distrust of mental health services are in play\u0026rdquo; (Davis et al., 2023, p. 5). \u0026nbsp;Peer support enables fellow students to relate to one another, generating feelings of belonging and connectedness which have been linked to improved mental health and academic success (Caporale-Berkowitz, 2022). Research found these to be cost-effective and successful at delivering prevention materials (Stice et al., 2023) and in helping address the equity gap that other interventions may miss (Tucker et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile the CHW literature includes reference to Peer Support Models (Malcarney et al., 2017), we found no research or reference to preparing student peers to serve other students using the knowledge and skills associated with CHWs. As noted above, CHWs are trusted community members and/or have an unusually close understanding of the community. In the context of campuses students supporting other students would naturally be those trusted community members. The aim of the research presented here was to explore the ways campus-based peer support services, offered through a campus-based Wellness Program, applied learnings from a CHW training program. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCHWs Role on College Campuses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article provides an overview of one university\u0026rsquo;s efforts to leverage the knowledge and skills of CHWs to address student SDOH. In Fall 2023, the Wellbeing Support Program, offered by the University of Montana Health Center, enrolled Wellbeing Support Coordinators (WBSCs) utilizing a Peer Support Model in a CHW training program (CHWTP) with the intention of further developing the WBSCs skills to bridge gaps in student supports and resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWellbeing Support Coordinators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Fall 2022, WBSCs were introduced to the University of Montana campus. The aim of the Wellbeing Support Program is to proactively reach out to enrolled students who may be struggling to offer support and additional resources before they require urgent, higher levels of sustained care. WBSCs function in a non-clinical capacity, as they are not licensed mental health providers, however, they do receive clinical supervision. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2017, 25% of students in Montana who enrolled and attended a public four-year university within the state did not return for their second year (Aderholdt et al., 2019). According to the University of Montana Fall 2023 Census Enrollment Report, there were 10,327 enrolled students with the following demographics: 67% white, 8% multiracial, 7% American Indian or Alaska Native, 5% Asian, 4.98 % Hispanic, 1% Black, with 4% \u0026ldquo;No Response.\u0026rdquo; Additionally, 14% of students had a documented disability, 23% were first generation students, and 19% were offered a PELL grant (University of Montana, 2023). By increasing overall student wellbeing, the program intends to impact academic success and retention rates. The program employed 11 WBSCs who were embedded in every college, housing, and the Native American Center on campus. In their role, WBSCs provide individualized wellbeing support sessions for students; training and support for faculty/staff on student wellbeing; and assist students in accessing resources on and off campus. WBSCs advocate for and with students to address challenges and offer a variety of outreach events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity Health Worker Training Program\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe University of Montana Center for Children, Families, and Workforce Development, through a Health Resources and Services Administration grant, began offering a CHWTP in Fall 2023. The CHWTP is a 10-week,\u0026nbsp;free, asynchronous training for new and existing CHWs. The curriculum includes five core Modules each with four lessons (see Table 1). Each Module includes case studies, a variety of content delivery methods to accommodate different learning styles, and quizzes to assess learning. For three months post-training completion WBSCs were required to enter peer client data for those served in an online encounter form. WBSCs receive a stipend for participation in the CHWTP. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003eTable 1: CHWTP Curriculum Overview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule Topic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003eLessons\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule 1: Introduction to CHW and Cultural Humility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eHistory of CHW\u003c/li\u003e\n \u003cli\u003eCHW Ethics and Values\u003c/li\u003e\n \u003cli\u003eProfessional Communication\u003c/li\u003e\n \u003cli\u003eCultural Awareness\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule 2: CHW Foundations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003ePublic Health and Social Determinants of Health\u003c/li\u003e\n \u003cli\u003eCommunity Health Needs Assessment\u003c/li\u003e\n \u003cli\u003eCHW Across the Lifespan\u003c/li\u003e\n \u003cli\u003eMaternal and Child Health\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule 3: Working with Clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDocumentation and Interviewing\u003c/li\u003e\n \u003cli\u003eMotivational Interviewing\u003c/li\u003e\n \u003cli\u003eCommunity Outreach and Engagement\u003c/li\u003e\n \u003cli\u003eAdvanced CHW Communication Skills\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule 4: System Navigation and Coordination Skills\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eService Coordination and Referrals\u003c/li\u003e\n \u003cli\u003eHousing Navigation\u003c/li\u003e\n \u003cli\u003eHealthcare, benefits, and system navigation\u003c/li\u003e\n \u003cli\u003eSystem Navigation\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 300px;\"\u003e\n \u003cp\u003eModule 5: Behavioral Health in Montana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eIntroduction to Behavioral Health in Montana\u003c/li\u003e\n \u003cli\u003eBehavioral Health Systems\u003c/li\u003e\n \u003cli\u003eBehavioral Health: Suicide Prevention\u003c/li\u003e\n \u003cli\u003eSelf-care in CHW\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe research question was: In what ways do WBSCs apply the knowledge and skills learned in the CHWTP with peers? With sub-questions related to the applicability of the specific topics covered and additional training topics recommended to address SDOH of a student population.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eFourteen WBSCs participated in the CHWTP, with 11 serving in the role at the University of Montana and three on affiliated campuses. Data were collected through focus groups and encounter forms completed by WBSCs after each peer meeting, in MyCap platform (Harris et al., \u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eFocus Groups\u003c/h3\u003e\n\u003cp\u003eThree focus groups were conducted with WBSCs who participated in the CHWTP as part of a larger program evaluation. Participants were recruited by email and provided verbal informed consent. All methods were carried out in accordance with relevant guidelines and regulations, and the program evaluation was determined exempt by the University of Montana Institutional Review Board.\u003c/p\u003e\n\u003cp\u003eThe researchers developed a semi-structured guide for the initial focus group covering topics related to overall satisfaction with the CHWTP and the application of knowledge and skills with peers. Questions for following groups were developed iteratively, with questions created based on previous responses, time since training completion, and emerging queries. Questions were related to most and least relevant knowledge and skills gained, application of knowledge and skills in work, and additional training needs.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData Collection and Analysis\u003c/h2\u003e\n \u003cp\u003eFocus groups were held at the end of the training, two months post-CHWTP completion (mid-semester), and four months post-CHWTP completion (end-of-semester). Each group lasted 60 minutes and was recorded, transcribed and a note taker was present to capture key themes.\u003c/p\u003e\n \u003cp\u003eWBSC participation varied with N\u0026thinsp;=\u0026thinsp;9 in group one, N\u0026thinsp;=\u0026thinsp;12 in group two, and N\u0026thinsp;=\u0026thinsp;11 in group three. Specific demographics of WBSC in each group were not collected; however, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e provides those of the WBSCs who participated in the CHWTP.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographics of WBSC Enrolled in CHWTP\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (N)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u0026ndash;29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u0026ndash;39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e40\u0026ndash;49\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmerican Indian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGenderqueer/Gender Non-conforming\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAfter conducting all focus groups, two of the authors analyzed transcripts and notes using strategies for rigor identified by Milne and Oberele\u0026rsquo;s (2005) to ensure (a) authenticity to the purpose of the research; (b) credibility or trustworthiness of results; and (c) intentional decision-making processes. To ensure integrity a participant was included in the data analysis process as a form of member checking. Authenticity was encouraged through ongoing examination of potential bias and peer review by co-authors.\u003c/p\u003e\n \u003cp\u003eData was analyzed using a method of focused and open coding, which combined deductive and inductive analysis (Emerson, Fretz, \u0026amp; Shaw, 1995; Mayring, 2014). Deductive codes were established through a review of notes from focus groups. Two authors individually reviewed the transcripts using the deductive codes and each added codes that emerged from the data. The authors met to review codes generated inductively and to clarify meaning and interpretation of findings and to collaboratively generate the themes. Salient quotes representative of the themes were identified, without reference to specific WBSC to maintain anonymity.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEncounter Forms\u003c/h3\u003e\n\u003cp\u003eEncounter data from WBSC peer meetings provide an understanding of the quantity and type of peer needs being addressed (see Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Nine of the 14 WBSC trainees completed encounter forms.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEncounter Form Data\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePeer Meetings (N\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber of Meetings (n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent of Meetings (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew Peer Meetings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFollow-up Peer Meetings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePeer Demographics*(n\u0026thinsp;=\u0026thinsp;87)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLGBTQ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow Income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003e*WBSCs entered demographics for new peers served and only when peers openly shared facets of their identity. Students may have identified as belonging to more than one\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe Encounter Form asked what, if any, health concerns were addressed during the peer meeting. Eighty-four peer meetings (58%) addressed a health concern (see Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHealth Concerns Addressed by WBSC\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHealth Concerns Addressed (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNumber (#)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent of Peer Meetings with Health Concern Addressed (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther (n\u0026thinsp;=\u0026thinsp;4, Disordered eating; n\u0026thinsp;=\u0026thinsp;1, nutrition; n\u0026thinsp;=\u0026thinsp;4, seizures and medication management)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaternal and Child Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical Activity (i.e., working out)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eActivities of Daily Living (i.e., hygiene and personal grooming)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eMental health was the most prevalent identified concern, appearing in 50% of peer meetings.\u003c/p\u003e\n\u003cp\u003eTo provide an understanding of how WBSCs engaged and supported peers, and the type of services required to address SDOH, the Encounter Form included questions related to specific CHW roles used (see Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e) and referrals (see Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: CHW Role or Strategy Used by WBSC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"599\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRole or Strategy Used\u003cstrong\u003e[i]\u003c/strong\u003e (N = 145)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent of Total Peer Meetings (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eHealth Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eProviding Culturally Appropriate Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eNavigation or Care Coordination or Case Management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eAdvocacy for Individuals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eEducation for Individuals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 323px;\"\u003e\n \u003cp\u003eSocial-emotional Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e[1] Less than 6% of peer meetings utilized outreach, enrollment in services and/or benefits, emergency response and recovery, building community capacity, community assessment, and advocacy for communities. No peer meetings required evaluation and research, and education for communities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Referral Type Made by WBSC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"575\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferral Type\u003cstrong\u003e[i]\u003c/strong\u003e (n = 58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent of Peer Meetings with Referral Type (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eHeath Insurance/Health Coverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eIncome Assistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eCrisis Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eFood Assistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eDisability Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 233px;\"\u003e\n \u003cp\u003eBehavioral Health\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv id=\"edn1\"\u003e\n \u003cp\u003e[i] Less than 4% of referrals were made for child care, employment, public health, transportation, housing support, legal services, and healthcare. No referrals were made for translation services.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eReferrals were made in 40% (n\u0026thinsp;=\u0026thinsp;58) of encounters and are provided to demonstrate the type of services required to address SDOH.\u003c/p\u003e\n\u003ch3\u003eFindings\u003c/h3\u003e\n\u003cp\u003eThe overall themes identified throughout the three focus groups were related to (1) CHWTP relevance and applicability; and (2) CHWTP content needed for campus-based programs. While WBCSs identified areas of the CHWTP requiring tailoring or increased content relevant to specific concerns of peers, overall, they found the training to be engaging and applicable to their work. The CHWTP content provided information that accompanied, further developed, or supplemented training they received as part of their onboarding as WBSCs.\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eCHWTP Relevance and Applicability\u003c/h2\u003e\n \u003cp\u003eWBSCs were specifically asked to reflect on the CHWTP to identify what knowledge and skills, and course features were beneficial to their work with peers. Within this theme sub-themes included relevant content, course structure, and CHW roles and referrals.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eRelevant Content\u003c/h2\u003e\n \u003cp\u003eWhen speaking about the CHWTP overall, one WBSC, acknowledging that they were new to working one-on-one with students, said that the training was, \u0026ldquo;really helpful for me just getting that foundational knowledge\u0026hellip;that has helped in this role.\u0026rdquo; Another WBSC further explained that the training was, \u0026ldquo;applicable to broader systems\u0026hellip;where we are mostly operating within the university system.\u0026rdquo; WBSCs also identified numerous content areas they found particularly applicable in their role which are highlighted below.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMotivational Interviewing (MI).\u003c/strong\u003e WBSCs talked extensively about how the MI content complemented the MI training they received during onboarding. They found the videos showing MI skills used in different scenarios helpful and appreciated their ongoing accessibility, allowing them to revisit the content. One WBSC found it particularly helpful in talking with peers whose primary reason for meeting was a general feeling of overwhelm\u0026mdash;echoing trends other WBSC consistently noted. MI was helpful in, \u0026ldquo;navigating the sessions, and what [students] they want, and why they\u0026rsquo;re there because\u0026hellip;they come in and they\u0026rsquo;re like, \u0026lsquo;honestly, I don\u0026rsquo;t know what I need. I\u0026rsquo;m just overwhelmed. I don\u0026rsquo;t know where to start.\u0026rsquo;\u0026rdquo; In alignment with the student-centered and -directed approach of the program, learning MI reminded them to ask open-ended questions and \u0026ldquo;really being intentional\u0026rdquo; with pausing, allowing the students to direct the session. Another WBSC spoke about utilizing MI to assess for SDOH saying, \u0026ldquo;After going through this training, I kind of made it a goal to check in with every student on those basic needs.\u0026rdquo; They asked questions like, \u0026ldquo;What is your housing like? How is that going for you? Do you feel safe there?\u0026rdquo; They shared how students will often meet for a specific reason, but when asked questions that assessed for SDOH, information would come to light that allowed for more holistic care in addressing stressors that may contribute to their initial concern.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eResource Mapping.\u003c/strong\u003e A primary service offered by WBSCs is to connect students to available resources. During onboarding WBSC learn about on-campus resources available for students, but the Resource Mapping content elicited a more comprehensive understanding of community resources they could refer students to as well. For example, one WBSC spoke about resource mapping with a student who was unhoused saying, \u0026ldquo;I thought I knew about some of the resources in Missoula but it was useful to understand how to sort of access more of them\u0026hellip;knowing how to connect him with some other resources.\u0026rdquo; They utilized resource mapping to ensure that their peer had a plan in place and had support.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGrief at Client Loss.\u003c/strong\u003e CHWTP content on grief did not initially seem particularly relevant, yet, upon further discussion, many WBSC described their experiences working with peers who had recently experienced a loss or with someone experiencing feelings of grief from an older loss. One WBSC insisted that the section on grief, \u0026ldquo;belongs because you just don\u0026rsquo;t know what kind of client is going to come through your door. I have also had students who are grieving the loss of a grandparent\u0026hellip;they saw their decline.\u0026rdquo; Another WBSC noted, \u0026ldquo;quite a few of us have worked with students who\u0026rsquo;ve lost someone in their life, so they\u0026rsquo;re dealing with grief\u0026hellip;because I think for a lot of people it\u0026rsquo;s been sudden\u0026hellip;and they\u0026rsquo;re dealing with a recent loss.\u0026rdquo; Grieving is not linear, and the content provided was periodically drawn on while working with peers who had, perhaps, come to a WBSC seeking support for something seemingly unrelated.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNavigating Healthcare Systems and Self-care.\u003c/strong\u003e WBSC while assessing for SDOH, found that some students share concerns that are potentially symptomatic of a larger health issue. Noting that many of the student meetings are with freshman and sophomores, one WBSC made it routine to ask questions like, \u0026ldquo;Do you know how to make a [doctors] appointment? Do you know how to get primary care?\u0026rdquo; and they will then refer them to medical care. The learnings from the training allowed WBSC to support peers\u0026rsquo; in addressing broader healthcare needs. Relatedly, one WBSC noted that, in addition to generally assessing for SDOH, they used the self-care assessment from the CHWTP with peers to expand their understanding of what self-care can actually look like in practice. They used the assessment to identify whether peers\u0026rsquo; notions of self-care included things like, \u0026ldquo;making it to the dentist, going to the doctor when you\u0026rsquo;re actually sick.\u0026rdquo; This allowed them to help peers identify and understand what areas they\u0026rsquo;re already doing well in and where there is room for growth.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSystems and Community Advocacy.\u003c/strong\u003e Reflecting on the Systems Advocacy Module, several WBSCs noted their appreciation of the distinction between general outreach and more targeted outreach it provided. One WBSC noted the module reframed their thinking on outreach and encouraged them to modify their outreach efforts, saying, \u0026ldquo;When I do my flyers, I think I\u0026rsquo;m going to\u0026hellip;move where I put information about me and\u0026hellip;highlight the most relevant stuff in a different way\u0026hellip;going off of what the course was saying was a good idea.\u0026rdquo; Another WBSC valued an assignment where they created a systems advocacy brief. It caused them to rethink how they created marketing materials including their \u0026ldquo;phrasing, how it looks, what\u0026rsquo;s on it\u0026rdquo; and the benefit of providing relevant statistics and information. The example brief provided an accessible and functional layout for creating outreach materials that specifically targeted peers whose needs WBSC could assist.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eCourse Structure\u003c/h2\u003e\n \u003cp\u003eWBSC reported the structure of the course to be engaging and accessible. In particular, the case studies with associated activities and varied presentation of information (i.e., text, visuals, podcasts, videos) accommodated for diverse learning styles. One WBSC noted it is always \u0026ldquo;helpful to have different ways of receiving information and different ways of being presented information and\u0026hellip;the modules did a really good job of that.\u0026rdquo; The accessibility and ability to continue to revisit modules as frequently as needed, even post-training, consistently came up. The CHWTP proved to be an ongoing resource, with one WBSC saying, \u0026ldquo;I really appreciate that we can go back\u0026hellip;look back and remind ourselves. I really appreciate that it\u0026rsquo;s still open to us. That\u0026rsquo;s really, really helpful.\u0026rdquo; WBSCs also frequently noted utilizing the PDF module summary handouts, saying they were \u0026ldquo;very, very succinctly made\u0026rdquo; and served as ongoing reference materials.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eCHW Roles and Referrals\u003c/h2\u003e\n \u003cp\u003eWBSCs shared numerous ways they applied learnings from the CHWTP with peers that aligned with typical CHW roles and referrals. Overall, when the APHA CHW definition was shared, participants generally agreed that it represented their understanding of the WBSC role. One WBSC shared, \u0026ldquo;It feels very relatable and kind of exactly what we do on a small scale. We\u0026rsquo;re like a University Health Worker.\u0026rdquo; They went on to share how so much of the daily work WBSCs do involves outreach and being a liaison within the university system to support students and increase their knowledge base and self-sufficiency, mirroring the work of a CHW. Many of the roles associated with CHWs coincide with WBSCs established role as a supportive resource for students, which was confirmed in encounter data identifying social-emotional support, education, and advocacy as primary roles used with peers.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial-emotional Support and Education.\u003c/strong\u003e Given the priority of WBSCs is to support student wellbeing and 96% of encounters were identified as using this role, not surprisingly, the social-emotional support provided was described throughout all of the focus groups by multiple participants. One WBSC spoke about peers who expressed a lot of stigma around seeking counseling and other services such as Office for Disability Equity (ODE) accommodations. Education was needed to address peers social-emotional needs and involved, \u0026ldquo;talking about the stigma and kind of demystifying it\u0026hellip;talking about misconceptions\u0026hellip;and fears around it and what it could imply for certain individuals.\u0026rdquo; Another WBSC reported, \u0026ldquo;I think the hope is to connect students\u0026hellip;work with students on the stigma around getting support with those more difficult kind of personal mental health issues, and then we can help them with\u0026hellip;general wellbeing.\u0026rdquo; This kind of de-stigmatizing education surrounding mental health and the services available was also import for faculty, who at times are not as open to acknowledging the mental health struggles of students.\u003c/p\u003e\n \u003cp\u003eMany WBSCs spoke about the stress and feelings of overwhelm students reported. One WBSC said that hearing, \u0026ldquo;I\u0026rsquo;m just stressed and overwhelmed\u0026rdquo; were the two things that most peers talked about. Another WBSC added, \u0026ldquo;overwhelming stress are the main things that I end up talking with students about\u0026hellip;students are stressed, and they don\u0026rsquo;t always know how to deal with that.\u0026rdquo; Yet another WBSC spoke about listening to peers feeling overwhelmed and \u0026ldquo;not just overwhelmed with the current but really overwhelmed with the future.\u0026rdquo; As one WBSC said regarding social-emotional support, \u0026ldquo;sometimes they [peers] come in, and they\u0026rsquo;re like, \u0026lsquo;honestly\u0026hellip;I don\u0026rsquo;t know what I need. I\u0026rsquo;m just overwhelmed. I don\u0026rsquo;t know where to start.\u0026rsquo;\u0026rdquo; One WBSC acknowledged that social emotional support was almost always needed because \u0026ldquo;everything is interconnected\u0026hellip;The way that we operate in the world impacts our mental health, and our mental health impacts the way that we operate in the world.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdvocacy for Individuals.\u003c/strong\u003e WBSC shared many examples of other advocacy efforts where they worked to empower students to advocate for themselves within the University system. For instance, one WBSC worked with a student trying to change his major who was receiving immense pushback from his advisor who wanted him to stay within the department and talked him out of changing his major. To support their peer, the WBSC explored possible majors and helped him identify and schedule meetings with advisors for majors he was interested in. As a result of this advocacy, the student changed his major to one he was excited about. Similarly, a few WBSCs worked with peers, with and without accommodations from ODE, to draft emails to their professors asking for extensions on assignments. Another WBSC, shared the experience of working with a student athlete who had four concussions in a three-month timespan and had received accommodations from ODE. However, one of the student\u0026rsquo;s professors had failed them before the end of the class. The WBSC was able to partner with the student\u0026rsquo;s advisor to advocate for a grade change and ensure that their accommodations were recognized and followed. These examples highlight the range of advocacy and support provided to individual students based on their specific needs and circumstances.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eCHWTP Content Needed for Campus-Based Programming\u003c/h2\u003e\n \u003cp\u003eWBSCs identified additional content that would be useful to include in a campus-based CHW training specific to the student population. Topics included navigating interpersonal relationships, prevention of substance use, and knowledge related to disordered eating. It is important to note that, while the training emphasized adults, the specific developmental needs of young adults should be considered in implementing campus-based CHW programming.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eNavigation of Interpersonal Relationships\u003c/h2\u003e\n \u003cp\u003eWBSC noted student needs related to interpersonal relationships \u0026ndash; both creating and navigating them. Given many students are in their late teens and early twenties, living away from home for their first time, they report experiencing social isolation and loneliness. One WBSC noted this experience is more prevalent at this time since \u0026ldquo;a lot of students missed out on a lot of social skills because of the pandemic and are stuck in a rut.\u0026rdquo; That WBSC went on to discuss how they\u0026rsquo;ve been helping peers learn how to \u0026ldquo;just talk\u0026rdquo; to other people in hopes of \u0026ldquo;reducing feelings of loneliness, depression, and anxiety, but that that work has been challenging\u0026rdquo;. Another WBSC noted they had been encountering peers who, \u0026ldquo;feel lonely, and they don\u0026rsquo;t know where to find people\u0026hellip;they just kind of end up staying up in their dorm rooms\u0026hellip;not going out and not knowing how to get started building a social network.\u0026rdquo; The CHWTP did not specifically discuss social isolation and its importance when addressing SDOH.\u003c/p\u003e\n \u003cp\u003eHealthy relationships and boundaries, both setting and respecting them, was another pattern in peers seeking support and an area where additional content could be helpful. One WBSC recommended that, \u0026ldquo;a section on understanding what personal and professional boundaries are, and then how to go about setting them in a way that feels comfortable\u0026rdquo; could be helpful for campus-based CHW training because they\u0026rsquo;re seeing students who are struggling with their relationships and navigating things like, \u0026ldquo;how can I set a boundary and still have my partner know that I care about them?\u0026rdquo;. It was also noted that some peers find it rather easy to set a boundary for themselves, but noted that it was, \u0026ldquo;really hard to accept somebody else\u0026rsquo;s boundary\u0026hellip;it\u0026rsquo;s kind of personal sometimes.\u0026rdquo; Another WBSC added a student they were working with who had many encounters with campus police for stalking and was really interested and motivated to learn about boundaries to develop an understanding of them from both sides. Students who are new adults and still feeling the social impacts of the pandemic are struggling within their interpersonal relationships or are lacking the skills/support to seek out connection with others.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eHarm Reduction or Substance Use Education and Supports\u003c/h2\u003e\n \u003cp\u003eHarm reduction as an overarching umbrella was another area WBSCs thought additional training on would be beneficial; Specifically, ways to decrease stigma associated with Narcan training and its accessibility, and how to have discussions about marijuana use. WBSCs noted how challenging talking with peers about substance use can be. One WBSC shared, \u0026ldquo;I have had some unique conversations with students, especially around marijuana\u0026hellip;a lot of students are using it as coping mechanisms for various reasons.\u0026rdquo; They went on to say that, when talking about their usage of marijuana, students are specifically naming it as a way to sleep and de-stress. Overall, harm reduction and its many applications to the variety of concerns students were having was an area of interest for WBSCs.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eKnowledge and Services for Disordered Eating\u003c/h2\u003e\n \u003cp\u003eDisordered eating was a common area of concern in peers and an area where WBSCs thought additional content was needed. WBSCs shared how delicate a topic it is and where knowledge of services to refer students too, would allow them to feel more confident approaching the conversations. One WBSC talked about working with students \u0026ldquo;wanting some support in nutrition or eating\u0026hellip;or that comes up as something their struggling with\u0026hellip;and I\u0026rsquo;m always cautious that I don\u0026rsquo;t want to cause harm by giving nutrition advice\u0026hellip;or what conversations are helpful for them.\u0026rdquo; Another WBSC added that they\u0026rsquo;ve interacted with peers seeking support in nutrition and exercise, but with a stated weight loss goal, and that \u0026ldquo;feels a little touchy.\u0026rdquo; There was an acknowledgment that WBSCs wanted to have the knowledge and skills to talk to students about these things in ways that are supportive and are not going to create harm.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eLimitations\u003c/h2\u003e\n \u003cp\u003eThe main limitation of the study is that WBSCs may have had preexisting knowledge and skills, received through WBSC onboard training or Master of Social Work classes, which may have impacted their assessment of the CHWTP. Yet, findings regarding the relevance and applicability of the CHWTP were likely unaffected. Though focus groups are used frequently in program evaluations, other studies might consider individual interviews to elicit different or diverging opinions and ensure quieter individuals have their views heard. The research design also was limited to reflections during one semester and additional time to reflect could lead to new insights. Future research could benefit from including the perspective of peers served through the program. Additionally, the number of WBSCs utilizing the Encounter Form limited the data collected on peers served and it is unknown whether all encounters were tracked. While this research does not allow for outcomes related to retention and graduation rates, data considering both should be tracked moving forward.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The findings indicate WBSCs applied knowledge and skills learned in the CHWTP in numerous ways in their roles as active supports for peers to address SDOH. Specifically, WBSCs identified content within the MI module to be useful when assessing for SDOH, as well as the Resource Mapping, Grief at Client Loss, Navigating Healthcare Systems and Self-care, and Systems and Community Advocacy Modules. Content included in these modules was particularly relevant for WBSCs in addressing student concerns for which they were initially seeking support and mirror survey data obtained by the American College Health Association (ACHA, 2024).\u003c/p\u003e\n\u003cp\u003eEach semester, the ACHA conducts a National College Health Assessment (NCHA) survey of students from universities across the country on health and wellbeing issues that impact their mental health and academic performance. In Spring of 2024, over 79,000 undergraduate students from 154 universities participated in the NCHA and having challenges similar or adjacent to the topics addressed in the CHWTP, including finances, career, academics, procrastination, personal appearance, the health of someone close to them, and the death of someone close to them (ACHA, 2024). This final listed challenge reiterates the WBSCs assessment of the importance of the Grief at Client Loss module within the CHWTP.\u003c/p\u003e\n\u003cp\u003eWBSCs drew several parallels between their roles and responsibilities and those typically associated with CHWs. While WBSCs primarily provided social-emotional support and de-stigmatizing education to students, they often acted as a liaison within the university system, working with peers to empower them to advocate for their needs.\u0026nbsp;WBSCs also noted how the CHWTP curriculum, particularly the resource mapping, helped them expand their role in engaging with the broader community to support peers.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The literature is clear in acknowledging that institutions of higher education are failing to meet the growing basic and mental health needs of their students. These needs are shown to exceed the infrastructure and capacity of most university systems as they currently function (Lyons et al., 2023). Including CHW training into existing campus-based staff training is an innovative approach to address student needs. WBSCs included in this study deemed the overall training to be valuable as it provided the necessary knowledge and skills to effectively meet student needs and increased their understanding of resources and services available in the community that could be leveraged when student needs exceeded their scope or the university’s support services. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings highlight the need for additional CHW training content tailored to the specific needs and challenges associated with SDOH of students. The WBSCs identified and recommended the inclusion of modules addressing how to navigate interpersonal relationships, harm reduction and/or substance use education and supports, and specific content on disordered eating. The data from the NCHA echoes the sentiments of the WBSCs, with 36% of students surveyed having experienced challenges with intimate relationships over the last 12 months, 42% of students reported having drank alcohol within the last two weeks and 17% reported having used marijuana within that same timeframe, and over 55% of students reported having challenges with their personal appearance (ACHA, 2024). According to the WBSCs, these were areas where they could have used extra training to effectively support students.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;The CHWTP was a grant funded program, and CHWs are typically also funded by grants. Because that funding does not lead to long-term sustainability of programs and ongoing training of peers is needed as students graduate, we recommend embedding CHW training with supervision into existing campus offices and student groups focused on student wellness. The CHWTP provided modules with specialized content intersecting in ways that address SDOH. Addressing SDOH among students promotes health equity, which is interconnected with educational equity for students. Given how important it is to address SDOH among students to promote health and wellbeing and academic success, it is the responsibility of higher education to prioritize health equity in unison with educational equity. This Wellbeing Support Program leveraged the specialized knowledge and skills provided by the CHWTP to address student needs and this research lends insight into the promising and emerging use of CHWs. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report there are no competing interests to declare. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of University of Montana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under award # 6 T29HP46745‐01‐01.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAderholdt, D., Oliveri, C., Clark, J., \u0026amp; Seifert, T. (2019). Informal Peer Mentorship: Listening to the Everyday Student. \u003cem\u003eStrategic Enrollment Management Quarterly, 7\u003c/em\u003e(3), 5-14. \u003c/li\u003e\n\u003cli\u003eAmerican Association of State Colleges and Universities. (2023). \u003cem\u003eIncreasing graduation rates by meeting students\u0026rsquo; basic needs\u003c/em\u003e. AASCU: Telling our story. Retrieved [2024], from https://www.aascutellingourstory.org/promising-practice/increasing-graduation-rates-by-meeting-students-basic-needs/.\u003c/li\u003e\n\u003cli\u003eAmerican Public Health Association. Community health workers. Retrieved [2024], from https://www.apha.org/apha-communities/member-sections/community-health-workers\u003c/li\u003e\n\u003cli\u003eBailey, C. P., Sharma, S., Economos, C. D., Hennessy, E., Simon, C., \u0026amp; Hatfield, D. P. (2020). College campuses\u0026rsquo; influence on student weight and related behaviors: A review of observational and intervention research. \u003cem\u003eObesity Science \u0026amp; Practice, 6\u003c/em\u003e(6), 694-707. https://doi.org/10.1002/osp4.445\u003c/li\u003e\n\u003cli\u003eCaporale-Berkowitz, N.A. (2022). Let\u0026rsquo;s teach peer support skills to all college students: Here\u0026rsquo;s how and why. \u003cem\u003eJournal of American College Health, 70\u003c/em\u003e(7), 1921-1925. https://doi.org/10.1080/07448481.2020.1841775\u003c/li\u003e\n\u003cli\u003eDavis, K., Dettmer, A., Salzer, M., Federici, M., Brusilovskiy, E., Tempesco, R., Baker, K. (2023) OR Mental Health America?? Peer support in mental health initiatives: Learning from the peer support movement. 2023. https://mhanational.org/sites/default/files/reports/College-Peer-Support-Report-2023.pdf\u003c/li\u003e\n\u003cli\u003eEllard, O. B., Dennison, C., \u0026amp; Tuomainen, H. (2023). Review: Interventions addressing loneliness amongst university students: a systematic review. \u003cem\u003eChild and Adolescent Mental Health, 28\u003c/em\u003e(4), 512-523. doi:10.1111/camh.12614 \u003c/li\u003e\n\u003cli\u003eGuzman, P. G., Lange, J. E., \u0026amp; McClain, A. C. (2022). The association between food security status and psychological distress and loneliness among full-time undergraduate students at a minority-serving institution. \u003cem\u003eInternational Journal of Environmental Research and Public Health, 19\u003c/em\u003e(15245), 1-13. https://doi.org/10.3390/ijerph192215245\u003c/li\u003e\n\u003cli\u003eHarris, P. A., Swafford, J., Serdoz, E. S., Eidenmuller, J., Delacqua, G., Jagtap, V., Taylor, R. J., Gelbard, A., Cheng, A. C, Duda, S. N. (2022). MyCap: a flexible and configurable platform for mobilizing the participant voice. \u003cem\u003eJAMIA Open, 5\u003c/em\u003e(2). https://doi.org/10.1093/jamiaopen/ooac047\u003c/li\u003e\n\u003cli\u003eHaywood, M., Garman, A., Johnson, T., Chrisopher, B-A M., Walker III, R. (2016). Advancing community health workers through higher education: Lessons learned from a basic certificate program implementation. \u003cem\u003ePedagogy in Health Promotion, 3\u003c/em\u003e(4), 228-233. https://doi.org/10.1177/2373379916671957 \u003c/li\u003e\n\u003cli\u003eHenry, B., Cormier, C., Hebert, E., Naquin, M., \u0026amp; Wood, R. (2018). Health and health care issues among upper-level college students and relationships to age, race, gender, and living arrangements. \u003cem\u003eCollege Student Journal,\u003c/em\u003e \u003cem\u003e52\u003c/em\u003e, 1, 7-20.\u003c/li\u003e\n\u003cli\u003eHopp, M. D. S., H\u0026auml;ndel, M., Bedenlier, S., Glaeser-Zikuda, M., Kammerl, R., Kopp, B., \u0026amp; Ziegler, A. (2022). The structure of social networks and its link to higher education students\u0026rsquo; socio-emotional loneliness during COVID-19. \u003cem\u003eFrontiers in Psychology, 12\u003c/em\u003e(733867), 1-15. doi: 10.3389/fpsyg.2021.733867\u003cem\u003e \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eKeisler-Starkey, K. \u0026amp; Bunch, L. N. (2024). U.S. Census Bureau, Current Population Reports, P60-284, Health Insurance Coverage in the United States: 2023, U.S. Government Publishing Office, Washington, DC.\u003c/li\u003e\n\u003cli\u003eKoon, K., Wettergreen, S., Hemstreet, B. A., Fink, R. M. (2024). Identification of social determinants of education among pharmacy students: results from a single-institution survey. \u003cem\u003eAmerican Journal of Pharmaceutical Education, 88\u003c/em\u003e(5), 1-5. https://doi.org/10.1016/j.ajpe.2024.100691 \u003c/li\u003e\n\u003cli\u003eLipson, S.K., Phillips, M.V., Winquist, N., Eisenberg, D., \u0026amp; Lattie, E.G. (2021). Mental Health Conditions Among Community College Students: A National Study of Prevalence and Use of Treatment Services. \u003cem\u003ePsychiatric Services, 72\u003c/em\u003e(10), 1126-1133. \u003c/li\u003e\n\u003cli\u003eLyons, K., Magsayo, M., Maheshwari, R. (2023). Loneliness \u0026amp; college students: A needs assessment regarding georgetown student experiences in a post-virtual world. \u003cem\u003eGeorgetown Scientific Research Journal, 3\u003c/em\u003e(2), 41-49. https://doi.org/10.48091/gsr.v3i2.70 \u003c/li\u003e\n\u003cli\u003eMalcarney, M-B., Pittman, P., Quigley, L., Horton, K., Seiler, N. (2017). The changing roles of community health workers. \u003cem\u003eHealth Services Research, 51\u003c/em\u003e(1), 360-382. doi: 10.1111/1475-6773.12657\u003c/li\u003e\n\u003cli\u003eMcAfee, N. W., Schumacher, J. A., Carpenter, R. K., \u0026amp; Ahmad, Z. (2023). College student mental health, treatment utilization, and reduced enrollment: Findings across a state university system during the COVID-19 pandemic. \u003cem\u003eJournal of American College Health, 71\u003c/em\u003e(6), 1-11. https://doi.org/10.1080/07448481.2023.2248495\u003c/li\u003e\n\u003cli\u003eMcCarville, E., Martin, M. A., Pratap, P., Pinsker, E., Seweryn, S. M., \u0026amp; Peters, K. E. (2024). Understanding critical factors associated with integration of community health workers into health and hospital systems. \u003cem\u003eJournal of Interprofessional Care, 38\u003c/em\u003e(3), 507-516. https://doi.org/10.1080/13561820.2023.2183183 \u003c/li\u003e\n\u003cli\u003eMental Health America (2019). \u003cem\u003eThe State of Mental Health in America\u003c/em\u003e. https://mhanational.org/sites/default/files/2019-09/2019%20MH%20in%20America%20Final.pdf\u003c/li\u003e\n\u003cli\u003eNational Heart, Lung, and Blood Institute. Role of community health workers. Retrieved [2024], from https://www.nhlbi.nih.gov/education/heart-truth/CHW/Role\u003c/li\u003e\n\u003cli\u003eReppond, H. (2019, December). Many college students struggle to have their basic needs met. \u003cem\u003eThe SES Indicator\u003c/em\u003e. http://www.apa.org/pi/ses/resources/indicator/2019/12/college-students-needs\u003c/li\u003e\n\u003cli\u003eStice, E., Rohde, P., Gau, J.M., Bearman, S.K., Shaw, H. (2023). An Experimental Test of Increasing Implementation Support for College Peer Educators Delivering an Evidence-Based Prevention Program. \u003cem\u003eJournal of Consulting and Clinical Psychology, 91\u003c/em\u003e(4), 208-220. https://doi.org/10.1037/ccp0000806\u003c/li\u003e\n\u003cli\u003eTerrell, K. R., Boggs, C., Adelstein, D., Hamadi, H. Y., Kulikov, E., Martinez, V., \u0026amp; Borreca, M. (2023). Mental health initiatives: Providing stress management, wellness, and mindfulness workshops on college campuses. \u003cem\u003eJournal of American College Health\u003c/em\u003e, 1-8. https://doi.org/10.1080/07448481.2023.2222830\u003c/li\u003e\n\u003cli\u003eTinto, V. (1993). \u003cem\u003eLeaving college: Rethinking the causes and cures of student attrition\u003c/em\u003e (2\u003csup\u003end\u003c/sup\u003e ed.). University of Chicago Press. \u003c/li\u003e\n\u003cli\u003eTucker, K., Sharp, G., Qingmin, S., Scinta, T., \u0026amp; Thanki, S. (2020). Fostering Historically Underserved Students\u0026rsquo; Success: An Embedded Peer Support Model that Merges Non-Cognitive Principles with Proven Academic Support Practices. \u003cem\u003eThe Review of Higher Education, 43\u003c/em\u003e(3), 861-885. https://doi.org/10.1353/rhe.2020.0010\u003c/li\u003e\n\u003cli\u003eUniversity of Montana (2023, July). \u003cem\u003eCensus Enrollment Numbers\u003c/em\u003e. Institutional Research. https://www.umt.edu/institutional-research/enrollment/census-enrollment.php\u003c/li\u003e\n\u003cli\u003eUniversity of Montana (2023). University of Montana Fall 2023 Census Enrollment Report. Retrieved from https://www.umt.edu/institutional-research/documents/census-reports-accessible/202370_census.pdf\u003c/li\u003e\n\u003cli\u003eU.S. Department of Health and Human Services. Healthy people 2030. Retrieved [2024], from https://health.gov/healthypeople/priority-areas/social-determinants-health\u003c/li\u003e\n\u003cli\u003eYao, N., Kowalczyk, M., Gregory, L., Cheatham, J., DeClemente, T., Fox, K., Ignoffo, S., and Volerman, A. (2023). Community health workers\u0026apos; perspectives on integrating into school settings to support student health. \u003cem\u003eFrontiers in Public Health, 21\u003c/em\u003e(11), https://doi.org/ 10.3389/fpubh.2023.1187855. \u003c/li\u003e\n\u003cli\u003eYang, M., \u0026amp; Chau, A. W. L. (2011). Social involvement and development as a response to the campus student culture. \u003cem\u003eAsian Pacific Education Review, 12\u003c/em\u003e(3), 393-402. https://:doi.org/10.1007/s12564-011-9149-x\u003c/li\u003e\n\u003cli\u003eYang, M., \u0026amp; Chau, A.W. L. (2011). Social involvement and development as a response to the campus student culture. \u003cem\u003eAsia Pacific Education Review,\u003c/em\u003e \u003cem\u003e12\u003c/em\u003e, 393\u0026ndash;402. https://doi.org/10.1007/s12564-011-9149-x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Community health worker, higher education, social determinants of health, peer support, college student health","lastPublishedDoi":"10.21203/rs.3.rs-8272882/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8272882/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The aim of the research was to explore the ways campus-based Wellness Program peer supports, applied learnings from a Community Health Worker Training Program (CHWTP) to address the Social Determinants of Health (SDOH) of students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e: Fourteen campus-based, embedded peer supports titled Wellbeing Support Coordinators (WBSCs) enrolled in the CHWTP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: WBSCs participated in three focus groups and collected data on peer meetings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Findings indicate that WBSCs applied knowledge and skills learned from the CHWTP to address SDOH among students in myriad ways and in ways that aligned with typical CHW roles and referrals (e.g., social-emotional support and advocacy). CHW training content tailored to the specific needs and challenges of college students was recommended.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Embedding CHWs in college campuses could provide the support needed to ensure that universities are equipped to address the SDOH of students.\u003c/p\u003e","manuscriptTitle":"Community Health Worker Training in Higher Education for Addressing Social Determinants of Health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 13:51:40","doi":"10.21203/rs.3.rs-8272882/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6e3ceeb-ee43-4aef-b80a-50c7c3a66fb6","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T08:42:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 13:51:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8272882","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8272882","identity":"rs-8272882","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}