Community Health Advocate

Brief Description

Are you ready to make a real difference in people's lives? Join the Harris Center for Mental Health and IDD as a Community Health Advocate. The Community Health Worker (CHW) serves as a frontline member of the Integrated Primary Care and Behavioral Health Home, supporting adults with Serious Mental Illness (SMI), including individuals with co-occurring chronic physical health conditions and complex social needs.

The CHW provides outreach, engagement, care navigation, and barrier reduction services to promote continuity of care, improved health outcomes, and long-term stability. Operating within a CCBHC framework and utilizing a “Channels of Reveal” approach, the CHW connects individuals who are disengaged from care or cycling through hospital, crisis, justice, and community systems to evidence-based treatment and wraparound supports. This role emphasizes relationship-based engagement, whole-person care, and coordination across behavioral health, primary care, and community partners.

• Conduct proactive, community-based outreach through “channels of reveal,” including emergency departments, inpatient units, crisis services, justice settings, and other community locations where individuals with untreated or poorly managed SMI frequently present.

• Engage individuals who are treatment-naïve, disengaged from care, or identified as high utilizers of emergency or inpatient services.

• Connect individuals with SMI to Integrated Health Home and CCBHC services using warm handoffs.

• Support appointment scheduling, care engagement, and follow-through with recommended treatment plans.

• Serve as a trusted connector between individuals and the multidisciplinary care team, including behavioral health clinicians, primary care providers, nursing staff, peer support specialists, and external partners.

• Assist individuals in navigating healthcare appointments, preparing for visits, understanding care plans, and following treatment recommendations.

• Support medication access and adherence in collaboration with the care team.

• Identify and address social determinants of health impacting stability and recovery, including housing, food insecurity, transportation, employment, legal issues, and access to benefits.

• Connect individuals to appropriate community resources and social service supports.

• Support individuals during high-risk transitions such as hospital discharge, emergency department visits, or community reentry following incarceration.

• Conduct follow-up outreach to reinforce discharge instructions, coordinate follow-up appointments, and support medication continuity to reduce avoidable crises and relapse.

• Document outreach, engagement, navigation, and support activities in the electronic health record.

• Participate in team huddles, case conferences, and care planning meetings.

• Contribute to quality improvement activities and support data collection related to engagement, retention, and utilization outcomes.

• Perform other related duties as assigned.

• High School Diploma or General Education diploma.

• Texas Department of State Health Services (DSHS)–Certified Community Health Worker or ability to obtain certification within required timeframe.

• Completion of DSHS-approved training and continuing education in accordance with state requirements.

• Compliance with Texas CHW Scope of Practice and Code of Ethics.

• Experience working with individuals with Serious Mental Illness and complex social needs preferred.

• 1 year of related experience.

• Ability to adapt to constant changes in a fast-paced environment.

• Maintain absolute confidentiality of all work-related matters and communicate effectively and tactfully within all levels of the agency.

• Provide emotional support, encouragement, and motivation to patients.

• Demonstrate knowledge of the correlation of physical & mental health challenges with the population served.

• Collaborate effectively with others.

• Strong communication skills.

• Identify & offer…