Johns Hopkins Medicine Community Health Workers Meet Patients Where They Are

More than 100 have been certified by Maryland to guide patient care outside of the hospital.

Workers meet patients hero
Published in Community Health - Community Health Stories

When Robert Gibson needed eye surgery, he was referred to the Johns Hopkins Howard County Medical Center’s eye care facility. There, Gibson was connected with the Johns Hopkins community care team to assist with his medical issues and transportation needs.

“When they came to my house, they sat with me for a long time talking,” he says. “They helped me fill out different forms because I couldn’t see some of the forms too well. They were so nice.”

As Amanda Toohey, the senior project manager of population health for Johns Hopkins Howard County Medical Center’s community health worker training program, explains, these workers are trained by the state at the medical center. The program has certified more than 100 people — two are now contributing to patient care as part of the Johns Hopkins Howard County Medical Center’s community care team.

“Community health work is rapidly growing,” says Toohey. “They are nonclinical health professionals who help people navigate health challenges. Social determinants of health can be a huge barrier, so community health workers provide education, applications and information. They connect patients with more resources and help them find affordable things. The goal is to empower the patients and give them the tools they need to succeed. We want to make sure there’s a system in place so patients can advocate for themselves.”

Toohey says it is vital for community health workers to be involved with and integrated into their communities.

“These are folks who are members of the communities they service and speak the patient’s language literally and figuratively,” Toohey says. “They strive to explain things in an understandable way. They’re able to build trust with the patients because they get to know them and understand what hesitations they might have.”

Gibson’s community health worker, Sandy Roschli, is at the heart of his care team. He says she is extremely supportive.

Before working with Roschli, Gibson was already connected to a care team at MedStar Health. He meets regularly with a social worker, a nurse, and a doctor. They work in tandem with the Johns Hopkins Howard County Medical Center’s community care team.

“I appreciate the support from everyone,” Gibson says. “Sandy is a nice woman. She follows up every week with me and makes sure I have everything I’m supposed to have. A lot of times, I forget about my appointments. She calls and reminds me, which I appreciate a lot. She also brought me a calendar and put all my appointments in there, so then I started putting them in myself.”

Roschli explains that she was trained to address the entire spectrum that determines health outcomes: housing, food and medical care. Community health workers act as bridges when patients are discharged from a hospital. After an initial assessment, they find out what the person’s needs are and if there are barriers to wellness. They help ensure the needs are being met, and if patients need support, community health workers put it in place. Roschli says the community care team strives to work collaboratively with other social services.

“We’re here to make sure that when you go home, you are getting the medical care, community services and support you need,” she says. “We work with the clients for up to 90 days. Our goal is to give people the tools they need to better manage how they’re functioning in the community. Sometimes, you have to get creative. If one door closes, we look for what other door we can open and try to overcome barriers to care. We help the clients to take small steps so as not to overwhelm them. We’re not here to tell people what they should or shouldn’t do. We’re just here for support.”

Roschli’s undergraduate degree is in gerontology from Towson University, and she was recently accepted into the Master of Social Work program at the University of Maryland. Roschli worked in the social services field for several years before becoming a community health worker. She has also been a licensed child care provider and a stay-at-home mother. Now that her children are teenagers, the community health worker program has provided an opportunity for her professional growth.

“I really love helping people, and I love helping the aging population,” Roschli says.

Her supervisor, Joey Lee, says Roschli has played an essential role in a grant-funded diabetes self-management training program. She often engages patients at the bedside and refers them to diabetes educators. Roschli conducts weekly follow-ups with each patient.

“When the patients stay healthy and connected to the needed resources, we will call it a success,” Lee says. “Sandy is always on top of following up with clients and ensuring their needs are met. She is a strong advocate for the patients and always has their well-being as her ultimate goal.”

For more information about the community health worker training program, visit