Success Story Form
  • Success Story Writing Guide

  • Please complete the following form with your organization's CHW/CHR success story. To view examples, go to www.chwsd.org/success-stories/.

  • Background of CHW/CHR Program

    Include a summary about your CHW/CHR program. There is a place at the end of the form to include an overall organizational background summary, so this is the location to include information specifically about your CHW/CHR program.

    Things to consider include:

    • Location of CHW/CHR program (include the communities served, and, if in a larger organization, area within organization)
    • If your program has been around for more than a few years, consider sharing a brief (one or two sentences) history of your program
    • Population(s) served through program
    • Number of CHWs within program
    • How the organization’s CHWs/CHRs are trusted members of and/or have unusually close understanding of the community they serve
    • What sets your program apart from other programs and other organizations/services that also serve the population you serve (i.e., Do your CHWs/CHRs speak mulitple languages?)
  • Patient/Client Background

    Give the background of the patient/client and why they were referred to or connected with the CHW/CHR program.

    Things to consider include:

    • What SDoH needs are not being met for the patient/client, why are they not being met, and for how long they have not been met
    • What details will help the reader better understand the situation (without sharing any private patient/client information)
  • Services Provided

    Provide a detailed narrative of the actions taken by the CHW/CHR to help meet the needs of the patient/client.

    • How did the CHW/CHR build trust with the patient/client
    • Which SDoH needs were addressed and how
    • What outside services/programs were involved in meeting these needs
    • What was the timeframe of these services
  • Patient/Client Success

    Detail any successes (big or small) as well as patient/client improvements, testimonials, or other relevant information to summarize the successes of the patient/client.

    Also consider including:

    • What evidence shows that trust was built between the patient/client and the CHW/CHR and/or your organization
    • Include any measures that would show success (i.e., cost savings, improved health outcomes, etc.)
  • Additional Information

    This is the section to include an overall organizational background summary. Include an overview of the entire organization, locations across SD, etc.

  • Other Information to Include

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