Who are Community Health Workers?

Defining the role

In simple terms, a community health worker (CHW) is someone who has a job related to helping people in their community stay healthy. However, the specific title and responsibilities of a CHW can be different depending on where they work and/or live.

In this lesson, we will cover the basics of who community health workers are, what kind of work they do, how they fit into the modern healthcare system, and what is expected of them in terms of skills and qualities.

Who are Community Health Workers?

A community health worker (CHW) is defined as:

A frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison or link between the community they work in and health and/or social services to facilitate access to services and improve the quality and cultural competence of service delivery.

In the past, health workers in the United States were usually part of local programs and were mostly volunteers. But things started to change in the 1960s when some people began to get paid jobs as community health workers.

Over the past 15 years, the importance of community health workers has gained recognition and appreciation. This was highlighted in 2010 when the US Department of Labor established a specific job category for CHWs. Additionally, their role was acknowledged as a professional field in the Patient Protection and Affordable Care Act.

There are more than 100 different job titles that describe the work of community health workers. Some of them include:

• Promotores de Salud
• Peer Counselors
• Patient Navigators
• Community Health Advocates
• Peer Educators
• Patient Care Navigators
• …and many more

Where CHWs work

The model of community health workers is a good fit for many places in a community, and CHWs can operate within or between a variety of care settings.

Where CHWs work

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CHWs can serve in many types of roles as they grow in their career, including:

• Entry level
• Generalist
• Advanced specialist (e.g., diabetes, substance use, age-specific focus)
• Trainer
• Supervisor

Integration into the formal healthcare system

In the past, community health workers often worked with local groups like churches, shelters, and food pantries to help people with their health and social needs. Nowadays, healthcare organizations have started to recognize the value of community health workers. They want to improve the quality of care they offer and address social needs that affect people's health.

Currently, CHWs are being integrated into healthcare in various ways. For example:

• They work with social workers to help with social needs, sign people up for public benefits, and create partnerships with community groups.
• They provide health education along with a nurse care manager.
• They visit people's homes or go with them to medical appointments to help with their care plans and encourage them to stay engaged in their healthcare.

Making the role of community health workers more official will help them become a part of the healthcare system in the following ways:

• It will show doctors, nurses, pharmacists, and others in healthcare how community health workers can work together with them to improve patient experiences and outcomes.
• It will give employers and healthcare payers confidence that community health workers have the necessary skills for their roles.
• It will create a standard for training and certification, which will give community health workers more job options because their skills can be used in different settings.

Which best describes why making the CHW role more official matters for the healthcare system?

CHW certifications and certificate programs

In the United States, different states are at different stages when it comes to creating certification processes for community health workers. Some states already have certifications run by either the government or private organizations. Other states are considering or working on developing certifications. Additionally, some states have CHW Associations that support community health worker programs.

State approaches to CHW certification

In different parts of the country, there are schools that provide certificate programs for CHWs. These programs give you credits for completing the training. They usually last at least two semesters and include hands-on experience through internships.

It's important to know that certificate programs are not the same as certification. Certificate programs give you a certificate to show that you finished the program's coursework. On the other hand, certification means getting official recognition from a governing body.

Sample courses from the City College of Chicago's CHW Certificate Program

• Introduction to Community Health Work
• Public Health and the Study of Disease and Epidemics
• Nutrition, Exercise, and Disease
• Mental Health Issues

CHW Roles and Competencies Support Pyramid

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The 10 core CHW roles

In 2018, the Community Health Worker Core Consensus (C3) Project finished a four-year effort with diverse stakeholders. They gathered information about how CHWs are used in different ways across the country. The result was a recommended list of CHW roles and skills, anchored in the CHW Roles and Competencies Support Pyramid above.

The 10 C3 core CHW roles

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Match each core CHW skill, as outlined by the C3 Project, with the description that best fits it.