Community Health Workers (CHWs)

Community Health Workers (CHWs)

• CHWs are lay members of a community
• They may be paid or volunteer
• They work in both urban and rural settings
• CHWs typically share demographic traits with the community they serve, such as ethnicity, language, socioeconomic status, and life experiences
• CHWs are often the first point of contact a community member has with a health or social service agency
• As frontline agents of change, CHWs help reduce health disparities in underserved communities
• CHWs provide interpretation and translation services
• CHWs provide culturally appropriate health education and information
• CHWs help people get the care they need
• CHWs give informal counseling and guidance on health behaviors
• CHWs advocate for individual and community health needs
• CHWs provide direct services, like first aid and blood pressure screening
• Common CHW titles and their prevalence include:
  • Promoter/Promoter (health): 25%
  • Community Health Representative: 45%
  • Outreach Specialist/Worker: 37%
  • Community Health Educator: 34%
  • Community Health Worker: 2%
• Over 87 more titles exist

The History of CHWs

• The World Health Organization (WHO) published a book in 1975 titled Health by the People
• The book consisted of case studies from different countries where CHWs were the foundation of innovative, small-scale community health programs
• This book was part of the intellectual foundation for the International Conference on Primary Health Care at Alma-Ata, USSR (now Kazakhstan) in 1978
• The conference was sponsored by the WHO and UNICEF
• The conference resulted in the Declaration of Alma-Ata
• The Declaration of Alma-Ata was known as the achievement of “Health for All” by the year 2000 through primary health care (PHC)
• The Declaration of Alma-Ata defined a role for CHWs, who “rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries, and community workers as applicable ... suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community"

CHW Employment Trends

• CHW training requirements are state-specific
• Most states have an agency that oversees their CHW workforce
• Community Health Worker Associations are local, state, or regional organizations
• They advocate for CHWs and provide training, resources, and networking opportunities
• The National Association of Community Health Workers (NACHW)’s mission is to unify the voices of CHWs and strengthen the profession's capacity to promote healthy
• Continuous learning for CHWs includes:
  • Formal education
  • Certification programs
  • Workshops
  • Seminars
  • Online courses
• Core competencies and advanced skills are components of skill development
• On-the-job training allows CHWs to apply their knowledge and skills in real-world settings
• National estimates for Community Health Workers:
  • Employment: 58,550
  • Employment RSE: 1.8%
  • Mean hourly wage: $25.30
  • Mean annual wage: $52,610
  • Wage RSE: 0.6%
• Percentile wage estimates for Community Health Workers:
  • 10%: $17.10 hourly, $35,560 annually
  • 25%: $19.47 hourly, $40,490 annually
  • 50% (Median): $23.17 hourly, $48,200 annually
  • 75%: $29.90 hourly, $60,740 annually
  • 90%: $36.53 hourly, $75,980 annually

CHW Program Models

• Promotora de Salud/Lay Health Worker
• Member of Care Delivery Team
• Care Coordinator/Manager
• Screening and Health Educator
• Outreach and Enrollment Agent
• Community Organizer and Capacity Builder

CHW Program Models Details

• Promotora de Salud/Lay Health Worker:
  • CHWs are members of the target population
  • Roles include patient advocate, educator, mentor, outreach worker, and translator
• Member of Care Delivery Team:
  • CHWs work alongside other medical professionals on a clinical care team
  • They take vital signs, calculate BMIs, perform disease screenings, provide first aid care, and counsel on medication
  • Also aid with chronic disease self-management, and patient navigation to improve access to healthcare services
• Care Coordinator/Manager:
  • CHWs support individuals with complex health conditions to navigate the healthcare system
  • Providing health information and community resources to patients
  • Coordinating transportation, making appointments, and ensuring patients receive appointment reminders.
• Screening and Health Educator:
  • CHWs deliver screenings and health education to the target population
  • Provide health screenings
  • Educate about chronic disease prevention, nutrition, safety, and environmental hazards, as well as stress management and smoking cessation
• Community Organizer and Capacity Builder:
  • CHWs promote community action and gather support and resources from community organizations to carry out new activities
• Outreach and Enrollment Agent:
  • CHWs conduct intensive home visits
  • Deliver psychosocial support, engage individuals and families in healthcare and supportive services, improve maternal/infant/child health, and provide education

CHW Scope of Practice

• The scope of practice varies based on the state and employing organization
• Most common responsibilities fall within the four domains listed
• Access: Increase access to care to help prevent disparities or inequities in healthcare
• Advocacy: Advocate for the individual needs of others
• Education: Provide health education and help people manage their chronic conditions
• Navigation: Teach people how to use health and social services and refer them
• CHWs cannot:
  • Give medical advice
  • Analyze clinical data
  • Make clinical decisions regarding a patient's plan of care
  • Give meds
  • Provide medical interventions without being trained
  • Provide formal counseling or therapy

CHW Core Roles and Skills

• CHW Core Skills include:
  • Communication Skills
  • Interpersonal & Relationship-Building Skills
  • Service Coordination & Navigation Skills
  • Capacity Building Skills
  • Advocacy Skills
  • Building Individual and Community Capacity
  • Individual & Community Assessment
  • Outreach Skills
  • Professional Skills and Conduct
  • Evaluation and Research Skills
  • Knowledge Base
• CHW Core Roles for a CHW include:
  • Cultural Mediation Among Individuals, Communities, and Health & Social Service Systems
  • Care Coordination, Case Management, and System Navigation
  • Advocating for Individuals and Communities
  • Providing Direct Services
  • Conducting Outreach
  • Providing Culturally Appropriate Health Education and Information
  • Providing Coaching and Social Support
  • Building Individual and Community Capacity
  • Implementing Individual and Community Assessments
  • Participating in Evaluation and Research