Community Health Workers are trusted members of the communities they serve.  They are also known as Tribal Community Health Representatives, promotores de salud, care navigators, community health or wellness advisors, family health advocates, community health outreach workers, peer health advocates, lay health advisors, and many similar titles.

CHWs facilitate access to services, improve quality, and reduce disparities by serving as ‘bridges’ between their communities and health/social service systems. CHWs build individual and community capacity by increasing health knowledge and self-sufficiency through activities such as: outreach, community education, informal counseling, social support, and advocacy. They provide practical services to individuals, families, and communities. CHWs can be found working in health and human service organizations, schools, faith communities, public health systems, and community health clinics.

In 2010, Community Health Workers obtained a unique labor classification, which is described below:

Several national workforce studies have documented the core roles and skills of CHWs, which are broadly agreed upon by national and state CHW professional associations, and recognized by federal agencies and state departments of health.

Links to the studies:

• National Community Health Advisor Study (1998)
• Community Health Worker National Workforce Study (2008)
• National Community Health Workers Advocacy Survey

Seventeen states have initiated or completed processes for setting standards for the training and certification of CHWs, reflecting national trends and, in many instances, guided by the best practice of having CHW leadership and input into those state processes. Advocates for certification believe it will standardize scope of practice, improve the quality of CHW training, increase CHW skills and recognition, and encourage reimbursement policies.  Others are concerned that standardization will erode the unique role of CHWs as cultural brokers, diminish trust by setting CHWs apart from their fellow community members, and make seasoned, successful CHWs jump through unnecessary hoops. There are also concerns related to the possible barriers certification may create for CHWs related to access to training, linguistic and literacy considerations in training and assessment, and immigration status.

The health extension infrastructure in a state, and health extension agents themselves, can play a vital role in training a CHW workforce and advocating for integration of CHWs into care systems. Health extension agents can provide training on chronic diseases, setting up group visits in a practice led by CHWs, and cultural competency.

For example, in New Mexico, there was a need for increased CHW capacity-building on issues such as diabetes, medical terminology, cultural humility and other topics. These topics have been specifically requested by CHWs and CHW trainers based on special interest and specifically tailored to meet the needs and enhance their practice based on their scope of work of the CHWs. Health extension agents (HEROs) identified the gap, realizing that training should be culturally and linguistically tailored to the needs of the CHWs and their academic background and learning needs as non-traditional adult learners. Through the use of technology and considering the budget constraints, CHWs from various rural and urban communities connected via telehealth to receive the training from HEROs, leading to increased capacity among the various groups of CHWs statewide. HEROs continue to offer ongoing trainings to keep this workforce updated, as well as offer trainings based on needs that arise at the CHW and community level.

CHWs may serve as vital members of the patient care team within primary care settings. The UNM HSC Office for Community Health, in collaboration with the Southwest Center for Health Innovation, developed a population health model for the integration of CHWs into clinical settings called “I-PaCS: Integrated Primary Care and Community Support”. Click here for access to information about the model and key tools.

In New Mexico, one sustaining funding source for HEROs has been Medicaid Managed Care. Forman and Kelliher described “Status One” patients as the top 1% of patients in any healthcare system consume 20% of the resources, the top 5% consuming 50%. The underlying causes of their high use are often social and economic, known as the “social determinants” of illness which traditional hospital and clinic-based health systems deal with poorly. The writer Atul Gawande popularized this problem in his New Yorker article called “Hot Spotters.” The degree to which social determinants contribute to ill health rises with degree of poverty. The University implemented a program supported by two Managed Medicaid programs in the state. The program trained and deployed community-based, culturally and linguistically competent community health workers to serve as client support navigators for these high risk patients. (ref) HEROs served the program in part as CHW trainers and in one site, as employers. The outcome was a significant improvement in quality of care patients received and a significant reduction in cost of ED visits, hospitalizations and prescribed medications. This program has now spread to a third of the counties in the state and to 16 states in which one of the companies, Molina Healthcare, Inc. manages care.

The following are priority areas CHWs can address for Medicaid Managed Care members:

• Poverty
• Health literacy
• Transportation
• Food
• Housing
• Training
• Jobs
• Assistance with enrollment in entitlement programs
• Lack of funding for such services as literacy classes, GED, ESL
• Gas for transportation
• Behavioral health
• Knowledge of how to navigate health system
• Chronic disease education (ex. asthma, diabetes)
• Access to local physicians
• Time constraints interfering with prioritizing appointments
• Medication needs
• Utility assistance
• Support for substance abuse

The following “photo voice” project was developed by community health workers participating in a two-semester-long course at the Taos branch campus of UNM. CHWs taking the course were given cameras and asked to take pictures that told the stories of their communities, as well as to describe what they saw occurring in the photos: