Project on Community Health Worker (CHW) Policy and Practice
Now Available C3 Project Reports 2016
The Project on Community Health Worker (CHW) Policy and Practice was created in late 2011 as a special statewide and national initiative of the Institute for Health Policy.
The Project’s purpose is to serve as a statewide and national leadership resource for advancement of the CHW workforce through the provision of research, policy analysis and stakeholder education. The Project Core Team includes national leaders in CHW policy development and research who are active in the American Public Health Association (APHA). The Core Team also has access to a broad network of other experts in specific aspects of the CHW field, and will seek public and private grants and contracts to support its work.
The Project is committed to the promotion of CHW leadership and self-determination through CHW involvement in these activities and support for CHW networks and associations at the state and national levels. The Center will support CHW roles in both provision of health care and community-based public health.
Community Health Workers
APHA Policy Statement 2009-1 defines CHWs 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 CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.”
CHWs, also known as Promotores de Salud, outreach workers, lay health advisors and other titles, have been contributing to public health for decades, but have come to greater prominence in recent years through a growing body of research attesting to their contributions, recognition as an occupation by the U.S. Department of Labor and prominent mention in the Patient Protection and Affordable Care Act. State and federal policy, however, have not kept pace with the growing interest in this workforce. At least a dozen states are seeing significant movement toward more supportive policies around CHWs.
Key aims of the Project are to:
- support development of CHW policy and financing strategies for CHW employment;
- promote awareness and recognition of CHW roles and contributions; and
- build CHW leadership capacity and offering technical assistance to CHWs, their networks/associations and their employers.
The Project and its core team have been engaged in the following initiatives since its inception:
- Research under contract from the Texas Department of State Health Services for a report to the Legislature on the “desirability and feasibility” of increased CHW employment in Texas (the report was submitted in December 2012)
- A CHW workforce survey for the Indiana State Department of Health
- A policy study for Public Health Seattle/King County on development of internal policies on CHW employment and linkages between public health and provision of safety net health care services
- A contract with a national CDC REACH project for evaluation and technical assistance services to 15 project sites in eight states
- Technical assistance to CHW state-level policy initiatives in Arizona, California, the District of Columbia, Florida, Michigan, Mississippi, Nebraska , New York, New Mexico, Nevada, Virginia and Wisconsin, and to multiple states through the National Governors Association and the National Conference of State Legislatures
- CHW and supervisor training services in Maryland, Nevada, Texas and Wisconsin
- A national study of CHW scope of practice and training curriculum content from leading programs in 6 states, for the National AHEC Organization
- Revision and upgrading of an e-learning series for the CDC, “Promoting Policy and Systems Change to Expand Employment of CHWs”
- Renewal of the annual Unity Conference, the largest national conference of and for CHWs
- Support for the Grantee CHW Learning Collaborative of the Center for Medicare and Medicaid Innovation
- A forthcoming white paper by the National Council for Behavioral Health on CHWs and the integration of behavioral health in primary care, for HRSA and SAMHSA
- A convening of national public sector interest groups and federal officials to track state implementation of new Medicaid rules allowing payment for provision of preventive services by non-licensed individuals
- Advisor panels for the National Peer Support Collaborative Learning Network, the Transition Clinics Network and an AHRQ-funded Johns Hopkins project on IT support for CHWs
- Conference planning for the Northwest Regional Primary Care Association, the DC Primary Care Association and Communities Joined in Action
CHWs as Leaders
The Project is committed to the long-term development of participation by CHWs in leadership roles in research and policy development. To that end, the Project is seeking to develop advisory bodies and internship opportunities for experienced CHWs in all of its future activities. Since the CHW discipline is not based in conventional academic preparation, special efforts will be needed to orient CHWs to the expectations of research and policy development. We believe, however, that such efforts are necessary for the long-term growth and stability of the CHW profession.
For more information
Please contact Dr. Héctor Balcázar, lead faculty for the Project, at Hector.G.Balcazar@uth.tmc.edu or 915-747-8507.
C3 Project 2016
The Community Health Worker Core Consensus (C3) Project: 2016 Recommendations on CHW Roles, Skills, and Qualities [PDF]
Understanding Scope and Competencies: A Contemporary Look at the United States Community Health Worker Field
Progress Report of the Community Health Worker (CHW) Core Consensus (C3) Project: Building National Consensus on CHW
Core Roles, Skills, and Qualities [PDF]
Health Resources and Service Administration (HRSA)
HRSA Community Health Worker National Workforce Study 2007 [PDF]
Policy and Practice
Project on Community Health Worker Policy and Practice Occasional Paper No 1:
Community Health Workers in Local Health Departments [PDF]
Project on Community Health Worker Policy and Practice Occasional Paper No 2:
Commentary on Indiana CHW Workforce Assessment [PDF]
Texas Community Health Worker Study (December 2012)
Prepared by the Department of State Health Services (DSHS) and the Health and Human Services Commission (HHSC), with support from research conducted by the Project on CHW Policy and Practice. Texas H.B. 2610, 82nd Legislature, Regular Session, 2011 (§48.102, Texas Health and Safety Code) charged the state of Texas to undertake a study of the “desirability and feasibility” of employing promotores or community health workers (CHWs) in Texas and to explore methods of funding and reimbursement.
The UTHSCH-SPH research team conducted a targeted literature assessment, multiple interviews (state and national), eight focus workshops, and an online survey of CHW employers and potential employers, and consulted with the Promotor(a) or Community Health Worker Training and Certification Advisory Committee.
Access the report online athttp://www.dshs.state.tx.us/mch/chw/progrule.aspx
Other publications by Project Core Team Members
Alvillar M, Quinlan J, Rush CH, Dudley DJ. Recommendations for Developing and Sustaining Community Health Workers (Report from the Field). Journal of Health Care for the Poor and Underserved, August 2011. 22 (2011): 745–750.
Balcazar H, Rosenthal EL, De Heer H, Aguirre M, Flores L, Puentes F, Cardenas V, Duarte M, Ortiz M, and Schulz L. (2010). A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008. Preventing Chronic Disease. 2010; 7(2). http://www.cdc.gov/pcd/issues/2010/mar/09_0106.htm
Balcazar H, Rosenthal EL, De Heer H, Aguirre M, Flores L, Vasquez E, Duarte M, Schulz L. (2009). Use of a community based participatory research to disseminate baseline results from a cardiovascular disease randomized community trial for Mexican Americans living in a U.S.-Mexico border community. Education for Health, Vol. 22, Issue 3. http://www.educationforhealth.net/
Balcazar HG, Rosenthal EL, Brownstein JN, Rush CH, Matos S., Hernandez L. Community Health Workers Can Be a Public Health Force for Change in the United States: Three Actions for a New Era. American Journal of Public Health, December 2011.
Brownstein JN, Hirsch GR, Rosenthal EL, Rush CH. Community Health Workers “101” for Primary Care Providers and Other Stakeholders in Healthcare Systems. Journal of Ambulatory Care Management July 2011. 34(3) 210-220.
Center for Health Economics and Policy, University of Texas Health Science Center at San Antonio. Community Health Worker National Workforce Study. HRSA Bureau of Health Professions (2007) [Rush CH, Rosenthal EL, uncredited contributing authors] http://bhpr.hrsa.gov/healthworkforce/reports/chwstudy2007.pdf
Family Health Foundation (Rush CH). The Community Health Worker and Putting Prevention into Practice (PPIP) under Medicaid Managed Care. San Antonio: Health Education Training Centers Alliance of Texas, 1998.
Gilkey MB, Garcia C, Rush C. Professionalization and the experience-based expert: Strengthening partnerships between health educators and community health workers. Health Promotion Practice, March 2011 (12.2) pp. 178-182.
Peña S, Rosenthal EL. Chapter 12: Health Issues in Texas Chapter in The Colonias Reader: Economy, Housing and Public Health in U.S.- Mexico Border Colonias. Editors: AX Esparza, and AJ Donelson. University of Arizona Press, 2010.
Rosenthal EL, Wiggins N, Brownstein JN, Johnson S, Borbon IA, Rael R, Guernsey de Zapien J, Ingram M, Meister J, McLeod J, Williams L Lacey Y, Blondet L. The Final Report of the National Community Health Advisor Study: Weaving the Future. A policy research project funded by the Annie E. Casey Foundation. University of Arizona. 1998. http://www.chw-nec.org/pdf/CAHsummaryALL.pdf
Meister JS, Moya EM, Rosenthal EL, Robinson JG, Careaga K. Community Health Worker Evaluation Toolkit. University of Arizona. 2001. https://apps.publichealth.arizona.edu/CHWToolkit/
Rosenthal EL. Chapter: The Evolution of the Community Health Worker Field. in Foundations for Community Health Workers. Editors: T. Berthold, J. Miller, and A. Avila. Jossey-Bass, 2009.
Rosenthal EL, Brownstein JN, Rush CH, Hirsch GR, Willaert AM, Scott JR, Holderby LR, Fox DJ. Community Health Workers, Part of the Solution. Health Affairs, July 2010. http://content.healthaffairs.org/cgi/content/abstract/29/7/1338
Rosenthal EL, de Heer H, Rush CH, Holderby LR. Focus on the Future: A Community Health Worker Research Agenda By and For the Field. Progress in Community Health Partnerships: Research, Education, and Action. Johns Hopkins University, Fall 2008.
Rosenthal EL, Macinko J. Preface: Journal of Ambulatory Care Management. Lippincott, Williams and Wilkins. Special Issues: Community Health Workers: Taking Their Place in Systems of Care. Vol 34, No. 3, July-September 2011. 208-209
Rosenthal EL, Wiggins N, Ingram M, Mayfield S, Fernandez L, Aguirre A, Guernsey de Zapien J. Community Health Workers: Studies of Then and Now. Journal of Ambulatory Care Management. Vol 34, No. 3, July-September 2011.1247-259
Rosenthal EL, DeHeer D, Rush CH, Holderby LR. Community Policy Brief - Focus on the Future: A Research Agenda by and for the U.S. Community Health Worker Field. Progress in Community Health Partnerships: Research, Education, and Action. The Johns Hopkins University Press. Fall, 2008. Vol. 2.3. 183-184.
Rush CH. Commentary: Return on Investment from Employment of Community Health Workers. Journal of Ambulatory Care Management, April-June 2012.
Rush CH. (2011) “Promoting Policy and Systems Change to Expand Employment of CHWs” Online E-learning series. Centers for Disease Control and Prevention. http://www.cdc.gov/dhdsp/pubs/chw_elearning.htm
Rush CH. Community Health Workers and Your Health Center: the Time is Now. Health Center News (Northwest Regional Primary Care Association), December 14, 2011 (http://www.nwrpca.org/health-center-news.html)
Rush CH, Rosenthal EL (2007). Building a National Research Agenda for the Community Health Worker Field: Proceedings of “Focus on the Future:” an Invitational Conference. Community Resources LLC, San Antonio, Texas. http://bit.ly/b0ZAub
Rush CH. Implementation of the Children’s Health Insurance Program in Texas. Texas Journal of Rural Health, Summer 2000.
Rush CH. Community Health Workers and Medicaid Managed Care: Some Lessons Learned. Invited article for New Professions SPIG newsletter, American Public Health Association, 1998.