Community Health Workers


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.


Project Goals


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:




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 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 at


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).

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.

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]

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.

Meister JS, Moya EM, Rosenthal EL, Robinson JG, Careaga K.  Community Health Worker Evaluation Toolkit.  University of Arizona.  2001.

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.

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.

Rush CH. Community Health Workers and Your Health Center: the Time is Now.  Health Center News (Northwest Regional Primary Care Association), December 14, 2011 (

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.

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.



IHP Hector Balcazar Héctor G. Balcázar, Ph.D. Collaborator 915-747-8507 Bio Mailing Address UT School of Public Health - El Paso 1101 N. Campbell CH 400 El Paso, Texas 79902
IHP CHW Fernando PinedaFernando Pineda, B.S. Research Affiliate 720- 495-3180 Bio
IHP Lee Rosenthal E. Lee Rosenthal, Ph.D., M.S., M.P.H. Collaborator Phone: 915-799 3100 Bio
IHP Carl Rush Carl H. Rush, M.R.P. Collaborator 210-775-2709 Bio
IHP Jacqueline Scott Jacqueline R. Scott, J.D., M.L. Collaborator 202-409-1442 Bio