Progress in Community Health Partnerships: Research, Education, and Action

• To develop a consensus definition of community health workers (CHW) informed by practitioners of the field.

• To document CHW training needs, both in content and training methods.

• To identify CHW concerns for potential impact of the growing regulation on certification and reimbursement.

• To engage CHW leadership and input to inform the study.

• Uncertainty among employers, funders, stakeholders, and CHWs themselves regarding the definition of a CHW.

• Confusion about CHW training needs, both in content and training methods.

• Lack of research is hampering the development of training, certification, and reimbursement strategies and policies.

• CHWs in New York have developed a consensus definition with uniformity of opinion on core elements of the definition.

• Community trust is central to CHW identity, essential to the conduct of the practice, and inviolate.

• We identified CHW training needs in the area of core competencies often neglected by health care systems, employers, or academia.

• We identified characteristics of a credentialing process that would be acceptable to CHW practitioners and help advance and support the field.

• Community-based participatory research (CBPR) methods provided unique insights into the definition, training needs, and credentialing concerns of CHWs.

• CHWs.

• CHW employers, including community- and faith-based organizations, government agencies, hospitals, community health centers, and other health care providers.

• CHW program funders, including state, local, and national governments, foundations, and philanthropies.

• Primary care providers.

• Chronic disease management programs.

• Public health professionals and other allied health workers. [End Page 201]

• CBPR is uniquely adaptable for research to address the growing interest in CHWs and their practice.

• CBPR provides a mechanism for CHWs to inform policy makers and regulators about their credentialing desires and concerns and the potential impact of the growing certification and regulation movement across the country.

• The CHW definition generated through the CBPR methods applied in this study is a potentially acceptable standard.

• CPBR provided a view into a potentially acceptable process for developing a CHW credential. CHWs in New York City are generally supportive of credentialing, but only for a process that involves them and their leaders in its development.

• This study has identified various content and methods training parameters that could lead to acceptable statewide credentialing standards for CHWs. CHWs in New York City have articulated specific training needs in two categories, including core competencies and health-specific topics.

1. a Core competencies include skills training in communication, documentation, behavior change, adult learning, informal counseling, goal setting, negotiation/mediation, conflict resolution, and community organizing.

2. b Training in health-specific topics includes chronic disease management, prevention and control, health care systems, insurance eligibility and enrollment, and immigration issues in health.

3. • CHWs recognize the individual and organizational maturity required of institutions to adapt to their specific training needs, both in content and methods, and are eager to advance a supportive relationship.

4. • CHWs identified themselves as nontraditional adult learners and therefore demand that educational institutions interested in providing training develop adult learning, participatory and interactive teaching skills to better serve the practice. CHWs further mentioned that evaluation of their competence should involve performance evaluation as opposed to standard test taking.

5. • CHWs are uniquely qualified to help address some of the persistent disparities in health and health care access for isolated populations traditionally hard to reach with more conventional strategies.

6. • CHWs must be involved in any certification, credentialing or training design from the very beginning. The integration of CHWs at all levels in program planning, implementation, and evaluation will provide the strongest foundation for creating a truly responsive educational program that builds on the CHWs’ knowledge of the communities where they live and work. Every opportunity in program development and implementation must be taken to ensure the voice of CHWs are included and respected.

7. • This study exposes the need for further inquiry into the feasibility of CHW-centered and CHW-led credentialing. [End Page 202]