Emerging Consensus on Community Health Workers

There are an estimated 120,000 community health care workers (CHWs) in the United States and ample evidence that they provide critical and valuable services. Yet there are no national standards defining what a CHW does as a member of the health care team or what criteria might be used to qualify CHWs for reimbursement through sustainable funding such as Medicaid.

A new survey, conducted in New York State by researchers at Columbia University’s Mailman School of Public Health, helps fill the gap. It found that community health workers and employers in New York were in consensus on five main roles of a CHW: outreach and community organizing, case management and care coordination, home visits, health education and coaching, and system navigation. Researchers also found a consensus view that community health workers should be members of the community in which they work.

The survey of 226 community health workers and 44 employers identified four to six tasks needed to accomplish each of these roles, amounting to a total of 27 tasks in which the CHWs and employers are expected to be competent. Virtually all of CHWs indicated their willingness to complete additional training if needed to attain professional standards; employers also supported standardized training. Results appear in August 16 online edition of American Journal of Public Health.

Compared to an earlier study conducted in 2005, the new study indicated a major increase in mutual understanding between CHWs and their employers on the CHW scope of practice. “This consensus on workforce standards comes at a critical time as health care teams in New York and elsewhere grapple with the best ways to incorporate CHWs into the new Medicaid care models, patient-centered medical homes, and Health Homes,” says lead author Sally E. Findley, PhD, Professor of Clinical Population & Family Health and Professor of Clinical Sociomedical Sciences.

The professional standards promise to guide the development of job descriptions and allocation of responsibilities between CHWs and other members of the health care team. This is particularly important for Health Homes, where the CHWs may be employed by community-based organizations or other agencies partnering with the health care providers. “Clarity of roles and tasks is essential for coordination and smooth functioning of the team,” notes Dr. Findley.

“With the Accountable Care Act poised to bring health care coverage to many of those who are currently uninsured,” says Dr. Findley, “community health workers are in a unique position to break down cultural and linguistic barriers that could otherwise prevent many from benefiting from this care.”

The new study was undertaken in collaboration with the Community Health Network of New York City, and other statewide CHW stakeholders, including regional CHW associations and CHW employers. Funding was provided by grants from the New York State Health Foundation and the New York Department of Health.