"Nothing About Us Without Us": Insights from State-level Efforts to Implement Community Health Worker Certification

Wennerstrom, Ashley; Sugarman, Meredith; Rush, Carl H.; Barbero, Colleen; Jayapaul-Philip, Bina; Fulmer, Erika; Shantharam, Sharada; Moeti, Refilwe; Mason, Theresa

doi:10.1353/hpu.2021.0070

Cited by 5 publications

(8 citation statements)

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“…Participants in this study also stressed the limits of certification as a tool to advance the CHW workforce. Our findings echo existing literature asserting that certification does not guarantee employment or Medicaid financing for CHWs [ 38 , 39 , 44 , 45 ] but continues to be a motivation for financial sustainability for the workforce [ 22 ]. This is a timely finding as California’s Department of Health Care Services (the agency responsible for administering Medicaid in California) has taken federal actions to finance CHW-delivered services for Medi-Cal members and California’s managed care organizations have begun integrating CHWs into their standard of care [ 20 , 30 , 46 , 47 ].…”

Section: Discussionsupporting

confidence: 85%

“…Peer-reviewed CHW certification literature is limited, and existing scholarship largely omits CHW perspectives on setting their own workforce standards [ 19 ], despite their expertise and deep knowledge of the organizational and systemic levers necessary to implement community programs. Echoing literature on certification [ 17 , 22 , 33 – 37 ], we found conflicting perspectives within and between all stakeholders groups on certification. Our findings confirm some findings from a 2021 study that explored perspectives on certification from seven states that have implemented or considered implementing certification [ 22 ] (e.g., CHW participation in decision making, concerns about certification requirements excluding CHWs).…”

Section: Discussionmentioning

confidence: 87%

“…Echoing literature on certification [ 17 , 22 , 33 – 37 ], we found conflicting perspectives within and between all stakeholders groups on certification. Our findings confirm some findings from a 2021 study that explored perspectives on certification from seven states that have implemented or considered implementing certification [ 22 ] (e.g., CHW participation in decision making, concerns about certification requirements excluding CHWs). In this study, some participants affirmed the financial and career opportunities offered by certification, while others feared it may inadvertently exclude vulnerable CHWs and the communities they serve and downplay advocacy at the heart of CHW identity.…”

Section: Discussionmentioning

confidence: 87%

“…Approximately 15 states have implemented certification based on training [ 44 , 46 , 58 ]. Echoing a recent peer-reviewed study of certification, this certification approach would limit requirements of formal education, English-language proficiency, history of incarceration, and legal residence status [ 19 , 22 , 57 , 59 , 60 ] to continue to foster the diversity that is a key feature of an effective CHW workforce. Most importantly, this approach respects promotores de salud and other CHWs that may not need certification for their work by not mandating certification and acknowledging their contributions [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…A key policy question is whether and how a state should introduce certification for CHWs [ 21 , 22 ]. The CHW workforce stands at a crossroads: to advocate for certification or oppose it.…”

Section: Introductionmentioning

confidence: 99%

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Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

et al. 2022

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Background For community health workers (CHWs) and promotores de salud (CHWs who primarily serve Latinx communities and are grounded in a social, rather than a clinical model of care), the process of certification highlights the tension between developing a certified workforce with formal requirements (i.e., certified CHWs) and valuing CHWs, without formal requirements, based on their roles, knowledge, and being part of the communities where they live and work (i.e., non-certified CHWs). California serves as an ideal case study to examine how these two paths can coexist. California’s CHW workforce represents distinct ideologies of care (e.g., clinical CHWs, community-based CHWs, and promotores de salud) and California stakeholders have debated certification for nearly twenty years but have not implemented such processes. Methods We employed purposive sampling to interview 108 stakeholders (i.e., 66 CHWs, 11 program managers, and 31 system-level participants) to understand their perspectives on the opportunities and risks that certification may raise for CHWs and the communities they serve. We conducted focus groups with CHWs, interviews with program managers and system-level participants, and observations of public forums that discussed CHW workforce issues. We used a thematic analysis approach to identify, analyze, and report themes. Results Some CHW participants supported inclusive certification training opportunities while others feared that certification might erode their identity and undermine their work in communities. Some program managers and system-level participants acknowledged the opportunities of certification but also expressed concerns that certification may distance CHWs from their communities. Program managers and system-level participants also highlighted that certification may not address all challenges related to integrating CHWs into health care systems. CHWs, program managers, and system-level participants agreed that CHWs should be involved in certification discussions and decision making. Conclusions To address participant concerns, our findings recommend California stakeholders build a voluntary certification process structured with multiple pathways to overcome entry barriers of traditional certification processes, maintain CHW identity, and protect diversity within the workforce. Positioning CHWs as decision makers will be critical when designing state certification processes.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

“…A key policy question is whether and how a state should introduce certification for CHWs [ 21 , 22 ]. The CHW workforce stands at a crossroads: to advocate for certification or oppose it.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

et al. 2022

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A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

Fulmer,

Rasool,

Jackson

et al. 2024

Prev Sci

Self Cite

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In the USA, structural racism contributes to higher rates of cardiovascular disease (CVD) including hypertension, heart disease, and stroke among African American persons. Evidence-based interventions (EBIs), which include programs, policies, and practices, can help mitigate health inequities, but have historically been underutilized or misapplied among communities experiencing discrimination and exclusion. This commentary on the special issue of Prevention Science, “Advancing the Adaptability of Chronic Disease Prevention and Management Through Implementation Science,” describes the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention’s (DHDSP’s) efforts to support implementation practice and highlights several studies in the issue that align with DHDSP’s methods and mission. This work includes EBI identification, scale, and spread as well as health services and policy research. We conclude that implementation practice to enhance CVD health equity will require greater coordination with diverse implementation science partners as well as continued innovation and capacity building to ensure meaningful community engagement throughout EBI development, translation, dissemination, and implementation.

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Public Health Training Centers' Support for Community Health Workers: Case Studies of Needs Assessment, Training, and Student Field Placement Initiatives

Lederer

Barrett

Shorter

et al. 2022

Journal of Public Health Management and Practice

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Context: Community health workers (CHWs) are vital frontline public health workers. Given their trusted roles and connection to and understanding of the communities they serve, CHWs are able to link underserved communities to resources and public health agencies. With CHWs' increased prominence in the public health workforce, calls have been made for expanding and supporting CHW training and career development opportunities. Program: Public health training centers (PHTCs) are mandated to assess public health workforce needs, provide evidence-based professional development trainings, and increase students' aptitude for working with underserved and underresourced communities through applied practice experiences. Public health training centers can support CHWs in each of these areas. Design: Case studies from 3 PHTCs are provided to exemplify how PHTCs are well positioned to support the critical CHW workforce via assessment, training, and student field placements.Implementation: A regional needs assessment survey with a designated section for CHWs, the provision of accessible and relevant CHW training, and CHW-focused student field placements were implemented in PHTC Regions 6/South Central, 1/New England, and 5/Great Lakes, respectively.

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"Nothing About Us Without Us": Insights from State-level Efforts to Implement Community Health Worker Certification

Cited by 5 publications

References 0 publications

Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

Don’t change who we are but give us a chance: confronting the potential of community health worker certification for workforce recognition and exclusion

A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context

Public Health Training Centers' Support for Community Health Workers: Case Studies of Needs Assessment, Training, and Student Field Placement Initiatives

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