Translating Workforce Development Policy Interventions for Community Health Workers: Application of a Policy Research Continuum

Fulmer, Erika; Barbero, Colleen; Gilchrist, Siobhan; Shantharam, Sharada; Bhuiya, Aunima; Taylor, Lawrence W.; Jones, Christopher D.

doi:10.1097/phh.0000000000001123

Cited by 7 publications

(16 citation statements)

References 11 publications

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“…This study describes the processes achieved in implementing statewide CHW workforce development initiatives as of September 2020. Findings are relevant to state level planning and evaluation frameworks ( 21 , 22 , 27 ). We found that states have largely implemented CHW workforce development initiatives using the processes reflected in our conceptual model.…”

Section: Discussionmentioning

confidence: 97%

Processes for Implementing Community Health Worker Workforce Development Initiatives

Barbero

Mason²,

Rush³

et al. 2021

Front. Public Health

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Introduction: The objective of this observational, cross-sectional study was to identify, document, and assess the progress made to date in implementing various processes involved in statewide community health worker (CHW) workforce development initiatives.Methods: From September 2017 to December 2020, we developed and applied a conceptual model of processes involved in implementing statewide CHW initiatives. One or more outputs were identified for each model process and assessed across the 50 states, D.C., and Puerto Rico using peer-reviewed and gray literature available as of September 2020.Results: Twelve statewide CHW workforce development processes were identified, and 21 outputs were assessed. We found an average of eight processes implemented per state, with seven states implementing all 12 processes. As of September 2020, 45 states had a multi-stakeholder CHW coalition and 31 states had a statewide CHW organization. In 20 states CHWs were included in Medicaid Managed Care Organizations or Health Plans. We found routine monitoring of statewide CHW employment in six states.Discussion: Stakeholders have advanced statewide CHW workforce development initiatives using the processes reflected in our conceptual model. Our results could help to inform future CHW initiative design, measurement, monitoring, and evaluation efforts, especially at the state level.

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Section: Discussionmentioning

confidence: 97%

Processes for Implementing Community Health Worker Workforce Development Initiatives

Barbero

Mason²,

Rush³

et al. 2021

Front. Public Health

Self Cite

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“…Most states have some level of CHW programs. In moving from action or knowledge to policy, 15 states have enacted legislation to establish CHW scope of practice, 6 have enacted laws that authorize a certification process, and 5 of the states with certification processes authorize the creation of standardized curricula on the basis of core competencies and skills training (Fulmer et al, 2020). Minnesota, and more recently South Dakota, are the only states that allow Medicaid payments for credentialed CHWs (Association of State and Territorial Health Officials, 2017) (Hynes, 2020).…”

Section: Chronic Care Clinicmentioning

confidence: 99%

Making the Case for Community Health Workers in Georgia

McCray

Haynes

Proeller

et al. 2020

JGPHA

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Background: Community Health Workers (CHW) can be an important and evidence-based response to reduce unnecessary morbidity and mortality in chronic diseases like asthma, heart disease, diabetes, cancers, HIV, and maternal/child health, and mental health. Georgia's urban and rural diverse populations are at high risk from many of these conditions. Largely the contributors to the poor outcomes for these health issues are non-medical and include social determinants of health, i.e., access to care, transportation, inadequate housing, and health literacy. CHWs can increase the capacity of individuals, families, and communities to improve their health. Historically, concerns of CHWs on healthcare teams to address these issues have centered on standardized training, credentialing, and challenges about the unique roles and responsibilities of CHWs. In this article, we discuss the evidence of effectiveness and return on investment as CHW interventions prove to reduce visits to the Emergency Departments and unnecessary hospitalizations from chronic diseases. They serve to connect social and medical resources and ensure patients do not fall through gaps, especially among the vulnerable populations. Methods: We conducted a scan of CHW research studies, projects and programs that demonstrate effectiveness and return on investment. We also reviewed CHW efforts in Georgia, timeline, and stakeholders to formally recognize, advance professionalism, and fully integrate CHWs as essential and sustainable members of the healthcare team. Results: There is significant evidence for the effectiveness of CHWs and the cost-benefit of CHW programs. Georgia has ongoing formal efforts to establish a sustainable and well-trained CHW workforce. Conclusions: A well-trained CHW workforce can be an important response to the transformation of Georgia's community health practice and status, decreasing excess morbidity and mortality, and advancing health equity. Georgia should build on its own considerable experience with CHWs and the evidence of effectiveness to adopt policies to fully integrate CHWs into the healthcare system.

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“…14,25 For example, a recent study of state telehealth laws and opioid prescribing practices found that 17 states had laws to address prescribing limitations, opioid treatment, patient plan review, and professional collaboration, 15 another study compared states' community health worker laws, identifying differences in scope of practice and training requirements. 16 While policy surveillance is an underutilized but potentially useful tool for health services researchers, 23 it does not address the issue of overlapping regulations. 26 Regulatory overlap of assisted living policies can occur through enforcement activities from multiple regulatory agencies or bodies, such as facility licensure by a health and human services agency, state Nurse Practice Acts that govern licensed nurses, and rules from local jurisdictions, such as county zoning regulations.…”

Section: Introductionmentioning

confidence: 99%

“…11 For example, hospitals, or units within hospitals, might serve patients with acute, traumatic, long-term, or mental health needs, or patients who are indigent. 12,13 Studies have used legal epidemiology 14 and health policy methodologies 15,16 to document the influence of policies using the state as the unit of analysis.…”

Section: Introductionmentioning

confidence: 99%

“…For example, hospitals, or units within hospitals, might serve patients with acute, traumatic, long‐term, or mental health needs, or patients who are indigent 12,13 . Studies have used legal epidemiology 14 and health policy methodologies 15,16 to document the influence of policies using the state as the unit of analysis. While these approaches are essential for analyzing policy impact and variation across states, regulatory overlap often results in variation within a state 8,17 .…”

Section: Introductionmentioning

confidence: 99%

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Connecting policy to licensed assisted living communities, introducing health services regulatory analysis

Smith

Carder

Bucy

et al. 2021

Health Services Research

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Objective: To document dementia-relevant state assisted living regulations and their changes over time as they pertain to licensed care settings.Data Sources: For all states, current directories of licensed assisted living communities and state regulations for each year, 2007-2018, were obtained from state agency websites and Nexis Uni, respectively. Study Design:We identified multiple types of regulatory classifications for each state and documented the presence or absence of specific dementia care provisions in the regulations for each type by study year. Maps and summary statistics were used to compare results to previous research and document change longitudinally. Data Collection/Extraction Methods:We used a policy analysis approach to connect communities listed in directories to applicable regulatory text. Then, we employed policy surveillance and question-based coding to record the presence or absence of specific policies for each classification and study year.Principal Findings: Our team empirically documented provisions requiring dementiaspecific training for administrators and direct care staff, and cognitive impairment screening for each study year. We found that 23 states added one or more of these requirements for one or more license types, but the states that had these provisions for all types of licensed assisted living declined from four to two. Conclusions:We identified significant, previously undocumented, within-state policy variation for assisted living licensed settings between 2007 and 2018. Using the regulatory classification instead of the state as the unit of analysis revealed that many policy adoptions were limited to dementia-designated settings. This suggests that people living with dementia in general assisted living are not afforded the same protections. We call our approach health services regulatory analysis and argue that it has the potential to identify gaps in existing policies, an important endeavor for health services research in assisted living and other care settings.

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Translating Workforce Development Policy Interventions for Community Health Workers: Application of a Policy Research Continuum

Cited by 7 publications

References 11 publications

Processes for Implementing Community Health Worker Workforce Development Initiatives

Processes for Implementing Community Health Worker Workforce Development Initiatives

Making the Case for Community Health Workers in Georgia

Connecting policy to licensed assisted living communities, introducing health services regulatory analysis

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