A Patchwork Quilt of State Approaches to CHW Training

May 30, 2019 | ASTHO Staff

Community health workers (CHWs) are front-line public health workers who have a unique understanding of the communities they serve through shared and lived experience. CHWs provide a wide range of services including advocacy, health education, patient navigation, as well as social-emotional support. According to NIH, some of the key outcomes of CHWs’ services include improved access to and use of healthcare services, better understanding and enhanced communication between community members and the health and social services systems, improved adherence to healthcare provider recommendations, and reduced utilization of emergency and specialty services.

While national standards for CHW training do not currently exist, the CHW Core Consensus (C3) Project has set a foundational framework for CHW training by defining ten roles and eleven core skills vital to effective CHW training curriculums and relevant in a variety of settings. Additionally, effective CHW training programs may offer different levels of training (e.g., a core competency program and additional courses on specialty topics), offer trainings in a variety of settings, involve experienced CHWs in program design and instruction, as well as include fieldwork and mentoring. CHW trainings are often provided by local entities, such as community-based organizations, state and local governmental public health agencies, and academic and education centers.

State Approaches to CHW Training Programs

States select and adopt CHW training models that best fit the unique needs of their population and workforce. For example, some states require that training programs be approved by the state (often states with some kind of CHW statewide certification program), while other states do not have such requirements in place. Additionally, there is a distinction between training standards and certification requirements, which have been adopted by a small number of states. While the two concepts are inter-related, having completed a CHW core competency training does not necessarily mean an individual has become certified as a CHW, unless the state confirms. The state-specific examples described below reflect the diversity of state approaches to training and certification.

First, states may certify the training entity, with all curricula meeting a defined set of standards. The Massachusetts Department of Public Health refers CHWs and CHW supervisors to eight training programs in community health education centers, community colleges, schools of public health, and other organizations. Trainers offer a curriculum that meets a defined set of ten core competencies, developed over two decades of consensus building in Massachusetts among key stakeholders.

Since 2003, the Texas Department of State Health Services has had certified training programs and individual instructors. An individual CHW is required to complete a state-approved training program in order to obtain state certification, but the state also allows individuals to apply for certification based on paid or volunteer work experience (a “grandfathering” approach). Meanwhile, the California Future Health Workforce Commission recently concluded that the state should set standards for training programs and did not recommend the creation of a certification program for individual CHWs.

States may also standardize a common, statewide curriculum, so that all CHWs who complete the training are presumed eligible for either Medicaid reimbursement under a specific state plan amendment or statewide certification. Minnesota has a state-wide, standardized, competency-based CHW educational program based in accredited, post-secondary schools and overseen by the Minnesota State Colleges and Universities System. CHWs who complete the voluntary training are eligible to participate in Medicaid and their employers can be reimbursed for certain patient education services. However, this policy is not described by the state or by the Minnesota CHW Alliance as CHW certification per se, since it only creates eligibility for Medicaid funding in limited circumstances.

The New Mexico Department of Health’s Office of CHWs has a standardized curriculum and offers voluntary certification to CHWs who are either “grandfathered in” based on work experience or who complete a department of health-approved training program using this curriculum. Similarly, the Michigan CHW Alliance has developed its own core skills training program, which is widely accepted as a standard across the state, though not formally recognized by the state government. The alliance is now licensing the curriculum to other training providers, and many employers accept completion of this program as de facto certification of a CHW’s qualifications.

States that do not offer state-approved certification for individual CHWs may support the CHW workforce by providing trainings. For example, Washington state offers CHW training through the state’s department of health, designed around interim core competencies for CHWs (subject to revision based on a recently completed task force study). Upon completion of the competency-based training program, the CHW receives a certificate of completion, which can be beneficial for professional development. In Nevada, there are currently two state-approved CHW training programs. One is a training developed by the Nevada System of Higher Education and is offered at two local community colleges. Additionally, the Nevada Division of Public and Behavioral Health offers a training course quarterly. CHWs receive a certificate of completion, but certification is not in place in the state.

CHWs play a vital role in bridging clinical and community connections. States are using various models to train and support CHWs based on their own contexts and needs. However, national models like the C3 Project offer recommendations for consideration related to CHW core roles, skills, and qualities. ASTHO will continue monitoring trends in CHW training.