Community health workers (CHWs) are frontline public health workers who have a close understanding of the community they serve. This trusting relationship enables them to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.
Community health workers also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. (American Public Health Association, 2008)
In January 2009, the Office of Management and Budget officially published the 2010 Standard Occupational Classifications (SOC) listing in the Federal Register. The 2010 SOC includes a unique occupational classification for Community Health Worker (SOC 21-1094).
Community health workers are dedicated individuals who function along a continuum ranging from individual and community development to service delivery and promoting community empowerment and social justice. They often help link people to needed health care information and services.
Community health workers work in all geographic settings, including rural, urban and metropolitan areas; border regions (colonias); and the Native American nations. Although their roles vary depending on locale and cultural setting, they are most often found working in underprivileged marginalized communities where people may have limited resources; lack access to quality health care; lack the means to pay for health care; speak English fluently; or have cultural beliefs, values and behaviors different from those of the dominant Western health care system. In these communities, community health workers play an integral role in helping systems become more culturally appropriate and relevant to the people the systems serve.
Community health workers typically have deep roots or shared life experiences in the communities they serve. They share similar values, ethnic background and socio-economic status and usually the same language as the people they serve.
The community health worker serves as a bridge between the community and the health care, government and social service systems.
The community health worker’s responsibilities may include:
- Helping individuals, families, groups and communities develop their capacity and access to resources, including health insurance, food, housing, quality care and health information
- Facilitating communication and client empowerment in interactions with health care/social service systems
- Helping health care and social service systems become culturally relevant and responsive to their service population
- Helping people understand their health condition(s) and develop strategies to improve their health and well being
- Helping to build understanding and social capital to support healthier behaviors and lifestyle choices
- Delivering health information using culturally appropriate terms and concepts
- Linking people to health care/social service resources
- Providing informal counseling, support and follow-up
- Advocating for local health needs
- Providing health services, such as monitoring blood pressure and providing first aid
- Making home visits to chronically ill patients, pregnant women and nursing mothers, individuals at high risk of health problems and the elderly
- Translating and interpreting for clients and health care/social service providers
Community health workers go by many titles, depending on where they work, who they work for and what they do. Common titles include health coach, community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter and public health aide. In Spanish-speaking communities, community health workers are often referred to as health promoters or promotores(as) de salud.
The role of the community health worker started as a societal position, appointed by and responsible to the community’s members. Advocates and activists dedicated their time and talents to ensuring that local people received the health information, resources and health care services they needed.
The success of their efforts has caused many government agencies, nonprofit organizations, faith-based groups and health care providers to create paid positions for community health workers to help reduce, and in some cases eliminate, the persistent disparities in health care and health outcomes in underprivileged communities. The organizations benefit by gaining access to information about health care needs in these communities, which they can use to improve the design of health services.
Community health workers (CHWs) often live in the community they serve. They spend much of their time traveling within the community, speaking to groups, visiting homes and health care facilities, distributing information and otherwise connecting with local people.
Some community health workers work in health facilities, providing case management, client education, interpretation and follow-up care. Others are employed by government agencies and nonprofit groups to provide community organizing, health education, Medicaid enrollment and preventive care services in the field.
Community health workers may:
- Staff tables at community events
- Provide health screenings, referrals and information
- Help people complete applications to access health benefits
- Visit homes to check on individuals with specific health conditions
- Drive clients to medical appointments
- Deliver health education presentations to schoolchildren and their parents and teachers
Community health workers hired by health care agencies often have a disease or population-based focus, such as promoting the health of pregnant women or children, improving nutrition, promoting immunization or providing education around a specific health issue, such as diabetes or HIV/AIDS.
Community health workers are defined by the trust they receive from the communities they work in. To be effective, community health workers must secure, preserve and develop that trust. This can put the community health worker in a difficult position, particularly when there is a disconnect between program goals and community priorities. For example, communities that rely on their own traditional medical practitioners (such as native healers) may resist efforts by a community health worker to refer patients to Western health care resources. Community health workers must be able to balance their responsibilities to the community with their employer’s agenda.
Salary Range and Outlook
Throughout the United States, the community health worker field is burgeoning, both in interest and demand, yet the practice lacks definition, standards and openly available training opportunities. The field is also rapidly expanding into new areas of health and community wellness as community health workers continue to improve chronic disease management programs, health insurance enrollment, immunization drives, HIV/AIDS treatment, access to mental health services and maternal-child health interventions.
Becoming a community health worker is almost an idiosyncratic process, involving individuals seeking opportunities to help their community through a patchwork of employment opportunities, often known only by word of mouth and with highly varied job requirements and situations. This is unfortunate in that the lack of community health worker identity and standards of practice has led employers to contribute to the confusion about who community health workers are and what they do.
Community health worker salaries vary depending on local economies, wage scales and demand. In major metropolitan areas, recommended starting annual salaries range from $35,000 to $42,000, while senior community health workers can earn $42,000 to $52,000 and supervising community health workers may earn $52,000 to $60,000. Community health managers generally earn salaries above $60,000.
Community health workers often are hired to support a specific health initiative, which may depend on short-term funding sources. As a result, community health workers may have to move from job to job to obtain steady income. This short-term categorical funding of health services is a challenge to the stability and sustainability of the community health worker practice.
Community health worker (CHW) training and educational requirements vary across states, cities, employers and employment sectors. The field lacks unified training standards, so trainings tend to be generally local and sometimes employer driven.
A few states have regulated training through various methods, including by developing a standardized curriculum, yet there are very limited examples that follow the recommendations in published promising practices. Until a core role is agreed upon, the development of a nationally recognized curriculum framework will continue to vary.
Recently, however, states are starting to develop training and credentialing criteria more informed by community health worker leadership and by documented promising practices.
The setting of community health worker training programs also varies widely. Some states have developed college-based training while others have implemented community-based training resources.
Today, community health workers are being recognized more and more for their contribution to community organizing, increasing access to health and improving health outcomes. This increased attention to the community health worker role by health care providers, community organizations and government officials has created interest in providing appropriate training and supervision.
Qualifications for community health workers vary widely. Some employers require only a high school diploma, while others require a college degree.
Community health workers typically receive up to 100 hours of additional training on the job, through classroom study, job mentoring or a combination.
Community health workers are not licensed, but employers may set continuing education requirements.
Several states have begun to develop credentialing programs for community health workers. An effort is also underway to develop state and national standards for training and capacity building for community health workers.
One initiative in particular is focused primarily on collecting and sharing promising practices among community health workers to ensure that training benefits from and is responsive to their experiences, needs and knowledge level. This unique effort was in part a response to the limited success of efforts by states and other regulators to impose standards on the practice without input from community health workers and leaders.
Also in light of this growing interest in regulating the practice, several independent professional associations of community health workers have recently organized to address the rapidly emerging policy issues relevant to their practice.
- Center for Sustainable Health Outreach
- Community Health Worker National Education Collaborative
- Community Health Worker Network of New York City
- Massachusetts Association of Community Health Workers
- National Association of Community Health Representatives (Native Americans)