Community Health Workers: the basics Center for Health Workforce Research and Policy Speaker Series The George Washington University January 16, 2014 Community Health Workers: the basics Carl H. Rush, MRP University of Texas-Houston Institute for Health Policy

What’s your definition of CHW?

Community Health Worker Definition American Public Health Association (1) The CHW is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW 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 Worker Definition - APHA (2) The CHW also builds 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. APHA Policy Statement 2009-1, November 2009

What Is Distinctive About CHWs? (1) Do not provide clinical care Generally do not hold another professional license Expertise is based on shared life experience (and often culture) with people served We have noted earlier that the occupation of CHW is different from conventional occupations, even within health care and public health. The first distinction is that they generally do not provide clinical care, beyond some simple screening tasks such as blood pressure and demonstrating medical devices like a glucometer. There are a few exceptions, mainly in remote rural areas, such as the tribal Community Health Representatives and the Community Health Aide/Practitioners in Alaska. The next three points, however, begin to get at the essence of the occupation. CHWs are effective because of their ability to create trusting relationships with community members. This is more important than their clinical knowledge; their clinical education is generally limited to essential knowledge in topics related to their specific job. They are typically not allowed to give any form of medical advice, and often refer patients to a clinical supervisor in dealing with detailed clinical questions. They do, however, have what might be termed “experience-based expertise,” and are helpful to the system as well as to the community by using their understanding of the culture and social structure of the community they serve. This understanding is generally based on actually sharing cultural background and similar life experience with that community rather than on sociological theory or advanced social work methods. Another distinction, and a strength of the CHW, is their ability to relate to community members as peers rather than purely as patients or clients. The conventional professional-to-client relationship can set up barriers to communication based on differences of power, status and culture; the CHW can avoid those distinctions, leading in many cases to greater trust, candor and cooperation on the part of the patient. And finally, most CHWs do not hold a license in another profession. There are some cases of licensed nurses, social workers and other professionals who choose to practice as CHWs for reasons of personal preference or commitment. Some foreign-trained medical professionals also work as CHWs, but the vast majority of CHWs are otherwise unlicensed, hence the common use of the term “lay workers” to describe them.

What Is Distinctive About CHWs? (2) Rely on relationships and trust more than on clinical expertise Relate to community members as peers rather than purely as clients Can achieve certain results that other professionals can’t

Current national CHW initiatives (1) CDC CHW policy e-learning series OWH CHW leadership training DOL “apprenticeable trade” OMH Promotora/CHW initiative DOL occupational definition