1. Preparing Community Health Workers for Their Role as Agents of Social Change: Experience of the Community Capacitation Center
Beth Poteet,
Teresa Rios-Campos,
and Noelle Wiggins

2. Objectives By the end of the session, participants will be able to:
Describe the history, current status, and outcomes of the CCC model for training CHWs
Discuss implications of the CCC model for other CHW training programs that wish to preserve CHWs’ role as agents of social change

3. Agenda Introduction Brainstorm: How does training influence CHW roles?
Sociodrama
Background on CHW training
CHW Training at the CCC
Best Practices in CHW Training
Brainstorm: Applications

4. Brainstorm
What do you imagine? How does training influence the roles that CHWs play?

5. History of CHW training programs
Documented examples in the US date to the 1960s
Until 1990s, most US CHWs were trained on-the-job
Drawbacks of on-the-job training:
no credential or academic credit
not portable
lack of standardization
insufficient time to build skills and knowledge
CHWs lacked opportunities to build peer networks
Before focusing on our training program, I’d like to briefly discuss CHW training more generally.
Documented examples of CHW training programs in the US date back to the 1960s, when the Indian Health Service developed its Community Health Representative Program, and CHWs were hired by the Office of Economic Opportunity during the War on Poverty.
Until the 1990s, most CHWs were trained on the job.
While on-the-job training did have some strengths, this training:
offered no credential or academic credit
was not portable when CHWs moved from job to job
lacked standardization, so employers couldn’t count on a dependable set of skills
often provided insufficient time for CHWs to build skills and knowledge, and
most importantly, on-the-job training did not provide opportunities for CHWs to come together across various programs and communities to develop peer networks and support.

6. History of CHW training programs
Early to mid-1990s: trend towards creation of training centers
Examples of CHW training centers:
Community Health Education Center, a project of the Boston City Health Dept. (1993);
Community Health Works, a joint project of San Francisco State University and City College of San Francisco (1994);
Community Capacitation Center, a project of the Multnomah County Health Dept., Portland (2000).
In the mid-1990s, these drawbacks led to a trend towards the creation of training centers, where CHWs could come together to network and gain support.
Early examples of CHW training centers included:
Community Health Education Center, a project of the Boston City Health Dept. (1993);
Community Health Works, a joint project of San Francisco State University and City College of San Francisco (1994);
Community Capacitation Center, a project of the Multnomah County Health Dept., Portland (2000).

7. Best and Promising Practices in CHW Training
Best or promising practice
Reports referencing this practice
Develop standard training curricula
NCHA Study, 1998; Love et al., 2004; CHW-NEC, 2008
Use popular education and adult learning methods
Love et al., 2004; CHW-NEC, 2008; NHLBI, 2011
Provide skills-focused as well as content-focused training
NHLBI, 2011; NCHA Study, 1998; Love et al., 2004
Confer academic credit for training
NCHA Study, 1998
Involve experienced CHWs in designing and conducting training
CHW-NEC, 2008
Prepare CHWs to play a full range of roles
Rosenthal et al., 2011; Farquhar et al., 2008
Provide training for CHW supervisors
Reduce barriers to entry
A variety of studies have identified best and promising practices in CHW training. These include:
Developing standard training curricula
Using popular education and adult learning methods
Providing skills-focused as well as content-focused training
Conferring academic credit for training
Involving experienced CHWs in designing and conducting training
Preparing CHWs to play a full range of roles
Providing training for CHW supervisors
Reducing barriers to entry

8. The Community Capacitation Center
A program of the Multnomah County Health Dept.
Has existed formally for 10+ years
Mission: To support communities to identify and address their own most pressing health issues
As well as providing CHW training, we also:
Conduct participatory research
Teach popular education
Do culturally specific health promotion
Lead the Health Promotion Change Process at MCHD
Before I focus on CHW training, I’d like to provide a bit of context, by briefly introducing the CCC.
As I said, we are a program of the Multnomah County Health Dept.
We have existed formally since 2001, though our roots go back much further than that.
Our mission is to support communities to identify and address their own most pressing health issues.
In addition to providing training for CHWs, we also:
Conduct community based participatory research projects
Teach a variety of groups to use popular education methodology
Conduct culturally specific health promotion in a variety of communities, and
Lead an internal change management process at MCHD.

9. CHW Training at the CCC: Roots
Noelle involved in training CHWs in El Salvador during the 1980s
Both Tere and Noelle employed by La Familia Sana Program in the early 1990s. CHWs from LFS trained other CHWs around the state.
Influenced by CHW training centers in other places, such as CHEC in Boston
Now, finally, let me describe briefly the CHW training program we have developed at the CCC:
The CCC’s standard CHW training curriculum is based on the findings of the Roles and Competencies Chapter of the Natl. Community Health Advisor Study (NCHAS, 1998). 
The curriculum is divided into three components: health issues, orientation to the health and social service system, and core skills.
The 80-hour version of the CCC curriculum was approved for academic credit by the Oregon State Board of Education in 2004. Through an arrangement with PSU’s Graduate School of Education, the CCC is able to confer 800-level academic credit for training.
Popular education, also known as empowerment and Freirian education, is both the underlying philosophy of the CCC curriculum as well as the methodology used to build skills and knowledge.
Because the CCC curriculum is based on the findings of the Roles and Competencies Chapter of the NCHA Study, it prepares CHWs to play a full range of roles, from connecting people to services and managing medical utilization, to advocating for community needs and building community capacity to address the social determinants of health.

10. CHW Training at the CCC: Curriculum
Based on 8 skills clusters identified in the 1998 Natl. Comm. Health Advisor Study
Skills- as well as content-focused
Can confer academic credit
Approved by Oregon Health Authority
Prepares CHWs to play a full range of roles

11. CHW Training at the CCC: Popular Education
A methodology and a philosophy for teaching and organizing
Developed in response to conditions of inequity in Latin America, the US, and around the world
Creates settings in which people most affected by inequity can:
Bring out their own knowledge
Build on their knowledge in community
Use their knowledge to create a more just and equitable society

12. CHW Training at the Community Capacitation Center: Outcomes
More than 95% of participants surveyed since 2007 state that participation in training enhanced their ability to promote health in their communities.
Two CBPR studies suggest that combination of content and methodology equip CHWs to effectively promote health in their communities.
Participants say training enabled them to:
Be leaders and show others they are capable
Do advocacy
Realize how much they knew
Teach using popular education

13. Best and Promising Practices in CHW Training
Best or promising practice
Present at the CCC?
Develop standard training curricula
Yes
Use popular education and adult learning methods
Provide skills-focused as well as content-focused training
Confer academic credit for training
Involve experienced CHWs in designing/conducting training
Prepare CHWs to play a full range of roles
Provide training for CHW supervisors
Reduce barriers to entry
Thus, you will see that of the best and promising practices mentioned earlier, the CHW training program at the CCC achieves 8 of the 8 practices.

14. CHW Training at the CCC Current Status
Participating with OHA to create standards for certification of CHW and approval of training programs
Licensing our curriculum to other groups around the state
Creating, along with partners like the Urban League of Portland, culturally specific versions of our curriculum
By March of 2014, we will have trained 150 of the 300 CHWs called for in Oregon’s Medicaid Waiver with our state-approved curriculum, titled, “We Are Health.”

15. Recommendations For creating and implementing CHW curricula
Include both skill development and training on health issues
Ground curricula in popular education
Involve experienced CHWs in developing and facilitating the curriculum
Prepare CHWs to play a wide range of roles

16. Applications
How can you apply what you have learned in your work with CHWs or as a CHW?

17. For more information, visit our website at: Web.multco.us/
health/community-capacitation-center
Thank you!
If you have any questions, my colleagues and I would be happy to try to answer them.