Community Health Workers (CHW) Inclusion Checklist
Including Community Health Workers in Health Care Settings: A Checklist for Public Health Practitioners
The Community Health Workers (CHW) Inclusion Checklist pdf icon[PDF – 226 KB] presents a general framework for public health practitioners to lead or assist in including CHWs and integrating the CHW scope of practice in health care settings. Learn more about CHW inclusion.
Public health practitioners and subject matter experts internal and external to the Centers for Disease Control and Prevention (CDC) developed the CHW Inclusion Checklist through an extensive review of peer-reviewed and grey literature.
- The CHW Inclusion Checklist was designed to be a conversation facilitator and can help to establish and strengthen relationships between CHWs and health care providers.
- It can also provide direction for public health practitioners.
- The checklist was designed to be a non-prescriptive tool that highlights potential action steps to include CHWs in health care settings.
- The checklist was not designed to be a comprehensive guide to implementing CHW-based health care interventions, nor does it address the nuances of incorporating CHWs in the day-to-day activities of a health care setting.
This checklist is for public health practitioners, including individuals and organizations working in a variety of roles and settings, interested in including CHWs in health care teams.
Potential checklist users include:
- Hospitals looking to engage CHWs to carry out nonclinical tasks, such as ensuring patients get to their medical appointments or fill their prescriptions.
- Health care systems looking to engage CHWs to address social determinants of health.
- Public health researchers working with practitioners to analyze how to engage CHWs for specific populations.
- Community organizations seeking to bridge the gap between the health care system and the people they serve.
CDC encourages public health practitioners to share the CHW Inclusion Checklist with key stakeholders. The checklist was designed for staff who are most knowledgeable about the current policies and practices being implemented in their organization.
This CHW Inclusion Checklist is organized into four phases:
Planning involves designing a thoughtful, systematic, and coordinated approach that is beneficial to CHWs, patients, health care providers, and community members.
Implementation involves taking actions to support or carry out the approach planned for CHW inclusion or CHW scope of practice integration.
Evaluation involves determining how stakeholders, including CHWs, benefit from your program, support quality improvement efforts, detect any unintended consequences, and add to the body of knowledge of “what works.”
Sustainability involves maintaining your CHW programs and the associated benefits over time.
Although these phases are presented as distinct and occurring in a linear fashion, in practice they build on each other in an interdependent manner (e.g., earlier phases might feed into subsequent phases) and might be addressed in nonlinear ways (e.g., you might address elements in the implementation phases and then revisit the planning phase).
Each phase in the checklist is designed to be completed individually or in its entirety. The length of time for completing these action steps will depend on the needs of and resources available to the community and health care setting involved in the CHW program.
In order to ensure buy-in and increase the success of a CHW program, it is important for public health practitioners to collaborate with CHWs and involve them in each of the phases and any decision making.
The CHW program is more likely to be successful if the perspectives of CHWs, who know their own roles and unique challenges within the target populations and the community, are considered.
The checklist consists of 59 potential action steps for evidence-informed strategies and best practices to include CHWs in health care settings. As you are completing the checklist, consider each action step you did not check, and talk with CHWs and other stakeholders about whether it would be beneficial and feasible, either now or in the future, to take the related action steps.
For the purposes of this checklist, several potential action steps related to program financing are listed. Long-term financing is a major determinant of sustaining CHWs in health care systems, and may involve showing the impact of return on investments to stakeholders. However, developing long-term partnerships, ensuring organizational capacity, adapting to changes over time, communicating strategically and frequently with stakeholders, and having a supportive climate are just as important for maintaining a program.
CHWs are a well-recognized workforce who can help to reduce health disparities and improve health equity. In addition, they have improved chronic disease control and prevention, as demonstrated for cardiovascular disease and type 2 diabetes.
There has been a growth of interest in including CHWs in health care settings to help reach patients experiencing health disparities. Although CHWs are not a new workforce, including a non-licensed, patient-centered role that spans both clinical and community settings is new for most health care settings.
Moreover, a lack of awareness, understanding, and respect for CHWs working within care delivery organizations could negatively affect CHWs’ ability to use their unique skillset. Using CHW programs effectively can help health care organizations set the stage for success.
The American Public Health Association’s Community Health Workers Sectionexternal icon promotes the community’s voice through CHWs and provides a forum to share resources and strategies.
The Association of State and Territorial Health Officialsexternal icon offers resources for state health agencies related to CHW financing, certification, and licensure.
The National Academy for State Health Policyexternal icon tracks state-level CHW policies, organizations and workgroups, and state agencies.
The Community Health Worker Core Consensus Projectexternal icon defines CHW roles and competencies for affecting health.
Dissemination & Implementation Models in Health Research & Practiceexternal icon describes theories and frameworks to aid researchers and practitioners in defining research questions, adapting programs based on context, and finding existing measurement tools for model constructs.
The Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention’s Community Health Worker Toolkit offers online education and training materials for building capacity for CHWs.
The Centers for Disease Control and Prevention Public Health Professionals Gateway provides resources collected from across CDC related to CHWs.
Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settingsexternal icon is a review of 50 articles published between January 2000 and April 2017 on CHW implementation.
Cardiovascular Disease: Interventions Engaging Community Health Workersexternal icon is a resource page related to the Community Preventive Services Task Force (CPSTF) recommendation of engaging CHWs to prevent cardiovascular disease among patients with increased risk.
Diabetes Prevention: Interventions Engaging Community Health Workersexternal icon is a resource page related to the CPSTF recommendation of engaging CHWs for diabetes prevention to improve blood glucose control and weight-related outcomes among patients with increased risk for type 2 diabetes.
Diabetes Management: Interventions Engaging Community Health Workersexternal icon is a resource page that highlights the CPSTF recommendation about engaging CHWs to help patients manage their diabetes.
This checklist was developed by the Division for Heart Disease and Stroke Prevention within the Centers for Disease Control and Prevention. This document was conceptualized and authored by Refilwe Moeti, MA; Sharada Shantharam, MPH (IHRC, Inc.); Caitlin Allen, MPH (Emory University Rollins School of Public Health); and Colleen Barbero, PhD, MPPA.
The following individuals contributed subject matter expertise and reviewed the document: Cassandra D. Brown, MPH (Office of Preventive Health, Mississippi State Department of Health); Gail Hirsch, MEd (Office of Community Health Workers, Massachusetts Department of Public Health); Rebecca Anderson, MSW (Kansas City CARE Clinic); Meredith Ferraro, MS (Southwestern AHEC, Inc.); Bina Jayapaul-Philip, PhD; Alberta Mirambeau, PhD, MPH; Betsy Rodriguez, MSN, CDE; Lauren Taylor, MPH (Centers for Disease Control and Prevention); and Amara Ugwu, MPH.
Centers for Disease Control and Prevention. Including Community Health Workers in Health Care Settings: A Checklist for Public Health Practitioners. Version 1.0. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.