Background on Statewide Community Health Worker (CHW) Certification
Technical Assistance for Stakeholders
In 2016–2017, the CDC Division for Heart Disease and Stroke Prevention and Division of Diabetes Translation examined community health worker (CHW) certification approaches, structures, processes, barriers, facilitators, and outcomes through a two-part project.
This section of the website provides:
- Background information on CHWs and issues with putting into action statewide certification
- An overview of the study’s objective and methods
- A list of potential decisions and case examples for stakeholders who are considering statewide CHW certification
Background on Statewide CHW Certification
Who are community health workers (CHWs)?
CHWs, including promotors/promotoras and Community Health Representatives (CHRs), are trusted frontline public health workers who contribute to preventing and managing chronic diseases and promoting health equity objectives. The Community Preventive Services Task ForceExternal recommends interventions that engage CHWs for cardiovascular disease prevention and for type 2 diabetes prevention and diabetes management.1–6
Why are states considering statewide CHW certification?
Pursuing statewide CHW certification is one potential strategy for advancing CHW workforce development. Statewide CHW certification involves developing a standardized process for documenting the proficiency of individuals across the state in the core skills and roles of a CHW.
There are many reasons stakeholders may consider establishing statewide CHW certification. For example:
- Certification could bring about a clearer definition of CHW scope, which could lead providers to a better understanding of how to engage CHWs in practice.7 Defining a CHW scope of practice in contrast to the scopes of practice of other healthcare workforce members has been identified as a possible strategy to ease stakeholder concerns about overlapping roles and duties.8, 9
- A certification process addressing core competencies could be beneficial to CHW practice.9, 10
- Financing and sustainability of funding for CHWs have been found to be key drivers for pursuing statewide CHW certification. Additionally, certification has been accelerated by health system transformations.9, 11
What is the current landscape of statewide CHW certification?
Voluntary statewide CHW certification systems are largely intended to support the CHWs who are interested in transitioning to working in integrated health and social systems of care. As of July 2018, nine U.S. states have implemented a voluntary statewide CHW certification process (Arizona, Florida, Indiana, Massachusetts, New Mexico, Ohio, Oregon, Rhode Island, and Texas).
The process of convening stakeholders to discuss the possibility of statewide CHW certification has been observed as helpful to organize the CHW workforce and create momentum for workforce development.9, 11, 12
At the same time, some states have set asidestatewide certification discussions for the time being, and instead are focusing on other strategies for CHW workforce development, including expanding opportunities for training and making the financing of CHW positions sustainable.
The current state policy landscape for CHWs7, 13 does not necessarily suggest that statewide CHW certification is a prerequisite for sustainable financing, but more research on this topic is needed.
The decision of whether or not to establish statewide CHW certification is an important one. Guidance and input from CHWs within a state must be taken into account. There is no empirical evidence showing that CHWs with certification perform their job better than CHWs without certification. Certification is not seen by the field as a prerequisite for CHW practice, as the core CHW functions of relationship- and trust-building involve skills and traits that are not easily taught.9
CHWs also have many nonclinical responsibilities that need to be addressed in the certification process.
What informed decisions
Based on a study completed in 2016–2017, CDC has developed a list of potential decisions for stakeholders who are considering statewide CHW certification. Such stakeholders include—but are not limited to—CHW associations, state health departments, Medicaid offices, and health systems.
Stakeholders in a given state may need to make several decisions during the process of considering and possibly setting up statewide CHW certification. The process is generally not linear, and its timeline will be influenced by state-specific factors, such as readiness, capacity, and the political, social, and economic environments. If the state’s CHWs are not supportive of statewide CHW certification, it is not advised to move forward with creating a certification process.
Visit the Related Pages linked in the box at the top of this page to learn more about why each decision is important, actions that stakeholders can take to make an informed decision, and case examples of decision making from select states.
- Proia KK, Thota AB, Njie GJ, et al. Team-based care and improved blood pressure control: a community guide systematic review. Am J Prev Med 2014;47(1):86–99.
- Community Preventive Services Task Force. Team-based care to improve blood pressure control. Recommendation of the Community Preventive Services Task Force. Am J Prev Med 2014;47(1):100–102.
- Njie GJ, Finnie RKC, Acharya SD, et al. Reducing medication costs to prevent cardiovascular disease: a community guide systematic review. Prev Chronic Dis 2015;12(e208):1–12.
- Community Preventive Services Task Force. Recommendations to reduce patients’ blood pressure and cholesterol medication costs. Prev Chronic Dis 2015;12(e209):1–4.
- Njie GJ, Proia KK, Thota AB, et al. Clinical decision support systems and prevention: a community guide cardiovascular disease systematic review. Am J Prev Med 2015;49(5):784–795.
- Community Preventive Services Task Force. Clinical decision support systems recommended to prevent cardiovascular disease. Am J Prev Med 2015;45(5):796–799.
- Mason T, Rush C, Wilkinson G. (2016). Certification of Community Health Workers: Issues and Options for State Health Departments. ASTHO webinar. http://www.astho.org/Community-Health-Workers/CHW-Certification-Presentation-Slides/ [PDF – 1.46 MB]External.
- Clary A. Community Health Workers in the Wake of Health Care Reform: Considerations for State and Federal Policymakers. National Academy for State Health Policy; 2015.
- Wennerstrom A, Sugarman M, Rush C, et al. Community Health Worker Certification (manuscript in development).
- National Center for Chronic Disease Prevention and Health Promotion. Addressing Chronic Disease Through Community Health Workers: A Policy and Systems-Level Approach. 2nd ed. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2015.
- Mason T, Wilkinson GW, Nannini A, et al. Winning policy change to promote community health workers: lessons from Massachusetts in the health reform era. Am J Public Health 2011;101(12):2211–2216.
- Bhuiya A. How Are State Public Health Agencies and Their Partners Supporting Community Health Worker Workforce Development? Presented at the AcademyHealth Annual Research Meeting; 2018. Seattle, WA. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwiElYDHtrbeAhVB6lMKHSneAzIQFjABegQIARAC&url=https%3A%2F%2Facademyhealth.confex.com%2Facademyhealth%2F2018arm%2Fmediafile%2FPresentation%2FSession14599%2FRushc.pdf&usg=AOvVaw3zeu8EX92nDblGbj1qLRYzExternal. Accessed November 2, 2018.
- Centers for Disease Control and Prevention. State Law Fact Sheet: A Summary of State Community Health Worker Laws. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2016. https://www.cdc.gov/dhdsp/pubs/docs/SLFS-Summary-State-CHW-Laws.pdf Cdc-pdf[PDF – 1 MB].
This study was supported by Cooperative Agreement Number NU38OT000141, awarded to ChangeLab Solutions, and funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.