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 Force 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?

Community health workers are trusted public health workers who contribute to managing chronic disease.

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 CHWs^{7, 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.