Stakeholder Perceptions About Certification

The interviews completed with 40 stakeholders in the CDC CHW Certification Study—including CHWs, employers, state health officials, and payers—revealed overarching perceptions about CHW certification, including attractive features and concerns.

Although many perceptions were shared across stakeholder groups, there were also specific perceptions held by CHWs, as well as specific perceptions held by employers. Different perceptions about CHW certification by stakeholder groups are provided below.

Perceptions about CHW certification held across stakeholder groups, including CHWs, employers, state health officials, and payers

Attractive features of CHW certification

• There may be more opportunities for sustainable employment for certified CHWs.
• Certification might help to increase awareness among employers about CHW roles.
• There may be increased job stability for certified CHWs.
• Certification may lead to increased CHW visibility and acceptance, which could result in greater inclusion of CHWs in healthcare systems.

Concerns about CHW certification

• There is potential for CHWs to lose their close connection with the community if certification moves CHWs further into the healthcare world.
• There may be barriers to CHW certification and training access.
• CHWs may resist a certification process that requires them to repeat previous training.

CHW perceptions about CHW certification

Attractive features of CHW certification

• Certification may lead to increased CHW compensation.
• Certified CHWs may experience improved working conditions.
• Certified CHWs may have more career opportunities.
• Certification could help to build the CHW professional identity.
• Certification could create more consistent standards across the CHW workforce.
• Organizing around certification could increase CHW participation in CHW associations.
• Certification could increase respect for the CHW profession in the healthcare arena.
• Certification could increase the credibility of CHWs to health professionals.

Concerns about CHW certification

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  Stakeholder interviews revealed specific perceptions about statewide CHW certification.

  Certification could create barriers to practice for noncertified CHWs.

• Certified CHWs may be regarded more favorably than noncertified CHWs.
• Certification could lead to overly prescribing roles for CHWs, who, in the past, have attributed much of their effectiveness to flexibility in job descriptions.
• If certification focuses on healthcare roles, it could lead to the over-medicalization of the CHW workforce.
• There may be burdensome certification and recertification costs for CHWs.
• Background checks for CHWs as part of the certification process could exclude some of the best CHWs for certain communities.
• CHW certification programs may not be offered in every language.
• It may be difficult for CHWs to maintain certification through continuing education.
• Some CHWs (e.g., rural CHWs) may have limited access to training programs.
• CHWs may be uncomfortable interacting with a formal system like the one required for certification.
• Communities may not want outsiders dictating or imposing rules through CHW certification.

Employer perceptions about CHW certification

Attractive features of CHW certification

• Certification may lead to more simplified CHW recruitment and selection for employers.
• Certification may reduce on-the-job costs to employers for CHWs.
• Certification could help employers more fully integrate CHWs into their healthcare teams.
• Certification could better prepare the CHW workforce.
• If certification leads to sustainable financing, this could reduce an employer’s dependence on short-term funding for CHW positions.

Concerns about CHW certification

• Employers may have to provide compensation or minimum pay for certified CHWs.
• Certification could limit an employer’s ability to make their own decisions about necessary training and standards for the CHWs they employ.
• There may be costs to employers associated with carrying out new regulations and restrictions related to certification.
• There may be increased overall CHW training costs for employers—for example, if employers end up paying for the training required for certification.