State Policy Support

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How might state policy support statewide CHW workforce development, including certification?

Where it is feasible, state policy could help support CHW workforce development, including statewide CHW certification. For example, state legislation has helped to establish CHW certification programs in several states. The policy process could also provide opportunities for CHWs to directly influence statewide CHW certification.

Potential actions for stakeholders
  • Reviewing the policies and partnerships [PDF – 1 MB] that other states have employed to advance CHW workforce development
  • Developing an in-depth understanding of the various roles, titles, and employers of CHWs in the state
  • Creating a formal, statewide CHW definition, scope of practice, and core competencies [PDF-616 KB] to help guide development of statewide CHW workforce development, including certification3
  • Ensuring that everyone who has concerns about statewide CHW certification, including the CHW workforce and other health professionals, has agreed upon certification’s potential value and the need for policy
  • Analyzing existing state CHW policies and working closely with CHW organizations and networks to develop an appropriate policy approach for the state
  • Engaging policy champions and recruiting allies to inform policies that support statewide CHW certification
  • Educating state legislators about the potential role of state law in the certification adoption and implementation process
  • When necessary, promoting CHW attendance at public hearings about the proposed statewide CHW certification process, so that more CHWs can shape policy and certification requirements

Case examples

A government building.

State legislation has helped to establish CHW certification programs in several states.

  • The Utah Broad-Based CHW Coalition developed a scope of practice and standardized training for CHWs in Utah to advance statewide CHW certification and financing through Medicaid. At the same time, a major data collection effort allowed Utah to better understand CHWs and CHW employers across the state. This involved local health departments conducting environmental scans and interviews with CHW employers addressing various social determinants of health.
  • In Arizona, legislation to establish a voluntary CHW certification program was proposed twice in 2017, both times led by the Arizona CHW Association. The second filing was designed to be budget neutral, gained support from the Arizona Nurses Association, and was passed in December 2017. Stakeholders in Arizona recall the importance of continually educating everyone involved in the legislative process about the value of certification and CHW roles.
  • CHWs in Oregon offered arguments against standard criminal background check requirements for certification through the public forums associated with the state rule-making process. As a result, Oregon now has a weighted process for the background check for CHW certification that allows consideration of supporting documentation, such as recommendation letters from previous employers or coworkers and documentation of volunteer efforts. This allows the consideration of mitigating circumstances to help otherwise qualified CHWs obtain certification.