Peer Support and Community Health Workers (CHWs) Series:

“ How are CHWs licensed and trained?”
This is the 2nd post of a 3 part blog that takes a closer look at the 3 action steps that can help promote full participation of community health workers (CHWs) in patient-centered primary care and the promotion of Community Wellness provided in a recent article by Balcazar et al.

As discussed previously, there has been an increased recognition of CHWs in the last decade including by the National Institute of Medicine, US department of labor and the Affordable Care Act. However, this increased recognition has also led to increasing attention to the licensing and training of CHWs.

Consequently, the US Health and Human Services Health Resources and Services Administration (HRSA) office released a toolkit in August of 2011 that included a discussion of training for CHWs (HRSA, 2011). This toolkit noted that there is no current standardized training curriculum for CHWs and that the content and focus of these training programs can vary greatly from community to community.

However, HRSA noted that at a more broad level many programs have developed on-the-job training programs that have been adapted from existing materials from the Centers for Disease Control and Prevention. Common components of these trainings include “cultural competence, patient intake and assessment, protocol delivery, screening recommendations, risk factors, insurance eligibility and enrollment, communication skills, health promotion, and disease prevention and management”(HRSA, 2011).

Furthermore, calls for more standardized training and licensing led to some state level policies for certification being established beginning in the 1990’s. The successes of these training and certification programs have allowed them to serve as case studies for other states to ultimately have CHWs incorporation into standard training and licensing programs and more integrated in the healthcare system as a whole. For example, Texas developed a state level certification program and in 1999 passed legislation requiring CHW program in health and human services to hire state-certified CHWs when possible (Rosenthal et al., 2011). More recently the Massachusetts Department of Public Health conducted a comprehensive statewide study of community health workers and recommended a community health worker “professional identity” campaign. This campaign included expanded training programs for workers and their supervisors as well as statewide certification (Office of Community Health Workers, 2012). The state currently offers CHW training at community colleges and is moving toward state level certification (HRSA, 2011).

Perhaps the most critical integration has taken place in Minnesota where an organization called the Community Health Worker Alliance has worked with a statewide stakeholder coalition to develop CHW training as well as a statewide credit-based curriculum. This alliance led to the state passing legislation in 2007 that approved hourly reimbursement of community health worker services under Medicaid (Rosenthal, 2011)

Thus, although there is much progress to be made in CHW occupational regulation, including the development of training and certification programs in many states (Balcazar, 2011), the progress that has been made training and licensing CHWs in the states of Texas, Massachusetts and Minnesota offers promise.

Through interactions with programs from around the world, the interests in training and certifying peer supporters like the case for CHWs in the U.S. are universal. Often these discussions raise issues related to program sustainability and quality control for “service delivery” which both are critical to effective peer support. Notably, Peers for Progress and a few Network Members are going to present at the upcoming annual Society of Behavioral Medicine (New Orleans, Louisiana, USA; April 11-14, 2012) . The presentations will help address some of these issues (see below).

· A seminar on peer supporter training, ensuring competencies, and intervention tracking by Tang et al.
· A symposium on impacts of “organizational home” on sustainability of peer support programs by Boothroyd et al.
· A symposium on implementation differences and underlying commonalities of peer support by Oldenburg et al.

You can click here to glance what these presentations will feature. Also stay tuned for more follow up discussions on CHWs, peer supporter training, program sustainability and more programmatic challenges.

References
Balcazar, H., Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Matos, S., & Hernandez, L. (2011).
Community health workers can be a public health force for change in the united states: Three actions for a new paradigm. American Journal of Public Health, 101(12), 2199-2203. doi:10.2105/AJPH.2011.300386

Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Hirsch, G. R., Willaert, A. M., Scott, J. R., et al. (2011). Community health workers: Part of the solution. Health Affairs (Project Hope), 29(7), 1338-1342. doi:10.1377/hlthaff.2010.0081

Office of Community Health Workers Boston (MA): Massachusetts Department of Public Health; c2012 [cited 2012 March 9]. Available from: http://www.mass.gov/dph/communityhealthworkers

U.S. Department of Health and Human Services, Health Resources, and Services Administration (2011). Community Health Workers Evidence-Based Models Toolbox. HRSA Office of Rural Health Policy. Retrieved March 9, 2012, from http://bhpr.hrsa.gov/healthworkforce/chw/default.htm.