Promoting the Health of the Community: Community Health Workers Describing Their Roles, Competencies, and Practice

Foreword
Preface
Acknowledgments
Contents
Editors and Contributors
About the Editors and Contributors
Contributors
Part I: The Story Behind the Book
	Chapter 1: Introduction: Why Community Health Workers (CHWs)?
		1.1 Why Community Health Workers?
		1.2 Who Are Community Health Workers (CHWs)?
		1.3 What Do Community Health Workers (CHWs) Do?
		1.4 Why Engage the CHW Model?
		References
	Chapter 2: The Community Health Worker Core Consensus (C3) Project Story: Confirming the Core Roles and Skills of Community Health Workers
		2.1 Introduction to the Community Health Worker Core Consensus (C3) Project
		2.2 Factors Impacting Growth and Development of Community Health Workers in the United States
			2.2.1 Implications for the C3 Project
			2.2.2 Integration of CHW Leadership and Other Stakeholder Input Is a Key Value of the C3 Project Research Team
		2.3 A Look at Scope of Practice and Competency Development in the Health Sector
		2.4 C3 Project Methods and Implementation
			2.4.1 Phase 1
				2.4.1.1 Looking Back at the National Community Health Advisor Study 1994–1998
				2.4.1.2 Selection of Benchmark Source Data
				2.4.1.3 The Crosswalk Analysis
				2.4.1.4 Consensus Building with CHW Networks and Associations
			2.4.2 Dissemination
			2.4.3 Phase 2
				2.4.3.1 Settings Input Phase and Framework Development
				2.4.3.2 Gathering Assessment Tools and Strategies
				2.4.3.3 Outreach to CHW Networks and Stakeholders for Continued Consensus Building
		2.5 C3 Project Recommendations
			2.5.1 Phase 1
			2.5.2 Roles
			2.5.3 Skills
			2.5.4 Qualities
			2.5.5 C3 Project Phase 1 Recommendations: CHW Roles and Competencies
			2.5.6 Phase 2
				2.5.6.1 The Influence of Setting on CHW Roles and Scope
				2.5.6.2 Outreach to the CHW Field
		2.6 Holding the Door Open: C3 Project Dissemination and Ongoing Work
			2.6.1 What Does This All Mean for CHWs and the Wider Development of the Field and Its Contributions to Improved Health?
				2.6.1.1 The Value of Consensus
				2.6.1.2 Next Steps
				2.6.1.3 National CHW Leadership
		References
	Chapter 3: Roles, Skills, and Qualities of Community Health Workers
		References
	Chapter 4: Describing Results from the “Promoting the Health of the Community” National Needs Assessment
		4.1 Demographics of All Survey Respondents
		4.2 Community Health Workers
			4.2.1 Employment Characteristics
			4.2.2 Barriers to Effectiveness
			4.2.3 Supervision
			4.2.4 Experience with Evaluation and Research
		4.3 CHW Instructors or Trainers
			4.3.1 Employment Characteristics
			4.3.2 Training and Instruction for CHWs
		4.4 CHW Supervisors
		4.5 CHW Stakeholders, Supporters, or Allies
		4.6 Employers of CHWs
		4.7 Conclusion
Part II: CHWs Describe Their Roles Through Their Stories
	Chapter 5: Cultural Mediation Among Individuals, Communities, and Health and Social Service Systems
		5.1 Introduction
		5.2 A Dose of Cultural Humility: Cultural Mediation and CHW/Promotores’ Contribution to Health Care
			5.2.1 Cultural Humility: Promotes Critical Reflection and Lifelong Learning
			5.2.2 Cultural Humility: Addresses Power Imbalance and Equity
			5.2.3 Cultural Humility: Institutional Accountability
			5.2.4 Cultural Humility and Healthcare Professionals
			5.2.5 Next Steps/Conclusion
		5.3 Community Health Workers and Behavioral Health Prevention
			5.3.1 Introduction
			5.3.2 Roles of Community Health Workers in Behavioral Health Prevention
			5.3.3 CHW Behavioral Health Prevention Interventions
			5.3.4 Impact on Using Community Health Workers for Behavioral Health Prevention
			5.3.5 Challenges
			5.3.6 Lessons Learned
	Chapter 6: Providing Culturally Appropriate Health Education and Information
		6.1 Introduction
			6.1.1 History of CHWs as Health Educators
			6.1.2 Definition of the Role
		6.2 Providing Culturally Appropriate Health Education in Amish Country
			6.2.1 Introduction
			6.2.2 Background
			6.2.3 Program Description
			6.2.4 Roles of the CHW
			6.2.5 Part of the Community
			6.2.6 Rewards
			6.2.7 Challenges
			6.2.8 Importance of Education/Certification
			6.2.9 As a Survivor
			6.2.10 Lessons Learned
			6.2.11 Advice in Working with Amish and Mennonite Communities
			6.2.12 Conclusion
		6.3 Community Health Workers: Trauma-Informed, Culturally Centered, Decolonizing Popular Educators
			6.3.1 Introduction
			6.3.2 The Spectrum of Health Education Approaches
			6.3.3 Introduction to Popular (People’s) Education
			6.3.4 History and Definition of Popular (People’s) Education
			6.3.5 Methodology in Popular (People’s) Education
			6.3.6 Popular (People’s) Education: Trauma-Informed, Culturally Centered, and Decolonizing
			6.3.7 Capacitating CHWs to Use Popular (People’s) Education
			6.3.8 Case Studies of CHWs Sharing Health Education
				6.3.8.1 Case Study 1: Health Education at the Individual Level—Health Navigators of Community Health Centers of Benton and Linn Counties
				6.3.8.2 Case Study 2: Using Popular Education to Increase Health Knowledge and Leadership in the Latinx Community in Wood Village, Oregon
				6.3.8.3 Case Study 3: Using a Decolonizing Approach to Health and Wellness with Community Education Workers
			6.3.9 Conclusion
	Chapter 7: Care Coordination, Case Management, and System Navigation
		7.1 Introduction
		7.2 Establishing a Patient Care Navigation System
			7.2.1 Introduction
			7.2.2 Description of Geographic Location/Population
			7.2.3 Implementation from the Front Lines
				7.2.3.1 Phase 1: Can We Improve Quality of Care?
				7.2.3.2 Phase 2: Introduction of the Community Health Workers
			7.2.4 Pilot Results
				7.2.4.1 Phase 3: Scaling Up to Other Primary Care Sites
			7.2.5 Successes
			7.2.6 Challenges
			7.2.7 Lessons Learned
			7.2.8 CHW Highlight
			7.2.9 Personal Stories
				7.2.9.1 Zoila Morales, CHW, Breath of Life Mobile Pediatric Asthma Clinic
				7.2.9.2 Jennifer Berry, CHW, Primary Care Clinic
				7.2.9.3 Pam Thurman-Ford, CHW, Primary Care Clinic
			7.2.10 Conclusion
		7.3 Special Connections: CHWs Engaged with CSHCN and Their Families
			7.3.1 Special Children, Special Families, and Special Communities
			7.3.2 CHWs as Trailblazers
			7.3.3 Veteran CHW Voices Shape Learning
			7.3.4 Aims of the Curriculum
				7.3.4.1 What Impact Does Learning That a Child Has a Disability Have on the Family?
				7.3.4.2 What Are the Challenges Families Face When Interacting with the Health Sector?
				7.3.4.3 What Innovations Are Community Health Workers Making in the Field?
			7.3.5 The Value of Continuous Learning
				7.3.5.1 How Do I Coordinate Services?
			7.3.6 Advice for the Future
	Chapter 8: Providing Coaching and Social Support
		8.1 Introduction
		8.2 Community Health Workers Extend Solutions to Violence Prevention
			8.2.1 Introduction1
			8.2.2 Disparities in Community Gun Violence in NYC
				8.2.2.1 Community Health Workers Preventing Gun Violence in NYC
			8.2.3 CHW Support and Coaching: Essential for Gun Violence Prevention
				8.2.3.1 Providing Individual Support and Coaching
				8.2.3.2 CHW Skills
					Extend Motivation and Encouragement for Seeking Services
					Be Mindful to Timing of Engagement
					Draw from Their Own Experiences Using Similar Services
					Speak on Their Own Transformation
				8.2.3.3 Building Neighborhood Resilience and Changing the Narrative
			8.2.4 Conclusion
		8.3 CHWs: A Bridge to Wellness
			8.3.1 Introduction
			8.3.2 Community Profiles
			8.3.3 History
			8.3.4 Sinai Urban Health Institute (SUHI)
			8.3.5 CHWs: Providers of Social Support
				8.3.5.1 How We Provide Social Support
				8.3.5.2 Social Isolation
			8.3.6 CHWs as Coaches
				8.3.6.1 History and Mistrust
			8.3.7 Social Support and Coaching Strategies
			8.3.8 Summary: Coaching and Social Support
			8.3.9 Successes
			8.3.10 Lessons Learned and Challenges
			8.3.11 Conclusion
	Chapter 9: Advocating for Individuals and Communities
		9.1 Introduction
		9.2 CHWs’ Collective Voice: CHWs Advocate for Their Profession
			9.2.1 Introduction
				9.2.1.1 Floribella’s Story
				9.2.1.2 What Is Professional Advocacy?
				9.2.1.3 Why Is Professional (Workforce) Advocacy Important?
			9.2.2 A Brief History of the Community Health Worker Workforce in Arizona
				9.2.2.1 Maria’s Story: CHWs as Patient Advocates
			9.2.3 History of Advocacy in Arizona
				9.2.3.1 Moving Beyond Individual and Policy Advocacy Toward Workforce Advocacy
					The Arizona Community Health Workers Association (AzCHOW)
				9.2.3.2 Lorena’s Story: Realizing the Need for Voluntary Certification
			9.2.4 Uniting the Workforce
				9.2.4.1 Brook’s Story: Community Health Representatives Joining the CHW State Efforts
			9.2.5 Creating a Coalition
				9.2.5.1 Jill’s Story: Coalition-Building
					The Arizona CHW Workforce Coalition
				9.2.5.2 Yanitza’s Story: Involvement of the State Health Department in the Voluntary Certification Process
			9.2.6 The Legislative Process
				9.2.6.1 Floribella’s Story: Describing the Legislative Process
				9.2.6.2 Difficult Decisions in the Legislative Process
				9.2.6.3 Knowing Your Allies and Your Opponents
				9.2.6.4 Floribella’s Story: Knowing Your Allies
				9.2.6.5 Legislative Success
			9.2.7 The Work of an Advocate Is Never Done
				9.2.7.1 Heather Carter: Advice from the Other Side of the Legislative Dais
			9.2.8 Key Takeaways
				9.2.8.1 Dedication
		9.3 Todo Corazón: Abogacía Durante la Pandemia (All Heart: Advocacy During the Pandemic)
			9.3.1 Global Pandemic: A Repeat of History?
				9.3.1.1 Enlace Chicago and PAES (CHW Networks)
					Enlace Chicago
					PAES (Promoviendo, Abogando y Educando por la Salud)
			9.3.2 Promotores with Heart
				9.3.2.1 Ilda Hernández
				9.3.2.2 Sahida Martínez
			9.3.3 Advocacy During the Pandemic
				9.3.3.1 Community Needs
				9.3.3.2 Support for CHWs During the Pandemic
			9.3.4 Conclusion
	Chapter 10: Building Individual and Community Capacity
		10.1 Introduction
		10.2 CHWs and Allies: Promoting and Sustaining the CHW Profession
			10.2.1 Introduction
			10.2.2 Motivation for Social Justice and Equity
				10.2.2.1 CHWs Motivate for Social Justice
				10.2.2.2 CHW-Ally Partnership: Bidirectional Motivation Toward Social Justice in the Community
				10.2.2.3 CHW-Ally Partnership: Bidirectional Motivation Toward Social Justice in the Workplace
			10.2.3 Ethical and Professional Engagement
				10.2.3.1 Ethics of Being a CHW Ally
				10.2.3.2 Developing Professional Presence and Boundaries in the Workplace
			10.2.4 Building Capacity for Change Through Relationships
				10.2.4.1 Creating Influence
				10.2.4.2 Accessing Influence
				10.2.4.3 Building Capacity for the Workforce as Partners Through CHW Organizations
				10.2.4.4 CHWs Supporting CHWs
			10.2.5 Conclusion
		10.3 Engaging Communities to Build on Strengths for Sustainable Change
			10.3.1 Introduction
			10.3.2 PASOs’ Work Related to Individual and Community Capacity Building
			10.3.3 Values: Our Starting Place
			10.3.4 A Different Way of Looking at Empowerment
				10.3.4.1 Training and Coaching: The Foundation for Success
					Training
					Individual Professional Development
					Peer-to-Peer Learning
					Coaching
			10.3.5 Providing Spaces for Communities to Shape Organizational Vision and Priorities
				10.3.5.1 Gathering Input; Listening to Voices
				10.3.5.2 Using Input and Perspectives to Drive Systemic Change
			10.3.6 Building Capacity Through Advocacy
			10.3.7 PASOs’ Impact
				10.3.7.1 Individual Impact
				10.3.7.2 Systems Change Impact
			10.3.8 Challenges/Barriers
			10.3.9 Successes and Lessons Learned
	Chapter 11: Providing Direct Services
		11.1 Introduction
		11.2 Alaska’s Primary Dental Health Aides: Adapting a Community Health Worker Program to Preventive Dental Care
			11.2.1 Introduction
			11.2.2 Program Context
			11.2.3 Education of Primary Dental Health Aides
				11.2.3.1 Role of PDHAs in Prevention
			11.2.4 Impact of PDHAs on Their Communities
				11.2.4.1 Data Demonstrating Success
			11.2.5 Financing and Sustainability
			11.2.6 Lessons Learned
		11.3 Community Health Representatives (CHRs) as Direct Service Providers in Native American Communities: When the Pavement Ends, the Dirt Road to Patient Health Care Begins
			11.3.1 Introduction
			11.3.2 Community Health Representatives (CHRs): A Historical Overview
			11.3.3 CHR Direct Service Impacts
			11.3.4 Health Education/Counseling
			11.3.5 Monitor Client/Community
				11.3.5.1 Case Management/Coordination
				11.3.5.2 Non-emergency Care and Emergency Care
				11.3.5.3 Health Promotion/Disease Prevention
				11.3.5.4 Translation/Interpretation
				11.3.5.5 Transportation/Delivery
			11.3.6 CHR Direct Service Impacts
				11.3.6.1 Dedication
	Chapter 12: Implementing Individual and Community Assessments
		12.1 Introduction
		12.2 CHWs Implementing Individual and Community Assessments: Examples from Hawai’i
			12.2.1 Introduction
			12.2.2 Community Health Workers in Hawai’i
			12.2.3 The Importance of CHW Assessment
			12.2.4 Individual Assessment
				12.2.4.1 Assessing Barriers
				12.2.4.2 Assessing Eligibility
				12.2.4.3 Assessing Social Determinants
				12.2.4.4 Assessing Communication, Culture, and Language Needs
			12.2.5 Community Assessment
				12.2.5.1 Utilizing Assessment Results to Meet Client Needs
			12.2.6 Conclusion
		12.3 Assessments: More Than a Piece of Paper
			12.3.1 Similar Interests
				12.3.1.1 Building Trust (Wes Warner)
				12.3.1.2 Older and Wiser (Melanie Apodaca)
				12.3.1.3 Madam (Roshni Biswa)
				12.3.1.4 Busy and Pregnant (Deborah White)
			12.3.2 Conclusion
	Chapter 13: Conducting Outreach
		13.1 Introduction
		13.2 “You Have to Build a Relationship”: Reflections on a CHW’s Career of Outreach in Communities of Color
			13.2.1 It All Began with a Relationship
			13.2.2 Creating a Nationally Recognized Model of Community Outreach
			13.2.3 Building Institutional Capacity for Community Engagement
			13.2.4 Supporting the Next Generation of Community Health Workers
			13.2.5 Conclusion
		13.3 Case Study: Diabetes Outreach in Rural North Georgia
			13.3.1 Introduction
			13.3.2 Team Members
			13.3.3 Project Initiation
			13.3.4 CHW Feedback on Outreach
			13.3.5 Participant Impact: In Their Own Words
				13.3.5.1 Outreach
				13.3.5.2 Knowledge of Study Design
				13.3.5.3 Relationship with CHWs
				13.3.5.4 Impact of Program
				13.3.5.5 Access to Care
				13.3.5.6 Technology
				13.3.5.7 Problems People with Diabetes Face
			13.3.6 CHW Perspective
			13.3.7 Program Impact
			13.3.8 Reflections on Barriers to Outreach
			13.3.9 Lessons Learned
	Chapter 14: Participating in Evaluation and Research
		14.1 Introduction
		14.2 How Patients and Community Health Workers Helped Design the IMPaCT CHW Model: Nothing About Us Without Us—And Make Sure It Doesn’t Go into the Cabinets and Collect Dust!
			14.2.1 Introduction
			14.2.2 Designing a Program Based on Research With and For Patients
				14.2.2.1 Seizing an Opportunity
				14.2.2.2 Assembling the Team
				14.2.2.3 Identifying the Questions to Answer
				14.2.2.4 Going to the Source
				14.2.2.5 Designing a Program Based on Patient Feedback
				14.2.2.6 Finalizing the Intervention
				14.2.2.7 Testing the Model
			14.2.3 Creating Systems to Support, Evaluate, and Improve CHW Work
				14.2.3.1 Core Competency Certification
				14.2.3.2 Performance Assessment
				14.2.3.3 Program Improvement
			14.2.4 Conclusion
		14.3 Community Health Workers as Stakeholders in Research: Training Community Health Workers in Patient-Centered Research and Their Impact on Clinical Trial Interventions
			14.3.1 Introduction
			14.3.2 Training and Certification of CHWs
				14.3.2.1 Certification of CHWs in Florida
			14.3.3 Community Health Workers in Research
				14.3.3.1 Part 1: Our Group’s Experience with CHWs in Healthcare Research
				14.3.3.2 Examples of the Impact of Community Health Workers as Stakeholders in Research Interventions and Clinical Trials
				14.3.3.3 Part 2: Creation of Standardized Research Training for CHWs
				14.3.3.4 Part 3: CHW Competencies and Training for Research Capacity Building
			14.3.4 Conclusion
Part III: A Bright Future for CHWs
	Chapter 15: Uniting the Workforce: Building Capacity for a National Association of Community Health Workers
		15.1 Brief History of CHW Practice in the United States
			15.1.1 Key Milestones for the CHW Workforce
			15.1.2 Local, State, and Regional Organizing
		15.2 History of Developing a National CHW Organization
			15.2.1 American Association of CHWs (AACHW), 2006–2009
			15.2.2 National Association of Community Health Workers (NACHW)
		15.3 A CHW Leader’s Story
			15.3.1 Opportunity and Hope: Why a National Voice Matters to Me
		15.4 Future of CHWs in the United States
		References
	Chapter 16: Where Do We Go from Here? A Closing Reflection
		References
Index